About 650,000 Americans are currently affected by End Stage Renal Disease (ESRD), and this number is increasing by 5% annually. The primary causes of kidney failure leading to ESRD are poorly managed diabetes and high blood pressure, the treatment options for which are limited to kidney transplant and dialysis. Unfortunately, there are currently more than 93,000 potential recipients on the kidney transplant waiting list and 80% of those individuals are on kidney dialysis while they wait.
Demand for Nurses is Growing
The specialty of nephrology and dialysis nursing continues to grow with these rising ESRD numbers. In fact, nephrology nursing is expected to grow over 25% within the next 10 years. These nurses can expect an attractive salary and a diverse working environment. Nephrology nurses might work on a typical hospital unit, but those who perform dialysis also work in dialysis centers, nursing homes, inpatient hospice centers, and even in-home health.
Nurses Develop Deeper Relationships with Patients
Renal failure is a chronic condition, so those who suffer from it must access care frequently. This means nephrology nurses will see their patients regularly. Dialysis nurses often have the ability to work with patients one on one, providing an opportunity to give care in a much more personal, attentive way. They also care for their patients through the continuum of the disease progression, so they get to know their patients quite well.
Certification and Advanced Education for Leadership
A nephrology nurse may elect to pursue certification or even further education and their Nephrology Nurse Practitioner certification. These nurses take their practice deeper, providing primary care for their patients who battle ESRD during dialysis and even after transplant—if and when that becomes possible.
There are plenty of worthwhile opportunities for nurses to make a difference in the lives of renal patients whose prognosis can be dire. Examples of such opportunities and further information on dialysis nursing can be found here.
The demand for qualified nursing personnel has rarely, if ever, been as high as it is today. Report after report shows clear evidence that hospitals and healthcare facilities are facing critical staffing shortages that jeopardize the health and well-being of our communities.
Colleges and nursing schools can be a powerful part of the solution to this crisis by being supported to provide increased on-campus clinical opportunities. We need to change the standards to permit one-third of clinical training to be obtained through simulation training— innovative, state-of-the-art simulation experiences that mimic real-life patient care scenarios in a safe learning environment. Doing so will enable colleges across the nation to enroll a greater number of nursing students, which is an essential step in the plan to stop the shortage.
How did we get to this point? The COVID-19 pandemic created the perfect storm for staffing, placing extreme stress on an already fragile healthcare system. This has resulted in large numbers of nurses and other healthcare workers retiring or simply leaving the profession.
These statistics help illustrate the magnitude of the problem:
From 2019 to 2020, job vacancies for nursing personnel increased up to 30%, and the trend is expected to persist, with an estimated shortage of up to 3.2 million healthcare workers by 2026. (Source: American Hospital Association)
New York State faces an estimated shortage of more than 39,000 registered nurses by 2030. (The American Journal of Medical Quality)
20-30% of front-line healthcare workers are considering leaving their jobs as a result of post-traumatic stress from the COVID pandemic combined with years of being undervalued. (Source: CNBC)
As the number-two nursing program in New York (ranked by Nursing.org), Rockland Community College (RCC) is in a unique position to help address this healthcare staffing crisis. We are working closely with our valued local healthcare facilities to develop strategies that will help close the gap in nursing shortages. RCC has made a strategic commitment to increase the number of nursing students that graduate from our nursing program and drastically expand the number of other healthcare degree tracks offered at the college.
We have already made positive strides: Our nursing school currently graduates 90-100 nursing students each year, with an NCLEX pass rate of 96.4 percent. We offer Associate’s degrees in Nursing, Occupational Therapy Assistant, and Human Performance Studies. We have also partnered with the online career-training firm CareerStep to train students in rewarding healthcare careers such as Caregiver, Certified Healthcare Documentation Specialist, Dental Assistant, EKG Technician, Fitness & Wellness Coach, Health & Lifestyle Coach, Hemodialysis Technician, Home Health Aide, Medical Administrative Assistant, Medical Assistant, Medical Coding & Billing for Outpatient Services, Medical Scribe, Patient Care Technician, Pharmacy Technician & Phlebotomy Technician.
Thanks to the passing of the Omnibus Spending Bill in January 2023, we will also be receiving $3 million for the construction and expansion of RCC’s Nursing Simulation Laboratory. The grant is instrumental in providing students with simulation training that can help provide on-campus opportunities for clinical experience.
With the increased use of simulation training, we can broaden our reach and boost the number of “workforce-ready” nursing students who can help to mitigate the current shortage.
That is why we strongly support Senate Bill S6717A, introduced on May 13, 2021, which aims to “permit one-third of clinical training to be obtained through simulation experience.” The bill advanced to a third reading in the Senate on May 16, 2022, and, if passed, will help nursing schools across the country to increase nursing enrollees and graduates.
RCC looks forward to future funding opportunities that will help us deliver high-quality healthcare programs that can make a huge difference in overcoming our current healthcare staffing challenges. By enacting strategic academic programs and working with the government and our healthcare and community partners, we can provide students with the education and training they need to become valued members of the healthcare workforce. The future health of our communities depends on it.
If you’ve reached the point in your nursing career where you feel like you can’t go on and might need to abandon nursing and never look back, you’re considering “the nuclear option,” which means leaving the profession for good. While this is always a possible course of action, it’s not the only one. So, before you pull that lever and exit stage left, consider the many avenues you might still wander while remaining an active registered nurse.
Burnout and Compassion Fatigue Are Real
Before we go any further, we must first establish that nurse burnout, and compassion fatigue are real. Whether related to the COVID-19 pandemic or not, nurses experience tremendous amounts of work-related stress. This has led to increasing public knowledge and media attention to the fact that nurses are leaving, or contemplating leaving, their jobs — or even the profession itself — in large numbers.
The underlying causes of nurse attrition, burnout, and compassion fatigue are numerous. However, nurses experiencing these phenomena should know they are not alone, and there is no shame in reaching out for help.
“What? No Hospital?” Alternate Career Pathways
Contrary to what many nurses might believe, there’s more to nursing than working in acute care. According to the American Association of Colleges of Nursing (AACN) Nursing Fact Sheet (updated September 2022), 55 percent of registered nurses work in general medical and surgical hospitals. While acute care is where the majority of nurses are steered right out of nursing school, the fact remains that a considerable proportion finds happy career homes outside of the hospital environment.
In the non-acute nursing world, numerous opportunities exist for nurses seeking an alternative career pathway. The COVID-19 pandemic has created a surging market of remote nursing positions in care management, quality, and chart review, among many others. Further areas of interest for those seeking non-hospital positions include:
Nursing on the sets of film and television productions
Nurse life care planner
Nurse journalist/writer
Genetics
Legal nurse consulting
Addictions
Medical claims analysis
Cannabis nursing
Nurse recruiter
Advanced practice (CRNA, APRN, clinical nurse specialist, etc.)
There are countless alternatives for nurses who feel that the hospital environment is no longer a good fit or never was in the first place.
Being Circumspect About the “Nuclear Option”
The nuclear option of leaving the profession altogether is undoubtedly a choice — albeit a radical one. If retirement is possible, this is a route to a new life beyond one’s previous career path. If not, there may be a new avenue that’s calling.
Some nurses find that psychology, social work, or careers still connected to human services and the caring professions are viable and attractive. Still, others seek to take their enormous nursing skill set (e.g., critical thinking, crisis management, leadership, problem-solving, communication, and multidisciplinary collaboration) and seek an industry where those skills are highly valued.
The choice to leave the nursing profession is serious, especially when you have devoted many years — or even decades — to your nursing career. What is often advised is that you retain your nursing license for several reasons:
Leaving the nursing career door open
Picking up per diem shifts for extra money
Keeping skills up to date
Maintaining your hard-earned nurse identity
In the end, nurses are highly valued members of society who are deemed the most trusted professionals in the U.S. year after year in the Gallup poll. With a broad and deep set of soft and hard skills, an individual with a history as a nurse brings a great deal to the table.
If you’re leaning towards the nuclear option, the best advice is to be cautious and thoughtful in making that choice. Burnout can understandably drive you to make hasty or regrettable decisions, so taking your time is paramount. Seek the counsel of those you trust who has your best interests in mind. Think long and hard, and consider staying if you can.
However, if you pull that lever and seek new professional pastures, may you do so with no blame, no shame, and your head held high with the knowledge of the enormous service you’ve done to society as a registered nurse. And finally, know that you’ll be welcomed back to the profession with open arms if you ever choose to return.
Daily Nurse is thrilled to feature Keith Carlson, “Nurse Keith,” a well-known nurse career coach and podcaster of The Nurse Keith Show as a guest columnist. Check back every other Thursday for Keith’s column.
In the course of many nurses’ healthcare careers, witnessing the illness, suffering, and death of others is commonplace. From dialysis and med-surg to home health and the ICU, nurses create therapeutic relationships with patients and their families, providing spiritual and emotional comfort, compassion, and skilled expert care based on many decades of nursing science and evidence-based interventions.
Aside from witnessing the challenges others face, nurses are human beings with their own life experiences, victories, and suffering. Therefore, how a nurse navigates their suffering plays a role in determining how they approach life, work, and the overlapping of the two.
Life is Suffering
In Buddhist studies, it has been said that life is suffering. I believe that this expression refers to the notion that our emotional attachment to the things that make up our lives (relationships, money, success, possessions, family) are what cause us suffering and the ability to live in the present without grasping for what we don’t already have can help to alleviate that suffering. In other words, our desires cause us to suffer.
Aside from our attachment to things and people, there is also the reality that bad things often happen to good people — we see children with incurable cancer, elders living alone and destitute, and many other situations that seem both untenable and patently unfair.
In nursing, medicine, and healthcare, what we’re grasping for is the health and well-being of our patients, sometimes against all odds. As a result, we grow attached to patients and their families, our compassion goes out to them in their hour of need, and we can feel like failures when things don’t go as we wish.
I’ve lost many patients over the years, and I sometimes blame myself when they suffered or died, especially when it seemed almost impossible to alleviate their suffering. I’ve seen patients consumed by cancer, heart or liver disease, dementia, stroke, multiple sclerosis, ALS, diabetes, and opportunistic infections that transform an HIV+ patient into someone living with AIDS.
Suffering is also witnessed by so many of us when we turn on the evening news, listen to the radio, or scroll through a news app on our phone or our Facebook feed. War, famine, terrorism, politics, the economy — each aspect of 21st-century life can reveal to us the crueler side of human nature and existence.
Our Suffering
I’ve lived with chronic pain for more than a dozen years, and I admittedly suffer to some degree every day. But, like many people with physical pain, I power through my days and then rest as best I can at night.
Throughout my years of providing career coaching and professional support to nurses, I’ve heard many stories that nearly broke my heart. Nurses with all manner of conditions have passed through my orbit, and I’m consistently inspired by the courage and persistence embodied by these incredibly strong human beings. From burnout and depression to cancer and brain trauma, nurses are themselves patients, too.
As nurses who serve the ill, injured, and vulnerable, how do we tend to our suffering while also being present for our patients? How do we allow ourselves the space to feel our feelings and deal with our issues without feeling guilty for being vulnerable ourselves?
Nurses often feel they need to be invincible, uncomplaining, and stoic, but we’re human beings, not angels and saints. We, nurses, need to honor our suffering, challenges, and pain — by doing so, we can then be even more available for our patients through the simple fact of our compassionate understanding of their plight and our very human experience.
Our Humanity
As nurses, healthcare professionals, and human beings living in a complex and often stressful 21st-century world, our humanity matters, even when we’re determined to deny our pain and suffering in the interest of being strong nurses helping others. Of course, denying our humanity and pain does us no good, but nurses are experts at doing so.
Nurses are fallible and prone to all the ills that our fellow citizens face. Like everyone else, we have our existential anxieties about family and friends, the environment, politics, finances, futures, careers, and anything else under the sun.
Nurses, too, live with debt, personal tragedy, and grief and loss — we also strive to create the best lives we possibly can for ourselves, our loved ones, and our communities. At times, admitting that we don’t have the answers is a very human thing to do. Yet, the ability to say “I don’t know” is a sign of strength, even for a nurse who prides herself on always having the answers to life’s vexing questions.
Our humanity has meaning, no matter our efforts to be superhuman and carry the weight of the world on our shoulders. As nurses, we must strive to recognize, accept, and celebrate our fallibility and create lifestyles and careers that honor our needs, pain, suffering, and the forward-thinking personal and professional lives we strive to live.
Daily Nurse is thrilled to welcome Keith Carlson, “Nurse Keith,” a well-known nurse career coach and podcaster of The Nurse Keith Show as a guest columnist. Check back every other Thursday for Keith’s column.
In these days of so much attention being (appropriately) paid to nurse burnout, nurse wellness, and existential fatigue from several years of the COVID-19 pandemic, what does it look like to be happy in your nursing career? What does it mean to be fulfilled, content, and satisfied as a professional nurse? And if you are indeed happy in your career, is it okay to be walking on the sunny side of the (nursing) street? And if you’re not there yet, how do you get there?
If You’re Happy and You Know It
Do you remember the children’s song, “If You’re Happy and You Know It, Clap Your Hands”? It’s an opportunity for kids to celebrate and make some noise if they’re feeling happy. Do you feel like your nursing job sometimes makes you want to express your happiness for the privilege and joy of what you get to do every day?
During my career, I’ve met many nurses who love what they do. From pediatric and ICU nurses to nurse researchers and entrepreneurs, plenty of nurses like their work, are treated well by their employer, earn enough money, and feel like their career has worked out pretty well. Is that you? It’s not a pie-in-the-sky pipe dream — it’s altogether possible, and you could join the ranks of satisfied nurses.
What’s the Secret to Finding Happiness in Nursing?
So, what’s the secret to a nurse being able to feel like there’s little to complain about and all is well? Unfortunately, there’s no real secret sauce or recipe that works for everyone, but there are certain things you can do to move in the direction of the sunny side of the street.
Get in touch with your values:
Understanding the underlying values that form the motivation for who you are and what makes you tick is an excellent place to begin. The Barrett Values Centre offers a free online values assessment that results in a robust emailed report describing the core values that your assessment reveals. Once you understand your core values, you can seek career paths and employers that speak to the important things..
Find your happy place:
Many nurses enter the profession thinking that hospital nursing is the only way to be a “real” nurse, but that couldn’t be further from the truth. Nurses find fulfillment in community health centers, private practices, home health, hospice, entrepreneurship, informatics, research, palliative care, dialysis, and other areas. Just because some people say you should work in acute care doesn’t mean you have to — ever.
Where you work matters:
The values and mission expressed by your place of employment can impact how you feel about your work and career. If one of your values is giving back to society in meaningful ways, working for an employer that provides opportunities to serve the community can be a morale booster.
If your employer has zero tolerance for bullying, incivility, and negative behavior, you likely feel much more safe and secure than if you were part of a workplace culture where people normally treat each other badly.
In terms of the size of the organization where you work, decide if you’re happier working for a small specialty practice than an enormous academic center. Then again, you might thrive in a work environment employing hundreds of people.
Know when it’s time to go:
The singer Michelle Shocked once sang that “the secret to a long life is knowing when it’s time to go.” One way to stay on the happy side of the street in your nursing career is to know when it’s time for a change. Unfortunately, some people stay because they don’t want to “abandon” their colleagues, feel stuck and have no other choices, or lack the courage and temerity to just go for it and make a clean break.
Create a strong network:
A strong professional network is like having a personal brain trust. Beginning in nursing school and throughout your career, making and maintaining positive collegial relationships can be a key pillar of your professional life.
Remember that behind each person you know are the dozens of people they know. When you need an introduction, mentoring, a connection in a new city, an informational interview, or some advice, your network is where you can find all that and more.
No Guilt, No Shame
If you’re happy in your nursing career and know it, there’s no need for guilt or shame. But unfortunately, many nurses are unhappy, working in negative and toxic environments, and feeling stuck with nowhere to go. This doesn’t have to be you, and while no workplace is perfect, you can do your best to find one that works for you. Start your own business, be a consultant, or create your iconoclastic or outside-the-box career path.
A fulfilling nursing career and a healthy workplace are your right, and only you can make them happen. Understand your values, gather good people around you, recognize when it’s time to go, and know deep in your heart that having a positive experience as a nurse is well within your reach.
Daily Nurse is thrilled to welcome Keith Carlson, “Nurse Keith,” a well-known nurse career coach and podcaster of The Nurse Keith Show as a guest columnist. Check back every other Thursday for Keith’s column.
