Cosmopolitan magazine recently published “14 Things I Wish I Knew Before I Became a Nurse” that received a lot of attention and commentary on social media. I’m sure it also caught the attention of healthcare consumers and prospective future nurses.
I found the article and its publicity disheartening. I’ve been a nurse for 36 years and found it an extremely rewarding career. I wanted to share that there are not only solutions to the challenges the author mentions, but ways to avoid the challenges altogether!
Here are the ways I think nurses can manage the “fourteen things” to have a truly enjoyable nursing career.
1. “Your schedule sounds great on paper, but it’s way more work than it looks.” The author laments “don’t plan to work only three 12-hour shifts a week.” “You will be frequently called on your days off and begged to come in due to a sick call or staff vacancies.” And, “You will feel guilty and go in because you were begging people yesterday for the same.”
SOLUTION: A rotating list of who will take the call or a voluntary sign-up list for desired shifts prevents the shotgun-scatter approach of calling multiple staff on their days off. These help prevent the stress and guilt that staff feel when not answering the phone or declining requests.
A culture of daily begging to work extra shifts is not a healthy norm. Extra shifts are preventable through problem-solving, beginning with a thorough assessment to identify the “why” behind the problem. Do certain days or shifts have higher absenteeism? Are there trends in employee turnover? Are people leaving the organization or are they transferring from the unit to another area? If you can connect turnover to a reason (e.g. nurses finishing an advanced degree and accepting a new role), then planning in advance for anticipated turnover is a possible solution.
Getting to the root of the problem and addressing the cause is necessary for sustainable improvement. Research has shown a strong correlation between absenteeism, employee engagement, and work satisfaction. Examine trends in the team culture of a unit related to absenteeism, staff recruitment and retention. These may signal opportunities for improvement with input from all staff. A shared governance council might work with the unit manager to tackle such concerns. Don’t just dread the phone call on your day off. Offer to work with your manager and co-workers to create an atmosphere that engages and retains employees who want to work as a cohesive team. Be a part of the solution!
2.”Being a nurse is not only medical care.” The author bemoans how many times a day patients ask nurses for the Wi-Fi password or on which channel to find NBC.
SOLUTION: Collaborate with the team and identify the most common patient and family questions. Standardize the answers and post them in patient rooms. Or, like hotels, provide a pre -printed reference card. This will minimize call lights for simple questions.
It’s excellent customer service to expect what the patient and family may need and to provide it upon arrival. It will make the patient’s stay more comfortable when they are not required to seek assistance for simple tasks or answers for basic information. One of our roles as nurses is to empower our patients with knowledge and self-care/self-control whenever possible.
3. “If you don’t have a good memory, you better come up with a system to help you remember everything.” The author suggests that nurses should write down everything they do, including latest test results, vital signs, urine output, and so forth that will be asked of them.
SOLUTION: Relying on memory poses a high risk for communication errors and omissions – ones that may cause harm to patients. We agree that a system is a good idea!
Many healthcare professionals use the SBAR outline (Situation, Background, Assessment and Recommendation/Request) to organize all communication. SBAR is an easy to remember method that you can use to frame conversations. It clarifies which information to communicate between team members. This is useful in critical patient care situations such as patient handoffs or shift changes, as well as in daily operations.
Document SBAR information in real time on the medical record. Or, carry index cards in your pocket – one for each patient in your care – and jot down questions that need answers or information that requires follow-up. Or, you can jot down the answers in advance to questions you anticipate will come up. Before contacting a physician, another department, or a patient’s family member, organize your notes. Have access to the patient’s medical chart if additional questions arise. Once you are familiar with SBAR as a communication model, and have success with it, you will want to use it regularly and develop tools that support its use. After a while, you will find that you are organizing your thoughts in SBAR format and communicating in this manner becomes second nature.
4. “Mistakes Happen. Your first mistake will be the worst, but they never get easier.“ “You will 100% cry (usually when you’re alone, in a closet where no one can see you).”
SOLUTION: Don’t recover from a mistake alone in the closet, because the one mistake no one should ever make is the one we don’t learn from. In a culture of safety, being transparent about errors is important. Sharing stories and learning from others is critical. How we support our peers after a mistake is vitally important, because all of us make mistakes.
A healthy break room or staff meeting discussion is to talk about mistakes. Ask others, “What is the worst mistake you’ve ever made as a nurse, and what do you do differently as a result? How did you cope with your feelings?” Engaging in honest, transparent communication to learn and to explore effective ways of coping is a helpful strategy in creating a culture of safety. “I made a mistake” are the most difficult and the most empowering and courageous words you will ever say. You may cry – that’s a normal response. But, don’t hide somewhere to cry – that will only shut out the understanding and wonderful support you need from your team.
Also, the literature is full of excellent articles on the most common mistakes and how to avoid making them. A common thread in error prevention is effective communication and eliminating distractions. Read the articles, stop and reflect.
No one should feel the need to hide in a closet and cry. This behavior reflects a department whose culture on handling mistakes requires examination.
5. “Nursing school will never prepare you for your first or 20th or last death.”
SOLUTION: It’s not that nursing school doesn’t prepare us for death. Life doesn’t prepare us well for death from an early age. The American culture has changed much over the years related to death and grief, but we are still learning and still changing. How we experience the death of a patient is often more related to our personal experiences and spiritual beliefs than what we can learn in a classroom.
It’s true that each patient death may affect us differently; but, focusing on our role to provide comfort, care and dignity never changes. If a nurse has not experienced the death of a patient, she/he needs our support when that time comes. Early in a nurse’s orientation we should ask what his/her experience is in caring for a dying patient – whether an expected or unexpected death. We need to offer our support, understanding and guidance as a privilege rather than a burden.
Many professions (first responders, child protective services, and others) expose people to difficult life and death situations. To be with a person during their last moments or hours is a sacred privilege that we become more prepared for with experience.
Team debriefings immediately following a patient’s death are an opportunity to share, vent, feel, cry, express … Take a few minutes and debrief. Accumulating grief can harm you.
6. “If you don’t have a sick sense of humor already, you will develop one quickly.”
SOLUTION: Humor is a necessary coping skill but “sick humor” can take on many meanings. Laughing at someone else’s pain or misfortune is never acceptable and is disrespectful. Laughing at situations and ourselves is healthy.
Just remember that conversations overheard can be misunderstood as terrible, lacking compassion, and so forth. Make the break room the safe humor room. Being aware of one’s surroundings is always necessary. Even hearing loud laughter from within a break room when someone has just received tragic news or there’s been a death can have a lasting negative effect. Departments that create a “signal” for when humor or laughter is inappropriate may be very useful. Sometimes an overhead chime or a dimming of corridor lights is effective to bring attention to the need for a somber, respectful awareness.
7. “You will be on the phone even more than you were as a teenager.” “Start practicing your nice phone voice now, because impatience will get you nowhere.”
We agree! Smiling when you talk makes it near impossible to be rude or curt in tone. Never hang up without politely saying goodbye. In healthcare, effective communication is critical to preventing errors and to assuring efficiency. Tolerance, patience, and kind, respectful politeness makes your job a happier, more helpful place.
8.” Your body will hurt. Crossfit has nothing on a nurse!”
SOLUTION: Nursing is physically demanding work, there’s no doubt about it. When we take care of ourselves with regular exercise, healthy eating, and good body mechanics, we condition our bodies to withstand the demands of nursing care. It’s vitally important to use equipment, tools, and teamwork for safe patient handling. Comfortable shoes are also a must for long hours on your feet!
That said, nursing is a profession that helps to keep us fit and it beats a desk job any day of the week. Those who work in office settings have to work extra-hard to get their “steps” in every day. In nursing, we have the benefit of exercising while we work. That’s not a bad thing!
9. “You will get calls, texts, pictures and emails from friends and family asking you for medical advice.” “People will want to tell you their stories. It can get annoying, but you love these people and you will try to find answers.”
SOLUTION: All of your colleagues get these kinds of inquiries, talk with them about the best ways to handle it. And friends, neighbors, relatives, and acquaintances ask professionals in many industries for advice. It’s human nature.
Sometimes the best advice you can give is a good referral to a medical provider: “She’s great. Her patients love her. And, she takes a lot of time to listen.” It’s perfectly okay to politely establish some boundaries and expect others to respect them. If you are comfortable giving advice (that is within your scope of practice) then do it. Just remember that the road goes both ways. Don’t hesitate to ask the inquirer for free professional advice if they can be useful to you.
10. “You’ll feel underpaid.”
SOLUTION: While you don’t have much control over your base salary, you have quite a bit of control over your work environment. You also have the ability to work extra or trade scheduled shifts with a coworker to increase your income or to take certain days off. Focus on the features of your profession that you love that money cannot buy. Ask yourself where you would find that kind of satisfaction in another line of work.
Also, consider your job security and flexibility. You can work part-time or full-time. You can work in many different settings, industries, and shifts that accommodate your personal needs. You can also work on an “as needed” basis and can find a job in just about any city in the country. The fringe benefits are valuable, especially compared to many other places of employment.
By changing the way we see our world we can change our energy and outlook. We can look for new pathways of thinking that focus on the many positive attributes of nursing to be grateful for.
Looking at the historical timeline of nurse salaries, nurses today earn a very respectable salary. It is impossible to make an apples-to-apples comparison to different professions in terms of salary. There are geographic differences even within a profession as well as variations based on roles. And I have yet to meet anyone in any profession who says they are paid what they think they are worth.
Studies suggest that $75,000 a year is the “happiness peak point” on the salary range. Based on a 36-hour work week, that’s $40 an hour. Many nurses have reached this salary level. In 2015, the average RN salary in the nation is $67,930 or $32.66 per hour (compared to the average U.S. National Salary of $45,790 or $22.01 per hour). In many states, RNs are earning over $75,000 (on average) and some metro regions offer six-figure salaries on average.
It’s important to remember that our jobs do not define us, our salaries do not determine our value, and money still doesn’t buy happiness.
11. “You will miss out on a lot of your social and family life. Be prepared to miss holidays and weekend events.”
SOLUTION: Explain to friends and family that your schedule is a commitment you take seriously because hospitals are 24/7/365. Celebrate holidays at work, and co-worker birthdays, too! Be flexible in your family celebrations to the best of your ability so you don’t miss out. Help co-workers cover shifts with schedule trades for the big things in life. (Free apps like NurseGrid facilitate shift swapping.) If you help someone, they will likely help you in return.
My experience is that nurses – and their families – are incredibly resilient and creative when adjusting social calendars. Sometimes it’s just a matter of asking.
And keep in mind, there are many places to work in nursing other than hospitals. Johnson & Johnson’s “Campaign for Nursing’s Future” identified 104 nursing specialties with fewer (or no) holiday, weekend, and night shift hours. 34 of these are in non-hospital settings.
For example, clinical nurses can work in an Ambulatory Care Center. Or they can be a School Nurse, Parish Nurse, Public Health Nurse, Home Health Nurse, or Forensics Nurse. The opportunities are vast. Non-clinical nurses work in management roles, research, informatics, medical device sales and teaching, insurance, as medical writers, and as consultants – to name a few. And, the industry shift towards population health has created several new roles for nurses.
12. “Your coworkers will truly feel like family.” “They understand your stress and love of work more than anyone else in your life.”
SOLUTION: Appreciate your team as you appreciate your family. Say thank you and mean it. Celebrate work anniversaries, birthdays, and give recognition to your coworkers (the Daisy Award, as one example). Show interest in life outside of work and get to know what coworkers enjoy doing in their “off time.” Have potluck meals at work and culture-sharing events to celebrate diversity. Have fun! Engage in workplace challenges and competitions. Decorate the department for holidays. Nursing is a team sport … don’t try to go it alone … there’s no “only child” in our work family.
13. “Eat a meal before work because it might be the only meal you get to eat all day.”
SOLUTION: Keep grab-and-go lunches and snacks in your locker or the break room. Learn to eat healthy, high-protein, quick bites throughout your shift. Low blood sugar causes grumpy people and bad outcomes. At the start of your shift, figure out a meal-break plan with a co-worker to cover for each other when you can. Be kind to the coworker covering you – have your patient care caught up before you go, including your documentation, and be sure your patients are comfortable and safe.
14. “Make sure this is really what you want to do.” “You will have the biggest love-hate relationship with your career.”
SOLUTION: Remember the good days, hold the best memories — those are what keep you coming back. Being part of an effective team is very rewarding. Finding a clinical area of interest and pursuing it with a passion to become an expert in your area is incredibly motivating.
And, there are so many pros to being a nurse – far more than the cons. There is no other profession where you will have as big an impact on someone’s life as you do in nursing. You get to wear scrubs with elastic waistbands and tennis shoes. You’re a superhero to patients and families and physicians. No two days are alike – you are not in a boring job. You will develop a bulletproof immune system and rarely get sick – and if you do get sick, you are surrounded by people who can help you! Nursing is consistently the highest ranked profession on the Gallup survey for public trust – that is instant honor and credibility!
It’s a serious job, yes, and often a hard job – but, the rewards are many and attitude is everything.
Let’s spread the positive attributes of the nursing profession just as widely as the “14 things.” What other aspects of your nursing career do you enjoy? Share in the comments section below!
Dianne L. Foster RN BSN MBA
Ask Dianne about reinventing the nursing profession: dianne@freemanwhite.com
Dianne has three-plus decades of clinical and leadership experience in 90-600+ bed hospitals. Her expertise in complex hospital operations, patient care environments, and cultivating relationships helps hospitals surpass the status quo.
