Six Health and Wellness Tips for Nurses

Six Health and Wellness Tips for Nurses

As a nurse, you already know that staying healthy should be a top priority. But too often other demands get in the way and doing what’s best for your physical, mental, and emotional needs gets pushed aside.

It’s time to stop this unhealthy cycle and work on increasing your energy and decreasing your stress. Health and wellness are the foundation for success not just at work but in your personal life, too. When you feel better, you perform better.

What better time than midway through 2017 to either create or improve steps to make your overall fitness a top priority. Here are six tips to help you improve your health and wellness:

1. Eat a healthy diet.

For starters, step away from sugar. It’s tough to do, as sugar is everywhere. Avoid foods with sugar listed in the first five ingredients.  Why? “Sugar makes you fat, ugly and old,” Brooke Alpert, a registered dietitian and coauthor of The Sugar Detox: Lose the Sugar, Lose the Weight — Look and Feel Great told CNN. “What we’ve discovered in the last couple of years is that sugar is keeping us overweight. It’s also a leading cause of heart disease; it negatively affects skin, and it leads to premature aging.”

2. Move your body.

Find activities you enjoy and commit to doing them for at least 30 minutes several days a week. Don’t like to jog? Walk. Hate lifting weights? March in place with soup cans while watching your favorite TV show. Increase your steps as a baseline. Be imaginative.

3. Focus on the present.

Adopt mindfulness. Pay attention when speaking to someone. Make time to connect with loved ones on a regular basis. Minimize multi-tasking. Consider scheduling one weekend a month as a time to disconnect from all digital devices.

4. Protect your sleep.

Adequate sleep protects your health. Make a date with your pillow and keep it so you feel motivated and ready for a new day.

5. Embrace education.

The American Nurses Association (ANA) noted that with over 200 free, online courses at Medline University, nurses can learn more about topics that will help enhance their well-being, including safe patient handling and hand hygiene best practices.

6. Join healthy employee initiatives.

Get fitter at your workplace. Not only are you taking charge to improve your health, you build camaraderie with your coworkers as you work toward your goals together.

The ANA designated 2017 as the Year of the Healthy Nurse. Do your part to make that true!

Addressing the Opioid Crisis

Addressing the Opioid Crisis

Nurse practitioners applaud recent enactment of legislation that empowers them to better address the nation’s opioid crisis.

The Comprehensive Addiction and Recovery Act (CARA) of 2016 gives nurse practitioners the ability to prescribe buprenorphine, a medication for the treatment of addiction to opioids, such as heroin or prescription painkillers. It can quell withdrawal symptoms, reduce cravings, and lower the risk of relapse.

The Act also seeks to increase the access of naloxone to first responders and law enforcement in order to reverse the effects of opioids.

Federal officials have called opioid addiction a national crisis.

Every day, over 1,000 people are treated in emergency departments for misusing prescription opioids, according to the Centers for Disease Control and Prevention.

“[The American Association of Nurse Practitioners] has been very supportive of this legislation to increase access to care for these patients,” says Anne Norman, DNP, APRN, FNP-BC, FAANP, vice president of education at the AANP.

Increasing Accessibility

“We are pleased that appropriately trained and educated NPs will be allowed to prescribe the necessary medications for these patients according to their state prescribing regulations and…contribute to the reduction of drug overdose deaths,” Norman says.

Allowing NPs to “treat addiction is a novel solution to bridge the gap in medication-assisted treatment for addiction,” says Peggie Powell, MSN, APRN, FNP-BC, a family nurse practitioner at VCU Health Community Memorial Hospital Pain Management Services in South Hill, Virginia, an affiliate of Virginia Commonwealth University.

“Educating patients about their addiction and the need for self-care are very much within the scope of practice for nurse practitioners. The Act empowers NPs to practice to their full extent, but it also increases access to medication-assisted treatment for those in need,” says Powell, a nurse for 23 years, the last 13 working as a NP.

CARA’s enactment extends prescriptive authority to advanced practice registered nurses such as women’s health nurse practitioners. “This is particularly significant as opioid use in pregnancy can have profound implications for both maternal and infant death,” says Susan Kendig, JD, MSN, WHNP-BC, FAANP, director of policy of the National Association of Nurse Practitioners in Women’s Health (NANPWH).

“When buprenorphine is utilized under careful supervision, pregnant women who are affected by substance abuse disorders have a mechanism to address their addiction while working to achieve a healthy pregnancy outcome. WHNPs often work side by side with our colleagues in OB/GYN and maternal fetal medicine in co-managing these conditions,” Kendig says. “Extension of prescriptive authority for buprenorphine to WHNPs can help to improve access to important care for women.”

Studies show that buprenorphine, a form of medication-assisted treatment, cut the risk of death in half from all causes—from overdoses to car accidents.

Educating the Public

Nurses are in a good position to help educate the public about opioid abuse since they practice in a variety of settings, from schools and clinics to home visiting agencies and community-based settings where “they are the face of health care and may indeed be the only health care provider interacting with an individual at any given time,” says Kendig. “This provides opportunity for assessment, education, and referral for opioid use and misuse.”

Nurses help the public learn the signs and symptoms of opioid abuse, which include sedation, slurred speech, itching, euphoria, constricted pupils, mood changes, and difficulty meeting work or school obligations. Signs of withdrawal include anxiety, nausea, and inability to sleep.

Nurses also teach the public how to safely store opioid pain medication and properly dispose unused opioids. “Never give or sell [it] to others as this is a felony, but also unsafe,” explains Powell.

What Works

“Educating the public about the signs and symptoms of opioid abuse is one of the best things we can do as nurses,” says Lorraine Byrnes, PhD, RN, FNP-BC, PMHNP-BC, FAANP, CNM, an associate professor and director of the undergraduate nursing program at Hunter-Bellevue School of Nursing.

“We must also advocate for access to treatment programs that use an evidence-based approach to treatment, which is essential in addressing this public health crisis. Community access and education about naloxone to reverse the effects of a drug overdose and save lives is a critical element in treating opioid abuse. We must also avoid stigmatizing opioid addiction by providing patient-centered care that meets the long-term and short-term needs of our patients and their families,” says Byrnes, who serves on the board of NANPWH.

To help reduce the opioid epidemic, patients treated with opioids must use the medication for a limited time to prevent dependence, opioid addiction must be treated as a chronic condition, and the stigma of addiction must be eliminated, nurse practitioners say.

“Although everyone who uses pain medication will not become addicted, we do know enough about how genetics, temperament, environment, and personal situation to develop individualized, tailored treatment plans for those who may become addicted,” says Byrnes. “Education in the proper use of opioids to manage pain must occur among prescribers and alternatives must be part of every pain management plan.”

Counseling is another crucial recovery component as well as the availability of naloxone without a prescription to families and communities dealing with addiction, says Byrnes.

Powell agrees that “Increasing access to naloxone and providing training on its proper use can save lives. Nurses, pharmacists, and nurse practitioners can be instrumental in educating the public on all these aspects.”

Other changes to address the epidemic include policy changes in insurance and medication drug coverage to reduce the opioid load in the public arena, says Powell. Insurance companies need to include abuse-resistant opioid formulations on their formulary and provide coverage for abuse-resistant opioids for chronic pain.

A Doctorate of Nursing Practice (DNP) student at VCU School of Nursing, Powell’s DNP project focuses on opioid safety in patients on chronic opioid therapy. She recently published an article on opioid safety on the Physician-Patient Alliance for Health & Safety blog.

Prescription opioid related deaths have quadrupled since 1999 in the United States and approximately 80% of deaths are due to unintentional overdose, according to Powell.

“In 2014, opioid overdose death from prescription opioids increased to approximately 19,000 deaths in the United States; this is more than three times the number reported in 2001,” she wrote. “Such statistics are staggering and indicate a need for action to help curb this epidemic. Utilization of risk assessment tools and mitigation strategies to detect and reduce the risk of opioid overdose are needed in clinical practice.”

The only tool that provides an actual quantitative score of opioid overdose risk is the Risk Index for Overdose or Serious Opioid-Induced Respiratory Depression (RIOSORD).

“I plan to utilize the RIOSORD to determine each patient’s risk of possible accidental overdose or serious opioid induced respiratory depression,” Powell says. “Patients determined to be ‘high risk’ will be given a prescription for naloxone that can be used in an opioid-related emergency to prevent death. The aim is to increase naloxone-prescribing practices among the providers at my clinic.

“Use of this tool will provide a quantitative risk stratification that is based on the patient’s medical history, opioid formulation, morphine equivalent dose, and the presence of concurrent prescriptions for benzodiazepines or antidepressants.”

“Every day, 78 Americans die from opioid overdoses,” President Obama said when he signed the CARA legislation into law this summer.

Among those ages 12 to 25, illegal opioid use more than doubled between 1991 and 2012. Yet nine out of 10 of drug-addicted youth ages 12 to 17 receive no treatment at all, according to the 2012 National Survey on Drug Use and Health.

Nora Volkow, MD, director of the National Institute on Drug Abuse, has called prescriptions such as buprenorphine “an essential component of an ongoing treatment plan” that allow people to “regain control of their health and lives,” according to USA Today.

Nurses are in a unique position to help patients reap the analgesic benefit of opioids without encountering the dangers since they are experts in non-pharmacological interventions to manage pain, including the use of mental imagery and relation therapy, nurse practitioners say.

Nurse practitioners, Powell says, are among the best qualified health professionals to help patients dealing with pain and addiction.  “We are vigilant in our monitoring; we are able to demonstrate empathy, but also ensure compliance with safe use; and we focus on educating the patient on the risks as well as possible benefits of opioid use,” she adds.

How to Quit Without Burning Bridges

How to Quit Without Burning Bridges

A frustrated Washington state nurse exacted sweet revenge after she sent her employer a cake with icing that spelled out “I QUIT!!!”

Sarah Childers told ABC News she signed the cake—official notice she was leaving her job at a psychiatric hospital—in thick black frosting.

Childers’ novel resignation notice earlier this year (Jan.) attracted media attention and likely a load of chuckles, but nursing leaders say such unprofessional behavior not only leaves a negative impression; it may serve as an everlasting roadblock.

Burning bridges is a shortcut to career suicide in an era where hospitals increasingly merge, career trajectories place former colleagues and bosses back in your orbit, and workplace reputations can be gleaned through social media, experts say. 

Anger or revenge should never influence the way you leave a job, says Michelle Podlesni, RN, president of the National Nurses in Business Association. An emotional departure that leaves a negative impression “is not worth a lifetime of possible future dealings” with former coworkers who may cross your career path, says Podlesni, who is also CEO and president of Bloom Service Group, Inc.

“Major hospital systems are becoming corporate. You may not think you have anything to do with X hospital system, but then when you move to another state, X hospital system has bought Y hospital system, and now it’s XY hospital system and they have your records. There’s a reason for not burning bridges. Don’t do it,” advises Podlesni.

Weigh Your Decision

Before handing in your notice and easing out the door, take a deep breath and determine if you are at your tipping point, which can be reached in many ways, says Keith Carlson, RN, BSN, NC-BC, a board-certified nurse coach. Boredom and ennui may be factors in your unhappiness.

Keith Carlson, RN, BSN, NC-BC

Keith Carlson, RN, BSN, NC-BC

“Is the position no longer serving you or contributing to your personal and/or professional growth? We can outgrow jobs, and then our next option is to find a new opportunity that will support our professional development and the personal satisfaction we derive from our work,” he says.

Also, be sure to examine whether your workplace culture is supportive. “There is more attention being paid to workplace culture in the 21st century, and there’s really no reason to remain in a job where you’re treated poorly, bullied, harassed, or left to wither in a dead-end position. Advancement and growth are paramount in our careers, and a job or employer that offer no ability to move vertically may be holding you back from achieving your potential. We can become complacent in our work, and we must always be on the lookout for opportunities to advance, elevate, and pivot in a new direction,” Carlson says.

When you’ve lost your peace of mind, it’s time to go, argues Podlesni. “Your internal GPS is off kilter and it doesn’t look like it will be on course. You start to doubt the very profession you wanted to be in.”

The first step is to be objective and stop reacting emotionally to the situation, which Podlesni has done several times during her 25 year plus career, which has included health care data analysis and medical cost-containment. “This is the time to really kick in the nursing process that we all know,” she says. “Instead of a nursing care plan, it is our care plan. This is the time to assess and analyze the situation.”

“It could be as simple as not thriving in that job function,” Podlesni says. “You may not want to be an ER nurse or a med-surg nurse. It could be a desire to change specialties or it could be you are frustrated in that you are not recognizing your potential. Maybe you have a desire to stretch in a role that has more responsibility, more management, and you feel stuck. You could find out nursing is not what you envisioned.”

Before resigning, consider making a table listing what’s important, which may include work-life balance, salary, stress level, and potential career advancement. The table should compare your current job to what you want in a potential move, says Kate Tulenko, MD, MPH, MPhil, a physician and global health specialist.

“There should be a clear-minded evaluation of the pros and cons of each job,” says Tulenko, who is also vice president of health systems innovation at IntraHealth International. “Do an analysis of the pros and cons of each of the jobs in all of those areas.”

Be honest about your own shortcomings and whether you play a role in your unhappiness, experts say. “If you do indeed leave, is there any baggage you’ll be taking with you to your next position? Is there some change in perspective that you may need to adopt?” says Carlson.

First Steps

After deciding to resign, give your immediate supervisor appropriate notice in writing. For a typical nursing staff position, that’s two weeks notice. Provide four weeks notice if you hold a management role. Before a vacation or holiday season, consider giving three or four weeks notice to help out the units, says Podlesni.

Donna Cardillo, RN, MA, CSP

Donna Cardillo, RN, MA, CSP

Notify your immediate supervisor in person, if possible. A phone call is the next preferred method of communication, says Donna Cardillo, RN, MA, CSP, author of Falling Together: How to Find Balance, Joy, and Meaningful Change When Your Life Seems to Be Falling Apart. Ideally, a typed, hard copy letter should be submitted at the time of resignation, Cardillo says.

Leave a good impression behind by not gossiping about any employee who factored in your decision to depart, experts say. When coworkers ask why you are moving on, share the same response. And handle your outstanding responsibilities by making direct reports aware of any projects that need to be completed or transitioned to your replacement before leaving.

“Meet with your supervisor or manager and present a list of the things that you handle on a daily, weekly, monthly, quarterly, or annual basis,” says Carlson. “Write up suggestions for how to move forward on any projects still underway. If you have time, create a narrative to hand off for your replacement, detailing outstanding issues that will require immediate attention.”

Consider capturing such information in a table. Writing a note may be time consuming since many people are either poor writers, don’t like writing, or fear writing, says Tulenko.

“Maybe you were supposed to finish a quality assessment or you were supposed to train some nurses. List those ongoing responsibilities as well as those that are one-off. Put all of that in the table, include what the status is, and who you plan to transition [tasks] to, and what you are going to do before you leave. Do that with every task and have it in the chart. Go over it with your manager. Then carry out your actions before you leave,” Tulenko says.

Before bidding farewells, exchange contact information with fellow employees with whom you have a good rapport. Get connected on LinkedIn and exchange testimonials.

Handling Honesty

One thorny topic is whether to disclose the real reasons for leaving. Opinions vary.

“You don’t want to burn any bridges, but you also want to be authentic,” advises Carlson. “It all depends with whom you’re speaking and why they need to know the details. Try to focus on the positive, and be careful about putting anything disparaging about your employer in writing.”

Authenticity and honesty matter, says Carlson. “An effective exit interview reveals the deeper reasons behind your leaving, as well as your suggestions for how the company or employer can improve the potential for your successor’s success. Three hundred and sixty-degree feedback can be priceless for an employer willing to hear it.”

Your response may depend on your situation, says Cardillo. “If your reason for leaving is something benign such as the fact that you are relocating, have decided to change specialties, or are looking for a different schedule, it’s OK to state that. If you’re leaving because you don’t care for the culture of the department or employer or don’t get along with your supervisor, you can simply say that you have decided to move on and try something new to broaden your horizons.”

Being honest doesn’t mean you will attack someone personally, says Podlesni. Nurses have to think about what gives them a sense of peace, fulfillment, and purpose. If those things aren’t being met that is what you say, not “This place is crazy and there are too many patients. Address those things in a constructive way…so that management can address the issues.”

Kate Tulenko, MD, MPH, MPhil

Kate Tulenko, MD, MPH, MPhil

Tulenko disagrees about the role of honesty as you head out of your former employer’s door one final time.

“You should never tell the real truth. This is the case where being fully and brutally honest is just going to hurt you, and the people you are brutally honest to are unlikely to change,” she says.

If you have any constructive suggestions, give those to your manager or the HR person or head of nursing. Say it in a positive way “rather than ‘you guys are such bad managers and you don’t listen to your nurses.’ This is not the time to be brutally honest. It’s difficult for people because they feel like they are lying or being deceitful, but I see very little benefit to full out honesty as you’re leaving,” says Tulenko.

“Remember that in the future when you’re looking for the next job, people are going to call your former employer. Even if someone did not provide a reference, we’ll call the HR department or the former employer.

“Often staff knows one another and someone will say, ‘This person came from that instituition. Could you ask your friend at that institution what people thought of her?’ And people say, ‘Well, wow, she ripped everyone a new one on her way out.’ That word gets around, there is no doubt about that.”

Why You Should Consider Becoming a Nurse Anesthetist

Why You Should Consider Becoming a Nurse Anesthetist

A Certified Registered Nurse Anesthetist (CRNA) ensures that patients survive surgery without pain or recollection. The critical performance of these advanced practice nurses places their position high on the hottest jobs lists.

Nurse anesthetists, who work in a variety of settings such as hospitals, surgery centers, physicians’ offices, dental centers, pain clinics, and military health care facilities, ranked fourth on U.S. News & World Report’s top 100 jobs for 2016.

The good news for CRNAs gets even better with the U.S. Bureau of Labor Statistics predicting the profession—which earned a median salary of $157,140 in 2015—is poised to grow by 19% by 2024, which translates into 7,400 new job openings.

Nurse anesthetists collaborate with surgeons, anesthesiologists, dentists, and other health care professionals to provide anesthesia to patients. So what does it take for a registered nurse to pursue this demanding role and become a CRNA?

Qualifications

Applicants need a bachelor’s degree in nursing or the equivalent and have at least one year of critical-care nursing experience. Nurse anesthesia education programs consist of 25 to 36 months of graduate work including both classroom and clinical experiences. A CRNA may sub-specialize in pediatrics, plastic surgery, dental, obstetrics, cardiovascular, plastic surgery, or neurosurgical anesthesia.

Nurse anesthetists tend to be detailed-oriented leaders with a drive to excel as an independent decision-maker, experts say. For nurses considering this role, know this: CRNA programs are rigorous and competitive.

Marc Code, DNP, CRNA

Marc Code, DNP, CRNA

“You have to be the cream of the crop because the competition is so stiff,” says Marc Code, DNP, CRNA, director of the nurse anesthesia program at Samuel Merritt University in Oakland, California. “The GPA has to be competitive. For us the mean is a 3.4, or a 3.5. I would presume for other schools it’s also about the same.  The student’s experience, the student’s emotional intelligence, and the student’s diversity all factor in. We’re looking for cohorts that reflect the diversity of our community. It is a competitive process, but not one with barriers so large that an individual who didn’t meet the bar in all the areas can’t do things to bring themselves up to become competitive to get in. But it will take more work.”

Diverse nurse anesthetists, as well as registered nurses, are needed to reflect the patient population, says Wallena Gould, EdD, CRNA, FAAN, founder and CEO of the Diversity in Nurse Anesthesia Mentorship Program. “Even in the black community, there are patients from Ghana, Cameroon, or Jamaica,” she says. Working with a CRNA who shares one’s culture or language can make a difference. “A lot of things can be missed, especially if you’re trying to take a patient history before the anesthesia or if they have questions,” says Gould, who is also chair of the American Association Nurse Anesthetists Diversity Task Force.

Expect Challenges and Sacrifices

Nurses entering the CRNA program lack any anesthesia experience so “what we have to do is take seasoned ICU nurses and turn them into nurse anesthetists in 27 to 36 months, and they have to have the same knowledge, skills, and critical thinking as a MD anesthesiologist because we are held to the same standards,” says Code. “We can do everything, everything that they can do. That’s a lot to learn in a very short time.”

When considering returning to school, review your monetary needs, as working full-time is likely not an option. Nurse anesthetist programs are quite different from the nurse practitioner programs, says Gould.

Before applying, take stock of the financial sacrifices you will need to make, advises Gould. If married, discuss how you will go from two incomes to one. Look at your credit worthiness, as many students will be loan dependent. Realize “you have to live off those loans… probably anywhere from 28 to 36 months. That’s almost three years without income coming in. It’s a huge sacrifice,” she says.

“A nurse practitioner program is doable in terms of working full-time and going to school. You cannot work full-time while in the nurse anesthetist program, so there are a lot of things to consider before enrolling,” says Gould.

When Gould started school, she was five months pregnant with an 8-year-old and the family lived on her husband’s income. “It was pretty difficult. You can no longer go on those lengthy vacations with family and friends. My husband and I didn’t exchange Christmas gifts. We cut back on social events. On a beautiful day during the summer when it’s 90 degrees, you are in the library. They take your life, basically. There are financial sacrifices, social sacrifices, and personal sacrifice you make before you enter a program.”

Nick Angelis, CRNA, MSN

Nick Angelis, CRNA, MSN

The overall job outlook for CRNAs is positive, but take time to “understand the restrictions and opportunities related to your options: CRNAs lack utility outside of surgeries and procedures (and) salaries are stagnating,” says Nick Angelis, CRNA, MSN and author of How to Succeed in Anesthesia School (And RN, PA, or Nursing School).

“The profession is nearing a saturation point in some areas, so it’s more important to excel in nursing school, get a job that offers valuable experience, and look around to see what the most interesting and rewarding options are if you intend to go back to school. If there’s a nurse practitioner program in town with a low attrition rate that graduates competent, happy practitioners, that makes more sense than moving to another state for the ultimate anesthesia program,” says Angelis.

“Planning too far ahead causes some students to skip over valuable skills they need to master before entering graduate school. The exception is finances; as I mention repeatedly in my books, it’s never too early to start saving. Otherwise, much of the hard work you put into anesthesia school will go to paying off exorbitant loans,” Angelis says.

Another suggestion is to take advantage of current learning opportunities. What can you learn in school or at the hospital every day? Welcome uncomfortable situations that stretch your knowledge and abilities, preferably with backup available, he says.

“Without an objective understanding of your own skills and weaknesses, it’s difficult to become a nurse ready for the independent decision-making required of a nurse anesthetist.

“For example, in basketball games such as HORSE or Around the World, a player selects shots they know they can make but their opponents will miss,” Angelis says. “The winner isn’t usually the best player. Rather, it’s the player who understands their own abilities and limitations the most.”

CRNAs are the highest paid of the advanced practice nurses, but that compensation reflects their ability to handle critical tasks.

“We take full control of every body function that a patient has during a surgery and we solve problems during the surgery, and bring them out awake and recovered on the other end,” says Code. “And we have done it thousands and thousands of times every day.  That responsibility has a compensation value and it’s very valuable.”

Gould agrees. “Our responsibility is much higher than all the other advanced practice nurses. When I tell high school students how much money we make, their eyes pop out of their heads. But the more money, the more responsibility. You literally have someone’s life in your hands every day and we make good decisions,” she says.

A CRNA can own their own anesthesia service to do their own billing and make even more money than a CRNA at a hospital or surgery center, experts say.

Match Jobs to Lifestyle

“The jobs are all over the United States,” says Code. “There are 17 states that have opted out of physician supervision, which allows nurse anesthetists to practice without supervision of a physician, which allows them to go into rural settings and provide the access to anesthesia care that wouldn’t be there otherwise.”

A 2015 study published in Nursing Economic$ found that CRNAs provide the majority of anesthesia care in U.S. counties with lower-income populations and people that are more likely to be uninsured or unemployed.

More advanced practice nurses are required to meet the population demand, which means greater job security, experts say. “With that being said, there is also security in the fact the nurse anesthetists are being utilized and are finding roles in more areas within the perioperative setting than just the operation room, and this allows them to practice to the full scope of their education and training,” says Code. “This also gives, I think, a great deal of security moving forward.”

Wallena Gould, EdD, CRNA, FAAN

Wallena Gould, EdD, CRNA, FAAN

For newly minted CRNAs, one of the biggest decisions is to choose a position that fits your goals, says Gould. “What type of lifestyle do you want? A Level I trauma center provides lots of opportunities to work and make considerable overtime if you want to. Some people want a local hospital…where it is less stressful. Some CRNAs just work at surgery centers that are only open from 7 to 4, no on-call and no weekends. So it depends on what lifestyle you want once you graduate,” she says.

The profession has the highest job satisfaction and highest compensation among advanced practice nurses, says Code.

“The opportunities are the greatest among advanced practice nurses. We can work in a team setting and we can work independently. Nurse practitioners cannot work independently. I currently practice still and I love the interaction, thought processes, and the problem solving. And the satisfaction that comes out of delivering a safe anesthetic and seeing the patients on the other side wake up. It’s just a wonderful feeling that you’ve done a fine job.”

Planning for Graduate School

Planning for Graduate School

More nurses with advanced education and skills are needed to care for the nation’s growing and graying population as well as to step into leadership, research, and teaching roles.

Given the expected growth of advanced practice roles, the nurse faculty shortage, and the Institute of Medicine recommendation to double the number of nurses with a doctorate by 2020, it’s more important than ever for nurses to obtain graduate degrees.

To join the ranks of these advanced practice nurses, you already know that you want to pursue a graduate degree. So, one of the first steps in planning for graduate school is to be honest with yourself. Are you clear on what you want to do and ready to make personal sacrifices, which include time and money to pursue your goals? Are you objective about your own skills and willingness to learn? Have you assessed your strengths and weaknesses? 

Answer those questions before deciding that graduate school is on the agenda, nursing experts advise.

“Unlike matriculating from a bachelor’s in business to an MBA, there aren’t any benefits to going to graduate school in nursing unless you have a specific goal in mind,” says Nick Angelis, CRNA, MSN, and author of How to Succeed in Anesthesia School (And RN, PA, or Med School). “ADN, BSN, and MSN nurses still have to wipe butts if they work on the floor or unit, even if a hospital provides salary differential.”

While assessing your readiness for graduate school, maximize your current learning opportunities. “Nurses can work in surgery to learn if first assistant or anesthesia type careers would fit their skills and interests, or shadow advance practice nurses to learn more about their jobs,” Angelis says.

Timing is Personal

In planning for graduate school, often the first decision nurses must make is whether to wait a few years after receiving a BSN or go to graduate school immediately after.

The answer depends on your circumstances and mindset, nursing experts say. “This is really more of an individual decision,” says Jan Jones-Schenk, DHSc, RN, NE-BC, national director of College of Health Professions and chief nursing officer at Western Governors University in Salt Lake City, Utah.

“It depends on time, money, and goals. My advice to all nurses is to not wait for long periods of time before pursuing your academic advancement goals. It’s so difficult to get started if you wait 10 years or more between degrees. The best plan is to get a time frame in your mind so you can be working towards it. For people who have clear ideas of their next steps, going right to grad school is a great step,” says Jones-Schenk. “For people who have lots of debt, complex lives, or are just exhausted, [they] may need to think more about next steps. It is worth thinking about a time horizon that is visible even if it isn’t immediate.”

Some nurses are focused at a young age and want to pursue a graduate degree right away, says Susan Alexander, DNP, ANP-BC, ADM-BC, DNP coordinator and clinical associate professor in the College of Nursing at the University of Alabama in Huntsville. For these students, going immediately into graduate school is a good choice. However, other students may benefit from working.

“What we are seeing now is a lot of students that pursue bachelor degrees are second degree students,” says Alexander. “And they frequently move on to master’s programs immediately after completing their BSN. They have identified a goal and they are prepared to move directly forward. It depends very much on the student and what their interests and goals are. I teach in the doctoral program presently, but I also work with the master’s students, and I work with some of the younger BSN-prepared students who have come into the MSN program, and they are great students.’’

To determine when it’s time to advance your education to advance your career, take specific actions. Consult mentors, stay engaged with contemporary trends, and take advantage of every growth opportunity that presents itself, Jones-Schenk suggests.

”I do think doctoral preparation for nurses is important, but not everyone will need a doctorate. I do think more and more nurses will need at least a master’s degree for certain roles, and education can be an important way of differentiating yourself. It isn’t just about career progression either; it can be enormously satisfying and can give you a different way of viewing situations and responding to them. Education is a great thing. There isn’t one academic path that is right for everyone, but lifelong learning is fundamental for every nurse,” says Jones-Schenk.

If undecided about how far to take your education, ask yourself: Where do you see yourself in 10 years? “If you see yourself in leadership, you need to think about graduate education,” says Alexander. “If you see yourself in an advanced clinical practice role, you need to think about graduate education. If you want to teach in an academic setting, you definitely need to think about graduate education.”

“The PhD program is great if you know you want to be a researcher or educator. The MSN program is great if you want to be in leadership, in the clinical practice. These are the programs that prepare you to do that. There is even a combined PhD and DNP program,” says Alexander.

“I’m a DNP-prepared nurse and I chose that because I always thought of myself as being very clinically based. I have been a nurse practitioner. I’m in education now because I wanted to teach, and teaching full-term wasn’t necessarily one of my goals; it’s something I had an opportunity to do and I’m glad that I had an opportunity. I wouldn’t have that opportunity without the Doctor of Nursing Practice degree. I worked with lots of students as a nurse practitioner with a MSN. I had an opportunity to precept other nurse practitioner students, but I wouldn’t have had an opportunity to be a full-time faculty member without the DNP degree. I’ve had lots of opportunities as a faculty member. It’s been very rewarding.”

Choosing a Program

Cost, support system, and quality of education are the three major factors influencing decisions for NP, CRNA, or other graduate school choices, says Angelis. “For example, a cheap program seven hours away loved by previous graduates may be difficult without any family or friends nearby or any connections at local hospitals.”

If only top-ranked schools land on your list, reconsider, experts say.  Ample literature exists that makes it clear that where you go to school isn’t the most important factor.

“If you wish to be a nurse practitioner, you obviously want to go to a program that offers the options you need,” says Jones-Schenk. “That said, if you attend an accredited program that has good outcome metrics and that current students and recent graduates speak highly of, that can be a very good choice. At the end of the day, students should be wary of incurring a bunch of debt or feeling pressured to go to ‘a top ranked school.’ Ranking of a school is not what makes a successful career. Graduate well-being studies tells us a good solid education is part school, part student, and part life fit.”

Whether your program leads to a MSN, DNP, or BSN-to-PhD, program outcomes exist that you should ask about. These include: graduation rates, retention rates, costs, student debt, graduation satisfaction, and placement rates. Don’t rely only on information from managers, or friends and family, says Jones-Schenk. Do your own research, collect data, and “align your findings with your personal and professional goals and you simply cannot go wrong.”

Explore financial ideas and resources to avoid financial ruin or decades of debt, experts say. In addition to keeping debts to a minimum and living frugally, seek grants to save money. Also, explore side gigs, advises Angelis, who knows a nurse who worked at a nice restaurant on the weekends for tips that exceeded the money he’d get working as a nurse for the same hours.

Make sure that you know your monetary needs and goals. “None of your financial plans should take into account ‘the money I’ll make while I’m in Anesthesia school,’ because it’s just not going to happen, although some nurse practitioner schools and other graduate degrees may afford some part-time work,” he says.

Another tip is to consider cheaper schools. The prestige factor is a small part of your health care success. “You’ll take the same boards after you graduate as someone at a more prestigious school, so the cost difference between graduate nursing programs is a major factor,” says Angelis. “What previous students tell you about a school’s reputation means more than rankings by U.S. News and World Report or other entities. And don’t overlook the power of tuition reimbursement if you can pursue that option to help lessen the cost of graduate school, he says.

Financial aid, especially federal funds, is frequently available, says Alexander. “When students are searching for programs, pick up the phone and call, send e-mails. I promise you that the faculty and admission coordinators will respond. And ask… about financial aid that is available.”

LISTEN TO EPISODE 2 OF NURSECASTS

Focus on the Sim Lab: How Patients with Disabilities are Helping Train Villanova’s Nursing Students

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