A New Nursing Infographic

Please enjoy this infographic on the ways in which nursing is growing, changing and creating opportunity.

Where Were The Doctors?

Last week, I attended an all-day conference on mind-body medicine here in Santa Fe. At the beginning of the day, the speaker obviously wanted to know the professional make-up of her audience, so she called out various professions and had us raise our hands in response. Of course, nurses made up the majority of the approximately 225 people in the crowded room, and psychologists, counselors and social workers were also very well-represented. And when she asked about doctors, only one person raised his hand. A murmur rippled through the crowd, and there was much ironic laughter. So, where were the doctors?

A Speech for Graduate Nurses

Since this is the time of year when nursing students are preparing for their graduation and entry into our esteemed profession, I am choosing to republish a commencement speech that I delivered at Holyoke Community College on June 23rd of 2005 for my graduating LPN students for whom I had served as lecturer during their course of study. This post is the most popular ever published on Digital Doorway, and it has received over 5,000 pageviews since its first publication. Enjoy.

Self Compassion and Empathy

Last night on RN.FM Radio, nurse and well-known author Carol Gino spoke eloquently about the need for nurses to develop self compassion before they can truly experience empathy for their patients. She was so right.

Nurses Face the Wounds of War

In a surprising and welcome announcement, 450 nursing schools have pledged to improve and expand training for nurses and nursing students on the "invisible wounds of war", including Post-Traumatic Stress Disorder (PTSD), post-combat depression and Traumatic Brain Injury (TBI).

Nursing Students and Self Care

Nursing school is a lot like boot camp. The student nurse is pushed to his or her limits, personal resolve is continually tested, students bond in their misery, and the majority come through the other side with new skills and a new career, perhaps a little worse for wear. But are they fully prepared---to care for themselves?

My Newest Blog Is Live

I am grateful to the good people at  LPNtoBSNonline for inviting me to be their new resident "expert blogger". The blog is now live, and you can visit the blog by clicking here. The posts are generally geared towards nurses---both seasoned and novice---and those who wish to enter the field.

Please stop by regularly since there will be two new posts every week!

A Nursing Student in Taos

Sitting in a Middle Eastern cafe in Taos, New Mexico this afternoon, my wife and I were lucky to strike up a conversation with a young man with whom we were sharing a low table surrounded by comfy pillows.

In the course of our conversation, it turned out that he's pursuing a degree in nursing, and it's quite heartening to see a thoughtful young man of heart and intelligence planning to enter the field. Nursing still seems to be all the rage among young people seeking an honest and remunerative career, and when I meet someone like this, I'm pleased to feel that, yes, I would want this person at my bedside when I'm in the ER.

Even as some areas of the country are seeing hiring freezes and a dearth of jobs in comparison to the number of students being churned out by nursing schools, it seems that some states (like Florida and Texas) still enjoy a high number of positions waiting to be filled. Apparently, demand may actually outstrip supply in Texas in 2010.

There are so many good people entering the field of nursing, and I'm very pleased that the profession is attracting many mature, educated individuals who are bringing their life experience and knowledge to the fore. I know several extremely intelligent and kind people now in the throes of their nursing education, and I'm certain that they will bring great compassion and thoughtful regard to their work in the very near future.

May the continued flow of high quality nursing students continue for years to come as long as the demand for their service persists, a scenario made very likely by the aging of our society and the need of the retiring Baby Boom generation for medical care. Nurses are still the backbone of the medical industry, and a strong backbone it is.

Surviving Nursing School

Today I met with a new friend who just finished his first year of nursing school. Listening to his (almost universal) story of the travails of nursing education, my mind wanders back to just how difficult it all was, even as the rose-colored glasses of time filter out the suffering that such an experience entailed.

It's funny how one cannot altogether remember pain. Even women who have been through childbirth often say that they know it was the most painful experience of their lives, but they simply can't conjure up the intensity of the moment. The human brain and body are so self-protective. We easily allow the vicissitudes of life to be covered over with the mental cobwebs of forgetfulness, and I guess that's a good thing.

So, back to nursing school. Why do nursing professors so often make it a living hell? Why does it have to feel like boot camp? If nurses still eat their young, is it assumed that it's best to prepare nursing students for their eventual consumption by roasting them alive as they're educated?

Even though I can't remember my specific complaints about nursing school (and there were two different schools through which I ushered myself), it was indeed a painstaking experience peppered with struggle and angst (especially as an Associate Degree candidate).

All nursing students have my sympathy as they ride the waves of nursing education, often faced with jaded professors and clinical preceptors. Still, there are always gems amidst the stress and heartache, and there were several educators for whom I had the highest esteem and regard.

Yes, we are the most trusted and respected professionals in America, but the process of becoming a nurse can often be rather difficult and distasteful. As Brad Roberts of the Crash Test Dummies once sang: "It's not as bad as eating one's own liver, but I'd like to think that there are better methods."

If I Was a Wannabe Nurse

So, I recently posted about the $500 million dollars appropriated by Congress for nursing education and other healthcare-related expansion. As I speak with nervous friends and acquaintances who are keen to apply to nursing school, I assure them that there is money coming down the pike. In the meantime, I tell them earnestly, they should take care of as many prerequisite classes as they can, do volunteer work to add to their resume, network with nurses and other professionals for advice, and research every available scholarship, grant, loan program and nursing-related entitlement out there.

For women of color who want to be nurses, I am even more adamant that there will be money available for them if they want to pursue it. African American women, Latina women, Asian women, Native American women, Pacific Islanders---nurses of color are needed and there apparently will be money available for those particular groups to pursue their healthcare-related education. Of course, no government pool of money appears to be unlimited (unless, of course, it's money for bank and corporate bailouts), and some of these women and men will not be able to avail themselves of appropriated dollars to pursue their goals. Still, nurses are needed, and as nursing schools build capacity to educate more students, the best and brightest with the most robust resumes will have a corner on the market.

At this point in history, if I was a wannabe nurse, I would get on the phone, interview every nurse I could find, look for places to volunteer and learn, insinuate myself in places where a pre-nursing student would be a welcome extra pair of hands, and I would then proceed to make myself indispensable.

I would build relationships with nurses, doctors and other sympathetic professionals. I would read books and magazines, and then troll the internet for the latest information on nursing scholarships, the hottest nursing schools, the schools with the highest level of open spaces for new students, and the schools without specific faculty deficits. I would befriend nurse bloggers like myself and get the inside scoop on as many aspects of nursing and nursing education as
I could.

Once I chose the schools that interested me, I would write to the Dean of Nursing of each school, request informational interviews, meet with faculty if possible, and ask current students what they felt most helped them to get accepted. Making friends with the administrative assistant or secretary at each school of nursing would also not hurt my cause, especially if some gourmet chocolate found its way to their desk when I paid a visit.

Once contact was made, I would send hand-written notes to each Dean or faculty member who met with me, and I would subsequently follow up by email periodically to ascertain any changes or developments.

This may all sound cynical and calculated, but I truly believe that in a world where loans and scholarships for a limited number of slots in a limited number of nursing schools is the norm, building relationships and connections is the best way to find your way into the school of your choice, or at least a school which you would accept attending if need be. Also, one secret at this point in history would be applying to schools in multiple regions of the country. The Northeast , Southeast and West Coast are densely populated, and it would behoove pre-nursing students to examine schools somewhat off the beaten track in regions of the country which are perhaps somewhat less desirable places to pursue an education.

Nurses will be needed in droves for many decades to come as Baby Boomers continue to retire in ever increasing numbers, and as the most trusted people in America for the seventh straight year, nurses are in good moral and ethical standing on a societal level. While nurses may not always earn salaries commensurate with their level of education and expertise, they are desirable professionals providing a valuable and meaningful service to millions of people every day.

Nursing will perhaps soon enter a new heyday, wherein nurses assume an even more central role in health care as preventive care gains an increasing share of the limelight. Most nurses are experts in preventive health care, and we need more nurses to educate and care for the aging population of the U.S. (and other countries).

So, Dear Reader, if you are a wannabe nursing student with a fire in the belly and an itch to get that education under your belt so that you can wield a stethoscope and the ubiquitous nurse's pen, work those connections and hit the ground running. Now is the time to jump into the fray as nurses continue to be the growing edge of the health care industry.

Obama Administration and Congress Invest in Nurses

Several major American nursing organizations are applauding the support demonstrated by Congress and the Obama administration for the nursing profession, with newly allocated funding that should have a profound impact on every aspect of nursing, including the central focuses of education, practice, retention and recruitment.

As part of the American Recovery and Reinvestment Act (H.R. 1), $300 million were awarded to the National Health Service Corps and $200 million will be divided between the Nursing Workforce Development Programs (Title VIII of the Public Health Service Act) and the Health Professions Training Programs (Title VII). $10 billion will also be allocated for the National Institutes of Health, with $7.4 billion distributed to various Institutes, including the National Institute of Nursing Research, further demonstrating that nursing's contributions to both the clinical and research worlds is indeed taken seriously.

The provisions in H.R. 1 allow for money to be distributed directly to nursing students and schools of nursing, with allocations for Title VII programs like Scholarships for Disadvantaged Students and the Faculty Loan Repayment Program.

Additionally, the monies allocated for the National Health Service Corps will fund scholarships and loans to nurse practitioners, certified nurse-midwives, primary care physicians, dentists, mental and behavioral health professionals, physician assistants and dental hygienists.

In blog posts leading up to President Obama's inauguration, I voiced cautious optimism (and some considerable doubt) that an Obama administration would pay close enough attention to the nursing shortage, addressing not only the need for increased scholarships and education funding for nursing students, but also funding to address the lack of qualified nursing professors available to educate new nurses. Seemingly, multiple levels of the nursing profession have been addressed under the auspices of these new programs, and the money allocated will not only provide scholarships for nursing students, but will also offer loan repayment programs for those nurses who might wish to teach but would likely be dissuaded by the relatively low salaries offered to nursing professors.

I am heartened by this news, and foresee a blossoming of the nursing profession at a time when a universal nursing shortage (and an economy in apparent free fall) inform the overarching zeitgeist that currently casts a pall over the entire health care industry. Yes, most nursing schools are filled to capacity, yet that capacity is generally hobbled by a profound shortage of professors, a reality which very well may be addressed as these funds become available.

These are difficult economic times for many Americans, and as President Obama's economic recovery plan is actualized, we will begin to see the ways in which the plan may succeed and fail. Over all, I feel optimistic that, in terms of the nursing profession and the profound shortage therein,we will sense a discernible sea change if the allocated funds are targeted and distributed as proposed. While I have not seen the fine print (and we all know that the large print can giveth and the small print taketh away), my hope is that the fine print will in no way diminish the potential impact of such an historically and economically significant investment in the future of nursing.

Despite the dire warnings and the hand wringing occuring nationwide as the unemployment roles grow, perhaps some optimism, positive movement and job growth within the nursing profession will have a ripple effect throughout the health care industry. And for this we can only hope.

New Nurses, Primary Care, and the Calculus of a Multifaceted Shortage

(Note: This is my twelfth---and final---post under the auspices of the nurse blogger scholarship which I recently received from Value Care, Value Nurses.)

It seems that everywhere I turn, someone is telling me that, a) they just applied to nursing school, b) someone they know just applied, or c) they or someone they know was just accepted/rejected from nursing school.

New nurses---and those who wish to be nurses---are entering a profession in transition, a profession that is losing its older members more quickly than its educational institutions can churn out novices ready to enter the fray.

Today I was interviewed on a radio program in Gainseville, Florida about a recently published book of non-fiction writing by nurses in which I was a featured contributor. The show's hosts seemed sincerely perplexed when I explained that older nurses are retiring faster than they can be replaced, and that nursing schools simply cannot offer faculty salaries that can compete with what nurses are paid in clinical positions. Thus, thousands of qualified applicants for nursing school programs are turned away each year since there are not enough professors to educate them.

As a consequence, far too many eager and highly qualified applicants are rejected from nursing schools around the country---and in fact, around the world, as well---and where do they turn? Do they re-apply the following year? Do they look for another school to which they might have a chance of acceptance? Or do they give up their quest to join the nursing profession and simply move in another career direction entirely?

At a time when aging Baby Boomers are living longer with chronic illnesses and are increasingly in need of quality nursing and medical care, it's time for our government and other influential entities to step up to the plate. The government itself must realize that the calculus of the nursing shortage must change, and this continuous hemorrhage of nurses from the profession without a consistent transfusion of new nurses must be short-circuited.

I will grant that we are in difficult economic times. I will also admit that the U.S. healthcare system is dysfunctional at best, and broken at worst. It is also plainly apparent to me that a growing lack of sufficient nurses to provide care in numerous facilities across the country is a recipe for a public health disaster of enormous proportions.

Meanwhile, if an Obama administration gains control of the White House, a push for near-universal healthcare coverage for all Americans will most likely be an important agenda item in the first year of such as administration. This is a laudable goal that may or may not be achieved. However, it must be acknowledged that the process of bringing more citizens into the healthcare system must be met by a similar process of encouraging more healthcare providers to take part in delivering that care.

The nursing shortage is real, and it is effecting how healthcare is provided around the country. Similarly, there is a very real shortage of primary care physicians, with more physicians opting for specialties in which the demands and low pay of primary care are eschewed.

Now, it is easy to see that if more citizens are insured (a goal that should absolutely be pursued despite the current economic climate), then we must simultaneously ensure that a sufficient number of physicians and nurses are available to provide the quality care that would consequently be delivered.

We must create incentives to lure physicians back into primary care, perhaps by reaching out to medical students and residents with a campaign to describe the value and rewards of primary care. Financial incentives such as loan repayment programs could also be enacted for new doctors who enter the field of primary care or family medicine, whether they work with vulnerable populations or not.

In terms of the provision of primary care, an expansion of Masters-level Nurse Practitioner programs and Doctoral nursing programs (especially for the new Doctor of Nursing Practice designation), could go a long way toward assuaging the nationwide shortage of primary care physicians, especially if interest-free loan programs and other incentives are created and fully funded.

We also must urgently expand the capacity of nursing schools by subsidizing nursing professors' salaries, expanding programs, and enacting a massive campaign of grants, scholarships and interest-free loans to make nursing school more readily affordable for a broad spectrum of prospective students.

Yes, these programs would indeed be expensive, and a great deal of money would need to be designated for such a sizable undertaking. Yet we must examine the relative costs of our inaction, and the crisis of untreated chronic illness and substandard medical care that will be the result of such a failure to act.

As the population ages and people live longer with more complicated constellations of chronic illness and multiple comorbidities, the provision of medical care will necessitate an enormous number of nurses as well as a solid base of primary care providers for patients across the lifespan. Nursing education must be funded and supported, nursing faculty must be recruited and well-compensated, and primary care providers must be given viable reasons for remaining in an area of medicine that has fallen from favor.

We cannot afford to ignore the multifaceted issues which are throwing the American healthcare system into crisis, and rest assured that any money invested now in improving the delivery of care will pay astronomical dividends in terms of prevention, improved healthcare maintenance, and increased cost-effectiveness. It is in our best interest to act, and we can only hope that political will and popular support will be enough to set these wheels in motion.

The ADN Track: History and Diversity

Please click here to read my recent article (published on Nurse LinkUp) regarding the history of Associate Degree nursing programs, an affordable educational trend which diversified the field of nursing and afforded many people like myself a convenient and fulfilling educational experience.