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.
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.
There are as many unique academic needs as there are
individual nurses. For successful interaction to begin, you need to know what
should be shared regarding your graduate nursing program. Questions that
prospective graduate nurses have include the following:
What is the class attendance format? Are
classes, online, in-person, or hybrid?
Is your program affordable?
Are academic and professional resources
What types of relationships does your program
have with local and regional clinical sites?
What are the clinical practicum requirements for
each program and how do they prepare the graduate student to take on a new
Will a graduate degree increase the graduate
nurse’s income significantly enough to warrant the investment?
The first of these is perhaps the most important. Today, there is a rapid shift happening in the norms of what is considered a learning environment. It has expanded far beyond the four walls of the classroom. Although the online format is increasing in popularity, it’s not for everyone. Many students avoid online classes because they either don’t feel capable of learning outside of the classroom, or they are concerned that the convenience of online learning sacrifices the quality of in-person learning. If your graduate program is online, you should communicate how you compensate for the decreased face-to-face interaction. If it is in person, you need to emphasize how the quality of education makes up for the lack of flexibility.
Beyond the learning environment, decide what makes your graduate program useful, and invest your resources wisely into it.
With student loan debt in the United States at $1.5 trillion
and growing, it’s no wonder Americans are reconsidering the notion that “more
is better” when it comes to education. Today, prudent potential graduate
students consider their return on temporal and financial investments for more
education before enrolling. This is why approaching established adult
professionals is so different from undergraduate programs. Especially for
those who are putting some of their income toward paying student debt, they may
be hesitant to move further in their academic career without a clear and sure
payoff. Promote your nursing education by sharing stories of successful
graduate nurses, and promoting any programs in place that assist before,
during, and after the transition from school to work, both financially and
Money and time aren’t the only concerns of potential graduate nurses. What is it about a graduate degree that could augment a nurse’s sense of purpose in their work? Engage nurses by showing them not only how their income could increase with a graduate degree, but how a greater sense of purpose can improve the quality of their careers.
The way to draw interest to any endeavor is to answer
questions before anyone has to ask. For nurses considering graduate
school, it’s not hard to imagine what the most common concerns might be:
work/life balance, financial and time investment, flexibility with their work
schedule and personal life, and of course, the practical application of the
degree in question. Be a resource for that content; nurses don’t have to
be applying to your program to get to your site. This can be done by having
a blog on your program’s site with topics potential graduate nurses are
interested in. Get nurses to your site through search engine optimization
(SEO). Have a web development team that can put this into place.
The sheer volume of social media users is reason enough to
utilize it to connect to prospective students. Having a social media
presence, in addition to targeted advertising on social media, are keys to
connecting to potential graduate nurses. As a requisite of modern nursing,
nurses are tech-savvy; they are on these sites. Many social media
platforms have become tools for nurses in their own right. YouTube is
packed with nursing skill review videos, exam reviews, and vlogging that is
specific to nurses’ lifestyle and career hints. LinkedIn is a popular way
to create a professional network. Collaborating with popular nursing
social media personalities, or “influencer marketing,” in addition to
traditional advertising, can connect you with many potential students.
Word of mouth is the most reliable and least expensive
advertisement there is. Foster positive relationships with your active
stakeholders; namely, your current students and clinical sites. Having working
nurses witness clinical graduate students on-site not only demonstrates the feasibility
of clinical placement, but it also allows the prospective student to have a
candid conversation that they may not otherwise have. For this reason, make
sure your current students have something good to say about your
program. Don’t let recruiting new students bypass the importance of taking
care of those that you already have.
The degree to which you implement and combine each of these strategies will depend upon your institution’s own budget and logistical limitations. Your formula for success will be unique to your organization and context. Engaging and attracting prospective students to graduate nursing programs take high-quality consideration of logistics and allocation of tasks.
Early in 2019, the World Health Organization (WHO) announced that 2020 would be the Year of the Nurse and Midwife. WHO is planning lots of programming and reporting around the year to celebrate nurses and support the profession. Here are six reasons why 2020 is the perfect time for the Year of the Nurse.
1. It’s the 200th anniversary of Florence Nightingale.
Florence Nightingale was born on May 12, 1820,
making 2020 the 200th year anniversary of her birth. The “Lady with the Lamp”
became the founder of modern nursing and the first woman to receive the Order
of Merit. During the Crimean War, Nightingale was put in charge of nursing
British and allied soldiers in Turkey. Her time in the wards, especially her
night rounds, earned her the nickname “Lady with the Lamp” and helped her begin
to formalize nursing education. She went on to found the first scientifically
based nursing school—the Nightingale School of Nursing at St. Thomas’ Hospital
in London—in 1860. She also helped institute training for midwives and nurses
working in workhouse infirmaries. Nightingale continues to inspire nurses all
over the world with her legacy of dedication and innovation. While
International Nurses Day commemorates her birthday every year on May 12, the
2020 celebrations will take place year-round and further champion nurses’ work.
2.It’s the release of the first State of the World’s Nursing Report.
In conjunction with the Year of the Nurse, WHO will be releasing its first-ever wh prior to the 73rd World Health Assembly in May 2020. According to WHO, “The report will describe the nursing workforce in WHO Member States, providing an assessment of ‘fitness for purpose’ relative to GPW13 targets.” GPW13 refers to the Thirteenth General Programme of Work 2019−2023, which lays out WHO’s leadership priorities in five-year blocks. Some of WHO’s 2023 goals include reducing the global maternal mortality ratio by 30% and reducing malaria case incidences by 50%. WHO will also be a partner on the State of the World’s Midwifery 2020 Report, which will be launched around the same time as the State of the World’s Nursing Report.
3. It’s the culmination of the Nursing Now campaign.
The three-year Nursing Now global campaign launched in 2018 and will wrap up at the end of 2020. Nursing Now is a collaboration between the World Health Organization and the International Council of Nurses and is championed by Kate Middleton, Duchess of Cambridge. Nursing Now focuses on five core areas: ensuring that nurses and midwives have a more prominent voice in health policy-making; encouraging greater investment in the nursing workforce; recruiting more nurses into leadership positions; conducting research that helps determine where nurses can have the greatest impact; and sharing of best nursing practices. Nurses can support Nursing Now by signing its support pledge, sharing about the campaign on social media, hosting events, sharing their experiences with other nurses, and organizing to advocate for the nursing profession. You can also start or join a Nursing Now group in your local or regional area. There are currently groups in more than 100 countries worldwide.
4.Nurses make up a majority of the worldwide healthcare force.
While doctors get much of the attention, especially in Western nations, nurses and midwives make up more than 50% of the health workforce in many countries. Nurses armed with clinical supplies are usually the front line of care and, in some cases, may be the only provider in the area, especially in developing countries. They make a difference not just in individual patients’ lives but also in the community as a whole. Due to their sheer numbers and the locations where they often work, nurses are vital players in improving public health outcomes around the world.
5.Nurses are a huge part of the health care worker shortfall.
Due to the major role they play in the worldwide healthcare workforce, nurses and midwives also make up a significant part of the nursing shortage–more than 50% of the shortfall in the global health workforce to 2030. Looking at just the U.S., the Bureau of Labor Statistics (BLS) predicts that employment of registered nurses is projected to grow 12% from 2018 to 2028, much faster than the average for all occupations. BLS also predicts that the U.S. will need an additional 200,000+ nurses per year from now until 2026, adding up to more than one million additional nurses. And that’s just one country that already had a health care infrastructure that’s significantly more developed than some others.
6. Supporting nurses boosts economic growth and gender equality.
As part of Nursing Now and its other efforts to support nurses, WHO often speaks of the “Triple Impact” that comes from giving nurses what they need: better health, stronger economies, and greater gender equality. While the first outcome is more obvious, the second ones are equally important. While men can and do become nurses, worldwide the vast majority of nurses are women. Becoming a nurse opens up opportunities for women, giving them the chance to receive formal education, enroll in training programs, secure a license, and finally get a job and its accompanying income. This improves overall economic growth and also increases gender equality in the workforce.
Nurses should already be
proud of themselves when they don
their scrubs for a shift, but in 2020, they’ll do so with the extra
confidence of knowing that it’s the Year of the Nurse and that organizations
all over the world are supporting their profession.
I have always had an interest in owning my own business but what could I do independently as a nurse? Without having a clue as to where to start, I conducted a general search, and found a book about starting a nursing agency. Thinking to myself, “I could do that!” I bought the book, but when I started reading, I realized the information was very generic. There were no specific “how-to” details; instead, it provided a very basic outline.
After finishing the book, I realized there was no blueprint for me to follow to start my own business. I would have to start down the path of becoming a nurse entrepreneur completely in the dark and form my agency on my own.
My Journey to Becoming a Nurse Entrepreneur
I first determined what expenses I would incur, made a budget, and then a business plan. At first, I felt lost in this process as my professional experience was strictly in the nursing world where I would care for patients without involvement on the business side of healthcare. I tried to seek help from friends who had gone through this process in different industries, but it became abundantly clear that my situation was unique. They were able to offer little support because starting an independent nurse-led business was a relatively novel concept. Undeterred, I persisted and found my way. I decided upon a name for my agency and determined the type of legal entity my company would be, went to the state office and registered my new business!
At this point I knew it was time to begin marketing activities.
I had brochures and business cards made and mailed to prospective facilities. I
asked my nursing colleagues to refer their friends who wanted to have per diem
opportunities. I continued the process by building a website, figured out
payroll processing, and just kept trying to move forward.
The whole experience of starting a business took me approximately
one year, dedicating a lot of research, time and expenses. There were
some bumps along the way, but resiliency was key to my progress. Shaping my
company is still an ongoing process, with lessons learned almost daily, but
after eight years of continued success I feel that every year gets better and
better and the lessons learned are teaching opportunities to improve!
I want to share my story to help other nurses realize they too can become nurse entrepreneurs. Nurses should feel empowered to conquer their fears and begin down the path to becoming independent business owners. Navigating the process was not easy for me because I had no business experience and no idea where to start. Providing nurses with the tools they need and guiding them through the process of building and running a business, is a huge gap in the industry today. I was thrilled when I was introduced to the team and concepts being developed at AlyxHealth. Dedicated to helping nurses thrive, AlyxHealth would have provided me with the tools I did not have at my disposal back when I started my own nurse-led business.
Why would a nurse want to start a business?
Nurses today work harder than ever, many times in understaffed
and unsafe situations to care for their patients. With more new nurses leaving
the profession than ever due to these situations, this has to stop! I want to
be sure that all patients are taken care of by a nurse—now, and in the future—and
if the number of job vacancies keeps rising, we will have no one left to care
for our sick and injured!
When talking with prospective nurse entrepreneurs who have expressed interest in starting their own businesses, I hear the same common concerns including:
lack of confidence in themselves; nurses are great at caring for people but are often intimidated by the financial aspect of healthcare.
lack of support (financial and emotional) and not knowing who to ask for help.
lack of expertise and fear of the unknown.
What kind of a business can a Registered Nurse run independently?
Patient coaching (for example, a Critical Care Nurse can teach heart health techniques for patients that are post-heart attack)
Dementia Care Therapy for private patients or facility educators
What kind of a business can an Advanced Practice Registered Nurse run?
In 23 US states, an APRN can practice INDEPENDENTLY from a
physician (with more and more states changing their guidelines).
Walk-In Clinic concept practices, such as:
Cough and Cold symptoms
General practitioner care
More Specialized APRN degrees can also include practices in:
The more RNs and APRNs providing care in the communities, the better the care will be!
About the Author
Karen O’Donnell is a Registered Nurse and the owner of Caring Nurses Staffing Agency LLC. More recently, Karen has taken on the role of Senior Director of Clinical Solutions and Practitioner Success at First Matrix Health, the creator of the AlyxHealth platform. AlyxHealth allows nurses to personalize their services and fees, set their own business hours, and choose where to deliver care. More information can be found on their website, www.alyxhealth.com.
Nurses have the opportunity to take on new and advanced roles through certifications and degree programs. For nurses working in maternal/child health, a lactation consultant is one such role to pursue. A lactation consultant, formerly titled IBCLC (International Board Certified Lactation Consultant), is a health care professional who may work in a variety of health care settings and specializes in the clinical management of breastfeeding. IBCLCs have been proven to improve breastfeeding rates, lower health costs, and improve consumer satisfaction and trust.
Many nurses and the general public may not know exactly what a lactation consultant does on a daily basis. Daily Nurse interviewed Robin Franzoni, a lactation consultant at a teaching hospital in central New Jersey. Robin worked as a NICU nurse for many years before she became an IBCLC. Here is what she had to say.
What first sparked your interest in becoming a lactation consultant?
When were you first exposed to an IBCLC?
My passion reaches back to when I was a new mom and getting ready to nurse my first child. My mother nor my aunt ever breastfed. I was one of the first one of my friends to have any children. My exposure to breast milk and pumping while working in the NICU was what really spurred my own decision to breastfeed. There were no lactation consultants at that time, but I saw how much better the babies did on their own mothers’s milk. I had horrible pregnancies and preterm labor with all three of my kids but I felt like the one thing I was successful at was nursing my own kids. So my success at breastfeeding and exposure in the NICU is what kind of gave me the interest.
What would you say your typical
day is like? What are your day-to-day responsibilities?
I see my discharge patients first and make sure they’re going home with all their questions answered and information for follow up after discharge, especially the ones who have had some difficulty latching or feeding or are losing too much weight. Then I see all the first time moms and assess the latch and get them motivated to start positioning the baby themselves. A large part of it is preparing them for what’s expected at home because they have such a short time in the hospital. Then after I’ve gotten through most of the first time moms, I see any other mothers having difficulty or who have asked for a consultation. But really my first priority is seeing, stabilizing, and supporting the first time mother.
What’s your favorite part of
I think being the person who has gotten a baby on for the first time or seeing a baby who’s been struggling and all of a sudden it clicks and they start eating. And the look of mom’s wonder on her face like, “Oh my gosh, it’s kind of happening.” I’ve been to hundreds of deliveries over my career and it used to be so exciting to watch a baby being born and they take that first breath. Seeing that baby eating for the first time is just as thrilling as watching the baby being born. It’s the culmination of many different things that are finally in perfect sequence and everything clicks and to me it’s really wonderful. It’s establishing that connection with the baby by nursing that is not only for the nutrition but the connection with the baby.
What’s the most challenging part
of what you do?
It’s the preconceptions people have that negatively impacts nursing. It’s unrealistic expectations and misinformation the mother has received from family members or friends. It can be like trying to knock down a barrier that’s been erected around themselves. But I think it’s mostly the lack of good education about breastfeeding.
How do you work together with
nurses when giving care to a patient?
Well, I feel that I’ve been really fortunate. I developed this routine that after I’ve seen the mother and the baby I usually go to the bedside nurse. And I think it’s just evolved into what I do because I’m counting on the bedside nurse to carry the ball after I’ve left. The reality is I’m probably only going to see that patient once on day 1 postpartum and at discharge. So the rest of it falls onto the bedside nurse. Teamwork gets it done. I want every nurse to feel that she is part of the breastfeeding support and that I’m depending on them and trusting them.
Do you have any advice for
nurses who may want to become an IBCLC?
I think they need some really good mother/baby or NICU experience first. I think you need a base and then after building that base then think about doing it. It’s something I really think you have to have a passion for because it’s one of the toughest things I’ve done to date. I thought it would be less stressful than the NICU, but it’s just a different kind of stress. You’re shouldering not only the baby and assisting them, but you’re also responsible for the emotional well-being of the mother and part of the physical well-being.
If you are interested in learning
more about the professional role of a lactation consultant you can visit www.uslca.org or www.ilca.org.
Information about obtaining certification can be found at www.iblce.org.
Subscribe to Clinical Lactation
Clinical Lactation is the official journal of the United States Lactation Consultant Association and a benefit of membership to the USLCA. The aim of the journal is to advance clinical practice for lactation specialists who work in a variety of settings: hospital, private practice, WIC, and mother-to-mother-support organizations.
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