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Take Charge of Your Nursing Career! "What's the ideal nursing job for me, and how can I get it?" "How can I feel more in control of my professional destiny?" "How will the nursing shortage affect me?" "What impact will the sweeping changes of managed healthcare have on my future?" These are the questions being asked by today's nurses as their jobs -- and their lives -- are permanently transformed by the turmoil of change. Drawing on the advice and strategies she developed as an educator and career counselor for nurses, Annette Vallano offers a new way of envisioning your career as an entrepreneurial enterprise. By following Vallano's plan for creating and marketing your own nursing "product," career mobility will be yours. Your Career in Nursing will help you de?ne the product you offer, develop a marketing plan, research the needs of the nursing marketplace, and target your approach as today's healthcare landscape inevitably changes. Special chapters for men in nursing, the newly graduated nurse, the older nurse, and second career nurses are included, along with strategies all nurses can use to manage stress and feel empowered. Your Career in Nursing is required reading for the 21st century nurse who wants to be on the winning side in the ongoing healthcare revolution.
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Annette Vallano is a clinical nurse specialist and practitioner in psychiatric mental health nursing in private practice in New York City. She is the founder and director of the Self Care Center for Nurses, an organization established in 1987 to teach and promote self care and personal empowerment strategies for nurses.Excerpt. © Reprinted by permission. All rights reserved.:
Chapter One: The 21st Century Nurse
In these first few years of the 21st century, we live in uncertain times, in the rapidly evolving times inherited from the jolting changes of the previous decade, and in the shadow of terror from the September 11th attack on America. The 1990s saw the birth and rapid growth of the age of information, in which technology exploded into our lives, and computers transformed how we used and accessed information, and the connections we made to one another as a result. The proliferation of fax machines, cell phones, and email created new communication possibilities that blurred the boundaries between work time and personal time, a phenomenon as exciting as it was overwhelming. The turbulent '90s created a stressful state of paradox that became the psychological hallmark of that time, and ours as well.
THE HEALTHCARE REVOLUTION
The 1990s were also the beginning of the healthcare revolution, in which historical as well as social, political, and economic factors led to the onset of managed care with its fiscal restraint. Managed care in turn led to organizational reengineering and the era of downsizing, in which job security was threatened for millions, including nurses, for the first time in the history of that profession. Interestingly, despite the artificial surplus of nurses created by the economic necessity of downsizing, there was still a nursing shortage that was growing more severe as the 1990s marched on and as the healthcare needs of many segments of the population, including aging baby boomers, increased. This nursing shortage is predicted to deepen as the 21st century marches on. You can count on it to impact your work as a nurse, as well as to influence the quality of healthcare people receive. You will find information about the nursing shortage woven throughout this book, particularly in chapter 2, "The World of Nursing Practice," and chapter 12, "The Market Research Department of You, Inc."
ON THE EDGE OF TRANSFORMATION
The world of work, including the work of nurses, has been and will continue to be transformed by these events and by the exciting new frontiers of health and medicine just now becoming known at the beginning of this century. The description below appeared in Newsweek (6/24/02) as an introduction to its special report on health and medicine titled "Medicine and Technology: What the Future Means for You -- The Next Frontiers." As you read it, imagine how these breakthroughs will influence your future as a nurse. See a glimpse into the not too distant future of healthcare, and of what might be required of professionals in it:
"How does the brain work, and why does it fail? An old medical mystery is yielding to new technologies. Scientists can now inspect, repair, and sometimes even replace dysfunctional parts of the nervous system. Advances in biotechnology and computerized brain scans mean that doctors can detect Alzheimer's earlier, and may lead to treatments that slow the course of this tragic disease. Researchers are working on 'neural prostheses,' which, like the prosthetic limbs that help amputees, may allow patients with impaired organs to regain the ability to speak, hear, and see. And an astonishing technique called 'deep-brain stimulation' is showing great promise in treating Parkinson's disease and other neurological disorders; it may also have potential in countering obsessive-compulsive disorder."
"This array of new technologies has changed what doctors need to know, and how they are learning it. The days of studying anatomy by dissecting a cadaver may soon be over. Computerized models simulate all kinds of diseases, injuries, and even responses to drugs or surgery. Med school students are wired as well, downloading critical information from their ubiquitous PDAs. In the revolutionary field of bionanotechnology, doctors foresee the day when they'll be fighting cancer, AIDS, and diabetes by delivering drugs to the specific cells that need them. In the war against disease, technology is an increasingly powerful weapon. The objective: better health, longer lives."
As these new technologies "change what doctors need to know," you can count on a parallel change in what nurses need to know. If "med school students are wired," so will be the nursing school students. Chapter 4, "The Nurse and Technology," will discuss the important influence of and relationship with technology that every 21st century nurse will experience.
We are indeed living in a world hard to imagine only a decade ago. The events of September 11, 2001 have also changed our world. As a result of that horrific day, we find ourselves collectively grappling with questions about liberty, freedom, and perhaps how civilized people are supposed to respond and behave. We are trying to figure out how to live with the simultaneous realities of being on perpetual alert, while going about our lives as usual. On a personal level, we are reevaluating our values, our priorities, the meaning we want our lives to have, and the way in which we want to spend our time. We are more keenly aware of the unpredictability of life, and are taking a second look at the quality of our careers, our work life, our relationships, ourselves. Rhema Ellis, reporting for NBC News (The News with Brian Williams, 6/7/02), summarized the essence of this reevaluation after she interviewed a cross-section of the nation's 2002 graduating classes and reported the following:
"Graduates are asking themselves, 'How can I help?' rather than 'What do I want?' They are less preoccupied with indulgence and more focused on reflection; they are feeling a greater responsibility to making a contribution to the world. Many are more interested in employment in the nonprofit world than in corporate America. There is a shift in predominant life values as reflected in a concern with who one has in one's life rather than what one has. Many are expressing a desire to make a difference, to do more than just have a job. Whether or not the graduate has changed their career path as a result of 9/11, most have committed themselves to be more effective in their daily life."
Many, if not all the desires and concerns expressed by these graduates, including the life and work values they want, are and always have been embodied in the profession of nursing. The desire "to make a difference, to do more than just have a job" is what often brings people into nursing to begin with. This life-affirming value, which is characteristic of being a nurse, is captured in the phrase, "Nursing. It's real. It's life!" During the spring of 2002, this phrase was flashed across the movie screens of selected cities as part of a print and television campaign developed by Nurses for a Healthier Tomorrow, a coalition of nearly 40 national nursing and healthcare organizations, including the National Student Nurses' Association and the Honor Society of Nursing, Sigma Theta Tau. The campaign is designed to encourage young people to enter the field of nursing.
Making a contribution to the world, making a difference in the lives of others, doing work that is more than just a job...this is what nurses do every day. They are witness to and participants in the pain and sorrow, joy and exhilaration, life and death that are part of the human condition. As they touch the lives of others, so too are they touched in return.
THE ESSENCE OF NURSING
These experiences, as described by the 2002 graduates interviewed by Rhema Ellis, are captured in the poem that appears below which was written by Jackie Cataldo, B.S.N., R.N., a nursing representative and organizer for the New York State Nurses Association, and an American Red Cross volunteer who serves on the Brooklyn Disaster Assistance Team. These are among five of her reflections about September 11, 2001, written as poems.
Smoke and Debris
Smoke and debris
Swirling mist in the artificial light.
Eeriness prevails the night.
Hell living through this tragedy.
Bodies mingled with concrete and steel.
Shattered glass and shreds of clothing.
Our mothers, fathers, sisters, brothers
and friends gone.
Breath crushed, seared from their lungs,
Hearts and children left alone. Pain.
Insurmountable pain for the buried
and the walking wounded.
Scream, I want to say to the rescue workers.
Staring at everything and nothing.
Scream your soul.
I want to touch your face,
Hold your mud-crusted hand.
You look into my eyes, holding tight
to my insides.
Your mouth almost smiles.
I smile for you.
Slowly, we pass each other and move
into the quiet thumping of the night.
In "Someone to Fill My Shoes" (Nursing Spectrum, 6/3/02), Janet Stevens, the Resource Manager/Clinical Educator for the Nursing Education Department at Good Samaritan Hospital Medical Center in West Islip, NY, wrote about how she found herself reflecting on what being a nurse meant to her when her daughter asked her, "What's the best part of being a nurse, Mommy?" What she said in this article reflects the essence of nursing. Stevens wrote:
"...It (nursing) is an investment in my patients' lives. I make a difference every day -- touching hearts and inspiring souls. This has been my passion for almost two decades. I am an ambassador of hope. I'm not famous and certainly not someone who brings home a six-digit yearly income. But the gifts of being a nurse are almost intangible. It's not measurable. Nursing has made me a better person, more patient, more understanding, and forgiving. I am in awe of the power of the human spirit. I appreciate the fragility of life and remind people to tell those who are precious to them how much they are loved. The World Trade Center's victims and their families gave us all this lesson. I'm reminded of this lesson every day. I am challenged to use leadership skills and motivated to connect with mentors and those they mentor. I nurture. I heal....I get back so much more than I give. I am so blessed."
The Nurse-Patient Caring Equation
A concern that has become heightened among many people, nurses included, in this post-9/11 world is a desire to ensure that the quality of one's personal life is not eroded or invaded by the intensity of the work one does. This is an old story and an eternal conflict for nurses that, left unattended, leads to stress and burnout, and eventually the diminishment of quality in the care they are able to give patients. In the wake of September 11th, and during what is predicted to be one of the most profound nursing shortages ever, nurses can no longer afford to ignore this issue, lest society depletes its already scarce nursing personnel resources. One way to understand what is required to meet this challenge is to see the nurse-patient relationship as a kind of math equation, which like all math equations requires balancing. This means that equal attention to both sides of the equation, the nurse and the patient, must occur if both are to benefit from the relationship. When the nurse attends to his or her own needs with the same degree of priority and focus as to the needs of the patient, balance can be achieved. This may never occur simultaneously, nor should it since the nurse-patient relation is not a reciprocal one; but it must occur eventually. To think that the nurse only exists for the benefit of the patient is not only naive; it has the potential to result in marginal care for the patient, while increasing the likelihood of stress and burnout for the nurse. Or, said differently, there is no real quality in patient care without "nurse care" as well.
Who cares for the nurse is an important question. It would seem that healthcare organizations that want to ensure the quality care they say they want for their patients would be sure that nurses had good work environments, safe staffing ratios, adequate meal breaks, etc. In the unfortunate absence of these essential work standards in far too many environments, it is left up to each individual nurse to balance the equation for himself or herself. Ignoring the need for this risks the stress and burnout that has long haunted the nursing profession. As a professional, it is up to you to take seriously your individual responsibility to balance the nurse-patient equation. Do this, and you go a long way to ensuring not only quality care for the patient, but professional satisfaction as well, with the added benefit of preventing burnout. See chapter 16, "The Resilient Nurse," for self-care and burnout prevention strategies.
MAGNET STATUS ORGANIZATIONS
Healthcare organizations that take responsibility to effectively balance this nurse-patient-care equation are frequently those who have been granted the prestigious Magnet Status by the American Nurses Credentialing Center (ANCC), an arm of the American Nurses Association whose mission is to promote excellence in nursing and health care globally through credentialing programs and related services. Just as nurses who want to achieve a standard of excellence in their nursing practice can seek ANCC certification, so can organizations. In 2001, 20 organizations (an unprecedented number) qualified for and were granted Magnet Status. Currently, over 50 Magnet organizations exist (see the appendix for a current list). These are certainly places from which to seek employment when at all possible. (An alternative might be to use the characteristics of Magnet organizations as a guide to evaluate your potential employers). ANCC's Credentialing News described what these excellence-focused Magnet organizations have in common:
· 100 percent of the chief nurse executives at Magnet facilities hold graduate or higher degrees.
· 97 percent of all Magnet organizations have affiliations with schools of nursing, and 91 percent are affiliated with allied health programs.
· 92 percent of the staff at Magnet hospitals attend at least one continuing-education program each year.
· 83 percent of all Magnet facilities have affiliations with schools of medicine.
· 63 percent of all applicants receive Magnet designation.
· 57 percent of nurses who serve in leadership positions at Magnet organizations have at least one graduate degree, 36 percent are advanced practice nurses, and 21 percent are certified.
· 27.5 percent of nurses providing direct care at Magnet hospitals are certified.
· 19 percent of Magnet organizations are organized for collective bargaining purposes.
· The average turnover rate of all Magnet hospitals is 11.5 percent.
· The average vacancy rate among all Magnet hospitals is 8.19 percent.
· The average length of employment among registered nurses at Magnet organizations is 8.83 years.
· The average number of licensed beds among all Magnet organizations is 487; the range is between 100-1,951 licensed beds.
· The average hours per patient day are 10.04 hours across the entire nursing department.
Credentialing News went on to summarize the importance of this data as follows:
"This and other data suggest that Magnet-designated hospitals have...
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