You started out on your journey through nursing school starry eyed, young, and idealist; ready to save the world and make it a healthier place. You put in hours upon hours of studying, memorizing, and working hard on your clinicals, and finally you stand at your graduation, proudly accepting your well-deserved diploma; about to embark on your dream career path as an RN clad in your new nursing scrubs.
Yet, in real life it’s not always easy
to keep that spring in your step and joy in your daily routine as a nurse
working in a hospital or facility. The hours are long and the work is often
grueling, making this not the ideal work situation for everyone.
There are those who are competent and caring, yet feel stagnated and restricted in their nursing position. Others worked on the floor for years, and feel like they are ready for a change, yet still want to stay within the same line of work. They seek a job that allows for more flexibility in terms of schedule, or dare I say, they dream of someday being their own boss. If you thought being a registered nurse means you are stuck working under others at a facility, then think again, because this amazing possibility of being your own boss does actually exist!
There are several ways you can create a lucrative and fulfilling career, while still pursuing the dreams of your youth and utilizing your qualities and talents that make you the idealistic, young (at heart), and extremely caring nurse. One way to achieve this is by becoming a nurse entrepreneur and starting your own business. In your role as a nurse entrepreneur you can be self-employed, all while doing the work that you love — it’s a win-win!
What work can be done as a nurse
There are several career options in the world of nursing entrepreneurship. Choose one that fits your needs, personality, and personal preference, and start enjoying your independence today.
If you are unsure which direction you want to take with your new entrepreneurship, have no fear! Changes are always difficult, but the benefits that you will enjoy once everything is in place will far outweigh any hardship you had to deal with initially.
It may be a good idea to keep your current position and cut your hours if possible, while devoting the other hours to starting your own business. This will make the change less overwhelming, and will enable you to still generate income and benefits from your part time position to tide you over until your own business is all set up and running. This will also allow you to slowly figure out what will work best for you in a more relaxed manner, as opposed to feeling pressured to figure everything out quickly as you start your new life as an independent nurse.
It’s also good to do some
self-exploration and ask yourself which parts of your current position you
enjoy most, or are passionate about. This will give you an idea which direction
you would like to take with your business and what area you want to focus on.
You may go through many ideas before you hit the one that feels right to you,
but don’t worry, that is totally normal.
Here are a few nurse self-employment ideas based on skills and areas of focus:
If you enjoy working one on one with patients by promoting wellness and helping those suffering from chronic diseases live their life to the fullest, then becoming a certified nurse coach might be the perfect job for you. A nurse coach focuses on promoting wellness by creating customized care plans for patients with chronic conditions or health related issues. They can also open wellness clinics or become holistic nurses. A holistic nurse is a licensed nurse who focuses on the mind, body, and spirit connection to promote wellness and good health.
If you are good at analyzing situations, identifying problems, and coming up with solutions to resolve the issues, then a nurse consultant may be your calling. You can work independently and get contracted jobs with hospitals, health care facilities, or even insurance companies to help with internal audits in identifying billing fraud and other compliance issues.
Or you can also focus on a specific niche such as legal work and become a legal nurse consultant. A legal nurse consultant provides invaluable expertise and works together with a legal team in assisting the attorney with understanding medical terms, reading through medical records, and deciphering the medical jargon in medical-legal cases. A legal nurse is needed in medical malpractice cases, as well as personal injury lawsuits. They do not practice law, but fulfill a unique role in the legal process, assisting in bringing about a positive outcome of the case in favor of the client.
Are you someone that enjoys educating others in health and nursing information? Then becoming a nurse educator might the perfect job choice for you. There are several ways you can fulfill this important role. You can become a teacher or trainer who formally teaches in nursing school or a speaker who presents at educational seminars and presentations. Another option in the field of nursing education is becoming a nurse writer. If you enjoy putting pen to paper then this is a great option. There is always a demand for high quality nursing and health related articles written by registered nurses, and the pay can be quite good as well.
So, for all those nurses out there who feel stifled at their current job, there is hope for a brighter future by starting your own business. Do your research, put your feelers out, and see where you find yourself comfortable and enjoy the freedom of becoming a nurse entrepreneur, all while living the dreams of your youth.
LAS VEGAS — There’s a lot more to
substance abuse disorder than physical dependence, which means that acute detox
treatment by itself isn’t an effective therapy, a researcher said here.
The real key, said Debra Gordon RN,
DNP, of the University of Washington in Seattle, in a talk here at the annual PAINWeek conference, is establishing a
relationship with patients so that behavioral changes can be implemented.
Withholding opioids from patients
with substance use disorder will not cure their addiction, she said. Moreover,
providing them with opioids will not necessarily worsen their addiction and may
help them accept behavioral therapies.
“There is no evidence that
detoxing someone in an acute situation or hospital setting is going to impact
that disease,” Gordon said in a presentation. “In fact, the evidence
seems to be they will be more at risk for using at their discharge and having
an overdose, some of that being in the prison system, but you see that in
Patients with substance use disorder
continue to use drugs despite recurrent problems in their social, workplace, or
familial spheres that occur because of their use. Many take multiple substances
and have underlying mental health disorders, both of which need to be screened
for, Gordon said.
These patients have a higher pain
threshold and the prevalence of chronic pain is also much higher in patients with drug
abuse disorder. As such, using the Numeric Rating Scale (NRS-11) to define their
pain will be insufficient, and providers should determine whether the source of
pain is acute, chronic, or related to the patient’s addiction.
Clinicians should also anticipate
that patients with substance abuse disorder may have had negative experiences
with the healthcare system previously, Gordon said, and asking open-ended
questions without judgment may mitigate feelings of shame or fear that prompt
them to withhold information.
Seemingly obvious physical comforts,
like turning off the lights or keeping a room quiet, also go a long way as
well, Gordon said. Cognitive behavioral therapy can also help patients change
their perception of pain and help with sleep, mood, and anxiety issues
co-occurring with substance use disorder.
Still, some patients may not be
willing to change, and others may try to use within the hospital. When
encountering patients who deny having a problem, or who recognize the disorder
but are unwilling to change, providers should focus on helping them transition
out of the hospital when the time comes and providing naloxone emergency
overdose kits to patients who may return to illicit drug use.
“Failure to engage in treatment
is not a failure,” Gordon said. “It’s part of the process and it’s
part of the disease.”
But despite the treatment options
available for patients with substance abuse, some providers may be unaware they
exist, or may be unsure of what they are authorized to provide, Gordon said.
“There are barriers in the
healthcare system in terms of the way we’ve traditionally been trained and
traditionally work in silos, and to care for this population we have to really
have a team approach,” Gordon told MedPage Today. “It’s one
thing to say stuff on paper and another to try and find out how it works in the
Gordon did not report any
by Elizabeth Hlavinka, Staff Writer, MedPage Today
Primary Source: PAINWeek
Source Reference: Gordon D “Acute pain in patients with active substance use disorder” PAINWeek 2019; Abstract ACU-01.
Contrary to popular belief, nurses don’t solely work in health care facilities. In fact, with their specific experience, they can bring quite a lot to many other types of positions—including the government.
Mary M. Martin, PhD, APRN, CS, while now a Contributing
Faculty member at Walden University’s Doctor
of Nursing Practice (DNP) program, is also a Colonel in the U.S. Air Force,
and she worked from 1997-2005 as the Air Force Reserve Medical Director at US Air Force Pentagon Office of the Chief, Air Force
Have you ever wondered how this type of government position works? Martin took time to answer our questions about it.
How did you
obtain your position? Did you apply? Were you appointed?
Prior to my appointment,
this position had only been held by physicians. The Chief of the Air Force
Reserve decided that a nurse with a PhD at the rank of Colonel would be better
for this position since nursing education provides a broader academic
perspective and emphasizes the ability to collaborate and advocate. I was
nominated by a former supervisor and then vetted by the Command Surgeon and the
Chief, Air Force Reserve. At the time, there were only about 50 nurses with
doctorates in the entire Air Force Reserve.
My prior experience
leading up to this point had included commanding two Air Force Reserve
aeromedical evacuation units, serving as chief nurse in an aeromedical evacuation
group, and a deployment to Spain during Operation Desert Storm.
What did you
do while in that position? What were your most crucial responsibilities?
I supervised a
small staff of policy analysts consisting of medical administrators, physicians,
and experienced senior enlisted advisors. I collaborated with other branches of
the armed services to negotiate for changes in the medical and dental insurance
coverage for members of the armed forces and their families. I also responded
to complaints about medical and health issues sent by members of the Air Force
Reserve and their families to the Secretary of the Air Force, the White House,
My most crucial
responsibilities were representing the Air Force Reserve’s unique needs in policy
interpretation and advocacy involving all the U.S. Armed Forces or the larger
U.S. government. Standards for medical and dental care for military personnel are
established by law, so it was important for me to understand and communicate
the reserve component’s priorities when advocating for changes.
As a nurse,
what did you bring to the table that other people or other health care
providers didn’t? Why do you believe it was important to have a nurse involved
in this work?
embeds the role of advocacy throughout all levels of educational preparation. Nurses
are coached throughout their academic and clinical experiences to listen
carefully and objectively before taking a position. We also spend a great deal of
time learning the science of health care and nursing using systematic
processes. Despite our expertise, nurses also take an egalitarian approach in
discussions and decision making and don’t assume that others should accept our
point of view just because of our credentials.
What were some
of your greatest challenges in this position?
The greatest challenges
came while negotiating for solutions with powerful groups of colleagues from
all branches of the armed services. Each branch of the armed forces has its own
unique roles and challenges in managing the health and welfare of its members
and their families. I didn’t understand that fully until I was in a position to
negotiate on things like family medical and dental coverage or the
implementation of anthrax vaccination.
challenging example: I was the sole Air Force Reserve representative on an interprofessional
team charged with resolving a conflict with line of duty determinations for
reservists not on active duty for more than 30 days. This case was in response
to a situation with a young pilot who suffered devastating injuries in a plane
crash while on his 14-day annual tour. He lost his regular job and insurance
and, because of legal restrictions on coverage for reservists on active duty
for less than 30 days, the military could not provide ongoing care or salary
after his initial treatment. The committee was led by Mary Lou Keener, a
nurse-attorney and presidential nominee who previously had been general counsel
for the Veterans Administration. It took us six months to reach a solution.
What were the
It was very
rewarding to be able to directly serve the men and women of the armed forces by
being able to advocate on their behalf to the Department of Defense, the White
House, and Congress. Knowing that I could work closely with powerful
institutions and people to help improve the health and welfare of our members
and their families was very satisfying.
reading this want to become involved in government or as an elected official, what
would you say to them? Why is it important for nurses to become involved at
I would say to do
it! You can get started by applying your own experience to things you see
happening in your own community. I won the Charleston Post and Courier’s Golden
Pen award by simply reacting to a news article that stated that two young teens
lost at sea and found after a week or so would “fully recover.” The letter I
wrote spoke to the emotional trauma they experienced and how important it is to
address it early. I related it to my own experience as an eyewitness to the
attack on the Pentagon on 9/11 and what it has taken to ensure that my reactions
to this traumatic event remain resolved.
I would recommend that people look at the social determinants of health in your city. Are the sidewalks walkable in all neighborhoods? Are your local schools empowered to monitor and implement enough daily activity to improve both health and learning? How is your community addressing the opioid crisis or vaping? Then, find an example of a successful solution in another community and give your local decision makers a call. Offer to help! Finally, run for office locally. The rewards are great and, as nurses, we know how to get things done!
anything else about being a nurse working in government that I haven’t asked and
you think is important for people to know?
Yes! When I was
at the Pentagon, people I didn’t know working elsewhere in the building often
sought me out for personal advice on their health matters, especially
insurance. After all, nurses are our community’s best neighbors and news travels
fast when we join an organization. People know we will graciously respond to
In honor of “Nephrology Nurses Week,” September 8-14, 2019, Daily Nurse is highlighting two very special dialysis nurses.
At 25 years old, Jackson, KY resident Bridgette Chandler was living with her husband and raising two young children while enjoying a satisfying career as a nursing tech.
Bridgette’s life changed forever after she rushed to the emergency room with what she thought was a case of the flu. Instead of flu, doctors informed her, she was actually suffering from kidney failure. During the long wait for a transplant she underwent arduous four-hour dialysis treatments three times a week.
Despite finding that dialysis made her “a completely
different kind of tired that sleep doesn’t fix,” in her determination to remain
actively involved with her young family, Bridgette opted for at-home dialysis at
the Fresenius Kidney Care clinic in Kentucky. With her home treatments, Bridgette
managed to experience all of the special events that happen in a family, from
games and recitals to the hubbub of birthdays and holiday seasons. She remarks,
“For me, being able to take part in special moments with my family was most
important and that’s why I chose home therapy. It gave me the opportunity to
take back some of the control of my health.”
Five years later Bridgette found a donor and had her kidney transplant surgery. Even before the hospital had discharged her, she asked her doctor how long she had to wait before she could start school and become an RN. Now, Bridgette is working alongside her former nurses, treating home dialysis patients at the same clinic that treated her. “Because of my personal experience, my intention had always been to become a nephrology nurse” she says. “I stayed in touch with my nurses and doctors who made such a difference in my life. When a position became available in the clinic with those nurses and doctors, I jumped on it.”
Bridgette’s experience also creates a special bond with her
patients: “helping patients find ways to make dialysis work for them has
definitely been beneficial. I’ve had so many patients tell me they respected me
so much more because I understand what they are going through. Many of my patients
have even told me that I give them hope. That is just as important to me
as it is to them. That’s why I wanted to be a nurse.”
Anne Diroll was also destined to become a nephrology nurse.
A year after losing her father to a sudden heart attack, 15-year-old
Anne was hospitalized for a week after being struck by a car.
During her time in the hospital, unable to walk, and suffering from a “huge hematoma,” she had plenty of time to think and look around. She saw—and deeply admired—the nurses who cared for her, and was inspired by fellow patients stories, learning of “tragedies and hardships in others’ lives that I had never experienced or been aware of at a young age, and [I] thought ‘this is a part of life that needs healing.’”
Anne began her nursing studies almost as soon as she was
discharged from the hospital. Initially working as a pulmonary nurse, when she sought
a new job, she “didn’t know anything about kidneys, except that they made urine.
In my interview for a dialysis nurse position, my interviewer explained that the
reason dialysis nurses exist is because [failing] kidneys don’t make urine, so
I was able to understand that dialysis is to kidneys as ventilators are to
lungs. I got the job and have been a nephrology nurse ever since.”
Today Anne manages a Fresenius Kidney Care clinic in
California, overseeing the care of 50 patients.
The American Nephrology Nurses
Association (ANNA) launched Nephrology Nurses Week in 2005 to give employers,
patients and others the opportunity to thank nephrology nurses for their
life-saving work. In addition, ANNA seeks to interest other nurses in the career
opportunities available in nephrology.
About 30 million adults in the
United States suffer from chronic kidney disease. The nephrology nurses who
treat them make a positive difference in the lives of patients and their
families every day. Caring for kidney patients requires nurses to be highly
skilled, well educated, and motivated, and nephrology nurses cite the variety
and challenges of the specialty as fueling their ongoing passion.
For more information nephrology
nursing, the Nephrology Nurses Week celebration, and more, visit www.annanurse.org/
You are seeing a newly booked
patient in your jail medical clinic. He states that the last time he was in
jail, he was given a second mattress because he had surgery on his back many
years ago. You note that the patient has not seen a doctor on the outside for
many years, that the patient walks and moves normally, and that he has a normal
neurological examination. You tell the patient that medical does not give out
passes for extra mattresses. The patient angrily erupts in a blaze of
obscenities and threatens a lawsuit.
Manipulation happens when a patient
wants something that they should not have (like an extra mattress and pillow)
and will not accept “NO” for an answer. There are several strategies
patients may employ in an attempt to force practitioners to change a
“No” to a “Yes.” This patient started with the “other
doctors gave me what I want” strategy and when that didn’t work, he
employed the “threatening” strategy. (I covered this in more detail in a post last month.)
Verbal Jiu-Jitsu is what I call the
technique of deflecting and defusing such manipulative confrontations. The
first and most important rule of Verbal Jiu-Jitsu is to remember that this is
not a war or a contest! There should be no “battle of wills” between
you and your patient. There is no winner or loser. Instead, you and your
patient are having a conversation. The whole goal of Verbal Jiu-Jitsu is to
avoid any kind of verbal battle.
I know that it is tempting to think
of an unpleasant verbal exchange as a debate-style contest, with a winner and a
loser at the end. But even if you “win” a verbal battle, you’ve
actually really lost because you have not accomplished your goal of getting
your patient to understand and accept your treatment plan! Your patient is
still not happy and will simply renew the verbal battle at another time in
another way — and maybe more effectively next time.
The second rule of Verbal Jiu-Jitsu
is to have compassionate understanding of your patient. That person in front of
you is not an opponent to be defeated. He is your patient. Like everybody else,
inmates are just trying to get by as well as they can in a very tough
environment — they’re in jail! It’s just that many inmates (and people on the
outside, for that matter) have poor interpersonal skills and resort to
pathological social habits. This is what they know and what works for them. If
a patient has successfully gotten his way throughout his life by bullying and
threatening others, that is how he is going to interact with you, too.
You don’t have control over this —
but you do have control over your reaction. When patients confront you with
threats, they will expect you to respond the way that most other people would
— which is either to fight back or to give in. You should do neither.
Take, for example, the case of this
patient in your clinic who has angrily threatened to sue you plus has lobbed in
a few F-bombs for good measure. There he is, red faced, fists clenched, and
LOUD. Nurses, deputies, and other inmates are watching. How are you going to
handle this? How will you accomplish your goal of defusing the situation and
facilitating reasonable communication with your patient?
The single worst thing you could do
would be to respond to anger with anger: “You can’t talk to me like that!
Get the hell out! Who do you think you are?” First of all, the patient is
accustomed to this type of response and will be far more comfortable and
effective with a loud confrontation than you.
Second, the patient (and everyone
watching) have now learned that a verbal confrontation is an effective way of
getting under your skin — very useful information! Also, since you (hopefully)
are not practiced and adept at angry shouting, your heart will be jack-hammering
and you’ll develop a monster headache — at least that’s what would happen with
me. You will have ruined your own mood for the rest of the day. How effective
are you then going to be with the rest of your clinic schedule?
Finally, the fight is not over! The
patient can (and will) renew the attack at another time.
Another wrong response is to
compromise: “There is no reason to be angry! Calm down and we can work
something out.” This is a mistake! If you compromise, you have established
the precedent that becoming angry is an effective strategy with you. Other
inmates will learn this and you will inevitably have to endure many more
confrontations like this.
Instead, defuse and deflect. One way
would be to say: “I see that you are angry, so we are done for now.
Security will take you back to your dorm. We’ll talk again later after you’ve
calmed down.” It’s important to say this without raising your voice and,
if possible, to betray no emotion on your face or body language. The lack of
any reaction goes a long way to defusing such situations. No compromise, no
bargaining, no reaction.
The next day — or even in an hour
or two — you can call the patient back to medical and confidently expect a
more productive conversation. It is important at this second interaction not to
upbraid or belittle the patient. You should act as if the last incident is
It takes training, practice, and
time to master verbal defense skills. The best way to learn is through
role-playing scenarios. The response to angry outbursts happens to be one of
the easiest Verbal Jiu-Jitsu skills to learn. The principles are: betray no
reaction or emotion, end the session (if the patient will not calm down
immediately), but make sure that such patients know that they are welcome back
as soon as they calm down. Bring them back later and act as if the incident is
Jeffrey E. Keller, MD, FACEP, is a board-certified emergency physician with 25 years of experience before moving full time into his “true calling” of correctional medicine. He now works exclusively in jails and prisons, and blogs about correctional medicine at JailMedicine.com.
Originally published in MedPage Today
Under the aegis of the Diversity Impact (DI) Program at Frontier
Nursing University, faculty and students are the vanguard of the movement to diversify
the ranks of nurse practitioners and nurse-midwives and improve health care
conditions among the underserved and marginalized.
Frontier’s current Chief Diversity and Inclusion Officer, Dr. Maria Valentin-Welch, takes great pride in the students’ achievements during and after their participation in the DI program, and says: “they are applying what is taught here in regard to diversity, inclusion, and equity, not only within their new areas of employment as graduates but across their communities. Some have established underserved programs, birth centers, and international programs. These students are passionate advocates for the underserved and disenfranchised people. They are the future catalyst of change.”
In addition to distributing some $300,000 in scholarship funds received through their Health Resources and Services Administration’s Nursing Workforce Diversity Grant, the program has implemented diversity training sessions for all faculty and staff and added diversity discussions to student orientation sessions. DI participants are also encouraged to attend annual conferences dedicated to fostering a more diverse, culturally aware health care workforce—where, under the guidance of a faculty mentor, students explore the benefits of active participation in professional nursing organizations.
The thriving program at Frontier received a 2018
Health Professions Higher Education Excellence in Diversity (HEED) Award
from INSIGHT Into Diversity magazine, and was cited as
a “Top College for Diversity.” In addition, the magazine added Dr.
Valentin-Welch herself to their Top 25 Women in Higher Education roster of standout
diversity advocates at US colleges and universities.
For an experienced professional proponent of diversity
and inclusion, the most daunting challenge, according to Valentin-Welch, is maintaining
belief in the goal of “uniting folks while our nation is receiving messages of
division and promoting actions of division and lack of compassion… However, I
feel midwifery and nursing have always held an important role in not only
listening to people, but also advocating for what is right.”
For further details on the Diversity Impact Program at
Frontier Nursing University, visit here.