Thursday, June 22, 2006

Nurses in Nontraditional Roles

Or Mary's answer to: "What did you used to do when you were a real nurse?"

There's a persistent and pervasive stereotype of a nurse as the person in white next to the hospital stretcher or bed, and a continuing misperception that "real nurses" only work in hospitals, or in agencies or settings intricately entwined with the acute care business: home health, nursing homes, and doctor's offices. Sadly, it's not only the general public who has this misconception. Nurses themselves often labor under the same misunderstanding of the wide range of nursing practice.

It's true most of us started in hospitals after graduation. That's really the training-bed for most of us, and is in fact the traditional basis for nursing education. Nurses of my mother's generation weren't asked where they went to school, they were asked where they had training. There are still some diploma schools hanging in there, to this day. You can still become a registered nurse by attending a "training" school.

But there is more to nursing and nursing education than bedside training, as important and bedrock as that is to our special skills. We can't really become nurses without learning to care for acutely ill hospitalized patients. But many of us have left the bedside.

We are still nurses.

Sometimes nurses---and nurse-educators---define nursing by what it is not: not medicine; not social work; not psychology. But some emphasis should be taken to define nursing by what it is: caring for patients across the entire wellness spectrum in a holistic manner.

Now, I'm aware of all the cliches in that one little definition! I know "holistic" is overused, and "wellness spectrum" is so 70s! And the definition of "patient" includes individuals, families, groups and communities. Nevertheless, that's what we do; we care for patients sick and well, assessing functioning across the entire range of human experience physically and psycho-socially and basing our care on an understanding of holistic human functioning. We care by promoting health, preventing illness, or ameliorating as much as possible the effects of illness or disability.

And we do that lots of places besides at the bedside.

Nurses, with their unique education in holistic care and training in assessment of individuals and communities, are in demand by many employers far removed from the hospital bedside. There are real nurses working in community health nowhere near the local public health clinic. There are nurses in forensics; nurses in advisory roles in law and ethics; and nurses (like me) working in case management and other roles on the periphery of acute care.

Case management of people with chronic illness is an area in which nurses are uniquely qualified; we have an understanding of the way bodies work and a good perspective on individuals as part of families, groups, and communities. We can assess physical and psycho-social aspects at the same time, and use the nursing process to guide care coordination.

Case management doesn't have the "coolness" factor of, say, ICU or the ER. But I haven't left nursing, because I have left the bedside. I'm still practicing nursing. I'm just dressed in street clothes and out and about in people's homes, instead of dressed in scrubs and starting IVs at the bedside in ICU.

So in answer to the nurse who asked me what I used to do when I was a "real nurse", my answer is: the same thing I do now. I cared for people. That's nursing, after all.

mary

16 Comments:

Blogger Dan said...

Unfortunatly, their are far too many nurses who do not work in a nursing capacity at all. Thanks for the great post!

3:32 AM  
Blogger Intelinurse2B said...

As a nursing student, I am still exploring all of my options. "What kind of nurse do you want to be?" is everyone's first question when I tell them Ive gone back to school to be a nurse. Thank you for the reminder that I can "be a nurse" outside of a hospital.

7:02 PM  
Blogger Keith, RN said...

I am one of those nurses who, graduating from nursing school in 1996 at the age of 32, declared that I would---gasp!---never work in a hospital. Everyone thought it was professional suicide. However, I have had no problem working as a community health center triage nurse, a visiting nurse with acutely ill patients just out of the hospital with mega-wounds and pumps and porta-caths, and now a Nurse Care Manager with some specialization in HIV, working with poor urban Latino populations. All three positions have been bilingual ones, and all very rewarding in their own way.

Although it would be difficult for me to "sell" myself as a travelling nurse without MedSurg experience, I know I could do almost anything with a little training. My assessment skills have been honed to sharpness due in large part to my history of working in the field, on my own with little back-up, making decisions relatively autonomously.

For any student nurses out there, you can forge a path away from MedSurg and never look back---if you dare!

9:10 PM  
Anonymous Anonymous said...

Brilliant and well-stated. Bookmarking this one. Thanks.

4:12 PM  
Blogger unsinkablemb said...

Great post. I will be re-reading this one as I think about my next move in nursing.

12:12 AM  
Blogger ksipes said...

I'm sorry, and I know that many will not agree with me, but once a nurse becomes a "case manager" he or she ceases to become a nurse in all of the most essential ways. You are owned by managed care. You do not care for patients, you "manage care." Your interests can longer be with the patient. You are a cog in the "holistic, patient driven, pay for performance, care rationing, managed care system. I feel sorry for you.

3:07 AM  
Anonymous Anonymous said...

it'a unfortunate that there are so many licensed nurses not working at a time when there is such a nursing shortage. perhaps, this is some insight into WHY there IS a nursing shortage. the job is rough - poor nurse-to-patient ratios, too much paper work, not only do nurses eat their young, they eat each-other. then, there are the nurse-managers, who forgot somewhere up the ladder that they were nurses too, and provide no support or encouragement to nurses. Heath care institutions treat nurses like factory workers. and the nurse is always the scapegoat if anything goes wrong - and it will when you're working under such stressful conditions. physicians are so rude, they're almost abusive. who in their right mind would wokr under these conditions? sure, there are the "non-traditional" nursing jobs out there, but they usually don't pay that well (hey're less stressful)because they're considered easy nursing jobs. i've been in nursing for over five years, have my BSN, and my goal is my masters in anything that will get me out of this field. until nurses become more cohesive and refuse such treatment, nothing will change. the money may be ok, but for the stress, and responsibility, it's not worth it.

7:24 PM  
Anonymous Anonymous said...

it'a unfortunate that there are so many licensed nurses not working at a time when there is such a nursing shortage. perhaps, this is some insight into WHY there IS a nursing shortage. the job is rough - poor nurse-to-patient ratios, too much paper work, not only do nurses eat their young, they eat each-other. then, there are the nurse-managers, who forgot somewhere up the ladder that they were nurses too, and provide no support or encouragement to nurses. Heath care institutions treat nurses like factory workers. and the nurse is always the scapegoat if anything goes wrong - and it will when you're working under such stressful conditions. physicians are so rude, they're almost abusive. who in their right mind would wokr under these conditions? sure, there are the "non-traditional" nursing jobs out there, but they usually don't pay that well (hey're less stressful)because they're considered easy nursing jobs. i've been in nursing for over five years, have my BSN, and my goal is my masters in anything that will get me out of this field. until nurses become more cohesive and refuse such treatment, nothing will change. the money may be ok, but for the stress, and responsibility, it's not worth it.

7:24 PM  
Anonymous Anonymous said...

I entered nursing at 38 yrs old. I worked the Med-Surge unit for 5 yrs once as an Assistant Mgr. while still caring for 10-11 patients. I worked the Ed for 7 years and tried ICU for 6 mos, I endured the poor staffing, the overtime with no pay and all the other crap. I got my BS in Management because that was my career goal, still un-fulfilled. I continued and got my MBA, I got Med surge certification and the PRI and Screen certification. I am in my 50's and am very active. I've had enough with the bedside. Yet when I go on an interview I'm told either you have been away from the bedside too long, or your degree is not in nursing, or I am concerned that you don't have any experience for a Case Management job. Its one thing or another. If I'm capable and competent to care for human life certainly I can learn the paperwork. Is NY the only city like this. I don't really care if I stay in Nursing or not at this point. I don't want to run all over the city doing home care. Now I'm floundering looking for a job.

4:55 PM  
Blogger KateSez said...

I just found your 2006 post tonight while searching for non-traditional jobs for RN's! I've done L&D since 1985, and before that med/surg & float. Poor KSipes - you really have a chip on your shoulder methinks. Anyway... I am so sick of bedside nursing I could spit nails. I've worked as a military RN, civilian contractor, civil service, and in the private sector. So far, working as a civilian in military facilities has been best. But I'm ready to get out - THANK YOU for this post and encouragement!

12:44 AM  
Anonymous Anonymous said...

Dear anonymous and all those battered RN's out there...I share your disillusionment with the bedside career path. This is my second career and I've been treated like an idiot and abused by staff and MD's since I started. I am one of the half-eaten young, and have witnessed the ugly side of nurse angst. Perhaps there needs to be "new nurse" support groups, or a rising tide of new nurses that won't tolerate the crap. This is not to mention all the other stuff that makes pt care difficult (inefficient systems and incompetent support staff, managers that only want to look good). Sorry, the pay is not worth it...that is why there are alot of nurses that have chosen other things to do not involved in nursing at all.

6:19 PM  
Anonymous Anonymous said...

I just wandered into this site... In need of a job I decided to look..yet again, at nursing after being away for more than decade. I'm a Yoga instructor, I love it and it's a lot of work for little money. I certainly didn't go into either fields for the money. I thought I could make a difference, yoga is rewarding but I've got a mortgage to pay. The thought of hospital Nursing literally turns my stomach. Slave labor is what it was for me. Had it not been for the patients I would've quit a few months after graduation. It did teach me a few things though...you have to teach people to treat you well and when physicians or administrators are not able to change and remember we're all human beings trying to do the best we can than... it's time to move on.

6:09 PM  
Anonymous college degree said...

Great post.

This post is very encouraging and after reading this post I have decided that I will be make sure to be one of the good nurse.

Great Stuff !

:)

Student of Nursing Programs

2:13 AM  
Blogger TERESA said...

Unfortunately, I have become disgusted overall, with nursing; I have been doing private duty for several years, mainly because of the flexiblity it provides to have a life outside of a job....eg. kids and husband....and taking care of MYSELF! But I am so tired of the cutthroat and visciously critical treatment that nurses receive from patients' families and other nurses, that I am just about ready to EJECT from the nursing field! I just want to teach health promotion and wellness, but nobody really wants to listen or be compliant...and I want to teach child health and safetly, but those who need it most won't listen either...and those "social service" type nursing jobs pay very little.....I refuse to kiss "corporate America's ass"....yes, I have an anti-authority attitude....but when something is wrong, I SPEAK UP! However, most "authority figures" don't like that! Anyway, I am "over it" and want to do something else, like run my own business....but WHAT???? It's NO WONDER THERE IS A NURSING SHORTAGE!!!!! THEY ARE RUNNING US OFF~ !!!! Any suggestions out there????
Teresa in Tennessee

2:38 AM  
Anonymous Anonymous said...

The real shortage is in good nursing leadership. All these problems wouldn't come to if we have smart, benevolent nurse leaders paving the way. But the cancer has metastasized leaving behind a culture that is so rotten it drives all the smart, good, sane nurses away from bedside. The one's left behind feel stuck or masochist, or simply in denial. No offense. I am looking to get out after 4 patient years. Yeah, there are great places out there but they are the exception. I have one life to live and I am not about to spend it feeling like I have not the time in the world to practice real nursing in-between senseless in-services, gazillion policies, squillion paperwork, and lateral hate from other spineless nurses who won't speak out to maltreatments but instead take it out on their colleagues. bleh.

2:44 AM  
Anonymous Anonymous said...

I am glad to see a forum for this type of venting. We need that, but its so hard to vent without fear. I too am frankly disgusted with what has become of hospital nursing. It feels as if we are corporate slaves and we are even given scripted responses that we should be using with patients, sort of like grocery store cashiers....Its all about customer satisfaction, never about true healing. Pain management patients can be so abusive, and yet the customer is always right and can have as many narcotics as desired, while unfunded and forgotten elderly suffer from lack of our time. What a money making industry...too bad..and very immoral.

9:45 AM  

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