EMPOWERING. UNITING. ADVANCING.
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Security WON’T Stop Workplace Violence
Nurse Beth ponders retirement Matt and Jesse Malone:
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EMPOWERING. UNITING. ADVANCING.
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EDITORS / CONTRIBUTING WRITERS Mary Watts, BSN, RN Judi Dansizen, MSN, APRN Beth Hawkes, MSN, RN-BC Joy Eastridge, BSN, RN Angela Simpson, BSN, RN Carol Ebert, RN, BSN, MA, CHES, CWP Julie Miller, BSN, RN, CCRN-K Brian Sorenson
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Contents Committed to Each Other — and to Lifelong Learning By Julie Miller
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28
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When Should I Retire?
An Advanced Degree was the Key to My Career
By Beth Hawkes
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Security Won’t Stop The Violence By Angela Simpson
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Got 3rd Act Issues On Your Mind? By Carol Ebert
By Judi Dansizen
Departments 6
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Editor’s Note
Nursing News Briefs
The Best Of...
Calendar
Career Tips
Get Social
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Editor’s Note
Brian Sorenson
Editor, allnurses Magazine
Connect
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Another summer is basically in the books. For kids and college students, that means it’s time to head back to school. For parents, it’s sometimes tearful goodbyes with youngsters getting on the big yellow school bus for the first time or not so youngsters making their way to a sprawling college campus as they take the next step in their education as an adult. For nurses, though, it can be a time to think about furthering your education. In this issue’s cover story, we look at married couples Matt and Jesse Malone and Jeremiah and Caitlin Darnell. They are nurses married to nurses. The similarities don’t end there, though. They have all made a commitment to lifelong learning. Their mantra is simple – “The nursing couple who works, learns, gets certified, has babies and plays together stays together.” It holds true as both
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Contact us
We welcome your story ideas. Reach us at magazine@allnurses.com
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“The aim of education is the knowledge not of facts but of values.” – William Ralph Inge
couples have experienced personal, family and professional growth through their years together. The timing of this story couldn’t be better. It also hits home as I have been working on furthering my own education above and beyond the learning which occurs every day in my job. With ongoing training, seminars and educational modules which I have been completing at a steady pace, I feel an even greater appreciation for the busy married nurse couples featured on the cover of this issue. It can be a struggle to find the time, energy and motivation to sit down after an already long day and learn more – especially when there’s a comfortable recliner practically calling my name. Whatever the case, enjoy this issue of allnurses Magazine and keep on learning!
Nursing News Briefs
Moxi the Robot to the Rescue to Assist Busy Nurses New Alzheimer’s Blood Test Shows 94% Accuracy in Detecting Changes in the Brain Related to Alzheimer’s
Although Alzheimer’s Disease was first described more than one hundred years ago, there isn’t a cure. There are many drugs on the market that can control some of the symptoms but nothing has been found to address the cause of the disease. Researchers at Washington University School of Medicine report they have developed a blood test that can detect early brain changes, allowing patients to begin treatment before brain neurons are damaged beyond repair. Tap to read more!
Many areas of the company are feeling the effects of the nursing shortage. A Texas-based company has created a unique solution. Meet Moxi, the robot who assists nurses by zipping through hospital hallways on supply room pick-ups and time-sensitive secure item transport. Moxi was built by Austin-based Diligent Robotics, which was co-founded in 2017 by Dr. Vivian Chu and Dr. Andrea Thomaz. “Our real vision is bringing robots to markets that are working side by side with people, that are changing the future of work,” Thomaz says. “It’s going to enable people to do so much more.” Tap to read more!
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Nursing News Briefs
Study: Social Workers at Increased Risk of Parkinson’s Disease An observational study in the American Journal of Industrial Medicine has found that women in social work, as well as those in the health care field,
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have a statistically significant increase in risk of Parkinson’s disease after adjusting for outside factors versus women in other professions studied.
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Future studies should determine the factors influencing the higher risk, researchers say. Tap to read more!
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47 States 74 Hospitals 48 Outpatient Centers 100s of opportunities Take a good look at jobs.tenethealth.com Fall 2019
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The Best of allnurses.com Each month, hundreds of amazing articles are published on allnurses.com, below are those deemed the best by our readers!
Ask Me If I’m Safe At Home
Ask your patient if she is safe at home -- even if her husband is handsome and charming, well-dressed and well-spoken. Ask even if you know her husband, he’s the life of the party or you’ve worked with him for years. Ask because maybe you’ve only met Dr. Jekyll; she may be living with Mr. Hyde Read more at http://nurs.es/safe
It’s Official: Workplace Burnout Gets an ICD-11 Code
Did you know that until this week workplace burnout wasn’t considered an actual diagnosis? The World Health Organization made the change this week by adding it as an occupational phenomenon in ICD-11. Discover more in this article. Read more at http://nurs.es/burnout
Nurse Beaten by Patient Denied Request for Unpaid Time Off and Fired
Imagine being beaten on the job, needing multiple surgeries, and then being told that you can’t have more time off and ultimately being terminated. This isn’t just an example scenario for Tina Suckow, an Iowa nurse. Read more at http://nurs.es/beaten
Ohio Hospital Fires 23 After Fentanyl Overdose Deaths
A hospital in Ohio recently fired 23 physicians, nurses and pharmacists after 25 patients died from excessive doses of fentanyl. In addition, 48 nurses and pharmacists were reported to state licensing boards for their roles in the overdoses. Read more at http://nurs.es/ohio
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Calendar of Events A brief and informative overview of events, conferences and special promotions for the nursing community.
TravCon 2019
September 8-11, 2019 SEPT.
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Las Vegas, NV
This is considered a homecoming reunion for travel nurses. Over 1500 attendees are expected and many opportunities exist for obtaining new assignments, networking with other travel nurses and just some general education. Tap here for more info!
Advanced Practice Institute SEPT.
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September 25-27, 2019 Iowa City, IA
The Advanced Practice Institute prepares nursing leaders to guide colleagues and teams in the integration of evidence-based knowledge into practice. For more information, tap here!
ANCC Magnet Conference National Nurses in Business Association Conference SEPT.
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September 27-29, 2019 Las Vegas, NV
This Conference is designed for nurses who are thinking about starting a business, those already in business, and those looking for career alternatives. Nationally acclaimed speakers and business experts will provide nurses with the information, tools and actionable take-a-ways you need to start your own nursing business—or to make your current business even more successful, as well as exposing you to a wealth of alternative career options. In addition, the six preconference workshops will give you in-depth, how–to information, resources, and dozens of tips whether you are a novice or a seasoned pro. For more information, tap here!
OCT.
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October 10-12, 2019 Orlando, FL
This is the largest nursing conference in the US. Inspirational general sessions with dynamic speakers.Happiness guru Gretchen Rubin, nurse and motivational speaker Charles Kunkle, and global adventurer Leon Logothetis will spark your desire to become a better nurse. For more information, tap here!
American Nephrology Nurses Association Nursing Practice Conference OCT.
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October 12-14, 2019 San Diego, CA
The conference will provide valuable information and resources to help you improve your nephrology practice and skills, whether your role includes clinical practice, advanced practice, or management. For more information, tap here! Fall 2019
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Career Tips
Background Check Reveals Arrest. Application to Sit Boards Denied by Beth Hawkes MSN, RN-BC, HACP
Beth Hawkes (Nurse Beth) is an accomplished nurse working in Acute Care as a Staff Development Professional Specialist. She is also an accomplished author, blogger and columnist. As Nurse Beth, she regularly answers career-related questions at allnurses.com. Click here to submit your career-related question to Nurse Beth today or visit https://allnurses.wufoo.com/ forms/z1j8p9o81puszdb/
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Dear Nurse Beth, I have recently graduated from school as an LPN. I just received a letter from state board of nursing saying my background reveals prior arrests, It states that they need a statement on why I fail to disclose the information. I have been in the health field now for almost 17 years. I have been in school for the last 7 years trying to obtain my nursing license from RN to LPN. It has been 20 years since the incident happened and I assumed I was under the first offender act and that I didn’t have to disclose that information because for 17 years I have been putting no to this question and not once have I had any problems. I’ve been working in the hospital for 17 years also sitting with clients, as well as long term facility. I am a licensed phlebotomist. I put no because I assumed that the information was expunged. Is all hope lost for me I have finally accomplished part of my goal being an RN is my passion and I have been fighting so hard? If I cant be a nurse I don’t know what I will do. I need help and some understanding on if I still have a chance being because I told them no for that question. If I knew I had to put yes, by all means, I would have put yes. I really didn’t know and God knows I was never trying to hide anything. I don’t know how to start my appeal or what to say. Could you please if you can give me some clarification on this process? I am lost and I feel like my life is doomed. Dear Background, You hoped if you ignored it, it would go away. You counted on the fact that you had concealed
it so far. You didn’t count on the fact that state boards of nursing conduct FBI level background checks. Nursing schools do not conduct FBI level background checks Employers do not conduct FBI level background checks Government agencies that protect the public do Now you are into damage control with the state board of nursing. Here’s what not to do: Do not minimize it “It was 20 yrs ago” Do not defend falsifying information “I answered no instead of yes because I thought no one would find out” Do not claim innocence “I didn’t know I had to answer truthfully” Before you write your letter of explanation, STOP. Take a deep breath. Your future depends on it. Right now, you are your own worst enemy. You must do a complete 180. If you can get your emotions and defenses out of the way, you have a shot at this. Also, a tip-your email address (not shown here) is cutesy and entirely unprofessional. Get a Gmail account with your name, such as BethHawkes@gmail.com. and use it for any remotely career-related correspondence. You must take complete responsibility for whatever happened and show that you have been rehabilitated. In other words, the letter you submit must be nothing like the one above. Read “Criminal Infraction? Writing a Letter of Explanation to the BON”.
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You must show insight and remorse for your actions. Not just remorse for being caught. You see, the state has one duty. To protect the public. They need to see you are not the person you were back then, and you would not repeat your mistake. How do you do that? Follow the steps in the article above. Depending on the nature of the crime, your rehabilitation, and the length of time since the arrest, I would hope for the best. This can be salvageable. It’s likely that the board has also notified your school. Reach out to the head of your program. It’s possible they will provide a letter of reference based on your performance during school and personal knowledge of your character. Consider consulting an attorney. There’s one on the allnurses site, Lorie Brown, and she has a column, Ask A Nurse Attorney. She’s a strong nurse advocate. I hope you will contact her for recommendations. Best wishes, Nurse Beth Author, “Your Last Nursing Class: How to Land Your First Nursing Job”...and your next!
10 TIPS
TO HELP YOU LAND THAT COVETED NURSING JOB
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Got 3rd Act Issues On Your Mind?
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Are you stressing over entering your Third Act? In denial that it is actually happening? Starting to have thoughts you never had before about “the end might be near?” As a nurse you are well aware that we can’t do our work unless we have a plan and can execute it effectively. So why not apply your nursing talents to creating your own “Third Act Care Plan” with a focus on a holistic approach to all the issues that might be on your mind. Carol Ebert RN, BSN, MA, CHES, CWP
Wellness pioneer, business entrepreneur and creative force for health education, Carol Ebert has an impressive career promoting optimal health through successful behavior change programming, wellness coaching and serving as a role model for the benefits of living a healthy lifestyle. Her passion for wellness spills over into every career choice she has made including nursing, teaching health in public schools and college settings, creating and facilitating wellness initiatives in medical centers, businesses, universities and communities. Fall 2019
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Once you enter your Third Act all kinds of different thoughts start entering your consciousness. Here are some of my concerns I never had to consider before. I’m sure you have even more.
Will I have enough money to live comfortably?
• Not everyone has retirement savings and social security is not enough to live the lifestyle you want. I can attest to that as I am on social security plus have no retirement savings so it is clear that you will need to prepare yourself with other revenue streams you might not have thought of before. • I’m so passionate about wellness that I’m always creating new initiatives that can bring in more money (like the new book I wrote Too Busy for YOU? which targets busy professional women based on what I know about that lifestyle) • What creative ideas do you have for generating more income?
Will I eventually be disabled and dependent?
• I have been extra healthy since most of my career has been wellness focused and I have practiced what I preach. It has certainly paid off as I feel years younger than many my age, but that doesn’t mean some things are starting to deteriorate. For me it is little skin lesions that keep popping up and needing to be biopsied and excised. Or the cartilage in my knee needed to be trimmed due to wear and tear from all the exercise I do. So no matter how healthy you might think you are, there are things that may occur that could impact your quality of life.
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• What are your thoughts about what you would do if you became disabled as you get older?
What if my partner/spouse is gone and I’m all alone?
• It’s a fact that women will live longer than men so odds are you will be living alone at some point. The average American man will live to age 76, according to the latest CDC figures, while the average woman in America will live to age 81. • What ideas do you have for dealing with the issue of being alone?
What will I do with my time if I’m not going to work every day?
• Imagine having all the time in the world with no demands on your time. You’ve probably been dreaming about that for a long time but once you retire it will be a reality. Based on my experience with other friends who are retired, they seem busier than ever and I often hear this: “I can’t believe how busy I am, even more now than when I was working”. Additionally I hear some of my nurse friends who do enjoy the freedom for a short while are then itching to do some work again. • What would fulfill you when you have plenty of time for YOU?
What kind of living arrangement should I consider as I age? • Remember the TV Show Golden Girls where 3 women shared a home together to share expenses and support of each other? That idea is starting to take hold. Online home-sharing websites, workshops and
meetings for prospective housemates are booming. I’ve even been giving it some thought as an option. • What examples of living arrangements have you considered as you get older?
When should I consider down-sizing?
• It’s never too soon to start clearing out all the stuff we accumulate. This issue has really been on my mind because it takes a lot of time and energy to live with and deal with all the possessions we manage on a day to day basis. And why do we have all this stuff? In my case I have a large county property with several out buildings that are full since we live on a hobby farm. Every day I think “how long can I keep up with all this?” And wouldn’t life be simpler if I had less “stuff” to deal with. • What surrounds your life that you know you could live without and how would it make you feel if you had less to deal with?
Should I have a pet, and who will care for it if I die?
This one is big for me because I have always had multiple pets and I know how important they are to my wellbeing. After I lost my last 2 dogs within one week I thought maybe
I’m too old to have a pet, and what if I die and leave it behind. Who would care for it? So what did I do? I got a puppy! But the caveat was it is a breeding dog from another nurse who breeds dogs and needed this little stud to be farmed out to a great family to be raised (that’s me) and just go back to her for breeding purposes. Before I accepted that offer I said to her “What if I die?” She said “I’ll take him back”. I got the answer I wanted and now everyone is happy – especially me! What are your thoughts about having a pet as you get older and what is your strategy? The bottom line for all these concerns, and I suspect you may have other concerns as well, is to not postpone thinking about them but face them head-on and create an exit plan. I often wish my parents had done that for me instead of leaving us in a state of confusion about where everything was that needed to be tended to. And then having to make decisions about what to do with everything that they left behind. It is a daunting task but for us who might be more aware we can take charge and create a plan. It’s easy to remain in denial about the fact that we will die at some point so the more responsible approach is to get your act together and make those tough decisions while you can. I know planning isn’t everyone’s “thing” and I’m not great at it either, but when I do put a plan together it actually reduces my stress and gives me the feeling of being back in control. And your family will love you for it!
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Security Won’t Stop The Violence
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“What if we hire more security at night?� This suggestion is a natural conclusion that many people suggest when discussing violence in hospitals. This particular person was Congressman Dutch Ruppersberger (D-MD), and we were speaking in the weeks following a (false alarm) active shooter incident at Walter Reed National Military Medical Center. Around 2:00 pm on November 28, 2018, an active shooter alert was called at the hospital. This alert, and the panic that went with it, lasted an hour and a half while occupants of the building sheltered in place. The disruption from this event was caused by an error in the usage of a mass notification system. During the lockdown, though, no one knew it was a false alarm, not even law enforcement. Given the recent history of mass shootings and active shooters in hospitals, the possibility of something like this being real likely was questioned by no one. In retrospect, it seems reasonable to assume a larger number of security officers with tighter, more thorough security methods, might prevent mass shootings in hospitals. Security is vital to the day-to-day operations of hospitals. There is no doubt they do keep us safer. There is, however, a pressing issue when it comes to workplace violence in healthcare: even if security is called, assaults often happen before security arrives. When they arrive, the damage is already done. One recent story shared with us by a Silent No More members illustrates this well. A nurse in the ED was hoping to get labs from a sleeping patient. The nurse decided to pull blood from the patient’s IV instead of waking the patient for a needle stick. A patient care tech (PCT) was there to assist. As the automatic cuff inflated, the patient awakened and kicked the PCT in the face using both feet. As the nurse attempted to block the next kick, the patient bit her. The patient held onto the nurse with her biting teeth, then grabbed the PCT by her hair. In the aftermath of that assault, it became known that this patient had a history of violence toward staff and law enforcement. This patient was alert and oriented, and not psychologically impaired by a medical condition. This event could not be predicted when it happened. Adding security would not have changed this. This situation required something altogether different.
So, then, what is necessary? What does work?
The unfortunate truth is that little research data specific to violence in healthcare workplaces exists on this topic. What is clear is that change will require collaborative, multimodality approaches. This is not only about reducing some risk factors. This is not only about hiring more security. This will not only be about legislation. Change requires multiple things. I am a large believer in looking at each assault and determining from its details what can be done differently next time. I had my own similar experience, much like the above story. A sleeping frequent flyer patient with
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dementia had a systolic blood pressure over 200. He had been refusing all medications the entire admission, so I took the opportunity while he was sleeping to try an IV anti-hypertensive. I did not realize his IV was clotted off, which woke him up. I was punched in my head before I even knew he was awake. The similarities between this and the other nurse’s story is clear: a patient was awakened by surprise, and we failed to recognize that in our focus on what we were doing. This is not something that has been overlooked since. Our eyes remain on the patient at all times. The root causes were clear, and we now are safer in our practice. Determining post-assault what can be done differently, is one of the best tools that a nurse has. However, this cannot be used as an opportunity to blame the victim. Too often, stories submitted to Silent No More Foundation are filled with retaliatory actions taken toward nurses who have been assaulted. This is not okay. Nurses need support when a traumatic event happens. Employers can provide self-defense training. This can be very helpful, especially if the self-defense program has experience with self-defense in healthcare. Nurses are in the unique position of being responsible for the safety of the violent patient, in addition to our own. A self-defense training program that recognizes the unique challenges we face can be very empowering. A nurse should know up front the level of force they can use and how to use it if a violent episode becomes inevitable. Another key factor in deterring assaults is to ensure we do not give our patients or their family members weapons that can be used against us. One brief Google search of nurses being strangled by stethoscopes that hung on their necks will return pages of relevant results. We place syringes on ourselves and on our computers, even when they are not needed. What’s worse, we walk away from those syringes or leave them in rooms where patients have access. We also do not consider our position in the room. Do you have a clear path for escape? If a patient makes you uncomfortable, do you bring someone into the room with you? Another personal safety measure: do you communicate risks to the next shift so they can protect themselves, too? Increasingly, resources are being presented through organizations and OSHA with limited data to support their recommendations. It is important that nurses advocate for the changes necessary for the prevention of workplace violence. If there is one thing to urge no matter your employer’s response to these guidelines, it is that each nurse pay attention vigilantly to the patient’s behaviors and movements at all times. Ensure weapons are not attached to you or left in the room. Bring someone with you if a patient is at risk for violence. Always prioritize your own safety. If you would like to learn more, find Silent No More Foundation. Protecting workers from assault is our mission. by Angela Simpson, BSN, RN
Founder & National Director of Silent No More Foundation angela@silentnomorefnd.com silentnomorefnd.com (410)864-0909
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An Advanced Degree was the Key to My Career Nursing is a wonderful career. It has afforded me a comfortable standard of living, and a job where I feel I can make a difference. However, it’s been a journey. by Judi Dansizen MSN, APRN, CNS Judi is an advanced practice nurse in the Midwest. She has over 25 years experience in various nursing roles. Judi is also the allnurses.com Assistant Community Manager.
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There are so many avenues to a nursing career nowadays both traditional like an ADN or BSN and non-traditional direct-entry MSN or DNP programs. All lead to the coveted RN credential. Everyone has a different journey and a different reason for pursuing it. Here’s my story…
The Beginning I was raised in a very traditional household where education was not emphasized. When I graduated from high school I was on my own to move out and get a job. I had worked since I was 16 at the usual high school jobs: fast-food and stocking at a local pharmacy. After graduation, I got a job at a local hospital as a nursing assistant (this was before certification was necessary) and started taking pre-requisites for nursing school. It wasn’t easy working nights at the hospital and going to school during the day. I managed this for approximately a year but then realized I didn’t know if
tests and then signed up. I quit school and within a week or so I was off to boot camp. I had asked for a health-care related job but the military in their own military way decided I was destined to be a journalist, specifically a broadcast journalist. After boot camp, I was off to school again - this time I was to learn how to be both a print and broadcast journalist. Japan was my first duty station: Tokyo was so busy and so big! Quite a bit different from my midwestern roots. I became friends with an Air Force guy and we eventually married. Fast-forward a few years and multiple moves in multiple countries; we moved back to the US. I then realized that I really DID want to be a nurse. So, off to the local community college, I went fully expecting to be greeted with open arms. After all, this was the early 1990’s and there was always a need for nurses, right? Remember when I quit school? Well, guess what? I didn’t drop any classes, I just quit going….I didn’t get a “W” indicating I withdrew from a class. Nope, not me. I ended up with all “Fs” that semester and ended up with a 0.7 GPA. Who knew that you could have a GPA < 1? Apparently, the school wasn’t too impressed either because while they admitted me to the LPN program, they made it very plain I was on academic probation.
LPN Classes
I REALLY wanted to be a nurse. So, one day I decided I needed a change. I went to the military recruiters locally and everyone was out to lunch except the US Navy recruiter. I took the necessary
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I just thought school was difficult when I was working nights! Well, school, job, two children and an active-duty husband who wasn’t always home was ten times more difficult. However, I had a lot more motivation the second time around - I retook all the prereqs and proceeded into the LPN program and clinical and did well. I enjoyed the clinical at the nursing homes and clinics. I was prepared to go on to the RN program immediately after completing the LPN portion of this 1 plus 1 program. Life had other plans though. My husband came down on orders for us to move cross country. So, off we went. I immediately started checking out schools but the waitlist for state schools was 2 years
long. As I was concerned about the possibility of yet another move, I checked out private schools that offered an LPN to RN program. I was able to quickly get into a school that offered a three-semester LPN to ADN program. I had it made!
ADN Program Clinicals for this program were centered in the hospital setting on several types of floors from ICU to OB to medical-surgical to ED. I instantly fell in love with the ED - the chaos, never knowing what was going to come thru the door, the busyness and most of all the adrenaline rush! Wow! I was in my element. However, when I graduated with my coveted ADN and subsequently passed NCLEX, there were no ED jobs available for new grad RNs, even ones with 2 years of LPN experience. Okay, so we
gotta pay the bills and the kiddos gotta eat; I went job-hunting. I landed a job in an ICU at the local VA hospital where I worked for about a year and a half before my husband retired from the USAF. He landed a job in another state so we moved yet again.
Another Move Now, however, I had some RN experience and I was able to get hired into an ED at a level one trauma center. Night shift - knife and gun club, staffing issues, but some of the best years of my career. Fast forward to 2004 and more and more hospitals were applying for Magnet status and I was told I needed to have a BSN in order to advance further. I checked into several schools including the state schools but most were on campus in the classroom. I got my BSN in 2004 and MSN in 2005 from the University of Phoenix. However, the MSN concentration was Management and Leadership so non-clinical. Once I got the MSN it really fueled my ambition to go further. What to do? I shadowed several CRNAs because that sounded like an absolutely cool job and for sure, they made $$$$$. However, I found that I just couldn’t stand still or remain in one little area for a long period of time. The CRNAs I shadowed and those I know today though 100% love their jobs. It’s a great career path. However, I chose the CNS route not really knowing the difference between CNS and NP and I regret that I didn’t do more investigating before registering. In retrospect, this is what I recommend: • Talk to CNSs and NPs, especially those who work in the hospital as well as those in offices and clinics. There are many specialties and types of work environments • Decide in general where you want to work. If you wish to work in the hospital, ensure you have clinicals and choose a concentration which will
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prepare you for that environment ie acute care for critical care or hospitalist role, primary care for clinics or family practice, pediatrics if you want to care only for children • Shadow APRNs in different roles to learn the “real” job of what they liked and didn’t like • Look into the forecast for availability of jobs and the projected vacancy rates (these statistics can be found at the Bureau of Labor Statistics • Join an APRN organization and attend some of the meetings - a great place to network and learn “off the clock” • If you plan to stay at your facility after you obtain your APRN, make sure they project some openings • Look at the certifying organizations (ANCC, AANP, etc) to ensure that your certification has longevity (see Consensus Model) • Learn about legislation and state regulations that might affect your ability to work - again look at the Consensus Model. Does your state endorse this? If so, how will it affect your ability to get a job in the specialty where you wish to work?
What Did I Choose? In the end, I did opt for an adult health CNS. When I finished in 2006 there were few jobs in the area and I wasn’t able to move due to a family situation so I continued in the ED for another 3 months. I interviewed at several private practices and was fortunate to get hired in large well-respected nephrology practice. I’ve been in my position for over 13 years. Along the way, I went back for a pediatric CNS and as a result, I can see all ages. It has been a journey and one with many steps. There are certainly easier ways to get an advanced
degree but I certainly do appreciate it. The advanced degree:
• Opened the door for much more autonomy • Allowed me the schedule flexibility so that my work-life is balanced • Afforded me benefits that include a very generous PTO allowance as well as a generous salary • Offered me the chance to precept and impact student APRNs in different settings • In conclusion, I do feel that an advanced degree was the key to my career! Don’t let life slow you down.
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by Beth Hawkes
MSN, RN-BC, HACP
My Struggle... Elephant in My Room
I didn’t sign up for this annoying aging thing, but I am getting older. Apparently. I’m 66, at last count. Which I’d like to point out is my early middle sixties, not my late sixties, or even my late middle sixties, but...even so. Unacceptable. Actually, kidding aside, I’m really fairly OK with the aging. It’s not the getting older, per se, that is bothering me. Fall 2019 allnurses
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It’s the big looming elephant in my room. Retirement. Until recently, it wasn’t even remotely on my radar. It was something that happened to other people. Other people as in old folks. I’ve been insensitive, especially when I realize that I’ve been able to work this long while others, even some young people, did not have that choice. But more and more, retirement seems like a real thing. For me. What I don’t love is how thinking about retiring is forcing me to examine myself.
sometimes daily. That’s a change. I think more in terms of not being at work than of being at home. By that, I mean I see it framed more as a loss than a gain. Recently I was awarded Nurse of the Year in my county by ACNL in the Lifetime Achievement category. Another sign that my career’s at the tail end? Then there’s my health. My back went out recently and I thought, “Is this it?’ but then I recovered. To work another day, month, maybe years? Weary Short Timer More and more I have the mindset of a weary short-timer. I no longer fight every battle, because maybe I’ll be gone before it all matters, anyway. I think I’ve distanced a bit, but then it never sticks. I haven’t quite reached that tipping point of disengagement. Sometimes I’ll sit back and see a decision being made and just shake my gray-haired head. But... no one asks me. Admin, “Beth, you’ve worked here as a professional clinician for over 10 yrs. What do you think? Will this new initiative work?” (scenario that never happens)
Signs it May be Time
There are signs. Friends and colleagues around me are retiring like flies. I have to ask myself if they know something I don’t. Like when to quit. Sometimes I feel like the last one standing. There’s actually a small group of us my age in the hospital, and we fist-bump or high-five when we run into each other out and about in the hospital or in the elevator. “Still here, right?” “Yep!” We talk in low tones about “How much longer do you have?” knowing it’s not wise to talk openly about retiring at work until you’ve decided. I’m aware I think about retirement more often,
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Then again, it’s not that they ever did ask me, but my tolerance for repeated mistakes is lower. I’ve seen the pendulum swing to the right and then to the left and back to the right again on any given issue. It’s a bad case of “Been there, Done that”. I lack enthusiasm for the Flavor of the Month. I zone out if someone starts saying they want to “move the needle” or do or don’t have the “bandwidth” to “pick the low-hanging fruit”. Just don’t admonish nurses to be “more resilient” when taking away resources. It’s not an opportunity to “do less with more”, it’s short-staffing. So I guess I’m still plenty passionate. I just don’t want to hang on too long as that old, negative, jaded nurse. I love what Laura Gasparis Vonfrolio, nationally
known CCRN guru and speaker, said when I asked her why she still works in ICU. She paused and said, “To be a pain in their a**”
I dread the, “Hi! What do you do?” “I’m retired” encounter. If I’m not an experienced, competent nurse, then who am I? I like being an expert. What good are all my certifications and accomplishments in retirement? Is my ego really as big as all this sounds? Now that’s scary. Shouldn’t I base my self-worth on how good of a person I am? I thought I was secure but maybe I’m actually deeply insecure. And am I over-analyzing all this? Probably.
Grief and Fears
Grief is not too strong a word when I think about my retirement. I’m grieving a stage of my life. The biggest, longest stage. Leaving my job is a loss. A loss of who I am and a loss of the community I’ve been a part of for 40 years. I’ll be in a new community. The AARP retirement community. Yikes. I’d miss helping nurses pass their Arrhythmia exam and connecting with the fresh and bright newly licensed nurses in each new cohort. I’d miss my work team and I still love my job. I’ve never been fearful. I wasn’t afraid to leave home when I was 16. I wasn’t afraid to leave an unhealthy marriage. I wasn’t afraid to attend nursing school as a single parent of 3 little ones, with no financial support. I wasn’t afraid to be a nurse manager and I wasn’t afraid to write and publish a book. I’m not afraid of taking exams or even of public speaking. But retirement? Terrified. Well, maybe not terrified. But maybe, yes, a little terrified. What’s so scary? At heart, it’s a loss of identity, of status.
Changes
Then there’s finances. Have I saved enough? Will I be able to live with a new budget? Maybe I spend more money than I realize on work, like gas and potlucks and gifts and clothes, and I’ll save money like others tell me. Or will I have to pinch pennies to buy my grandchildren birthday gifts? How about my extensive work wardrobe? I work out of an office, some days I wear scrubs, and other days I wear clothes under a lab coat. I love expressing myself through my clothes and colors, and combinations. And shoes. And accessories. Will I be relegated to lounge wear? Will I schlep around in boring leggings, T-shirts and flipflops? Vain much? Guilty. My vanity needs some structure. Or will I turn into a couch potato and not get dressed at all? Without my existing structure will
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I be lost. Is this the beginning of the end?
write a novel or maybe an autobiography.
What will being with my loving husband 24/7 day in and day out be like? Granted, we’ve been married for 21 yrs., but not during the work week. I’ll be switching my work wife for my husband.
I’ll spend more time with family, and I’ll travel more. Garden. Maybe I’ll do take up mosaics.
Options
Maybe I’ll volunteer. But then I laugh and think, “Right!”. In less than 2 months, I’d probably try to re-organize and take over whatever poor, unsuspecting organization that takes me on as a volunteer. In other words, I’d be working, not volunteering. Fortunately, I do have other options. I have purposely built bridges to help me transition, such as my side jobs as a nurse writer and subject matter expert. I could definitely spend more time on my blog, nursecode.com., which I would love to do.
I’ll visit my sister in the fall in Vermont and watch the leaves change together. I love to learn, I live to learn, and that needn’t change. Maybe I’ll read the classics and Shakespeare and learn something new. Study a new language. I’ll sit with this upcoming shift in my identity. It’s my next major life challenge. Deep breath. I’m going to rest in the not-knowing and stay in this space, not avoid it. I can do this. I think I’ve decided. I’m not going to retire, not right now. I’m warming up to it. But I’m not there yet.
Epilogue
But how relevant will I be as a blogger if I don’t know the very latest thing happening in hospitals? What if they initiate electronic white boards or robots or something and I’m not there to critique it, make all my jokes about it?
So my husband just sat down beside me and asked me what I’m writing. I told him it’s an article titled “Retirement: My Struggle”. He laughed out loud, which I wasn’t expecting.
Final Finale Thoughts
“Yes!” (laughing harder)
According to Erik Erikson, I’m officially in the final developmental stage of my life- integrity vs despair. I choose integrity. That means not having regrets when I look back. But I do have to reflect on myself closely in order to move forward authentically and grow.
“Really? So, what about it is funny?” (puzzled)
In retirement:
I can channel my creative energy. I have a huge amount of creative energy and I spend a lot of it for my employer in my practice as a Nursing Professional Development Specialist. Maybe it will be amazing to channel all of it on what I choose that day. Every day. I’ll write another book. I’ve always wanted to
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“Is that funny?”
“Beth, you’re not struggling!” “I’m not?” “No! You have too much fun at work! I watch you every day. Honey, you love what you do” Oh. Right. He’s right
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Committed to Each Other — and to Lifelong Learning It’s often said that the couple who plays together stays together. In the nursing world, we can extend this saying to read, “The nursing couple who works, learns, gets certified, has babies and plays together stays together.” The two couples featured here — Matt and Jesse Malone and Jeremiah and Caitlin Darnell — are nurses married to nurses. For both couples, their shared nursing careers provide the impetus for their personal lives, outside interests, individual growth and commitment to lifelong learning. by Julie Miller BSN, RN, CCRN-K Julie Miller is a Clinical Practice Specialist at the American Association of Critical-Care Nurses, where she serves as clinical lead for AACN’s flagship Essentials of Critical Care Orientation online course.
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Jeremiah and Caitlinallnurses Darnell Fall 2019 35
Matt and Jesse Malone
In 2017, Matt and Jesse Malone had the kind of year they will never forget. In addition to preparing to welcome their first child, Trevor, into the world in early 2018, they studied together and both earned their CCRN critical care nursing certification in October 2017. The Malones, who both worked as nurses in the Surgical ICU at Inspira Health Network in Vineland, New Jersey, met through mutual friends, got to know each other while socializing with their friends, and dated for a while before getting married in 2012. Both had individual goals of being certified; they decided to make it a mutual goal. “I knew I wanted to be certified from the moment I became a nurse,” Jesse says. “I knew it confirmed my expertise.” Matt says that his employer, MidAtlantic MedEvac/AtlantiCare Flight Team, in Atlantic City, New Jersey, is very supportive and encourages all of their nurses to be certified in their specialty. So he set it as one of his goals on his evaluation that year. Jesse says that the couple had been trying to get pregnant around the same time they decided they also wanted to get certified.
“I said either we do this now, or it may be a long time before we’ll be able to do it” 36 Fall 2019
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“One day, I just had a feeling — that it had happened,” she says. “I said, ‘We need to go to the drugstore.’ I found out I was pregnant that day — on Matt’s birthday, June 27!” Matt says the experience of finding out Jesse was pregnant meant the two “had to buckle down and get certified.” “I said either we do this now, or it may be a long time before we’ll be able to do it,” he says. They both describe the experience of preparing for the exam as going “pretty smoothly.” “A lot of the nurses we worked with were really awesome, loaning us books and encouraging us,” Jesse says. “My hospital and Matt’s unit were great to us. And we really did buckle down.” Matt says they were both committed to getting certified, but because of Jesse’s pregnancy they had to be flexible. “We scheduled mini-workdays where we would plan to just study for the exam,” he says. “But then Tuesday would roll around, and Jesse would be too tired or under the weather, so we’d change our plans. We’d watch Netflix instead. But we committed to studying and most of the time followed through when we could — unless we needed to go for a latenight pregnancy-related milkshake run!” The couple took the exam in October 2017 — week 20 of the pregnancy. “We got our high-quality ultrasound picture the week before we took the exam,” Jesse says. “We brought it with us for inspiration.” The inspiration worked. Both Jesse and Matt passed the exam on their first attempt to become CCRNs. “The experience of finding out at the same time that we both had passed was wonderful,” Matt says.
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“I’m so glad we went through the experience of getting certified together,” Jesse says. “We were able to bring different ideas and views to the table. If one of us understood an idea and the other didn’t, we could explain it to each other.” And how did the experience of becoming certified change them? “We grew as people,” Jesse answers. “I’m a better nurse as a result of being certified. I’m more professional.” The two also decided in advance that if one of them had failed the exam, they would treat it as though both of them had failed. “We would continue to study the way we did before,” he says, “until we both passed.”
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Jeremiah and Caitlin Darnell In many ways, Jeremiah and Caitlin Darnell’s story mirrors Jesse and Matt’s story. When they met, they both worked at the same hospital, Scripps Memorial Hospital in La Jolla, California. But it took a chance meeting at a nursing conference — the American Association of Critical-Care Nurses’ National Teaching Institute & Critical Care Exposition in 2012 in Orlando — for them to connect. Caitlin, whose specialty is cardiac surgery, describes their whirlwind courtship: “I was attending the NTI pre-conference for CCRN. Jeremiah already had his CCRN, but he was going to the review to accumulate more knowledge. We met each other while getting coffee, and we spent the rest of the conference pretty much inseparable.” She says the two attended conference sessions during the day and then at night would explore Orlando together. “We went gator hunting, mini golfing, ran around Disney World,” she says. “We had a great time together, and then once we went back to California, that was it — we started dating and got married two years later. Now, we’re expecting a baby.” Jeremiah, who works in a neurosurgical trauma critical care unit, agrees that it seems like a whirlwind and says that was in part because they connected so quickly and strongly based on the bond all nurses share. “Nurses have a very special way of communicating with each other and dealing with stress,” he says. “Our humor levels are the same. It’s a very, very strong and important bond that nurses share.” Caitlin agrees that the shared profession offers opportunities for growth for each other. “I think being in the same profession impacts Fall 2019
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our relationship positively because we work with a lot of the same people,” she says. “When we come home, we’re able to debrief with one another about certain people we work with or with the situations that are going on.” She adds that sharing information and helping each other learn more about the work they do are side benefits of being married. “We like to learn similar things,” she says. “So when I learn something at work, I run home and I tell him, and then he can apply it in his unit. It’s this nice knowledge share.” The knowledge share even extends to the area of certification, where each helps the other to succeed. “I obtained my CCRN a few years before Caitlin did,” Jeremiah says. “When I went back to get my CNRN for neuroscience, she helped me study, would quiz me, run me through, and then offer insights and tidbits that I hadn’t thought about. It’s just one of the perks of being with someone who understands the thought processes and the science behind it. It is a pretty incredible thing to share.”
“...If we’re doing this work, we feel we should be certified in our specialty. It just makes sense.” Caitlin agrees that having a supportive relationship with a person who understands the nursing world is of paramount importance. “Jeremiah got his CNRN, and that encouraged me to go get my CCRN,” she says. “Then I plowed through that, and he helped me. It’s a great, supportive relationship to have.”
Growing Together For Jeremiah and Caitlin, the foundation of nursing that they share is invaluable, but they point out there are enough differences that they feel they are continuing to learn and grow on their own paths.
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“This is great,” Jeremiah says, “because we can come together and share those things. When you learn from each other, it really helps elevate both of your practices and your personal relationship. You both continue to grow together.” Matt and Jesse share similar sentiments. They say becoming certified should be a priority for all nurses — married or single. “It’s not just your job,” he says. “It’s your career. You should take it seriously by getting certified. Also, pair up with someone if you can. It is a huge help in staying motivated throughout the hours of studying required.” Jesse concurs. “We decided to get certified mostly because of self-pride,” she says. “But if we’re doing this work, we feel we should be certified in our specialty. It just makes sense.”
Matt Jesseallnurses Malone Fall & 2019 41
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