Many of us with advanced degrees struggled with the decision to return to school. There is literally no perfect time to go back to school after you’ve accomplished the tremendous feat of RN licensure. There are hundreds of reasons not to return to the academic life, yet here you are still reading this article, so this might be the right time for you to plan your next degree. Now the question is, which degree to pursue? There are several considerations on whether you should hop into a BSN program or skip that step entirely and jump directly into the MSN journey.
First, let’s chat about your career aspirations. What kind of “nurse” do you want to be when you grow up (so to speak)? Do you want to remain at the bedside or perhaps be a Charge Nurse where you’re leading operations, supporting the bedside crew, and performing direct-patient care? Does your organization require a BSN to advance through the clinical ladder? Would you like to teach at a nursing assistant or LPN/LVN school? Would you like to be a public health nurse and lead community health events or provide in-home care? While most of these roles require a BSN (depending on the institution and state, of course), having an idea of where you want to go with your career path can lend insight into your next step.
You may have already entered “RN to BSN” into a
search engine, become completely overwhelmed with the over 54 million (yes,
million) results, closed your eyes with a sigh, and thought, “Not
today!” Well, it doesn’t have to be that confusing. If you’ve decided on a
BSN program, the next step is to decide on the format. If you’re the
I-need-to-work-this-school-thing-around-my-life person, then online programs
might be the best option. Or perhaps you know you’ll be more successful with
in-class accountability, so narrow your search for those programs. The cost can
range widely, such as the $5k at Winston-Salem State University (WSSU) in North
Carolina to nearly $22k at Ramapo College of New Jersey plus any additional
fees for clinical hours, so buyer beware.
Nurses considering the RN to MSN track are typically looking for more of an advanced-practice career such as teaching in nursing schools for ADN or BSN students, leadership roles in organizations, or becoming a nurse practitioner, a nurse-midwife, or clinical nurse specialist (CNS). There are also some newer and exciting (yes, I used the word exciting about education) MSN degrees specializing in informatics and innovation. Once you have decided that the MSN is the route for you, choose your focus and specialty area and then select your school. While the MSN is designed for the working professional, it’s still a considerable investment of time and money, so you want your advanced degree to be in something you’re interested in and will enjoy. As with the BSN programs, the cost can vary greatly from not only from school to school but also by specialty area.
No matter which pathway you choose, I want to reinforce that
all nurses, no matter what the title or the pedigree papers state, should
always act in a professional manner. As we are the most trusted profession in
America, we hold an obligation to our patients, to the communities we serve,
and to ourselves to keep the bar very high. Social
media is a blessing and a curse in many ways of allowing people a glimpse
into our private lives, so whether you are a diploma nurse on up to a DNP, the
piece of paper does not make one professional. Make sure you are
choosing to represent our profession at all times positively.
Being a nurse is part of our identity. It’s not something that we only recognize when we’re clocked into the corporate payroll. We are nurses first, and we build on those skills as we gain wisdom and knowledge through many pathways such as mentors, colleagues, organizations, and formal education. Choose your next step based on where you see yourself heading within the profession of nursing, yet know that education is an investment in yourself that is earned and can never be taken.
Urbanization and declining farm incomes are causing many rural communities to struggle, and the healthcare providers who serve those communities are facing major challenges attracting talent and sustainably treating a dwindling, aging population. This shortage of providers directly impacts access to care in rural communities. A recent NPR poll of rural Americans found that, despite 87 percent reporting having some form of health insurance, more than one quarter of respondents had not been able to access healthcare when they needed it at some point in the last few years.1 These troubling statistics are a call to action for healthcare leaders, and a call to reimagine and reinvent how we deliver care in rural areas. Undoubtedly, nursing will play a critical role.
The Growing Role of Telemedicine
The gap between rural healthcare needs and provider capacity is growing—literally, by miles. From 2013 to 2017, 67 rural hospitals closed, 23 of which were 20 or more miles away from the next closest hospital.2 As the distance between providers and patients increases in rural areas, telemedicine will play an important role in care delivery. For decades, nurses have counseled patients over the phone regarding health questions, but technological advancements are creating exciting new possibilities like enhanced remote patient monitoring and advanced telehealth apps. By improving the suite of telehealth resources available to rural area patients, they’ll have easier access to preventive and primary care in their own communities—often, from the comfort of their own homes.
However, there are many primary care services that must be
delivered on site by a provider, and rural communities are suffering from an
acute shortage of healthcare providers. According to the National Conference of
State Legislators, 77 percent of rural counties are designated as health
professional shortage areas.3
Compounding the existing shortage is the fact that rural primary care
physicians are, on average, older than their urban counterparts, which will
only worsen this troubling trend over time.
Filling the Care Gap with NPs and PAs
Addressing the supply shortage, the number of nurse
practitioners (NPs)4 and physician assistants (PAs)5 who
graduate each year is outpacing the number of medical doctors (MDs)6.
In 2017, there were approximately 68 percent more new NPs and PAs than MDs. The
numbers of NPs is projected to continue growing,7
and they must be empowered to meet primary care needs with a widened scope of practice,
enabling them to treat patients more independently. Nurse practitioners can
provide essential in-person care without a physician. Twenty-two states and the
District of Columbia have pursued some expansion of scope of practice for NPs,8
including rural states like Nebraska, where 13 of 93 counties lack even one
primary care physician.9
Additionally, other Advanced Practice Registered Nurses (APRNs), like certified
nurse-midwives and clinical nurse specialists, can also address rural health
needs when physicians cannot.
Nursing talent will play an essential role in expanding access to rural healthcare, but it will require a concerted effort to recruit, educate, train, and retain nurses in rural areas. First, healthcare leaders and nursing educators need to elevate this opportunity in our dialogue with students. Rural nursing is a high-need role for professionals excited to make a difference and pioneer innovative approaches to care. Healthcare providers have continuity in small towns, getting to know patients personally and addressing their needs.
Providing Healthcare to All Communities
As called for in the National Academies of Sciences, Engineering, and Medicine’s 2011 The Future of Nursing report, we must continue to encourage nurses to pursue advanced education, enabling them to take on advanced practice responsibilities.10 This can be done through innovative programs designed to increase access to education and prepare them without having to leave their communities. Educating nurses where they live may mean they’ll stay there longer, which is especially helpful in addressing the need.
In rural healthcare, the nursing profession has the
opportunity to showcase the full range of its abilities and embrace the future
of expanded nursing practice. Close collaboration between nursing educators,
policymakers, regulators, and health systems will enable us to embrace these opportunities,
making care more efficient, affordable and accessible for rural America.
Working together, let’s reaffirm our commitment that all citizens, wherever
they live, deserve a system equipped to meet them where they are and provide
superior care. The nursing profession stands ready and eager to do our part.
Karen Cox, Ph.D., R.N., FACHE, FAAN, is President of
Chamberlain University, which has the largest nursing school in the country,
and Immediate Past President of the American Academy of Nursing.
Notes on sources:
Academy of Certified Nurses Enrollments and Graduations 2017-2018
Assistants Education Association Program Report 33, 2017
- https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm (visited June 2019 ). Data reflects a projected percentage
change in employment from 2016-2026 and may not reflect local economic
The world is watching the developments related to this new
coronavirus, officially designated 2019 Novel Coronavirus or
2019-nCoV, As a nurse, you may be wondering what to tell your
patients about this life-threatening virus.
Coronaviruses are so named due to their particular shape,
which is similar to a crown. They are very common; many are responsible for the
upper respiratory infections from which we often suffer and treat their
symptoms with rest and over the counter medications. But occasionally
coronaviruses become much more serious, as in the cases of Severe Acute Respiratory
Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).
To help you educate and prepare your patients, we’ve provided some basic information and tips to help them avoid panic and stay as healthy as possible.
As of this writing, there have been 31,472 confirmed cases of 2019-nCoV, according to the real-time status map from Johns Hopkins University’s Center for Systems Science and Engineering. The majority of cases have been in mainland China and surrounding Asian countries. There have been 638 deaths thus far, all of which were outside the United States. In North America, there are twelve cases confirmed in the US, five in Canada, and none in Mexico at this time. No deaths have occurred in North America.
You should be concerned about
any patient who has recently traveled to China and is symptomatic. You should
also be concerned about any patient who has been exposed to a lab-confirmed
2019-nCoV within fourteen days of the onset of symptoms. For any patients
presenting with a fever and cough, you should obtain a detailed travel history.
As with most viruses and illnesses, the most medically fragile are those who are most at risk. The Journal of the American Medical Association (JAMA) reports the median age of patients is 49 to 56 years, with rare cases in children.
There have been many news reports of
Asian retailers of medical face masks being out of stock, as people rush to
purchase them for protection. Unfortunately, these masks give
a false sense of protection against the disease for healthy persons, as
coronavirus is not airborne, and they do not prevent the wearer from putting
their hands behind the mask to touch their face. The CDC is
not currently recommending the use of facemasks for the prevention of
coronavirus. However, they can be beneficial for infected persons to prevent
them from coughing or sneezing into their hands and thus more readily spreading
The best prevention tactics are the very same as the CDC
recommendations for the common cold, says Neha Pathak,
- Wash your hands thoroughly and regularly
throughout the day.
- Avoid touching your eyes, nose, and mouth with
- Avoid contact with people who are sick.
Symptoms of coronavirus can
appear in as few as two days or as many as fourteen after exposure to the
virus, according to the CDC. Some of the most common symptoms are fever, cough,
and shortness of breath. People who suspect that they may have been exposed
should contact their doctor immediately.
Treatment for coronavirus is the same as for a cold- namely supportive care – rest, fluids, and over the counter medicine for sore throat and fever. But if the symptoms worsen, those individuals should contact their physician.
What About a Vaccine?
There are multiple efforts underway to create a vaccine for
2019-nCoV, however, there are none expected to be ready for deployment until
approximately April of 2020. One of the potential vaccines is the previous
labors to develop a vaccine for the coronavirus
SARS, which was shelved before reaching clinical trials. The
vaccine was shelved when SARS was defeated by improved hygiene efforts.
The second potential
vaccine is under development in Boston, an mRNA vaccine
that is showing promise. The earliest trials with people show a good immune
response, but the vaccine has not yet been tested in an outbreak. There are
reportedly other vaccine candidates being developed as well.
For daily updates on the worldwide developments of
2019-nCoV, in addition to the real-time map from Johns Hopkins, you can follow
WHO’s daily situation
reports or the CDC’s Situation Summary.
Duke, Rutgers, University of Alabama-Birmingham, and nine
other colleges and universities have been recognized as the “2019 Best Schools
for Men in Nursing” by the American Association
for Men in Nursing (AAMN).
Winning institutions are selected based on the significant efforts they have made to increase the number of male applicants, enrollees, admissions, and/or retentions in their programs, and have been shown to provide a supportive educational environment for male student nurses. All schools applying for the award are accredited by the National League of Nursing or the Commission on Collegiate Nursing Education and have had a minimum NCLEX pass rate of 80% over the past three years.
2019 Best Schools for Men in Nursing
In alphabetical order, the winners are:
- Duke University School of Nursing
- John Hopkins University School of Nursing
- Lewis University College of Nursing and Health
- Nebraska Methodist College of Nursing
- Northern Illinois University School of Nursing
- NYU Rory Meyers College of Nursing
- Rutgers School of Nursing
- University of Alabama-Birmingham School of
- University of Cincinnati College of Nursing
- University of Wisconsin-Oshkosh College of
Vanderbilt University School of Nursing
- West Coast University College of Nursing
2019 Best Workplaces for Men in Nursing:
- New York Presbyterian Hospital
- Vanderbilt University Medical Center
For a full list of 2019 AAMN awards, visit the AAMN awards page.
All nurses should
invest in malpractice insurance, but for nurse
entrepreneurs who want to operate their own practice, malpractice coverage is essential.
If you are planning to venture out on your own and create a healthcare business,
you need to protect yourself from potential claims by selecting the right insurance
carrier based on the type of practice model you intend to deliver.
Finding insurance companies that recognize standard brick-and-mortar practice options is not hard, but if you want to incorporate the growing field of telehealth into your practice, you should take a close look at the options offered by different malpractice insurance carriers. While each company adopts the same state guidelines (e.g. nurses located in MA cannot provide telehealth services to a patient in FL unless first seeing them for an in-person visit) coverage can vary on the ratio of allowable in-person to telehealth visits. If you already have a malpractice carrier and are thinking about including telehealth within your practice, be sure to assess your plans in this area, consult with your current carrier, and shop around, as coverage varies considerably.
If you’re not yet
insured and are just starting to make your business plan, here’s what you can
expect regarding coverage: if you are a self-employed individual registered
nurse who a) doesn’t work in a correctional facility, b) doesn’t provide
cosmetic or medical aesthetics procedures, and c) has not been subject to a
medical malpractice claim or disciplinary board action within the last 5 years,
your coverage should come to around $250 per year. Such a policy should cover
$1 million per incident and $3 million in aggregate. If you are providing a walk-in clinic-type experience where you are
seeing most patients in-person, providing services like physicals, blood
pressure monitoring, wellness checks, wound care, suture removal, etc. this
type of standard coverage ought to fit your needs. However, if you are interested
in expanding into telemedicine, keep in mind that many carriers place a
limitation on in-person to telehealth visits of 75:25, where three-quarters of
your patient visits need to be in-person.
If you intend to
provide telehealth services that might include consultations, outpatient
visits, nutrition therapy, smoking cessation services, alcohol misuse
screening, depression screening, advanced care programs, and annual wellness
visits, your malpractice insurance is going to be higher than it would be for
an all bricks-and-mortar practice or a practice with limited telehealth options.
For a telehealth-focused practice, you can expect your insurance to cost approximately
$400 per year. This insurance ought to cover $1 million per incident and $6
million in aggregate coverage. Thus, for that additional $150 per year, your
insurer should provide for $3 million of additional aggregate liability, and impose
no limitations regarding the ratio of in-person to telehealth visits that are
required for an individual policy.
If you are just
starting to plot out the parameters of your business, now is the time to decide
whether telehealth is a good fit for yourself and your prospective patients. With
no end in sight to the nursing shortage and our aging population, telemedicine is
no longer just for rural districts; it’s an expanding field no matter where you
work and live. For many, the flexibility it offers is highly attractive as
telemedicine allows you to work from home and other sites outside a
conventional brick-and-mortar office. If you expect to work with patients
remotely, estimate what proportion of your practice you want to devote to
telehealth, what your expected ratio of in-person-to-virtual visits will be,
and start making inquiries among malpractice insurers.
Goodall, MBA is managing director of AlyxHealth. A 20-year financial services
industry veteran, Rob is the head of sales and principal financial
modeling strategist at AlyxHealth. He provides guidance on fiscal analyses,
strategic partnerships, product design, development, and launch. Within this
role, he also provides a cost savings analysis to expand profitability and
revenue growth for clients and the firm.
More information on
AlyxHealth can be found on their website, www.alyxhealth.com. Click here
to join the AlyxHealth Community.
You’re good at your job. Perhaps you’re even great at it.
No matter what, if you want to get ahead in your career, you need to trust
yourself. On a daily basis, you may have confidence in the physicians, social
workers, and techs whom you work with. But you also need to have that same
faith in yourself.
We asked Tina Marie Baxter, MSN, APRN, GNP-BC of Baxter Professional Services, LLC in Anderson, Indiana for tips on how nurses can empower themselves. She gave us a lot of fantastic information as well as some things to think about.
Some nurses are so focused on caring for patients that they don’t think about themselves. What are some of the basics that they should know about empowerment and what it can do for them?
Nurses forget that we are the biggest population of health care workers. According to The Truth About Nursing there are 10 nurses to every three physicians in the United States. The American Association of Colleges of Nursing reports that nursing is the “nation’s largest health care profession, with more than 3.8 million registered nurses nationwide” (Nursing Fact Sheet). We hold tremendous power. We need to remember that when we are confronted with a problem in our jobs and are looking for creative solutions.
As nurses, we are advocates for our patients. We should be sitting at the board room table and not be afraid to participate in the discussions that affect not only our practice but also patient outcomes. I have seen nurses downplay their skills and knowledge saying, “I’m just a nurse.” We are not just nurses. We are heroes. We need to embrace it. We are the experts in our field. This is not to say that we can’t learn anything new, but if we invest in ourselves and our personal development, we will be the better for it. We can empower each other by standing up to bullying that we see in the workplace and letting others know that it is not okay. We can empower each other by using our natural skills as problem solvers to improve the conditions on the unit.
As an individual, you can contact your local legislator about a problem in your community. You are a person of influence there, and you should never forget that people look up to nurses. You often hear, “I could never do what you do” from the public. You are a nurse and are in a uniquely privileged position. This is one of the reasons I have contacted my state representative about drafting legislation to stop violence against nurses in my state because I saw a nurse assaulted by a patient, and nothing was done. This is empowerment at its best, speaking out for the good of all.
What action steps can nurses take to empower
themselves? Can you give some tips?
Nurses can become advocates for themselves. We need to do
the homework and back up our findings with facts. Nurses are very creative. We
need to hone that creativity and encourage it in the workplace.
I encourage nurses to engage in lifelong learning. By lifelong learning I do not necessarily mean going back to school to get another degree — although that is a viable option if one is so inclined. I mean engaging in learning a new skill that is not necessarily nursing related. For instance, I am learning about SEO, affiliate marketing, and podcasting as a way to reach a new audience with what I have to offer to the market place. You may learn a new skill or sharpen a talent that you already possess to make impact.
For example, in our local community, we had a nurse who
had a beautiful singing voice. She would be requested to sing for the patients
when they were coming out of surgery if they were scared or when they needed
There is a lot to learn out there that does not cost a lot of money. There are wonderful podcasts, TED talks, webinars, and YouTube tutorials that are free on the internet. You have to take advantage of it.
How will empowering themselves help them career-wise?
Each nurse’s journey will be individual and different. I
can say for myself that I would not want to do anything else. I have maintained
an open mind and a natural curiosity. I want to know how things work. Whether
it is a system, a process, or patient problem, I want to know the answer. If you
approach your career as an investment in yourself, you can go far as you want
to go. I look at each new challenge as an opportunity to better myself.
Is there anything I haven’t asked you about how nurses
can empower themselves that is important for them to know?
Find a mentor. Find someone that you admire, introduce
yourself and invite them out for coffee or lunch. You will be surprised at how
many people would genuinely like to help you. Listen to the advice you are
given and put it into action.
Many nurses, and people in general, make promises to themselves,
but fail to put a plan of action together. You have to make a plan, commit to
it, and work it out. This is something I encourage my clients that I mentor and
coach to do. We sit down and map out a plan of action with measurable outcomes
or milestones along the way.
One final note, as you are working your plan, celebrate
the small successes along the way. Did you meet one new contact that will help
you further your business? Did you finally complete your certification?
Celebrate. Publish your success, and invite your friends to celebrate with you.