Makings of a Nurse: Interview with Nurse Teeny

For our sixth installment, we reached out to a nurse pursuing her Master’s degree. “Nurse Teeny” is a community health nurse who currently works supporting seniors and people with disabilities. She will be earning her Master’s degree in Clinical Nurse Leadership in May, 2012. She has been blogging at “The Makings of a Nurse” for four years.

The bold statements are taken directly from her posted works, followed by our questions and her responses.

Age 17 … decided to be a nurse. Promptly told I had “too much potential” – why not go to med school? Given your perspective now, what would be your advice to someone who is hearing that from their own family members or advisors?

I would say wouldn’t you want to have a smart nurse looking out for you?!?!? Demeaning nursing as a career that is “beneath” women and men with potential only reinforces traditional hierarchies and stereotypes. Nursing is a profession that has undergone a lot of transformation, and health care organizations are beginning to realize that having smart, autonomous nurses is a huge benefit to patients.

I would also say to keep an open mind about your future. There are a lot of pluses and minuses to going back to school for nursing, rather than choosing this profession from the beginning. I’m very thankful for the experiences I had pre-nursing and I think I’m better at my job thanks to those experiences. So by being discouraged at first, people ironically did me a favor.  The point is, you don’t have to make up your mind at age 17.

(re: July posts of struggling with hospital in BSN)[I was] putting my foot down and demanding they make it possible for me to get my BSN so that I have a degree to back up my RN license. How much does having the degree behind the license affect professional opportunities in a working/hospital environment (opposed to teaching)?

The Institute of Medicine has set benchmarks to further the profession of nursing, and one of these benchmarks is increasing the number of nurses with BSNs. Hospitals and health care organizations (especially magnet hospitals, which are great places to work) have made BSNs “preferable” in their job descriptions and many hospitals are moving toward requiring BSNs in the near future. Having a degree behind a license is becoming indispensable. Even though I have a previous Bachelor’s degree and the equivalent of a BSN (in my opinion), not having those three little letters definitely presented a barrier in my job search. Especially in the era of online applications and impersonal screening processes, meeting those “minimum recommendations” by having a degree is pretty much a necessity.

One of the things I love most about my job is that it feeds my inner nerd. Whereas I was lucky if I had time to look up an unfamiliar medication in acute care, I have the luxury of conducting my own research in order to encourage evidence-based practice among my colleagues and by other health care providers. If a student wanted to professionally cater more specifically to their inner-nerd, what would you suggest as ways to help focus their efforts, or specific areas in nursing where this has been more common?

I think it is possible to cater to your inner nerd wherever you practice, but the time constraints and everyday demands of nursing can present a challenge. I have found community health to be wonderful for me because I have time to grow my own practice. On the other hand, it’s been difficult because we have fewer resources and less impetus to foster evidence-based practice because there is no financial or professional pressure to do so. You have to be internally motivated.

I would definitely encourage nurses with intellectual interests to further their education, but I think we also have a responsibility to take this academic learning and find ways to translate it into professional practice. Whether it’s through teaching or leadership opportunities, what is the point of learning in the Nursing Ivory Tower if isn’t used to improve care. It’s ultimately about the patients.

One way to advance learning in practice is to see if your hospital has a Clinical Ladder program, which gives you opportunities for promotion (and higher pay) based on practice improvement projects, research and/or leadership opportunities that you get involved with at your workplace.

in 2007 wrote: Though I feel confident about where I am headed, part of me whispers, “How can you know what you will do with your nursing degree until you’re an actual nurse?” You write about being attracted to Pediatric Hematology/Oncology Nursing – but this is not where you arrived. How confident now are you in your professional direction, and how accurate was that statement for you in retrospect – were you qualified to know what you wanted, even in a general sense?

Not confident at all, actually.  One of the particular challenges of becoming a nurse in this economy is that my choices have been limited. I thought I would be a peds nurse, but I’m working in geriatrics instead (the irony!). I’ve taken the jobs I can get, rather than the jobs that I want. I’ve learned that I can be happy in unexpected settings and I’ve learned the virtues of flexibility (a key nursing skill!), but I can’t say that I’m “thrilled” with my current path.

Of course given our aging population, I’m probably setting myself up for a pretty secure future. But I still find myself drawn to my clients dealing with cancer. So I still think oncology is where I ultimately belong (whether with kiddos or adults is less important).

In a way, I still think my previous goals were pretty accurate and that I had made those statements based on (limited) experience. I knew what brought me joy and interested me, even back then. (I knew that cancer fascinated me looooooong before I stepped foot in nursing school). However, I also think that by not “getting my way”, I actually benefited by learning the value of an open mind and realizing that I had unexpected skills and gifts to offer.

I’m still not sure where I’ll end up but I guess I’ll know when I get there. And that is part of the adventure!

Almost 18 months into life as an RN and I’ve been struggling. Struggling to find my place. Asking myself “Was it all worth it?” Usually the answer is a resounding “Hell yes!” but I have my moments of doubt. … The future is out of my hands and the best I can do is take care of myself today. What has changed the most in the time since you wrote this? Does time in the field help to dispel some of these internal struggles, or how do you take better care of yourself today in this regard?

I wish I could say I’ve moved past this sentiment. For the most part I’m okay with the struggle and have gotten better about accepting what I can’t change and focusing on self-care (which is harder than it sounds when you’re a full-time grad student and you’re also planning a wedding). I’ve learned that self-care includes being thankful for the fact that I can go home to my family and even on my worst days, I’ve got it pretty damn good.

When I send clients away in ambulances for two weeks in a row, when I have clients who play mind games (even if I know intellectually that mental illness is to blame), when I know that the counseling and advice and therapeutic relationships I bust my rear end to establish won’t make a lick of difference for 95% of my clients, that gets to me. And makes me occasionally question the choices I have made.

But then a small victory happens. And that’s all it takes to sustain me through multiple setbacks.

Even when you set boundaries between yourself as nurse and your patient as consumer/client/call them what you will, community health nursing  often calls for an emotional investment beyond what I ever experienced in the hospital. They tell you in nursing school that you should ideally be looking ahead toward termination of the relationship from Day 1. That’s easier said than done. If a future nurse has a leaning toward more involved and personalized care, where would you suggest they seek opportunities? Have you seen great disparities where this is concerned between different units in a hospital?

I think the reality is that acute care nursing discourages personalized care. Nurses can do their best to provide person-centered care, but in 12 hours, chances are you will never see your patient again. Chances are that psychosocial concerns you express will be deferred to social workers. As patient acuity gets higher and higher, it’s just physically impossible to “get to know your patient” in the hospital, at least at the level I wanted. It doesn’t mean that you should dismiss hospital nursing altogether, because there are a lot of skills you can learn (assessment, critical thinking and TIME MANAGEMENT). There are also certain specialties that lend themselves more to a high level of personalized care (long-term care, oncology, rehab, even ICU at times). I think that’s one of the reasons I loved my peds oncology capstone so much – the staff really knew the patients and their families. Some nurses shudder at the thought of getting so close. To me, it was a non-negotiable.

Health is political. As much as we would like to pretend that we can talk about health without discussing issues of policy, equity, access, and disparities, we are dead wrong. The system is a mess and it’s going to take a lot more than direct care providers to fix it. How would you suggest that a nursing student might better equip themselves – educationally, politically, etc. –  to be able to become part of the solution?

This is one of the most frustrating parts of being a nurse. Many of our leadership classes discuss issues of policy, financing, etc. – and yet I continue to hear from colleagues that they don’t care about that “stuff” and they just want to learn how to be nurses. To me, learning about “that stuff” is part of learning how to be a nurse. And yet nursing school is already so exhausting and demanding that I can at least understand the sentiment. Working as a nurse also places demands on your heart and mind and a lot of people just don’t have the energy to give more. There is also a perception that administrators don’t understand what it’s like in the trenches and are disconnected in their policies and practices. I don’t have an answer to this larger problem. I can say I think we have a responsibility to equip ourselves to learn about the bigger picture. I just can’t say that everyone agrees with me. I think it will require a culture change at a macro level.

Give yourself permission to try jobs and clinical rotations that you never imagined you might like. Despite the multiple headaches and challenges, I continue to find that community health nursing offers a wonderful fit for me. Despite the barriers, I still feel that I am part of the solution. My job is absolutely insane. And I wouldn’t have it any other way. How many different types of care have you personally explored in your career, and do you still open yourself up to changes like this – or does time tend to tame the professional wanderlust?

I have been a nurse for almost two years now and I have practiced in critical care and community health. Neither of them were where I expected to be. I think my career trajectory is due less to “wanderlust” than necessity (see above). I needed to work as an RN. I found jobs that were willing to give me a chance. I think I have learned important lessons about being more open-minded and less myopic and I’m much more willing to try jobs that might not have appealed to me at first glance. On the other hand, I think that if I loved the work I did through and through, I’d be less likely to wander and more likely to seek opportunities for growth in the area I loved. At this point, I have changed jobs because I had to and I still feel restless. Hopefully I will find my place.

All three of the [MSN] programs to which I applied encourage you to work part-time as an RN once you pass your boards and begin the graduate-level work. So it’s not like I’ll only be in school without working too. I’ll be learning in the classroom and on the floor. If a current nursing student has interest in pursuing a Master’s, would you suggest they stay in school and keep at it (so perhaps only working part-time through it all), or would you suggest more full-time work in the field first, so they are more seasoned with real-world experiences?

I think it depends on 1) whether you can balance work and school and 2) where you are in your professional journey. I think there is a misconception that people in second-degree MSN programs are ill-equipped because they don’t have “real-world experience” as nurses. But I think that belief discounts other real-world experiences that lead us to be well-rounded people (nurses are people too!). The development of particular nursing skills and instincts can only occur in nursing, it’s true. But I think the life skills and instincts that make us human and help us relate to patients are minimized to the detriment of the profession.

If you are finishing up your nursing education and looking at Master’s programs for afterward, whether you go straight on depends on how burned out you are (and whether you think you’ll go back to school after years of being away). It also depends on what you want to accomplish with your Master’s degree. Do your homework and make sure the investment is worth the exhaustion!

[from 2007] From what I’ve read, doctorate-level nurses will be where it’s at in a few years. I am 27 and have been in school forever. The thought of getting my nursing degree, practicing and then having to go back to school to get my Master’s is daunting. Medical students have to go to school for one year more than I would, and they get to be called doctors. Do I need more patient contact before I can claim that I am advanced in my profession? In the three years since you wrote this, you have completed your degree and enrolled in a Master’s program. Have you found this is coming true, that you are seeing more doctorate-level nurses in daily working environments?

I have yet to meet a doctoral-level nurse in my practice (except for Ph.Ds as professors and nursing reseasrchers). All of the nurse practitioners I have met are Master’s-prepared and they all have different opinions about the move to the DNP. However, the DNP is still extremely new and I don’t think there are that many doctorally-prepared NPs in clinical practice yet. I am intrigued to see whether there will any professional tension once “Dr. Nurses” start becoming more prevalent.

You are about to be married (congratulations!) – so how has nursing played directly into your thoughts of stability and long-term commitments? To be clear, were there professional aspects (where to work, when to go to school, which shifts to take, etc.) that directly affected decisions made in your personal life – and if so, how has nursing helped? Has being a nurse ever felt limiting?

I made the decision to become a nurse during my first marriage (a long story!) and the decision had little to do with my personal life. I was intellectually and personally drawn to nursing and I honestly didn’t give much thought to the interplay between my professional and personal life. I just knew I wanted to move forward.

That disconnect from my personal life has certainly changed as I have “grown up” and have realized that the professional and personal are intertwined for me. I don’t feel personally fulfilled if I am not professionally fulfilled, and vice versa. I met my husband-to-be just as I was about to start my nursing education and I am fortunate enough to be marrying a man who understands how integral my work and my studies are to my identity. He has patiently stood by (and moved with me more than once) as things have gotten off to a somewhat bumpy start for me. And he has put some of his own goals on hold. The beauty of nursing is that I know I can take it with me, so to speak. When I graduate in May, I’m giving myself a break and also tipping my cap to his patience. I know that if we move for his education or for him to pursue a professional opportunity, that it doesn’t limit me (especially with my MSN…I hope).

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Thanks for sharing your experiences and wisdom, Nurse Teeny! Be sure to check out more of Nurse Teeny’s writing on her blog The Makings of a Nurse (this links to her new, self-hosted site, too!)

Tomorrow, our seventh installment of the series will talk with Kim McAllister about her experiences in nursing, and how and why they have changed through the years.