Many people go into nursing because it offers a unique opportunity to care for others and make a profound difference in peoples’ lives. However, you need to balance these lofty aims with an awareness of the day-to-day realities of the profession. You should certainly hold on to your ideals—they make the daily grind worthwhile!—but make sure you enter your career with your eyes open.
If you are a new nurse just starting out, here are 8 things that many veteran nurses wish they had known at the beginning of their careers.
1. There is a Lot of Fine Print
While your schedule on paper may seem doable, with a few 12 hour-long shifts or so, this quickly expands when your commute time, changeover duties, and key patient information exchange after and before every workday are factored in. Additionally, you may not have as much time off as you expect. Your promised off days will very likely begin with early morning calls requesting you to come in when the hospital is understaffed.
Weekends and holidays are not guaranteed to be off and loved ones may not be able to see you. Furthermore, the term “nursing” is a nebulous one that goes beyond simply the medical care you had been trained to provide. A nurse can be anything from a counselor and advocate to an engineer and deliverer. Thus taking a more holistic approach to the profession is the best approach.
2. Memory Matters, and Mistakes are Inevitable
With all the patients you will come into contact with, you will have to deal with large quantities of information. Apart from the quantity, the quality also matters, as this information is not only strongly protected by medical privacy laws but is essentially a matter of life and death. You will be expected to know it all and at all times. Finding a way to recall facts and keep things in order is vital in a profession where so much is at stake all the time.
At the same time, though, mistakes are inevitable. How you react to them, though, makes all the difference in the world. Learning from your mistakes and not repeating them is a more realistic goal than seeking outright perfection. Medications are something to be mindful of, as they are the easiest to confuse.
3. You Will Learn to Cope with Death
As you learn to handle mistakes, so too will you learn to deal with death. Nursing school, for all it teaches you, does not prepare you for coping with death. Each death is as unique as the patient and does not get easier, as each one hits hard in a different way. Part of the way you will learn to cope is by way of a dark sense of humor.
4. You Will be on the Phone a Lot
In the midst of dealing with large quantities of patients and pressure, you will be spending very large amounts of tedious periods of time on the phone, calling, answering, and mediating among staff, departments, and companies.
5. Your Body Takes a Beating
Long shifts involving standing, lifting, squatting, and walking are bound to take their toll on your body. For this reason, stretching properly and wearing supportive garments can help you manage these stresses.
6. Work and Life Become One
With nursing, the line between work and life becomes blurred. An example of this is that your family and friends, while seeing less of you on holidays, nonetheless become extra patients who will look to you for your expertise. Conversely, your coworkers and patients become like a second family to you, weathering the storms of your career with you as one.
In addition to family, fashion bleeds into nursing, too! You need to be comfortable and there are certain fashion scrubs for nurses out there to make wearing them all day into the night a lot easier on you.
7. You Will be Underpaid
Unfortunately, the pay is not going to match the work that has to be done to fulfill the basic duties. However, there are plenty of chances to take up overtime and more shifts, through which you can earn more so long as you are willing to do the additional work.
8. Nourishment Matters
Breakfast is something too many people skip as they begin their workdays, but given how few chances there are to eat, it is imperative to have that first meal in order to have the energy to keep up with the demands. Stocking up on nutrition bars and beverages can help. Nursing is not an easy profession to get into and succeed in, and it is not for everyone. Make yourself aware of the realities of the job and learn to take them in stride. If you love the job, then you can surely persevere.
We as nurses want to see our profession thrive and be prepared for the future. We as individuals can take actions that will lead to advancements in nursing as a whole. These steps on their own may not seem like much, but the following can lead to long-term change and elevate the profession.
Belong to Associations
Attending chapter meetings not only helps nurses stay current with new issues and topics, it also helps with networking. Networking is so valuable not only for camaraderie, but also for future jobs or references. Not sure which association to join? You can find your state’s nursing association and corresponding website through the American Nurses Association. Many associations are now holding online or virtual meetings so networking and participation is still possible. Even belonging to associations in one’s personal life lead to socializing and can prevent career burnout.
Continue Your Education
Stay up to date within your specialty – CEUs for RN license renewals are not sufficient. Take courses or go to seminars (check if your employer reimburses). As with nursing associations, education courses are now online and attendance dates and times may be flexible. Sigma Nursing has a web page with links to nursing specialty associations. Another way to make progress within the education realm is to advance your degree. Whatever you decide, be it learning a new skill or obtaining a new degree, either option is a valuable investment in yourself and your nursing career. In the long run, you are advancing the profession by your additional knowledge and by being a well-rounded nurse.
Mentor New Nurses
Mentoring can mean on-the-job or more formally through a college or vo-tech school. By teaching what we know, the mentor actually learns more through questions, explaining procedures and processes. Some facilities have programs that train the mentor. Others utilize the facility’s clinical educator as a resource for mentors. We must remember that we’ve all been “the new nurse.” Some of us have had positive experiences and others, not so much. Mentoring is crucial in bringing the next generation of nurses to practice. Mentoring can be fulfilling, especially once the new nurse “graduates” to being on his or her own.
Are you concerned about staffing ratios or other issues you’re facing on the job? Make the policy makers aware. If we don’t communicate our concerns or issues, nothing will change with the ways things are done. Letters to those in congress or governors can focus on concerns within your state or the county as a whole. If you’re unsure how to craft a letter, the National Council of State Boards of Nursing (NCSBN) has a user-friendly template that nurses can use. The template’s wording is geared toward advanced practice nurses but can easily be tailored to any nurse. This is especially important with upcoming elections, which could lead to the state of the nation’s health being in limbo. Nurses are in a perfect position to speak up to help create changes in policies that would better the profession and health care as a whole.
Continue to Project a Professional Image
Throughout the day we take for granted who sees us…the public, peers, our families. Nurses have been named the most trusted profession for 18 consecutive years for good reason. The public trusts nurses for their knowledge, compassion, and ethics. Nurses must continue to uphold our reputation and our code of ethics to keep those who are ill safe. Although the code of ethics for nurses is not legally binding, nurses should be familiar with the attributes and strive to embody them daily in their practice. Another area to be mindful of is our social media presence. Even though we may be posting personal photos or opinions, if we list the name of our workplace and/or what we do, we are still being linked with the nursing profession.
In Donna Cardillo’s book, The Ultimate Career Guide for Nurses, many additional tips are reviewed. She recommends the concept of career management. This does not just refer to finding a new job, but rather, ongoing maintenance of one’s profession. By maintaining our individual nursing practice, we in turn elevate the profession. A part of maintaining our individual practice is self-care and recognizing our strengths, weaknesses, and limitations. Nurses must realize that by keeping up with our self-care and addressing burnout, we can give more of ourselves and further build up the profession.
Thoughts to Take Away
There are multiple ways to elevate the profession. We discussed that nurses can advance their education or skills, write to those in congress, become involved in associations, and project professionalism. Nurses can also contribute to the greater good by mentoring. The most important piece of advice: get involved! By speaking up and making our voices heard, the profession can flourish for centuries to come.
This is part of a monthly series about side gigs—nurses with interesting side jobs or hobbies. This month, we spotlight Jax Nurses Buy Houses (JNBH).
More than 10 years ago, when they were still in nursing school, Chris McDermott, MSN, APRN, AGNP-C and Joshua Rodenborn, BSN, were discussing the idea of starting Jax Nurses Buy Houses (JNBH). They founded the company in 2019 with friend Sunny Kapadia, as a way to build a portfolio of rentals for retirement as well as a chance for them to give back to their community. As life-long natives of Jacksonville and seeing multiple areas for improvement there, they made it their social mission to donate a portion of our proceeds to medical care and research.
McDermott works full-time in private practice in Jacksonville Beach, Florida. Kapadia, although not a nurse, is a specialist in the health care field, coordinating physician groups within the greater Jacksonville area. Finally, Joshua Rodenborn is an Intensive Care and Post-Anesthesia nurse in a major hospital in Jacksonville, Florida as well as a managing member of Jax Nurses Buy Houses.
McDermott and Rodenborn told us all about their business.
Explain what Jax Nurses Buy Houses is—what do you do?
JNBH acquires residential properties through traditional or distressed sale. Often, we help sellers who perhaps inherited a property or just want to sell fast to someone reputable and honest. Distressed sales include properties we acquire at foreclosure or tax deed auctions. We will analyze a property and determine if it is a good fit for our rental portfolio, renovate and retail, or wholesale.
Do you personally rehab houses or do you subcontract out?
When first starting out, it was “all hands on deck.” As we have continued to scale our operations, we have subcontracted work to skilled contractors. DIY sounds romantic and lets you keep more profit; however, it is near-impossible to scale up a business this way. And your results may not be a professional-level quality. We learned early on that building a team is the key to success (and much less stress).
What do you like most about your business?
It is rewarding to take a home that is the biggest eyesore in a neighborhood and bring it back to life, turning it into affordable housing. It’s one thing to talk about transforming a neighborhood; it is a whole other thing to literally do it yourself through your own will from start to finish.
There is a double pay-off: the satisfaction of being your own boss in a well-run business and the satisfaction of improving a piece of this city, one brick at a time.
What would readers be surprised to know about your side gig?
Joshua, while working as a nurse, actually cared for the wife of a rental applicant months before he applied. It’s surprising how small the world is sometimes.
What have been some of your most challenging experiences with your side gig?
There is a saying, you can have a job good, fast, or cheap, but you can only pick two. For example: If you want a job done good and fast it won’t be cheap. Another example, if you want a job done cheap and fast it won’t be good.
Challenging experiences include dealing with and selecting contractors, while staying on schedule. We’ve had contractors not show or even do something incorrectly—once damaging our air conditioner in our newly renovated home.
Spend your time vetting and getting to know your contractors and vendors of materials.
What have been some of your best experiences/greatest rewards with your side gig?
The relationship the founding members have built with each other is one of the most unexpected and rewarding things that have come. Early morning breakfast—where we divvy up the tasks and plan our next move—have become a welcome staple in our COVID-restricted social world.
Another experience: We were able to help a prospective tenant move from a crime-ridden area (shooting occurred outside/bullets struck her headboard) into a newly renovated home in a matter of days.
What have you learned from having this business?
Formulate a plan and have multiple exit options. It may sound trite, but not having a plan is a plan to fail. With all of us working full-time jobs and having full-time families, it has been imperative that we all stay on the same page through the acquisition, renovation, and disposition process. We each rely on one another to complete our roles through each step of the process.
Jumping into real estate is like a very complex ICU patient with multiple variables that are interdependent on each other. If you are starting down this journey (“I wanna be a real estate investor!”) you need to build a team to be successful. Think of needing to call a consult at midnight, and you know they will respond. Now think of this as plumber for a pipe that just burst. Additionally, you need to be organized and know your cost and expenses for each project.
Is there anything else that is important for our readers to know?
Stay positive and remain adaptable to your conditions. With COVID-19, we have suffered delays with acquisitions of new properties and our local county courts. There will always be a hiccup along the way, and you never know what’s going to happen. Don’t take it too personally, never kick yourself when you’re down, and get back up and keep trying. You have to feel success in your bones.
What does effective communication mean to you? All individuals have their own natural ways of communicating that stem back to culture, past experiences, and background. How one culture communicates may seem very different to another. Health care melds together practitioners and professionals with various experiences, abilities, and backgrounds. Therefore, it is critical for nurses to develop systems to communicate effectively.
Communication is an important skill for any industry. There are numerous resources available that provide tips to improve communication. But what about communication geared toward nurses? Nurses need to communicate changes in patient condition, hand-off during shift changes, and information to families in a succinct and clear way. Brushing up on communication skills or learning new ways to clearly communicate is always a smart idea for both new and experienced nurses.
“Communication skills can be effectively trained but are best achieved through reviewing our own style of communication,” according to K.C. Rajashree, author of a 2011 study on training programs in communication skills for health care professionals. As a component to improving our communication skills as nurses, we must take an honest look at ourselves and how we as individuals communicate. If we do not assess ourselves, we won’t realize the areas we need to improve on in the first place. We can assess ourselves by checking if the information we’re communicating is clear enough or too detailed; do we “get our point across?” Or is the person guessing at what we’re trying to say?
As we know, “effective communication within a healthcare setting is critically important. Workers of varying skill sets within a healthcare setting must communicate clearly with each other to best coordinate care delivery to patients, ” says Haran Ratna, author of a 2019 study published in Harvard Public Health Review. One commonly used method is SBAR. SBAR means Situation Background Assessment Recommendation. Clinicians use this acronym because it delineates the pertinent information that is to be conveyed. Some facilities provide SBAR tear-off worksheets so that it can be used conveniently and consistently.
Other communication methods include Call-Out, Check-Back, and Hand-off. These tools involve team communication and many are “closed loop.” That means the person receiving the message repeats it back to ensure accuracy and receives confirmation that what they’ve heard is correct. Closed loop is beneficial particularly during a code or emergency when someone must ensure the information conveyed is accurate.
Ticket-to-Ride is a method for brief hand-offs. This method would be used if the patient were leaving the unit for a test. Ticket-to-Ride would convey basic information to the staff accepting the patient in order to keep the patient safe. This method is not the same as a change of shift hand-off; it is only basic information for short-term care.
Studies have shown that training nurses on improving communication increases patient safety. A study by Dingley, et al developed a communication “toolkit” that provided various communication strategies and ways to implement teamwork. The toolkit included four “tools”:
- SBAR (or a standardized communication tool)
- An escalation process
- Daily multi-disciplinary rounds with goals
- Team huddles during each shift
The study also revealed that using the toolkit consistently could be translated into other care settings besides a hospital. Using the toolkit showed improvement in communication between disciplines; however, implementation was dependent on managers and leadership. With creating any new habit, consistency is key. Providing education can encourage consistency as well as having the tools easily accessible through templates or worksheets.
BATHE protocol is another method, similar to SBAR. BATHE stands for Background, Affect, Trouble Handling, Empathy. This method is useful for communicating with patients, their families, or in a conflict situation. Observing the affect of the person is useful. If the person has a flat affect or is withdrawn, the nurse’s tone of communication may differ compared to having an upbeat or happy affect. Trouble Handling is another component to consider. What is troubling the patient and how are they dealing with it? This method is useful in psychiatric settings.
Which method is best? It all depends on the situation. In an emergency, closed loop communication works by repeating back the information. During change of shift hand-offs, more information is conveyed and clarity is important. In the case of Ticket-to-Ride, the information is brief and basic—just the facts to keep the patient safe. SBAR and other methods are appropriate when speaking with doctors and other team members by organizing information and maintaining consistency in the way communication occurs. Check with your unit’s educator or hospital policies. Your hospital may prefer one method versus another.
Nurses may take for granted the act of effective communication. However, communicating clearly and accurately makes all the difference in quality of care and patient safety. Utilizing SBAR, Hand-off, BATHE, or other tools with closed loop methods can improve transfer of information between nurses and others. By polishing nurses’ communication skills, patients and the health care team as a whole will benefit.
Ask most of our employees why they work at VA. Their top reason is often the same: they want to improve the lives of Veterans.
When you work at VA, there are so many ways that you can make a difference. Whether it’s working on cutting edge research that improves their treatment options, proposing a simple process improvement to make access to care easier, or just lending a sympathetic ear.
VA encourages a culture of innovation. VA gives its employees the chance to lead the way and change lives at the only nationwide health care system in the U.S. Here are five of the ways they’ve helped make an impact for Veterans:
1. Curing more than 100,000 Veterans of chronic hepatitis C infection.
Curing chronic hepatitis C infection and advanced liver disease, cutting death rates by up to 50%. Hepatology pharmacist Long Do helped get us there with a simple but innovative approach that significantly increased testing and treatment rates. As a member of VA Portland’s Hepatitis Innovation Team, Do recommended including hepatitis C treatment flyers in all prescription bags at the VA Portland pharmacy. Do and his colleagues also reached out to Veterans who were either homeless, lost to follow up, or lived in remote areas.
2. Working to end diabetic limb loss.
Through a partnership with Podimetrics, at-risk, diabetic Veterans are given mats that measure the temperature of their feet to detect diabetic foot ulcers (DFUs) up to five weeks early. Since a DFU can lead to amputation or even death for the one-in-four Veterans who suffer from diabetes, this is a game changer. In 2019, we treated 75,000 DFUs, accounting for more than 80% of non-traumatic amputations in VA. Beyond costing more than $3.2 billion that year, amputations also take an incalculable toll on the Veterans affected.
3. Bringing 3D printing to VA to improve individualized treatment.
Model kidneys made on 3D printers help physicians prepare for surgery at the VA Puget Sound Health Care System and save doctors up to two hours per surgery. That’s two hours that patients don’t have to be under anesthesia. Occupational therapists also use the printers to manufacture specialized, same-day hand orthotics, reducing the need for Veterans to make multiple visits for fittings. These are just two ways our national 3D printing network is improving care for Veterans. Spearheading the innovative use of 3D printers, Radiologist and Chair of the VHA 3D Printing Advisory Committee Beth Ripley, M.D., Ph.D., is a finalist for a 2020 Samuel J. Heyman Service to America Medal.
4. Connecting Veterans to care no matter where they live.
Another effort up for a 2020 Samuel J. Heyman Service to America Medal is our Connected Care initiative, which includes telehealth options, mobile apps and other digital health solutions. These efforts help the nearly 3 million rural Veterans enrolled in VA health care receive treatment without having to travel to a VA facility. In 2019, more than 900,000 Veterans completed nearly three million telehealth appointments. VA Video Connect sessions increased by a whopping 235%, while VA’s patient portal, My HealtheVet, surpassed five million registered users. Veterans can use My HealtheVet to send providers secure electronic messages, access medical records, check lab results and refill prescriptions.
5. Using artificial intelligence (AI) to help identify Veterans at risk of suicide or homelessness.
The Veterans Signals (VSignals) platform does more than survey Veterans, eligible dependents, caregivers and survivors on their VA experience. It also saves lives. AI automatically analyzes free text responses and routes them to the Veterans Crisis Line and National Call Center for Homeless Veterans when Veterans leave feedback indicating they might be at risk for suicide or homelessness. As of June 2019, over 691 suicide crises and 343 homelessness crises had been sent to VA experts who provided help to Veterans in need. The effort won a FedHealthIT Innovation Awards in 2019.
Work at VA
Are you ready to join a team devoted to making life better for the 9 million Veterans in our care?
HEAR from current VA employees.
There’s no doubt about it — VA will set an agency record for telehealth care in 2020.
Veterans attend about 25,000 telehealth video appointments each day, a 1,000% increase from 2019. VA already surpassed last year’s number of telehealth encounters by 7 million.
Because VA already had robust telehealth infrastructure in place — with nearly two-thirds of primary care and mental health providers having already used VA Video Connect to see patients — providers quickly ramped up telehealth capabilities to meet increased demand.
Making Care Connections
Telehealth can benefit Veterans, particularly those who find it difficult to travel or the one in four who live in rural areas far from care centers.
“VA is committed to offering Veterans the health care they deserve, whenever and wherever they need it,” said VA Secretary Robert Wilkie in November 2019.
Thanks to telehealth, VA providers have been able to make a difference in the lives of patients like Daryll Martin, a Veteran with high blood pressure who is unable to drive or use public transportation due to a history of narcolepsy.
Telehealth care coordinator Jasmine Pace monitored Martin’s blood pressure remotely. She then sent nurses to his home to evaluate him and help sort his medications.
“They went through every single one of his pills and as soon as he started to take his medicines his numbers came down immediately,” Pace said.
“As far as I’m concerned, telehealth saved my life,” Martin said. “Telehealth stepped up. I’m very fortunate, and very grateful for them.”
Veteran patients have been relieved to be able to maintain continuity of care and most have not had trouble adjusting to the new technology, according to Kimberly Braswell, a nurse practitioner in the cardiology unit at the James A. Haley Veterans’ Hospital in Tampa, Florida. Her oldest patient using telehealth is 99 years old.
“You can see the Veterans’ relief and happiness,” she said. “They can connect to their providers and have their issues addressed without interrupting their care. It’s one thing to talk over the phone, but making that face-to-face connection and being able to see their provider on video increases Veterans’ level of confidence with their care.”
Be an Innovator
VA is always looking for ways to improve care for the nation’s Veterans, whether it’s expanding telehealth, researching a new treatment or just streamlining a process. VA encourages employees to be key players in a culture of innovation.
In addition to a supportive work environment and a rewarding mission of serving heroes, employees enjoy competitive pay and unbeatable benefits. These include 36-49 days of paid time off per year. There’s also access to a range of premium-paid health insurance plans and robust retirement plans.
Other perks that come with choosing a VA career include:
- Flexible work schedules and shifts.
- Diversity and inclusion policies and programs.
- Leadership development and mentoring programs.
- Career training and enhancement opportunities.
- A smoke/drug-free workplace.
- On-site child care centers at select facilities and child care subsidies.
Work at VA
Consider joining an organization that’s committed to high-quality care through innovation.