Nursing as a second career: older nurses prove it’s never too late

Alberta Hunter in her nurse uniform at Goldwater Memorial Hospital before her retirement in 1977

Alberta Hunter in her nurse uniform at Goldwater Memorial Hospital before her retirement in 1977

In 1955, blues and jazz legend Alberta Hunter decided to begin a second career as a nurse after reaching the pinnacle of a music and theater career spanning more than 4 decades.  Yet, she was turned down when she first applied to the School of Practical Nursing at the Young Women’s Christian Association branch in Harlem.   The director of the school told her that she was simply too old to become a nurse.
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Nursing Job Outlook in 2014

Smiling Nurse With Thumbs Up PosingAs 2013 began, some experts declared that not only was the nursing shortage over but that it was a “myth” (See our February 2013 article: “Is the nursing shortage a myth?“) and a number of news outlets began reporting on just how difficult it was becoming for new nursing school graduates to find a job. However, as we enter 2014, it is clear that there is still a shortage of experienced nurses in some regions, that the demand for nurses will continue to rise and that new nurse graduates still have a much better chance of finding a job than new graduates in other fields.

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Real Nurse Photo Contest!

 

A collage of some of the photos that have been submitted to the Real Nurse Photo Contest. See all the photos at RealNursePhotos.com

A collage of some of the photos that have been submitted to the Real Nurse Photo Contest. See all the photos at RealNursePhotos.com

NursingJobs.us recently announced its Real Nurse Photo Contest:

Are you a nurse? We are offering $100 in our nurse photo contest!

Real portrayals of the nursing profession are few and far between and instead of settling for buying fake-looking models posing in Halloween nurse costumes for our stock photographs we at NursingJobs.us figured that we might as well try asking the many nurses who use our nursing job board to send us their own, real, photos and let us use them to better represent the face of nursing to the world.


You can see some of the photos that have been submitted at RealNursePhotos.com.  Want to see your image there and possibly win $100?  The contest doesn’t end until March 15, 2013 so there is still time for you to enter!  Find the contest rules and instructions for submitting photos at the Real Nurse Photo Contest announcement page.

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Living and Working as a Nurse in Houston

The University of Texas M. D. Anderson Cancer Center (Photographer: Wikimedia Commons/Zereshk)

The University of Texas M. D. Anderson Cancer Center (Photographer: Zereshk)

Home of NASA’s Mission Control Center, Houston is also home to some of the best hospitals in the country. Some of the best nursing jobs in Houston can be found at the Methodist Hospital, St. Luke’s Episcopal Hospital, University of Texas M. D. Anderson Cancer Center, Memorial-Hermann Texas Medical Center and TIRR Memorial Hermann, which are all well-rated by  US News and World Report, and all have high-ranking specialties.

Many Houston nursing jobs are in hospitals located on Portsmouth Street, including Bayou Medical Center, or Fannin Street, where the Women’s Hospital of Texas is located. The Shriners’ Hospital for Children and Kindred Hospital Medical Center are also located on Fannin.

Nurses working in the Houston area have salaries that are moderate as the cost of living is also somewhat middle of the road.  Staff RNs average about $66,000 per annum. Licensed practical nurses average just under $42,000 per year, with CNAs averaging just under $29,000 in annual pay. All figures are from Salary.Com for 2012.

For travel nurses visiting the city, there are all sorts of places of interest to see and experience, from the Johnson Space Center to the Houston Museum of Natural Science to the Theater District and the Aquarium. Plus, there’s the Mahatma Gandhi District, the Houston Zoo and the Houston Arboretum. Sports enthusiasts will surely enjoy watching the Astros, the Rockets, and the Texans, and a pilgrimage to the Astrodome is also in order. History buffs will have fun checking out the Clayton Library and the Sam Houston Hotel, or strolling around the Fifth Ward’s Frenchtown – or taking a trip west to see the San Jacinto Battleground in La Porte, which is about a half an hour away.

Houston night skyline (Photographer: eflon on Flickr)

Houston night skyline (Photographer: eflon)

Whether residing in Houston or visiting as a travel nurse, getting around is not too bad, as the center of the city is laid out in a grid. Interstate 45 (also known as the Gulf Freeway) cuts through and then skirts the city to the west, and then it arcs around to the north. Route 610 makes a ring around the city and then another ring, Route 8 (Beltway 8), goes around that. Route 59 proceeds from the southwest to the northeast. It eventually intersects with Interstate 10.

Houston travel nursing jobs are often in the Fannin Street area, which is to the southwest. That area is near Route 59 and Route 288.

Another popular transportation option in Houston is the comprehensive public transportation system. METRO (the Metropolitan Transit Authority of Harris County) consists of buses and regional rail. The Red Line travels from Fannin Street South to the University of Houston Downtown stop.

Housing is more expensive the closer you get to the center of things. Prices can be very high in affluent bedroom areas such as Washington Avenue and the Allen Parkway area. Prices are a bit lower outside of the city, in areas such as Tomball and Jersey Village. According to Trulia, the market is on the rise, but overall sales seem to be decreasing in early 2013. Apartment living can be in modern townhouses or developments.

Educational opportunities are plentiful, as Houston is home to a concentration of great colleges and universities. Nursing programs are available at (among others) the Houston Baptist University, Prairie View A & M and Texas Women’s University. All of these schools can improve the experience of nursing in Texas.

Houston – it’s an impressive global city. Got any more insights into living and working in Houston? Let us know in the comments section!

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Protecting nurses from workplace violence in Montana

Montana State Rep. Kathy Swanson, Sponsor of HB 269

Montana State Rep. Kathy Swanson, Sponsor of HB 269

Reports and surveys by the American Nurses Association, the Emergency Nurses Association and the Bureau of Labor Statistics indicate that workplace violence is widespread in the healthcare sector.   In an attempt to address the problem, thirty-eight state legislatures have enacted laws that enhance criminal charges and penalties for those who assault nurses and other healthcare workers.   These are similar to the criminal statutes that exist in nearly every state that provide for enhanced penalties for those who assault police officers and other public servants.   Yet there are still a dozen states that don’t have such laws to protect healthcare workers.  In some of those states there are enhanced penalties for assaults against sports officials (such as baseball umpires and basketball referees) but no enhanced penalties for assaulting a nurse, doctor or other healthcare worker.   One state that has yet to enact a law to deter workplace violence against healthcare workers is Montana.

Last December, the Montana Nurses Association and Montana State House Representative Kathy Swanson decided to change that with the introduction of Montana House Bill No. 269 (“An Act Creating The Offense Of Assault On A Health Care Provider Or Emergency Responder; And Providing Penalties”).

In a letter to the editor published yesterday, Don Judge from the Montana Nurses Association reiterated some of the reasons for the legislation:

HB 269 is simply a law designed to protect healthcare workers from vicious assault in their workplace. According to the U.S. Department of Justice, over 500,000 nurses are violently assaulted in their workplace every year! Workplace violence against healthcare workers ranks no. 1 with over 50 percent of all workplace assaults occurring in healthcare situations. This situation is especially bad in Emergency Rooms where fully 54.8 percent of nurses surveyed reported being assaulted at work in the last seven days.

Montana is not immune from such assaults, at least three nurses in our state received injuries from workplace assaults last year which will likely prevent them from ever returning to their chosen occupation. HB 269 recognizes this problem and creates a separate offence of assaulting a healthcare worker.

A hearing on the bill was held on January 31, 2013.  There were a number of objections to the bill by the American Civil Liberties Union and advocates for the disabled and mentally ill.  On February 7, 2013, the bill was tabled by the Judiciary Committee of the Montana House of Representatives.  It is likely to be reintroduced with amendments to satisfy some of the concerns raised.

Here are some video excerpts from the hearing:

Kathy Swanson introduces Montana HB 269

Montana nurse Rebecca Sturdevant on Montana HB 269

Nurses speak out in support of Montana HB 269

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Is the nursing shortage a myth?

Nurstoons: Nursing Shortage 2 (Carl Elbing)

A recent press release by a nursing education and career portal claims that a survey indicating that 62% of newly graduated nurses have difficulty finding a job is evidence that the nursing shortage is a myth.

“The so called nursing shortage is really a myth”, said Cathy Miller, Director of Education for NursingDegree.org. “The idea that we as a country are experiencing a drastic shortage in nurses is not really correct. Most nursing jobs now specifically state they are not interested in non-experienced nurses.”

There is no question that it is harder for new graduates with no experience to find a nursing job.  In January 2013, CNN reported on how difficult it is for many newly graduated nurses to find employment.  However, this does not indicate that the nursing shortage is a myth.  There may not be a shortage of new graduates of nursing programs but there is a very real shortage of experienced nurses.  New graduates can increase their chances of landing a job by getting additional certifications, gaining experience by participating in internship and preceptorship programs and being willing to relocate to areas where there is a higher demand for their services and more employers willing to hire new nurses.   While it may take longer, newly graduated nurses who are persistent will eventually find a job.

Labor statistics indicate that the nursing shortage is indeed very real and not a myth.  A recent press release by the Bureau of Labor Statistics reported that the healthcare sector added 23,000 jobs in January 2013 and 320,000 jobs in 2012.  This is significant increase over the 296,900 healthcare sector jobs added in 2011.  Most of those jobs are for nurses and there are many more jobs that are going unfilled due to a shortage of experienced nurses.  As the economy recovers, nurses retire, the U.S. population ages and tens of millions of previously uninsured Americans gain health care insurance in 2014 when certain provisions of the Affordable Care Act take effect, health care spending will increase significantly and the demand for nurses and nurse practitioners will continue to increase and remain strong.

It is clear that filling this growing demand will require hundred of thousands of new nurses over the next few years.  It is also clear that nursing schools and healthcare employers need to provide more opportunities for nursing school students and new graduates to get clinical on-the-job training so they have the experience needed.

What do you think?  Is the nursing shortage a myth or very real?  What should nursing schools and healthcare employers do to increase opportunities for nursing school students and new graduates to gain the experience needed? Let us know in the comments or the forum.

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Living and Working as a Nurse in Indianapolis

One of the most recently revitalized cities in the United States, Indianapolis is home to some great Midwestern hospitals. Some of the best nursing jobs in Indianapolis can be found at the St. Vincent Hospital and Clarian Health Partners, which are all well-rated by  US News and World Report, and have high-ranking specialties.

Many Indianapolis nursing jobs are in hospitals located on various numbered streets, including the Richard Roudebush VA Medical Center and Wishard Health Services.
Nurses working in the Indianapolis area command salaries that are moderate as the cost of living is about average compared to the rest of the country.  Staff RNs average about $67,000 per annum. Licensed practical nurses average about $40,000 per year, with CNAs averaging just under $28,000 in annual pay. All figures are from Salary.Com for 2012.

For travel nurses visiting the city, there are all sorts of places of interest to see and experience, from the Children’s Museum to the Museum of Art. Plus, there’s the Indiana Repertory Theatre, and the Kurt Vonnegut Memorial Library. Sports enthusiasts will surely enjoy watching the Pacers and the Colts, and a pilgrimage to the Motor Speedway and Hall of Fame Museum is a must. History buffs will have fun checking out the President Benjamin Harrison House, or strolling around the Colonel Eli Lilly Civil War Museum – or spend time at the Indiana State Fair in November.

Whether residing in Indianapolis or visiting as a travel nurse, getting around is not too bad, as the center of the city is laid out in a grid. Interstate 465 rings around the city and intersects Interstate 74. The White River runs to the west of the city and is crossed at Maryland Street.

Indianapolis travel nursing jobs are often in the downtown area, which is where a lot of the numbered streets are. Other downtown cities are named after presidents or states, with New York Street cutting all the way across from east to west, and Pennsylvania Street traversing north and south.

Another popular transportation option in Indianapolis is the comprehensive public transportation system. IndyGo (the Indianapolis Public Transportation Corporation) consists of buses with connections to CIRTA (Central Indiana Regional Transportation Authority), a regional rail service. Several of the bus lines service area hospitals, particularly the #10 and the #28.

Housing is generally more expensive the closer you get to the center of things. Prices can be higher in affluent areas such as Forest Hills, Herrin-Morton and Windsor Park. Prices are lower in the Warren Park and Devington areas, and are rather low in comparison to other parts of the United States. According to Trulia, the market is in flux, with many listings rising but sale prices falling in early 2013. Apartment living can be in modern townhouses or sometimes in developments.

Educational opportunities are plentiful, as Indianapolis is home to a concentration of great colleges and universities. Nursing programs are available at (among others) Indiana University, Purdue University, Marian University and the University of Indianapolis. The experience of nursing in Indiana can be greatly improved by attending any of these schools.

Indianapolis – it’s not just the Speedway. Got more great ideas about living and working in Indianapolis? Feel free to add them in the Comments section!

Care Coordination: Opportunities for Nursing

Coordination of care is not a new role for nurses, but it has never been fully appreciated. As nurses, we coordinate patient care and ease the transition from hospital to home, often preventing readmission to hospital and improving the quality of patients’ lives. Finally, this vital role is being seen as a valuable one, not just in terms of patient care, but in financial terms for nurses who perform this essential service.

The Medicare fee schedule is set to change in January of 2013. It contains new codes that will have a great impact on care coordination, which is typically performed by nurses in a physician-supervised setting. Currently, reimbursement for non-face-to-face visits is lumped under payment for face-to-face visits. Both physicians and nurses have argued that the current codes are insufficient, as they do not account for communication with persons other than the patient, home visits or conveyance of patient information over the phone, common practices which are not adequately addressed under the current codes.

“Specifically, this HCPCS G code would describe all non-face-to-face services related to the TCM furnished by the community physician or qualified nonphysician practitioner within 30 calendar days following the date of discharge… The post-discharge TCM service includes non-face-to-face care management services furnished by clinical staff member(s) or office-based case manager(s) under the supervision of the community physician or qualified nonphysician practitioner” (Centers for Medicare and Medicaid Services, 2012).

Required elements for post-discharge transitional care management include:

  • communication with the patient/caregiver within two (business) days of discharge (communication by phone, electronically or face-to-face)
  • medical decision-making of moderate to high complexity
  • to be eligible to bill for the service, there must be a face-to-face visit with the patient within 30 days of the transition in care or within 14 (business) days following the transition in care

What does this mean for nurses? Nurses provide an essential service and should be reimbursed for this service, according to the American Nurses Association. Care coordination activities are often performed by RNs and have been shown to reduce patient costs, improve outcomes, prevent readmission to hospital and increase patient satisfaction. This move by the CMS increases the likelihood that nurses may soon be able to directly reimburse for these services. This may create the need for new nursing jobs to fill the growing need for nurses skilled in this area, particularly as the population is aging rapidly and more elderly individuals are living in the community.

As physicians will be able to bill for services performed by nurses who provide transition services, this will encourage the growth in jobs in this area. “Although the rule does not allow separate billing for care coordination, some private insurers likely will use the codes to reimburse providers directly for the service…[reimbursement policy] could expand the RN job market and raise recognition for nurses” (Nurse.com, 2012).

Sources:

Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, DMEFace-to-Face Encounters, Elimination of the Requirement for Termination of Non-Random Prepayment Complex Medical Review and Other Revisions to Part B for CY 2013. Centers for Medicare and Medicaid Services, 2012.

CMS rule creates reimbursement opportunities for RNs. Nurse.com, November 15, 2012.

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The Affordable Care Act


D.aniel – Fotolia

The election is over and Barack Obama has won a second term. Although many people may have been hedging their bets, waiting on the outcome of the election, the Affordable Care Act is here to stay. What does this mean for Medicare, healthcare institutions, healthcare workers and the general public? As nurses, we care for our patients regardless of insurance status, but we all know that insurance is a major issue for many of our patients. Keeping in mind that some of the key features won’t be implemented until 2014, here are some of the highlights of the Act and how they will affect individuals and corporate entities:

Health insurance: At the present time, no one is required to have health insurance, but by 2014 this will change. Most individuals will be required to have health insurance or face a fine of up to 1% of their income (or $95 per year, whichever is greater). By 2016 the fine will rise to 2.5% of income or $695, whichever is greater. For families, the penalty for not having insurance will be 2.5% of the combined household income. However, these requirements could be waived when financial hardship is an issue. Some states have passed laws to block the necessity of carrying health insurance; however, federal law supersedes state law. Many more people are expected to be eligible for Medicaid or will be able to access federal subsidies to buy health insurance.

Current health insurance plans: For those individuals who already have insurance through their current employer, it is possible that nothing will change. However, employers may change premiums, network coverage, co-pay amounts and deductibles, just as they could before the Affordable Care Act. Some of the effects of the Affordable Care Act have already been enacted; for example, lifetime coverage limits have now been banned, and adult children (up to the age of 26) who don’t have health insurance through work can stay on their parent’s plan.

Medicaid: For people who want health insurance but can’t afford it, starting in 2014 the federal government is offering to expand the Medicaid program so that individuals and families who earn incomes at or lower than 133% of the federal poverty level will be eligible for this benefit. This is not yet a hard-and-fast law — the governors of several states, such as Alabama, have stated that they will refuse the expansion of Medicaid and the Supreme Court has ruled that states cannot be mandated into making this change to Medicaid. For people who earn too much money for Medicaid but still can’t afford health insurance, government subsidies will be put in place to allow them to purchase insurance from state-based exchanges, which will sell insurance to small businesses and individuals.

Seniors: Changes to the Medicare Part D prescription plan will mean that seniors will only be required to pay for 25% of their prescription costs, without a certain initial cost to be paid first before coverage begins. Preventive services will be expanded and seniors will be allowed a free annual wellness visit.

Other changes:
- No out-of-pocket costs for certain screening tests (i.e., mammography, cholesterol tests)

- Coverage cannot be cancelled if you become ill (known as rescission)

- Coverage for pre-existing conditions cannot be refused (for children this is already the case, for adults will be enacted by 2014)

- Rebates to be provided to customers if they spend less than 80-85% of premium dollars on medical care

Like it or hate it, agree or disagree, the Affordable Care Act is here to stay. Although there is apt to be some confusion over the next two years, as well as some contention as the last kinks in the plan get worked out between Democrats and Republicans, the end result will be that most people will have health insurance by 2014.

Addicted to Helping People

 

joyfnp/ Fotolia

A new book focusing on American nurses is nominally a book of portraits, intended for coffee tables. But a doctor writing in the New York Times, Abigal Zuker, found the the narrative to be the most affecting part, hitting her “in the solar plexus.”

For example, she appreciated the observation of a hospice nurse named Jason Short in rural Kentucky who has had a number of jobs, including auto mechanic and commercial trucker. He turned to nursing when the economy went under. This pragmatic decision turned into something more, and Mr. Short says he’s a nurse for good. “Once you get a taste for helping people, it’s kind of addictive,” he says in the book, called “The American Nurse.”

The book tells the stories of 75 nurses. Some of them wanted to be nurses from when they were very young, while others took Mr. Short’s more pragmatic approach. All of the nurses profiled exhibit the same “surprised gratitude,” according to Dr. Zuker.

The nurses profiled come from many different health care settings from many different places in America, ranging from large academic institutions like Johns Hopkins to very small places like the Villa Loretto Nursing Home in Mount Calvary, Wisconsin. There are administrators, home health care workers, emergency room nurses, military nurses, and much more.

All describe unique professional paths in short first-person essays culled from video interviews conducted by the photographer Carolyn Jones. Their faces beam out from the book in Ms. Jones’s black-and-white headshots, a few posing with a favorite patient or with their work tools — a medevac helicopter, a stack of prosthetic limbs or a couple of goats.

But even the best photographs are too static to capture people who never stop moving once they get to work. For a real idea of what goes on in their lives, you have to listen to them talk.

Here is Mary Helen Barletti, an intensive care nurse in the Bronx: “My whole life I’ve marched to a the beat of a different drummer. I used to have purple hair, which I’d blow-dry straight up. I wore tight jeans, high heels and — God forgive me — fur (now I am an animal rights activist). My patients loved it. They said I was like sunshine coming into their room.”

Says Judy Ramsay, a pediatric nurse in Chicago: “For twelve years I took care of children who would never get better. People ask how I could do it, but it was the most fulfilling job of my life. We couldn’t cure these kids, but we could give them a better hour or even a better minute of life. All we wanted to do was make their day a little brighter.”

Says Brad Henderson, a nursing student in Wyoming: “I decided to be a nurse because taking care of patients interested me. Once I started, nursing just grabbed me and made me grow up.”

Says Amanda Owen, a wound care nurse at Johns Hopkins: “My nickname here is ‘Pus Princess.’ I don’t talk about my work at cocktail parties.”

John Barbe, a hospice nurse in Florida, sums it up: “When I am out in the community and get asked what I do for a living, I say that I work at Tidewell Hospice, and there’s complete silence. You can hear the crickets chirping. It doesn’t matter because I love what I do; I can’t stay away from this place.”