Product Description

Your Career in Nursing, Fifth Edition features:

• Valuable advice for updating and upgrading clinical skills
• Practical business tips for entrepreneurial and freelance nurses
• Profiles of real nurses who have adapted their careers
• A description of the different disciplines available for registered nurses
• Updated nursing resources
• Tips for new nurses

Product Details

• Amazon Sales Rank: #84839 in Books
• Published on: 2008-12-02
• Original language: English
• Number of items: 1
• Binding: Paperback
• 320 pages

About the Author
Annette Vallano is a clinical nurse specialist and practitioner in psychiatric mental health nursing in private practice in New York City. She is the founder and director of the Self Care Center for Nurses, an organization established in 1987 to teach and promote self care and personal empowerment strategies for nurses.

Excerpt. © Reprinted by permission. All rights reserved.
Chapter One: The 21st Century Nurse

In these first few years of the 21st century, we live in uncertain times, in the rapidly evolving times inherited from the jolting changes of the previous decade, and in the shadow of terror from the September 11th attack on America. The 1990s saw the birth and rapid growth of the age of information, in which technology exploded into our lives, and computers transformed how we used and accessed information, and the connections we made to one another as a result. The proliferation of fax machines, cell phones, and email created new communication possibilities that blurred the boundaries between work time and personal time, a phenomenon as exciting as it was overwhelming. The turbulent '90s created a stressful state of paradox that became the psychological hallmark of that time, and ours as well.

THE HEALTHCARE REVOLUTION

The 1990s were also the beginning of the healthcare revolution, in which historical as well as social, political, and economic factors led to the onset of managed care with its fiscal restraint. Managed care in turn led to organizational reengineering and the era of downsizing, in which job security was threatened for millions, including nurses, for the first time in the history of that profession. Interestingly, despite the artificial surplus of nurses created by the economic necessity of downsizing, there was still a nursing shortage that was growing more severe as the 1990s marched on and as the healthcare needs of many segments of the population, including aging baby boomers, increased. This nursing shortage is predicted to deepen as the 21st century marches on. You can count on it to impact your work as a nurse, as well as to influence the quality of healthcare people receive. You will find information about the nursing shortage woven throughout this book, particularly in chapter 2, "The World of Nursing Practice," and chapter 12, "The Market Research Department of You, Inc."

ON THE EDGE OF TRANSFORMATION

The world of work, including the work of nurses, has been and will continue to be transformed by these events and by the exciting new frontiers of health and medicine just now becoming known at the beginning of this century. The description below appeared in Newsweek (6/24/02) as an introduction to its special report on health and medicine titled "Medicine and Technology: What the Future Means for You -- The Next Frontiers." As you read it, imagine how these breakthroughs will influence your future as a nurse. See a glimpse into the not too distant future of healthcare, and of what might be required of professionals in it:

"How does the brain work, and why does it fail? An old medical mystery is yielding to new technologies. Scientists can now inspect, repair, and sometimes even replace dysfunctional parts of the nervous system. Advances in biotechnology and computerized brain scans mean that doctors can detect Alzheimer's earlier, and may lead to treatments that slow the course of this tragic disease. Researchers are working on 'neural prostheses,' which, like the prosthetic limbs that help amputees, may allow patients with impaired organs to regain the ability to speak, hear, and see. And an astonishing technique called 'deep-brain stimulation' is showing great promise in treating Parkinson's disease and other neurological disorders; it may also have potential in countering obsessive-compulsive disorder."

"This array of new technologies has changed what doctors need to know, and how they are learning it. The days of studying anatomy by dissecting a cadaver may soon be over. Computerized models simulate all kinds of diseases, injuries, and even responses to drugs or surgery. Med school students are wired as well, downloading critical information from their ubiquitous PDAs. In the revolutionary field of bionanotechnology, doctors foresee the day when they'll be fighting cancer, AIDS, and diabetes by delivering drugs to the specific cells that need them. In the war against disease, technology is an increasingly powerful weapon. The objective: better health, longer lives."

As these new technologies "change what doctors need to know," you can count on a parallel change in what nurses need to know. If "med school students are wired," so will be the nursing school students. Chapter 4, "The Nurse and Technology," will discuss the important influence of and relationship with technology that every 21st century nurse will experience.

REEVALUATING VALUES

We are indeed living in a world hard to imagine only a decade ago. The events of September 11, 2001 have also changed our world. As a result of that horrific day, we find ourselves collectively grappling with questions about liberty, freedom, and perhaps how civilized people are supposed to respond and behave. We are trying to figure out how to live with the simultaneous realities of being on perpetual alert, while going about our lives as usual. On a personal level, we are reevaluating our values, our priorities, the meaning we want our lives to have, and the way in which we want to spend our time. We are more keenly aware of the unpredictability of life, and are taking a second look at the quality of our careers, our work life, our relationships, ourselves. Rhema Ellis, reporting for NBC News (The News with Brian Williams, 6/7/02), summarized the essence of this reevaluation after she interviewed a cross-section of the nation's 2002 graduating classes and reported the following:

"Graduates are asking themselves, 'How can I help?' rather than 'What do I want?' They are less preoccupied with indulgence and more focused on reflection; they are feeling a greater responsibility to making a contribution to the world. Many are more interested in employment in the nonprofit world than in corporate America. There is a shift in predominant life values as reflected in a concern with who one has in one's life rather than what one has. Many are expressing a desire to make a difference, to do more than just have a job. Whether or not the graduate has changed their career path as a result of 9/11, most have committed themselves to be more effective in their daily life."

Many, if not all the desires and concerns expressed by these graduates, including the life and work values they want, are and always have been embodied in the profession of nursing. The desire "to make a difference, to do more than just have a job" is what often brings people into nursing to begin with. This life-affirming value, which is characteristic of being a nurse, is captured in the phrase, "Nursing. It's real. It's life!" During the spring of 2002, this phrase was flashed across the movie screens of selected cities as part of a print and television campaign developed by Nurses for a Healthier Tomorrow, a coalition of nearly 40 national nursing and healthcare organizations, including the National Student Nurses' Association and the Honor Society of Nursing, Sigma Theta Tau. The campaign is designed to encourage young people to enter the field of nursing.

Making a contribution to the world, making a difference in the lives of others, doing work that is more than just a job...this is what nurses do every day. They are witness to and participants in the pain and sorrow, joy and exhilaration, life and death that are part of the human condition. As they touch the lives of others, so too are they touched in return.

THE ESSENCE OF NURSING

These experiences, as described by the 2002 graduates interviewed by Rhema Ellis, are captured in the poem that appears below which was written by Jackie Cataldo, B.S.N., R.N., a nursing representative and organizer for the New York State Nurses Association, and an American Red Cross volunteer who serves on the Brooklyn Disaster Assistance Team. These are among five of her reflections about September 11, 2001, written as poems.

Smoke and Debris

Smoke and debris
Swirling mist in the artificial light.
Eeriness prevails the night.

Hell living through this tragedy.
Living?
Bodies mingled with concrete and steel.
Shattered glass and shreds of clothing.
Our mothers, fathers, sisters, brothers
and friends gone.
Breath crushed, seared from their lungs,
Hearts and children left alone. Pain.
Insurmountable pain for the buried
and the walking wounded.
Scream, I want to say to the rescue workers.
Eyes blank.
Staring at everything and nothing.
Scream your soul.

I want to touch your face,
Hold your mud-crusted hand.
You look into my eyes, holding tight
to my insides.
Your mouth almost smiles.
Energy low.
I smile for you.
Slowly, we pass each other and move
into the quiet thumping of the night.

In "Someone to Fill My Shoes" (Nursing Spectrum, 6/3/02), Janet Stevens, the Resource Manager/Clinical Educator for the Nursing Education Department at Good Samaritan Hospital Medical Center in West Islip, NY, wrote about how she found herself reflecting on what being a nurse meant to her when her daughter asked her, "What's the best part of being a nurse, Mommy?" What she said in this article reflects the essence of nursing. Stevens wrote:

"...It (nursing) is an investment in my patients' lives. I make a difference every day -- touching hearts and inspiring souls. This has been my passion for almost two decades. I am an ambassador of hope. I'm not famous and certainly not someone who brings home a six-digit yearly income. But the gifts of being a nurse are almost intangible. It's not measurable. Nursing has made me a better person, more patient, more understanding, and forgiving. I am in awe of the power of the human spirit. I appreciate the fragility of life and remind people to tell those who are precious to them how much they are loved. The World Trade Center's victims and their families gave us all this lesson. I'm reminded of this lesson every day. I am challenged to use leadership skills and motivated to connect with mentors and those they mentor. I nurture. I heal....I get back so much more than I give. I am so blessed."

The Nurse-Patient Caring Equation

A concern that has become heightened among many people, nurses included, in this post-9/11 world is a desire to ensure that the quality of one's personal life is not eroded or invaded by the intensity of the work one does. This is an old story and an eternal conflict for nurses that, left unattended, leads to stress and burnout, and eventually the diminishment of quality in the care they are able to give patients. In the wake of September 11th, and during what is predicted to be one of the most profound nursing shortages ever, nurses can no longer afford to ignore this issue, lest society depletes its already scarce nursing personnel resources. One way to understand what is required to meet this challenge is to see the nurse-patient relationship as a kind of math equation, which like all math equations requires balancing. This means that equal attention to both sides of the equation, the nurse and the patient, must occur if both are to benefit from the relationship. When the nurse attends to his or her own needs with the same degree of priority and focus as to the needs of the patient, balance can be achieved. This may never occur simultaneously, nor should it since the nurse-patient relation is not a reciprocal one; but it must occur eventually. To think that the nurse only exists for the benefit of the patient is not only naive; it has the potential to result in marginal care for the patient, while increasing the likelihood of stress and burnout for the nurse. Or, said differently, there is no real quality in patient care without "nurse care" as well.

Who cares for the nurse is an important question. It would seem that healthcare organizations that want to ensure the quality care they say they want for their patients would be sure that nurses had good work environments, safe staffing ratios, adequate meal breaks, etc. In the unfortunate absence of these essential work standards in far too many environments, it is left up to each individual nurse to balance the equation for himself or herself. Ignoring the need for this risks the stress and burnout that has long haunted the nursing profession. As a professional, it is up to you to take seriously your individual responsibility to balance the nurse-patient equation. Do this, and you go a long way to ensuring not only quality care for the patient, but professional satisfaction as well, with the added benefit of preventing burnout. See chapter 16, "The Resilient Nurse," for self-care and burnout prevention strategies.

MAGNET STATUS ORGANIZATIONS

Healthcare organizations that take responsibility to effectively balance this nurse-patient-care equation are frequently those who have been granted the prestigious Magnet Status by the American Nurses Credentialing Center (ANCC), an arm of the American Nurses Association whose mission is to promote excellence in nursing and health care globally through credentialing programs and related services. Just as nurses who want to achieve a standard of excellence in their nursing practice can seek ANCC certification, so can organizations. In 2001, 20 organizations (an unprecedented number) qualified for and were granted Magnet Status. Currently, over 50 Magnet organizations exist (see the appendix for a current list). These are certainly places from which to seek employment when at all possible. (An alternative might be to use the characteristics of Magnet organizations as a guide to evaluate your potential employers). ANCC's Credentialing News described what these excellence-focused Magnet organizations have in common:

• 100 percent of the chief nurse executives at Magnet facilities hold graduate or higher degrees.
• 97 percent of all Magnet organizations have affiliations with schools of nursing, and 91 percent are affiliated with allied health programs.
• 92 percent of the staff at Magnet hospitals attend at least one continuing-education program each year.
• 83 percent of all Magnet facilities have affiliations with schools of medicine.
• 63 percent of all applicants receive Magnet designation.
• 57 percent of nurses who serve in leadership positions at Magnet organizations have at least one graduate degree, 36 percent are advanced practice nurses, and 21 percent are certified.
• 27.5 percent of nurses providing direct care at Magnet hospitals are certified.
• 19 percent of Magnet organizations are organized for collective bargaining purposes.
• The average turnover rate of all Magnet hospitals is 11.5 percent.
• The average vacancy rate among all Magnet hospitals is 8.19 percent.
• The average length of employment among registered nurses at Magnet organizations is 8.83 years.
• The average number of licensed beds among all Magnet organizations is 487; the range is between 100-1,951 licensed beds.
• The average hours per patient day are 10.04 hours across the entire nursing department.

Credentialing News went on to summarize the importance of this data as follows:

"This and other data suggest that Magnet-designated hospitals have outcomes that are positive for patients, nurses, and employers. For patients, lower Medicare mortality rates for patients with AIDS have been seen, as well as shorter lengths of stay, decreased utilization of critical care beds, and increased patient satisfaction. For nurses, satisfaction is increased, as is R.N. skill mix, perception of productivity, and perceived ability to give high-quality care. For employers, there appears to be a lower incidence of needlestick injuries, and nurse burnout rate, as well as an enhanced ability to recruit and retain nurses. Finally, JCAHO (Joint Commission on Accreditation of Healthcare Organizations) scores among Magnet organizations are higher."

The positive influence organizations with Magnet designation have on the welfare of the patient and nurse alike, and how this has the potential to ease the nursing shortage was described in Report, the official newsletter of the New York State Nurses Organization (June 2002), which stated that these facilities:

• Respect nursing professionals' knowledge in the development of policies
• Included direct-care nurses on the nurse practice committees that establish staffing plans based on patient acuity and need
• Do not penalize or intimidate nurses who question policies or work to change practices that negatively affect patient care
• Do not force nurses to work overtime to fill gaps in staffing schedules

While seeking employment in a Magnet status organization is a career strategy that can go a long way to ensuring that the nursing practice environment you choose supports both your professional and your personal needs, it cannot be the only strategy, since there are not yet enough of them. Perhaps stated more accurately, not enough healthcare organizations have awoken to this 21st century workplace necessity that benefits patient and nurse alike.

MEETING YOUR PROFESSIONAL AND PERSONAL NEEDS

It may very well be up to you to ensure a viable and healthy work environment for yourself. The capacity for this kind of proactivity is one of the hallmark characteristics of the nurse practicing during these early years of the 21st century. Consider the advice of Gloria Steinem, who asserts that actions taken by the individual are as essential as those taken by organizations. In her book, Revolution From Within, A Book of Self Esteem, Steinem said that two revolutions were needed if both society and the individual were to achieve egalitarian wholeness and equal opportunity. The first revolution was the one she has led since the 1960s against sexual and racial barriers using social and political action. Her book connects that outer revolution to a necessary inner revolution of spirit and consciousness. She had initially believed that inner change was not necessary for societal change to occur. She became suspicious, however, that something was missing when she encountered women with too little self-esteem to take advantage of "hard won, if still incomplete, opportunities, and too many (though not only) men who were addicted to authority and control as the only proof of their value." Both, she said, lacked faith in a unique self: that "core" self-esteem without which no amount of situational self-esteem can be enough.

She encourages a persistent, consistent focus and an awareness on two fronts: the individual and the collective; the personal and the professional. In nursing, that translates into an awareness of yourself as a nurse, as well as the organization for which you work; of your individual nursing practice and the nursing profession to which you belong.

One without the other dilutes the effect of both. What this means for the nurse who wants personal and professional well-being (which translates to burnout protection) is clear: support, work towards, facilitate, and fight for organizational change, but don't wait for it! This is a good example of coping with simultaneous realities, another characteristic of the 21st century nurse: know what you need to take care of yourself (inner awareness), even if the organization (outer awareness) has not provided for it, or worse, creates obstacles when you attempt to do it.

For example, what can you do, or, what are you willing to do to ensure that you have adequate nutrition, hydration, and rest when working a 10-hour shift, even if the meal breaks usually are not taken because the workload is too great? Reflect on how you generally respond (or how you imagine yourself responding) as you read what follows.

THE BALANCING ACT

Being routinely unable to meet one's basic needs, as described in the dilemma above could potentially be seen as a disruption in homeostatic balance, in the status quo of one's life, oftentimes evoking a crisis, depending on your response to it and support during it. A crisis is a turning point in which there is the potential for danger as well as opportunity. Interestingly, in the Chinese language, which is written in symbols, the symbol for the word crisis is translated to mean both danger and opportunity.

A crisis is a kind of wake-up call, a call to action, if you will. Depending on the action you take or don't take you will either:

Thrive and grow, personally and/or professionally; learn something from the situation

Survive, stay the same, possibly stagnate

Collapse, possibly regress or retreat

What will influence which of these outcomes occurs is your ability to apply the balancing features described below to your situation, as well as how you answer the questions that accompany them. As you read what follows, consider your actual or imagined responses to the dilemma described above.

THRIVING ON CHANGE

While 21st century nurses are certainly not immune from being bewildered, exasperated, and stressed by changes in the status quo, even if this should evoke a crisis, what makes them thrivers rather than survivors or victims is their perception of the situation as a challenge and the opportunity they see in it for personal and/or professional growth. They are able to navigate through the difficulties that change brings and come out winners, often bringing others along with them.

Another way to envision how this 21st century nurse functions is to imagine yourself in a boat with other people, rowing down a river, when suddenly the water becomes turbulent and foamy, rocking the boat and the people in it and skirting the choppy, uneven surfaces of half-hidden rocks and boulders. You might be aware that this kind of water is called whitewater and the challenging sport associated with it is called whitewater rafting. Permanent whitewater is a term used by Jane Schuman in her article, "Navigating the Whitewaters of Change," as a metaphor to describe the permanent conditions of continuous, accelerated change that typified the 1990s and that have become a well-known companion to everyone's life today. Schuman described three different responses to this experience. Which most closely resembles you?

The Victim: You expect the worst and are sure that the danger you imagine just around the next bend will do you in. You are reactive rather than proactive. You spend a lot of time gripping the sides of the raft with white-knuckled terror, blaming and criticizing those trying to steer the boat. You fall into the water, requiring others to divide their attention between steering the boat and rescuing you.

The Survivor: You have your life jacket buttoned securely and will stay afloat, but believe you are only along for the ride and have no choice about the direction of the boat or power to influence anything in the situation. Although you stay safely in the boat, you use all your energy holding on and contribute nothing to guiding the boat to safe waters.

The Navigator: You see this unanticipated situation as a challenge. You are scared at times but get through the swelling currents by developing new skills and retooling old ones. Your confidence grows in proportion to your ability to work with those who are doing the steering. You save the Victim when she falls into the water and reassure the Survivor, whose anxiety is distracting those steering the boat.

It is not so much the intensity of the change that determines whether or not you become a navigator in any particular situation, but rather the degree of control you believe you have over the shape and direction of your predicament. Even though navigators find themselves pessimistic at times (seeing the glass half empty), it is their capacity to recognize their state of mind and shift to the half-filled nature of the glass that distinguishes them from the victim or the survivor.

The following profiles describe the experiences of three newly hired direct care nurses who have just completed orientation to the cardiac care center and are all faced with the same dilemma. They are working ten-hour shifts and discover that while meal breaks are assigned by the nurse manager, they are rarely taken by the staff who cite the nurse-patient ratio and patient acuity as too high to permit adequate break time. Which description most closely resembles how you might respond to the situation?

Profile of a Victim: Vicky

Although it is not her preference, Vicky feels obliged to do what others do, and takes no meal breaks. She gulps glasses of water when she can and has learned to ignore the hunger pangs she feels toward the middle of her shift. She has developed headaches but does not connect them to her lowered blood glucose level or need for nutrition. She's also not sleeping as well as she used to.

She finds herself wondering why there is such a mental and physical frenzy among nurses in this new work environment, remembering that in the cardiac care center she just came from, meal breaks were routinely taken even though they had just as few nurses and just as many sick patients. She left that job because she felt harassed by a coworker who complained to the nurse manager that her change of shift reports were too long. She felt too intimidated to confront this coworker or seek assistance from the nurse manager. She had wondered about finding someone to talk to about all this but couldn't figure out how to go about it. She still wonders why her thoroughness was so misunderstood.

Seeing the problems she is in for at this new job, she begins to blame herself for leaving her last job, even though it felt like the right decision at the time. She feels preoccupied, sometimes depressed. She thinks she is powerless to react differently and doesn't see a way out of her situation. She is rarely aware that the needs and preferences of other people almost always take precedence over her own, and when she is aware, she doesn't know what to do about it. She finds herself wondering if nursing was a good career choice after all.

Profile of a Survivor: Sam

Sam usually takes his meal breaks but spends them complaining and being angry because it is so difficult to do so. He is very critical of the nurse manager's organizational skills and leadership style, and believes that the administrators of the medical center care more about their "bottom line" than the patients or the nurses who take care of them. He calls in sick frequently, telling some of his coworkers that he's entitled to these "mental health days" in exchange for the abuse he has to put up with working under conditions he believes are unfair.

He is assigned to be a preceptor for Tim, a new graduate, and seems unaware of the negative influence his attitude is having on him. He feels it is his moral responsibility to show Tim the "ropes" so he knows how to "play the game." He encourages Tim to think twice in responding to requests from peers for assistance if he wants to leave work on time. He declined to participate when the nurse manager asked him to attend a staff meeting to discuss how to develop a strategy for ensuring that nurses got their meal breaks, telling a coworker, "Why bother, nothing ever changes around here. Anyway, that's her job, not mine."

Sam waits impatiently for his next long weekend off or his vacation. He frequently talks about "putting in his time" until retirement.

Profile of a Navigator: Nancy

Nancy is new to cardiac care, having spent the first four years out of school on a general medical unit. While she found it very difficult to take meal breaks as a new graduate, she soon linked her afternoon crankiness and mental dullness to not eating lunch. At first she tried having a snack while doing her morning documentation, but soon realized that while she was sharper mentally as a result, she was still irritable. She eventually recognized that a short rest, along with nutrition and hydration, was essential for these long, intense workdays. Over a two-week period, she figured out how to organize her day around her patients' needs as well as her own. While not ideal, she now takes two or three 20-minute breaks, on most days, during her 10-hour shift, even though it is far less than what she knows she is entitled to.

She also decided to sign up for a relaxation class offered by the Employee Assistance Program and now alternates visualization with meditation for ten minutes during these breaks, and plans to buy a portable CD player to listen to relaxing music so that the noisy hustle and bustle of the unit is dampened.

During her three-month probationary evaluation with June, the nurse manager, the problem of meal breaks came up and Nancy was surprised to find that June felt as strongly as she did about her staff taking their meal breaks but had given up encouraging them in the face of the resistance she met when she did so. The reasons the staff gave her for ignoring their breaks were varied, including inability to organize their time, having trouble saying no, and problems establishing priorities. June believed that her staff indeed wanted meal breaks but couldn't figure out how to take them. As a result of this discussion, June decided to have a staff meeting to discuss the issue and asked Nancy to share her personal struggles and solutions. Nancy agreed and also volunteered to post a notice about the meeting and to generate interest in it.

Nancy's initial feeling of achievement is being slowly eroded by the peer pressure she is experiencing from Sam, one of her coworkers, which started out as subtle criticism. Recently, he has become generally uncooperative and mysteriously unavailable to cover her patients during her breaks. Unsure how to handle this, she sought the advice of Mary, her preceptor for the first job she had after graduation, and who now is one of her mentors. Mary helped Nancy realize that she would benefit from taking an assertiveness course and told her about one she took and how it helped her deal with the dysfunctional communication patterns that typified some groups of nurses. She was fascinated by the term "horizontal violence" used by Mary to describe how a sense of powerlessness to take action or be heard by those in charge can lead to subtle and overt hostility aimed at one another. She decided to learn more about this after she completed the cardiac care orientation next month.

While Vicky might eventually decide to leave nursing practice, it is likely that Sam's survival skills will enable him to stay, but the degree of professional satisfaction he will have is certainly questionable. The capacity Nancy has to navigate the challenges she faces will go a long way to ensuring a productive and satisfying career, with the additional ability to lead others as well. Nancy's attitude, behavior, and self-awareness is characteristic of what is required of the 21st century nurse.

CHARACTERISTICS OF THE 21ST CENTURY NURSE

The person who practices nursing in the 21st century requires a commitment to the development and deepening of the personal and professional characteristics described below. As you read this list, use it to determine which characteristics you already have and which you need to develop. This list is not meant to be all-inclusive, but rather, an overview and introduction to additional characteristics you will find in the chapters that follow.

21st Century Nurses:

• Recognize the importance of having a B.S.N. or are working toward it
• Participate in continuing education in traditional as well as online venues
• Have professional certification at the generalist or specialist level, or at the basic or advanced level
• Seek professional membership, including the American Nurses Association and other associations or organizations relevant to their nursing practice interests
• Possess broad cross-training in nursing skills and competencies
• Are the Nurse CEO's of their self-owned nursing practice called You, Inc., considering themselves self-employed even if they work for others
• Know how to maintain loyalty to self, while simultaneously committing to the mission of the organization that is currently employing them
• Can articulate the vision, mission, and values that drive their nursing practice
• Find mentors and mentor others
• Demonstrate leadership and are self-starters
• Are self-directed as well as team-oriented
• Utilize proactive behaviors and assertive communication styles
• Are flexible and creative thinkers
• Are willing to take informed risks and learn from their mistakes
• Take self-care skills as seriously as patient-care skills, recognizing that one without the other neutralizes the effectiveness of both
• Expect changes significant enough to alter their work or personal lives about every six months
• Know their limits and are not afraid of using the word "no."
• Never abdicate personal responsibility for themselves
• Are technologically proficient, computer literate, and Internet savvy
• Are avid personal and professional networkers in traditional and online venues

YOUR THREE-LEGGED STOOL OF NURSING SUCCESS

To succeed as a 21st century nurse means to control the direction and the quality of youship and are self-starters
• Are self-directed as well as team-oriented
• Utilize proactive behaviors and assertive communication styles
• Are flexible and creative thinkers
• Are willing to take informed risks and learn from their mistakes
• Take self-care skills as seriously as patient-care skills, recognizing that one without the other neutralizes the effectiveness of both
• Expect changes significant enough to alter their work or personal lives about every six months
• Know their limits and are not afraid of using the word "no."
• Never abdicate personal responsibility for themselves
• Are technologically proficient, computer literate, and Internet savvy
• Are avid personal and professional networkers in traditional and online venues

YOUR THREE-LEGGED STOOL OF NURSING SUCCESS

To succeed as a 21st century nurse means to control the direction and the quality of your nursing practice by attending to these three inextricably linked skill-sets:

• Professional and clinical skills
• Career management skills
• Self-care skills

You can envision these companionate skill-sets as three distinct but interrelated legs of a three-legged stool. Imagine what would happen if one or more of these legs were unevenly matched to the others. It would certainly wobble and fail to support anyone using it. Likewise, neglecting one or more of these legs representing the tripartite whole of your nursing practice is a prescription for the lack of balance typically responsible for stress and burnout.

Your nursing education, whether basic, graduate, or continuing, supports the professional/clinical leg of this three-legged stool. Career seminars and resources such as this book or Internet sites support the career management leg. Learning stress management skills, attending personal development seminars, and even psychotherapy are ways to ensure that the third leg, self-care, reflects the same strength as the others. Chapter 16, "The Resilient Nurse," will deepen this discussion and provide you with opportunities to explore what this means to your career as a nurse, and the quality of your life as a whole.

NURSES: THE PEOPLE IN THE PARENTHESES

We have become what psychologist and human potential expert Jean Houston calls "the people in the parentheses," those people suspended between what was and what will be as the healthcare industry and the nursing profession continue to position and reposition themselves to meet the needs of patients and workers alike. We belong to the generation of nurses bridging the gap between old and new, past and future, now and to be. Life within the parentheses is challenging and sometimes threatening to our professional and personal wholeness, integrity, and well-being as we struggle to maintain our footing in a constantly changing world.

John Naisbett, author of Megatrends: Ten Directions for Transforming Our Lives, echoes this by saying:

"We are living in the time of the parentheses, the time between eras. Those who are willing to handle the ambiguity of this in-between period and to anticipate the new era will be a quantum leap ahead of those who hold on to the past. The time of the parentheses is a time of change and questioning. Although the time between eras is uncertain, it is a great and yeasty time, filled with opportunity. If we can learn to make uncertainty our friend, we can achieve much more than in stable eras. In stable eras, everything has a name and everything knows its place and we can leverage very little. But in the time of the parentheses we have extraordinary leverage and influence, individually, professionally, institutionally, if we can get a clear sense, a clear conception, a clear vision, of the road ahead. My God, what a fantastic time to be alive!"

And, what a fantastic time to be a nurse!

Copyright © 2002 by Kaplan, Inc.

Customer Reviews

Most Helpful Resource
A great book for experienced nurses or folks like me, who are just starting in the profession. Annette Vallano's book answered questions about nursing I wouldn't have even known to ask. I'm changing careers after twenty-five years as a teacher, and this workbook/resource book contained the best career advice I could have received. It gives a realistic, honest, nuts and bolts picture of what nursing is like today, both the good and the bad. I have a head start in how to be assertive and pro-active in finding and creating the nursing position that will suit my skills, interests and life-style. I also understand some of the work related pitfalls can happen and how to avoid them. Finally, the book has a heart and soul that gives meaning and importance to the unique abilities we each have to offer in our work as a nurse.

A must read for nurses
The book, Your Career in Nursing, is a wealth of information for new graduates, nurse educators, and the seasoned nurse. This book is a guide for developing a positive and rewarding future in nursing. Your Career in Nursing provides the new graduate with realistice guidelines for choosing which career path to take and gives them strategies to use when difficult situations occur. The book furnishes the seasoned nurse with a marketing plan for themselves if they are attempting to make changes in their career. It gives the nurse educator strategies with helping the diverse population of nursing students, tools for dealing with managing stress, and provides the educator with resources for staying on top of the ever changing world of nursing. Your Career in Nursing is a pragmatic book which provides current approaches and resources for the twenty-first century nurse.

This book is great
I used this book for one of my nursing classes, but it really isn't just for nurses, this book can be read and used by all different people from all professions. It helps for you to find the real you lying underneath the flesh and bone of your body.
I highly recommend this book.