Nurses, like many professionals, build their confidence by learning, asking questions, and then doing. However, according to a Fidelity Investments® Money FIT Nurses Study, more than half of nurses surveyed (56%) say they lack confidence in making financial decisions.
But Alexandra Taussig, senior vice president of marketing and business management at Fidelity Investments, believes that while more than half of nurses lack confidence when it comes to managing their money, it is often unwarranted.
“Many nurses are diligent savers and are actively saving for their retirement, so it may start with a mental shift,” says Taussig. “The more educated nurses are about financial planning and investing, the more empowered they will be to control their financial future.”
Steven A. Boorstein, president and CEO at RockCrest Financial LLC, recommends nurses who are hesitant about making financial decisions to start small. “Starting something begins to take you down the right path now. Over the course of a year or two, if you tackle the small issues, you find that you’ll start to clear up the mess and can focus on the bigger issues (e.g., student loans, retirement, major purchases, college planning for your children).”
According to Taussig, one specific step nurses can take regarding retirement planning is to strive to save 15% of their salary (including any employer match) each year towards their retirement. If that is too difficult to start, commit to increasing savings 1% each year until you get to the 15% savings rate.
For nurses in their mid-30’s or later who haven’t started planning, Boorstein says it’s critical to not only start saving, but also to start setting specific financial and retirement goals.
“As you get into that age range, college planning, housing expenses, childcare, retirement, and other issues start to become more important,” he says. “It’s easy to push those things off, but in your thirties they are now more prominent and are going to take potentially more effort to solve.”
Making Time to Plan
The same Fidelity Investments study found that four in 10 nurses (41%) attribute their lack of confidence in their financial decisions to not having enough time to focus on them. But taking steps to address your financial future is not as difficult as many of us like to think. Just as the health care community encourages patients to get annual physicals; a similar approach can apply to your own financial wellness. Taussig suggests the following:
- Write down your financial goals.
Taussig recommends writing them down as it helps visualize and feel more accountable. Also think about the timeline when you want to reach each goal.
- Check retirement readiness.
Check your retirement score to see how you are tracking toward your savings goal. After answering a few quick questions, find out if you’re in the green, yellow, or red “zones” and learn how small adjustments may help bolster your readiness
- Get guidance at work.
Find out what financial resources your employer offers. Schedule a time to talk with a financial professional to discuss your financial goals and retirement readiness.
Knowing When to Retire
Nurses have always worked past the traditional age of retirement. But Taussig believes when it comes to preparing for retirement, age is an important factor when making some decisions, and less critical in other areas. For instance, she says age is a significant factor when it comes to tapping into benefits such as Social Security, because eligibility is determined by one’s age. The longer a person can wait before they start taking social security (up to age 70), the greater the social security monthly benefit will be. So, it’s important to understand what you are eligible for and at what age.
“Furthermore, full retirement age (which differs depending on the year you were born) is when people are entitled to begin receiving their full monthly benefit,” Taussig explains. “However, many people (often more women than men) take benefits earlier than Full Retirement Age—meaning they lock in a reduction to this benefit for life.”
Age should also be considered when investing, especially for a substantial goal like retirement. The longer a person can invest their savings, the longer their investments can potentially grow. However, Taussig says age is less important in determining one’s mental and physical readiness for retirement.
“There are many factors that people need to consider as they prepare for retirement in addition to their finances—they need to look holistically at their job situation, their health, their family obligations, lifestyle needs, etc.,” she says. “Having a sense of readiness comes less from achieving a certain age, and more from feeling that all those elements are well-aligned.”
There are a number of pitfalls nurses can make when retirement planning. Taussig says that taking loans from retirement savings plans is a huge blunder. Even more, she says they’ve seen an increase in the number of loans nurses are taking from their retirement savings plan. From 2012 to 2015, outstanding retirement account loans has grown 35%.
“Nurses should borrow from their workplace retirement savings only as a last resort,” she says. “These types of loans, like any other, are another expense that must be paid and the impact to their total retirement savings may be greater than they expected.”
Boorstein says not protecting income is the one of the biggest retirement planning mistakes he sees people make. They don’t know the risk that they are taking with their investments and either stay too aggressive or become too conservative in retirement.
“As you get to the last 10 years or less before social security kicks in, I think the discussion needs to shift from how much a person has in assets to what kind of income that they can generate throughout the rest of their plan,” he says. “And that usually requires taking money that is probably in riskier investments at that point, and shifting it into investments that can help them sustain a certain standard of living no matter what the stock markets do over the short or intermediate term.”
Lastly, Taussig says most employers offer financial guidance as a free employee benefit but 62% of nurses who are eligible for free workplace guidance don’t take advantage of it. However, guidance is important and can lead to action.
“Fidelity data finds that 35% of nurses take actionn after receiving guidance,” she says. “For instance, of those nurses, 69% of those that have taken action increased their retirement savings contribution without 90 days of completing a guidance interaction by phone, in person or online.”
Boorstein advises nurses who have not started saving or investing, to start creating a retirement plan today. Once you’ve done that, he suggests coordinating your plan with your other goals and risks.
“Review your plan every six months to a year and gauge where you are at that point. It’s much easier to make small adjustments than it is major changes,” he says. “If you’re 37 and you make 30 small adjustments every year, it’s much easier than waiting to do your retirement plan at 60 and realizing you only have seven years to make major life changes and it may just not be possible.”
Janet Patterson, 64, has worked as a nurse for over a quarter of a century. After graduating from Santa Rosa Junior College, she worked in adult telemetry/step-down ICU, helping to implement a number of new programs at her hospital, including cardiac surgery. Over the next few decades, she worked in the ICCU, PICU, and ICN, as well as pediatrics, where she took care of one of the children from the 1989 freeway collapse caused by the Loma Prieta Earthquake. In 2009, she graduated from Sonoma State University with her BSN. However, despite her 35 years of experience, Patterson says she’s often talked down to as though she could not understand new drugs and treatments.
“Sixty is not the new 40. Sixty is an age to be appreciated for itself,” Patterson says. “A nurse who is 60 years old and has 30-40 years of work experience may not be up on the latest version of a drug, but that doesn’t mean they can’t learn.”
Unfortunately, Patterson is not alone. Age discrimination cases are not new or rare. Psychiatrist Robert Neil Butler first coined the term in 1969 and defined it as “a process of systematic stereotyping or discrimination against people because they are old, just as racism and sexism accomplish with skin colour and gender.” Over the years, ageism has been defined as negative attitudes, prejudices, or discriminations against people based solely on age.
As the nursing profession ages, a pervasive attitude toward older nurses will continue to increase and create profound implications for nurses. According to a 2013 survey conducted by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers, 53% of the RN workforce is age 50 or older. Yet, ageism has been said to be a largely ignored topic in the nursing industry.
Eileen Sollars RN, ADN, believes ageism in nursing is ignored because not everyone sees it. She says with hospitals looking to trim their budgets and reduce costs, older nurses are often replaced with new nursing graduates.
“Older nurses’ salaries can be larger than new grads, and in some cases, the hospital could afford to hire two new grads to the salary cost of one experienced nurse,” she says. “Without nurses seeing what is happening to older nurses, the administration can silently push these nurses out of their workplace.”
Dispelling the Myths
As ageist attitudes toward older nurses become more prevalent, the issue of ageism in nursing must be addressed. One way to do that is by dispelling some of the more popular myths.
Myth #1 – Nobody wants to hire older nurses.
Not true, according to Jennifer FitzPatrick, MSW, author of Cruising Through Caregiving: Reducing The Stress of Caring for Your Loved One. FitzPatrick says with our expanding aging population—one-third of Americans are 50 or older—older patients really enjoy working with nurses in their age groups.
“There is a nursing shortage in the U.S. and there are many jobs in nursing homes, assisted living, adult day, hospice, home health, and home care, which serve a great many older patients,” she says. “Older nurses are often able to empathize with many of the issues their older patients are facing.”
Christine Colella, MSN, CNP, CS, RN, associate professor of clinical nursing and director for the nurse practitioner programs at the University of Cincinnati College of Nursing, agrees.
“Coming from an academic setting, the aging of the nurse workforce and how that impacts the nurse and patient care is often discussed,” Colella says. “As nurses age and retire, health care loses their collective wisdom, experience, and insights to patients and their care.”
Myth #2 – Older nurses are too frail or damaged to do the physical work.
It’s true that nursing is physically demanding. According to the U.S. Bureau of Labor Statistics (BLS), the incidence rate of overexertion injuries averaged across all industries was 33 cases per 10,000 full-time workers in 2014. By comparison, the overexertion injury rate for hospital workers was twice the average (68 per 10,000), the rate for nursing home workers was over three times the average (107 per 10,000), and the rate for ambulance workers was over five times the average (174 per 10,000).
Patterson says it’s true that wear and tear has its way with bodies. Due to three on-the-job injuries, she agrees that she’s not as athletic as she used to be and is limited by the consequences of those injuries. “I don’t move as fast. I can’t stand for 12 hours at a time. It takes me longer to lift someone over 60 pounds because I have to do it more carefully, but that doesn’t mean older nurses are incapable of working,” she says.
Sollars adds that nursing is not as physical as it was years ago. “The way we do the job today is safer and less physically stressful than it was before.”
According to the Centers for Disease Control and Prevention, health care and social assistance is one of many occupational sectors studied by U.S. federal agencies such as the BLS, as well as the Occupational Safety and Health Administration and the National Institute for Occupational Safety and Health. Their research-based evidence has led to the development of safe patient handling standards and ongoing legislation to enact laws requiring or promoting the use of safe patient handling programs in health care settings.
Myth #3 – Older nurses are too slow, too stubborn, and do not want to (or cannot) learn new skills.
Patterson says that older nurses are farther out from their anatomy, physiology, and pharmacology classes than younger nurses or may not be interested in learning another new IV pump system, but that’s not a reason to say they are not good nurses anymore.
“Of course nurses need to keep up with the fields they work in,” she says. “It’s not safe if we don’t, but it doesn’t automatically follow that nurses fresh out of school are smarter than nurses who’re older.”
Sollars admits that older nurses often get the bad rap of being unwilling and resistant to change. But that’s because of their wisdom and experience.
“We don’t see the need for change just for the sake of change,” she says. “If we have a system that is working for the patient and the nursing staff, why change it? I’ve seen change and then a few years later things would go back to the way it was.”
How to Address Ageism
What can hospital administrators do to address ageism and dispel the myths often associated with it? For starters, Colella says to honor the wisdom and experience of nurses who have always been the foundation for the entire hospital system because they care for the patient 24/7. Their value, however, is not as appreciated as it should be and now with the impact that these retiring/aging nurses will have on the system it has become a concern.
“Value the expertise of the older nurses by having them at the table to discuss ways to improve the work environment,” Colella adds. “Incorporate ways to have them share their wisdom and experience.”
FitzPatrick believes hospital administrators should create an environment where the nurse is judged by his or her performance only, not age or any other factor. “One way to do this is to be aware of the nurse’s generational affiliation but to not make assumptions based on it,” she says. “Administrators need to prioritize age diversity awareness and making training about it as strongly as they do other workplace inclusiveness initiatives.”
According to the Mayo Clinic, stretching helps improve flexibility and range of motion in the joints. Improved flexibility decreases the risk of injuries and enables muscles to work more effectively. Stretching also increases blood flow to muscle, flushing out oxygen-depleted cells and increasing energy levels. Jeff Miller, a certified personal trainer and owner of Function Fitness, recommends the four best stretches for nurses to stay relaxed and loose during a shift.
1. Neck stretch
Stand up straight with your head level. Place one hand behind your back as if standing “at ease,” only with the back of your hand on your lower back. Put the other hand on top of your head, and gently pull your head to the side until you feel a stretch. You should feel the stretch in your neck, shoulder, and a little bit in your core. Hold for 20 seconds, then do the other side. Do this once an hour to help keep your neck muscles loose and balanced.
2. Chest and shoulder stretch
Stand up straight with good posture. Put your hands out to your side, and rotate your hands so your thumb is pointing backward until they’re pointing at the wall behind you. Arch your back, pressing your shoulder blades together, and hold for five seconds. If you do this once an hour, it will help prevent back, shoulder, and neck pain caused by constantly leaning over your patients and looking down at their charts.
Put your hands on your hips and slowly swivel them around like a hula-hooper. Do this five times per side every hour. It will help keep your hip and back muscles stable and balanced, preventing low-back pain.
4. Standing row with tubing
Attach some exercise tubing (just medical tubing with some grips on it) to a coat hook or something else relatively close to eye level on the wall. Holding your hands thumb-side up and your arms straight out in front of you, pull your elbows straight back toward the wall behind you. Do three sets of three reps 12-15 times, at least three times per week.
To date, there have been over 350 travel-associated Zika virus disease cases reported in the United States according to the Centers for Disease Control and Prevention. We consulted a group of experts to help us compile a short A-Z index of everything you need to know about the Zika virus.
The Zika virus is spread to people primarily through the bite of an infected Aedes species mosquito. While there are more than 3,000 mosquito species, three types are primary responsible for the spread of human diseases. The Aedes mosquito—one of the key three—can transmit Zika, as well as yellow fever, dengue, and chikungunya.
If you believe you have been infected, your doctor may order a specialized blood test for Zika, or other blood-borne viruses like dengue or chikungunya. It’s important to note that Zika is moving quickly from affected regions to other warm climates, resulting in a rapidly changing infection zone that has already reached the United States.
Most people that contract the Zika virus will not experience symptoms. In fact, only one in five will develop a mild fever, rash, joint pain, and/or conjunctivitis lasting several days to a week. Conjunctivitis, is a common eye condition causing inflammation of the conjunctiva—the thin layer that lines the inside of the eyelid and covers the white part of the eye. Many viral causes of conjunctivitis clear without treatment or any long-term effects.
Residents and visitors to warm climates should add mosquito repellent to their daily regimens, applying liberally and at regular intervals. Use an insect repellent with the active ingredient DEET, which is safe for children as young as two months old. Long clothing, screens on windows, and air conditioning can also help protect against exposure to the carrier mosquito.
If you or your partner are pregnant or planning to become pregnant, evaluate your risk of contracting the disease with your physician. The virus may lead to severe birth defects or miscarriage. And while the correlation with Guillain-Barre—a rare and sometimes fatal affliction that can cause paralysis—is unconfirmed.
This will include any areas around your home with standing water or garbage, like old tires and plant pots. Eliminate them to reduce mosquito breeding grounds.
Take precautions. Make sure that you check with your doctor, wear long sleeves and pants, and avoid mosquito infected areas.
Those who are pregnant or may become pregnant are at the highest risk.
Infectious diseases spread both through mosquito bites and sexual transmissions. In known cases of sexual transmission, the Zika virus can be spread by a man to his partner; however, we do not know if a woman can spread Zika to her sex partners.
The particular mosquito that carries the Zika virus only travels approximately 100 meters, meaning not very far. They will not fly from Central America to the United States, for example.
Dr. Kleber Luz works for the Federal University of Rio Grande do Norte (Brazil), where he specializes in infectious disease. Dr. Luz and colleagues were among the first to realize that a new disease had emerged in Brazil. They ran tests to rule out related viruses, including dengue and chikungunya, and then began exploring other options. Last June, Dr. Luz and his team published their findings in the journal Memórias do Instituto Oswaldo Cruz, the Brazilian equivalent of the Morbidity and Mortality Weekly Report published by the CDC—and the world took notice.
In early 2016, The Lancet published the complete genome, or full genetic blueprint, of Zika virus from the Americas. This important step allowed scientists to pinpoint where the Zika virus circulating in South and Central America came from.
There have been reports of a serious birth defect of the brain called microcephaly in babies of mothers who had Zika virus while pregnant. Microcephaly is a severe birth defect where a baby’s head is smaller than expected when compared to babies of the same sex and age. Babies with microcephaly often have smaller brains that might not have developed properly.
Like all infectious agents that circulate in blood, there is potential for Zika to spread by blood transfusions, tissue donation, or needle sticks. There have not been any documented cases of Zika transmission between a patient and a health care worker; however, this potential should be carefully considered when drawing blood from suspected patients.
There has been a lot of discussion of infants born with microcephaly. An additional complication experienced by infants born to Zika-infected mothers that has not been discussed as frequently is the damage to the optic nerve. The optic nerve transmits images observed by the eye to the brain, allowing us to perceive what we see. Will the observed damage leave these infants blind? It is not yet known.
Pregnant women traveling to countries with an outbreak of Zika should be evaluated if they experience symptoms of the disease. If testing is negative for the virus, they should receive routine prenatal care, including an ultrasound at 18-20 weeks of gestation to check the fetal anatomy. Additional ultrasounds may be recommended later in the pregnancy to assess the cranial and brain development.
Most questions about Zika can be answered by going to the CDC website. Some organizations, such as the Public Health Agency of Canada, are recommending travelers speak with a travel health specialist at a travel clinic before they go to a Zika-affected area.
The only way to prevent Zika is to not give the mosquitoes the opportunity to come in contact with humans. The CDC recommends the use of EPA-registered repellents. Products with DEET, picardin, and IR3535 provide long-lasting protection. Clothing that covers the arms and legs should be worn. Premetherin products can be sprayed on clothing to offer extra mosquito protection. Label instructions should be followed. The cuffs of pants and shirts should have special attention, as the mosquitos access the skin by coming through any opening.
The most common symptoms of Zika are fever, rash, joint pain, or red eyes. Symptoms also may include muscle pain and headache. If pregnant, and these symptoms occur within 2 weeks after traveling to an area with Zika, a health care provider should be contacted.
Zika is treated like the flu with rest, fluids, and Tylenol for the fever and body aches. Hospitalization is uncommon.
Ultrasounds of a developing fetus are used to screen for changes potentially caused by Zika, such as abnormal calcifications or microcephaly.
There is no vaccine for the Zika virus.
Water in receptacles such as old tires and bird baths can serve as breeding sites for the Aedes mosquito, which carries the virus.
X-rays are not part of the routine evaluation of Zika.
Yellow Fever is another disease spread by the same mosquito as Zika. The virus that causes yellow fever is also in the same family of viruses as Zika.
The virus is named for a forest in Uganda where the virus was first identified in 1947.
Nurses know stress. Ever-increasing demands on health care resources combined with the rollout of the Affordable Care Act (ACA), long hours, and staffing challenging have put serious strain on the nursing profession. Although all of these stressors are significant, two new stressors are of growing concern: technical medical errors and questions about the entry level of education for nurses.
Technology-Induced Medical Errors
For years, health care professionals have advocated the importance of technology in the health care industry. Advancements in technology have made it possible for patients to use portable devices to access their medical information and monitor their vital signs. Now, there’s a call for better interoperability, saying a lack of sufficient progress on this front contributes significantly to medical errors.
According to “Missed Connections: A Nurses Survey on Interoperability and Improved Patient Care,” a March 2015 report from the Gary and Mary West Health Institute, meaningful progress in reducing medical errors requires using technology to create an automated, connected, and coordinated health care system. This is only possible when there is a seamless flow of information among all devices involved in caring for a patient.
Callie Ballenger, RN, an online adjunct nursing instructor at Ottawa University, notes that nurses are surrounded by medical devices—from IV pumps to computers used for documentation to devices implanted in patients. She says this technology is nice when it all works but can make for a great deal of stress when it does not work properly.
“Nurses need to be properly trained on the care of patients with these medical devices and contact information for the manufacturer of these devices needs to be readily available to nurses,” Ballenger says. “There is a great deal of stress when you are in a patient emergency and do not have this information readily available.”
The survey of more than 500 nurses (conducted online by Harris Poll on behalf of the institute), revealed that 50% witnessed a medical error resulting from a lack of coordination among medical devices in a hospital setting. Roughly half estimated that as many as 25% of medical errors and adverse events might be prevented if devices could share information seamlessly. According to a 2013 study published in the Journal of Patient Safety, preventable medical errors are estimated to cause more than 400,000 American deaths each year.
The lack of information-sharing between devices can affect how a nurse does his or her job. The survey found that nurses spend a lot of time programming and setting up devices, followed by data transcription. About 41% said they spend three or more hours per shift on these tasks.
Sonya Curtis, MSN, an assistant nurse manager at the North Texas VA Health Care System, notes that medical devices are examined by biomed. Biomed places a sticker on the device to show the last time they have recalibrated or assessed the device to ensure it is working properly. The nurses’ job is to review the sticker before using the medical device.
“A nurse can be held liable for using a medical device on a patient causing an adverse event,” she says. “The nurses’ workload, short staffing, and quick orientation [to unit and equipment] can cause negative patient outcomes. This can be a tremendous stressor.”
“Taking time to read manuals and programming medical devices, can add to their overwhelming emotions (i.e., stress); furthermore, affecting nursing productivity,” Curtis adds. “All this can lead to medical errors.”
The Entry Level Debate
There have been a number of initiatives aimed at addressing the nursing shortage in the U.S., including state and federal grants to nursing schools to increase the number of faculty and students. But as these nurses graduate and enter the workforce, they are faced with stress regarding their level of education.
Determining the entry level of education for nurses has been a controversial topic for at least three decades, according to Constance Dallas, PhD, an associate professor at the University of Illinois at Chicago College of Nursing. But the ACA, with its emphasis on increasing the scope of nursing practice, and the increase in Magnet Hospital status, with the focus on BSN-prepared nurses and evidence-based care, have revitalized the conversations.
“These conversations can be stressful for nurses when they trigger worries about their job security. Financial demands and family demands may influence the ability of some nurses to continue their education,” Dallas says. “Low-income students may be reluctant to consider a nursing career that requires a minimum educational level of a DNP or PhD.”
A more highly educated workforce saves lives and reduces stress in nurses. A study published in the October 2014 issue of Medical Care found that a 10% increase in the proportion of BSN-prepared nurses on hospital units was associated with lowering the odds of patient mortality by 10.9%. The study also found that increasing the amount of care provided by nurses with BSNs to 80% would result in significantly lower readmission rates and shorter lengths of stay.
Curtis personally and professionally believes the entry level of the nursing profession should be a BSN.
“With higher education comes more responsibility and prepares the nurse to obtain a broader knowledge of nursing practice. This in itself is stressful,” she says. “The BSN nurse does have more educational courses, which assist to a better patient experience and patient outcome.”
Ballenger agrees. “There is a great deal of information that nurses need to know, and we are trusted to care for people in some of the most critical times in their life, so I do not think we can sacrifice knowledge and skills by requiring lesser education,” she says. “If all nurses are BSN-prepared it levels the playing field and decreases stress, as the ADNs do not feel that they have lesser education or that BSN nurses are above them.”
Overall, Curtis argues that these new stresses are only the tipping point so nurses need to be prepared to deal with this stress in their nursing education.
“Health care is an evolving field and change is constant so it is important for nurses to be lifelong learners and educate themselves on new equipment and procedures so they can provide the best care to patients,” she says.