RN/BSN Special Issue January 2023

By Julia Quinn-Szcesuil

Michele Wojciechowski

Louis Pilla

Editor’s Notebook

Happy Nurse New Year! It’s 2023, and time to turn your resolutions into attainable goals!

Some of your goals might be to get away from the stress and burnout, while others want to learn new skills and take on a new role. The sky is the limit for today’s nursing professionals with advanced degrees to define success on their terms by creating the career they truly want.

If you’re considering a career pivot, be sure to have a process in place so you can continue to grow your career in ways that fit who you are today and who you want to become tomorrow.

Here are a few points to consider as you begin your nursing journey in 2023.

• Discover your strengths. What area of nursing do you excel at to make the best use of your talents and skills?

• Decide what you want. For example, do you want a better work-life balance, higher pay, more flexible work schedule?

• Research careers and salaries. Consider annual compensation, work hours, and benefits that address your needs.

• Consider more education and training. Advanced education is key to creating the career you want, so check out online nursing programs that fit your lifestyle.

• Become a nursepreneur. You have the training, skills, and education, so why not leverage the professional skills you’ve built as a nurse to become a liaison to your clients and provide needed, valuable services to your community?

This month, Minority Nurse focuses on leveraging your RN to BSN, nursing careers, and nurse residency programs.

• Beginning an entrepreneurial nursing path begins with an RN to BSN, and Julia Quinn-Szcesuil details how advanced degrees clarify goals and help you earn more valuable skills.

• It might seem a bit overwhelming when you’re a new nursing graduate starting a new job, so Michele Wojciechowski profiles nurse residencies and how they can help.

• The darkest days of COVID brought ethical conversations to the fore. Louis Pilla explores the role of the clinical ethicist in 2023.

“To know even one life has breathed easier because you have lived. This is to have succeeded.”

– Ralph Waldo Emerson

-Reneé

Beginning an Entrepreneurial Path: How an RN-to-BSN Offers Time to Clarify Goals and Earn More Skills

BY JULIA QUINN-SZCESUIL

Nurses are often advised to pursue advanced degrees, beginning with a BSN. The additional education offers deeper critical thinking, business, and nursing knowledge and skills. But many nurses find that earning their RN first and then beginning a BSN program later–an RN-to-BSN path–gives them hands–on experience and time to further define and clarify their goals. For some, the process gives them the training and inspiration to begin an entrepreneurial path.

Entrepreneurship isn’t a quick path to success or money, say nurses running their businesses. Their work hours routinely rival those of back-to-back shifts, which are the final point for the business’s success or failure. But nurses who choose to combine a business and nursing path say they do so because of their deep devotion to nursing and patient care.

Their desire to make a bigger impact doesn’t always fit into a traditional nursing role. “You’re not a traitor if you leave the bedside,” says Veronica Southerland, RN, BSN, FNP-BC , founder and CEO of Vee the NP, and author of A Nurse’s Journey To Entrepreneurship. “It’s not that you don’t care.”

“You’re not a traitor if you leave the bedside.”

As nurses progress through a career, some decide that the traditional path isn’t for them.

“When I worked in a hospital system, I had ideas and wanted to do something with them, but I felt that I wasn’t seen, heard, or appreciated,” says Catie Harris, Ph.D., MBA, RN, and founder of NursePreneurs

“I had the urge to do something bigger for myself.”

Southerland agrees, noting that an entrepreneurial path offers a professional choice many nurses aren’t aware of. “You don’t have to be the boss,” she says, “but if you want to, you can be.”

Using All the Skills

For Harris and Southerland, entrepreneurship gives them the freedom to pursue ideas and the authority to make them happen. As someone who helps nurses on this path, Harris says it’s exciting to see nurses start a business and then also assume the leadership role of running the business–and succeeding.

are most problematic in the industry.

successful offices, she quit her direct nursing role to become a full-time entrepreneur. But when the 2008 stock market crash effectively wiped out most of her business, Southerland returned to school for her MSN/FNP.

Harris, who initially earned her RN before pursuing her advanced degrees, says the work experience and additional education offer different growth opportunities. However, connecting with nurses with business experience is especially helpful. Harris, who now connects nurses interested in entrepreneurship, says talking with nurses who are entrepreneurs helps you avoid some common pitfalls and learn from their experiences.

“If I wanted to do anything, I needed to get the BSN.”

By chance, Southerland found personal benefits in IV hydration and changed her business focus to that area. Her expertise, she says, is something she is driven to share with others. “It’s a successful model,” she says of the medical and business approach. “If I can do it, you can do it, too. I enjoy helping other nursing entrepreneurs look at why they should do this. But, ultimately, they want the freedom to run their own business.”

Find a Network

Shawn Nixon, MSN, APRNCNP, owner of Affinity IV Hydration & Med Spa, is one of Southerland’s mentees. Before opening his IV med spa business in 2022, Nixon took a winding path to entrepreneurship, but the experience gave him the time to fine-tune his goals.

“Nurses have the skill set they need to get started in business,” she says. “They have critical thinking and listening skills and know how to operate on a shoestring budget.” As frontline workers, nurses also have first-hand knowledge of the issues and processes that

Southerland went into nursing after a career in human services and spent five years as an RN before pursuing her BSN. Her first taste of entrepreneurship came when she started a home care-focused company while still an RN. “After opening my business, I knew I needed to go back to school to get my BSN,” she says. “If I wanted to do anything, I needed to get the BSN.”

When Southerland’s business grew to encompass six

Nixon began with EMT basic certification before earning his RN and then a BSN and MSN/ FNP. As an NP, Nixon was on a fast-moving path with hospital supervisors encouraging him to pursue administration, but it didn’t feel quite right. “That’s what they saw for me,” Nixon says, “but I didn’t see that for myself. I wanted to create my own space and my legacy.”

Seeking some information about entrepreneurship, Nixon and Southerland had a discovery call that ended with some tough feedback from Southerland. “She asked me questions like who are you,

“Nurses have the skill set they need to get started in business.”

what do you want, and how do you want to serve people,” he says. “And I couldn’t answer her.”

Although Nixon has been grappling with those questions, his hesitation was a needed revelation. “She gave me a starting point,” he says, noting that his bedside nursing experience is essential to his business practice.

Make a Plan and Protect Yourself

Southerland encourages nurses interested in an entrepreneurial path to follow their passions. But she also cautions that taking the time to develop a solid plan will help protect you.

For example, when Southerland’s initial business fell apart, she still could work as a nurse because she kept her credentials current. “Protect your nursing licensing at all costs so you can always go back.”

And also know that failure is part of the entrepreneurship process.

“You discover something about yourself each time you fail,” says Nixon, “and you’ll fail many times before you do well. It’s about resilience. You have to be comfortable with being uncomfortable.” Harris agrees. “What you do from the present on is the potential of what could happen,” she says. “The universe will send you all kinds of obstacles. So stay persistent in your belief.”

Julia Quinn-Szcesuil is a freelance writer based in Bolton, Massachusetts.

Sotherland encourages nurses interested in an entrepreneurial path to follow their passions.

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Determining Your Direction: Nurse Residencies and How They Can Help

BY MICHELE WOJCIECHOWSKI

When you’re a new graduate of nursing school, you get your RN licensure, and you’re starting a new job—it might seem a bit overwhelming. Sure, you’ve treated patients during your clinics, but now you’re on your own.

But you don’t have to be. You can pursue a nurse residency.

Physicians and other healthcare workers are known for having residencies. However, in nursing, the formal nurse residency program was founded in 2000 by the American Association of Colleges of Nursing and the United Health System Consortium, says Yvonne Eaddy, RN, BSN, MSN, Vice President, Regional Patient Care Services, Home Care from VNS Health. Residencies were started “to support the onboarding of new graduate nurses. Over the years, nurse residency programs have been established nationwide.

While not all nurses take residencies, they really can be beneficial.

“Nurse residency programs help transition graduate nurses into bedside clinical practice. Ideally, the program will help new-to-practice nurses develop critical thinking skills while utilizing the knowledge acquired during nursing school,”

“Nurse residency programs help transition graduate nurses

into bedside clinical practice. Ideally, the program will help new-to-practice nurses develop critical thinking skills while utilizing the knowledge acquired during nursing school,” explains Kathleen Gaines, MSN, RN, BA, CBC, and News and Education Editor at Nurse.org. “The length of nurse residency programs depends on the hospital and the unit. Typically, nurse residency programs last roughly a year; however, nurses working in a critical care setting can expect residency programs to last closer to two years.”

In addition, a nurse residency program can also support the transition to those nurses who are new to their specialty field, says Eaddy. “New nurses can feel overwhelmed and need to be supported to build their confidence in their knowledge and skills as they transition to practice.”

Nurse residency programs can be quite easy to find. Gaines says interested nurses should consider local hospitals they may want to work for and check their websites. Eaddy adds, “Healthcare organizations publicize their residency programs on job search platforms, their websites, LinkedIn, and career search websites.”

If you’re not sure what a nurse residency is or how it works, Eaddy says, “A residency program provides extra guidance and support to new nurses as they prepare to practice independently, can help build job satisfaction, can reduce turn-over, and improve retention." Residency programs focus on supporting the transition to practice from

the academic setting and the transfer of knowledge and skills to actual practice.”

“Residency programs focus on supporting the transition to practice from the academic setting and supporting the transfer of knowledge and skills to actual practice.” She also adds, “at VNS Health, our nurse residency program for our home healthcare nurses is a two-year program with an evidence-based curriculum to support the transition to practice of the new graduate nurses or nurses new to the specialty field with less than a year of nursing experience.”

“Throughout the residency process, most new-to-practice nurses will be paired with a preceptor and/or mentor. This experienced nurse will help guide you through orientation and be there to support you,” says Gaines.

Nursing residencies are available in all different areas of nursing. However, Eaddy says the type of residencies offered depends on each organization's wants.

What should nurses expect from a residency?

“Once accepted to a residency program, a nurse resident can expect to participate in classroom sessions, become knowledgeable about organizational policies and procedures, build new skills, and engage in

hands-on clinical experience supported by an educator, a preceptor, and their program or clinical director /manager,” explains Monica Cayemitte, BSN, RN, Clinical Manager, Nurse Residency Program, Home Care from VSN Health. “Nurse residency programs are offered as part of the onboarding process of the hiring organization. There is no cost to the participant. A resident is a salaried employee of the hiring organization.”

The biggest challenges of nurse residencies tend to be with time and commitment. “A concern with nurse residency programs is that most nurse residency programs do require a long-term commitment from the individual. For example, most programs require nurses to sign a minimal one-year commitment after the end of the residency,” says Gaines. “Another significant concern is the lack of control over your schedule.

After being paired with a preceptor or mentor, you will

“Once accepted to a residency program, a nurse resident can expect to participate in classroom sessions, become knowledgeable about organizational policies and procedures, build new skills, and engage in hands-on clinical experience supported by an educator, a preceptor, and their program or clinical director /manager.”

be assigned to work their shifts. This means you may work weekends, nights, or holidays.”

Cayemitte adds, “They need to be able to give the required time commitment for a residency, as determined by the organization. There is also a classroom component and time spent on building and developing clinical skills; there is the time adjustment to the work environment, learning a new work schedule and job responsibilities.”

But, as our sources indicate, the benefits are worth it. “Nurse residency programs help new nurses gain confidence and expertise in a specialty,” says Gaines.

“Rewards of residency programs include developing critical competencies like communication, critical thinking, problem-solving, and decision-making abilities,” says Cayemitte. “In addition, residencies strengthen hands-on planning and care-delivery

skills. For example, residents build self-confidence through practice; they build camaraderie and friendships by being part of a cohort with fellow residents and have dedicated role models with their preceptor/ mentor.”

Michele Wojciechowski is a national award-winning freelance writer based in Baltimore, Maryland. She loves writing about nursing but comes close to fainting when she sees blood. She’s also the author of the humor book, Next Time I Move, They’ll Carry Me Out in a Box.

Exploring the Role of the Clinical Ethicist

By LOUIS PILLA

The darkest days of the COVID-19 pandemic brought ethical conversations to the fore about allocating scarce resources such as ventilators for acutely ill patients and PPE for clinicians. Such discussions called for the expertise of clinical ethicists, who offered perspectives and insight on these most fateful decisions.

Although those pandemic conversations are in the past, clinical ethicists continue to grapple with issues affecting healthcare delivery. Read on to learn what clinical ethicists do and whether this role might be right for you.

Dealing with “Ethical Angst”

Clinical ethicists are responsible for addressing the ethical issues or challenges that could arise within a hospital or other healthcare organization, according to Connie M. Ulrich, Ph.D., MSN, RN, FAAN, Lillian S. Brunner Chair, professor of nursing and professor of medical ethics and health policy, University of Pennsylvania School of Nursing. Ulrich speaks from deep experience, having been the first nurse trained in bioethics as a postdoctoral fellow at the National Institutes of Health from 2001 to 2003.

think because I saw ethical issues with children and their parents and how parents had to make very difficult ethical decisions, I felt as though I needed to learn more about some of those ethical challenges and how I could best help myself, but also help others in the process,” she says.

Clinical ethicists may be called to consult on or provide an objective analysis of a situation that has created “ethical angst,” she says. For instance, clinicians might struggle with ethical concerns about an endof-life issue or conflicts arising between clinicians, patients, and family members on treatment goals.

During the COVID-19 pandemic, clinical ethicists helped organizations think about handling the influx of seriously ill patients and allocating limited resources, notes Ulrich. Ethicists “were critical to decisions being made within hospitals,” she said in an interview.

Nurses Well Positioned

Most clinical ethicists hold an advanced degree, notes Ulrich. Clinical ethicists can be physicians and nurses with a master’s degree or a doctorate.

“Any nurse should consider this career path,” says Ulrich. “I encourage any nurse interested in ethics or bioethics to consider this career path because I believe they are well positioned to address the daily ethical concerns within hospitals or other organizations.”

Gallup’s annual ranking of professions for having high honesty and ethics. “This sense of trust is key for working collaboratively with other clinicians, patients, and their families on some of the most difficult decisions they often have to make,” says Ulrich.

Clinical Ethicists and COVID-19

During the COVID-19 pandemic, clinical ethicists faced a series of perhaps unprecedented challenges. A study authored by Ulrich and others published earlier this year in AJOB Empirical Bioethics detailed five themes:

• ethical issues that were increasingly more complex

• moral distress that was “endemic”

• shifting ethical paradigms from the focus on the individual to the population

• fostering a supportive environment

• organizational ethics: variation in the value, roles, and policy input of clinical ethicists.

“Nurses are also excellent listeners,” says Ulrich. “They’re organized and systematic in their thinking. These characteristics are all very good and important for conducting an ethical analysis.”

“We also live in a very diverse society,” she notes. “So, I would argue that we need individuals who can bring different cultural and social perspectives to the complex ethical challenges the public faces.”

“The most significant finding for me was the sense of profound moral distress that we did see from nurses and physicians,” says Ulrich. “Clinical ethicists were feeling morally distressed as well. And in many ways, we were unprepared for the physical and emotional toll the pandemic has taken on the healthcare team.”

Dealing with Risks

As to her background, Ulrich trained as a pediatric nurse. “I

For one thing, nurses remain the most trusted profession in the U.S., as they have year after year. In Gallup’s annual rating of the honesty and ethics of various professions published in January 2022, for the 20th straight year, nurses led

Nurses can gain experience in this field by serving on an ethics committee, Ulrich notes. They can become “an excellent resource for others on their unit who might have ethical issues and concerns.” She notes that most hospitals have an ethics committee, though that can vary depending on geography.

“One of the issues that I’m still not settled with is how much risk nurses should accept when they were placed at risk within their organizations because of a lack of personal protective equipment and other resources,” Ulrich says. “That was a major theme that we heard from clinical ethicists.”

“Certainly, I know from my nursing practice that there are inherent risks in being a healthcare provider, and to some degree, we accept those

Clinical ethicists are responsible for addressing the ethical issues or challenges that could arise within a hospital or other healthcare organization.

“I encourage any nurse interested in ethics or bioethics to consider this career path because I believe they are well positioned to address the daily ethical concerns within hospitals or other organizations.”

risks. But it was very disheartening to hear the many stories of moral distress and how our colleagues tried to overcome the limitations by devising their protective gear, in some instances, so they could continue to care for their patients. This just should not be the case. Rightfully so, there was fear and anxiety, which we also heard throughout the study.”

“We also need to think about the ethical care required for our nurses, physicians, clinical ethicists, and other individuals who support that care and the treatment of those patients in hospitals across our country.”

Changes Needed

With the recent COVID-19 experience in mind, Ulrich points to three changes needed for ethical care. First, “every clinician should know what resources are available to them within their healthcare organization and how they can access them without fear of retribution.” For instance, nurses should know if their organization has an ethics committee open to all employees, patients, and families. They should also understand whether mental health resources are readily available. Second, during COVID-19, nurses themselves became ill and could no longer work, she notes. “Nurses cannot provide ethical care for patients and their families when they are physically, emotionally, and morally ill themselves,”

Ulrich says. “How do we build a sustainable workforce given the demands that the COVID-19 pandemic placed on clinicians?”

Finally, she notes that ethical care often focuses on patients and families. “I would argue that we also need to think about the ethical care required for our nurses, physicians, clinical ethicists, and other individuals who support that care and the treatment of those patients in hospitals across our country. How do we ethically care for them when they were suffering in a system that should have protected them, and how do we determine what the ethical care should look like as we move forward from the pandemic?”

“We need to focus on our clinicians, nurses, physicians, and others,” Ulrich says. “We need

to listen to their concerns. We need to provide empirical evidence of their ethical issues, and we need to continue to stress their value to the public and with the leadership team within health systems if we want them to flourish and remain in their organizations because vulnerable patients rely on their expertise and certainly their skilled assessments.”

Louis Pilla is a seasoned publishing expert with over 20 years of experience providing content and digital products to healthcare audiences.