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Journey to Jobs — Promising Paths for Nurses

Monday September 8, 2008
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Whether one is a retiring nurse who is mapping out a graceful exit plan or a newly minted RN who is ambitiously plotting the course of his or her career, the reality is there are more options in the profession now than ever before.

“When I began my career, there just weren’t that many career paths,” says C. Fay Raines, RN, PhD, president of the American Association of Colleges of Nursing (AACN). “It was fairly clear: you graduated [from nursing school] and then you went to work in a hospital.”

Not so today. No matter where one is on the continuum of his or her nursing career, there are numerous options open. With careful thought, self-examination, and planning people can choose an appropriate nursing career path.

Where do you want to go?

“It’s important for nurses to think early about a career path,” says Raines. “Do they want to remain at the bedside? Do they want a leadership position either in a hospital or another type of healthcare facility? Are they interested in a research career or in a faculty and teaching position?”

For a new nurse, the first year or two of nursing experience helps set the groundwork for where he or she might want to go from there. The acute care environment is not the only choice of entry for new graduate nurses, but most experts advise new nurses to begin their careers in hospital settings because of the valuable basic clinical training they get that they really can’t get elsewhere.

Donna Cardillo, RN, MA, career coach, speaker, and author, says she has received letters from nurses who did not work in the acute care environment early in their careers and regretted it later.

New nurses also can choose a specialty earlier than in the past because many medical centers and hospitals now have well-developed, well-supported orientation programs in specialty areas.

“We used to think nurses needed to spend a year or two in med/surg units, but I don’t believe that is true now,” says Mary Jean Schumann, RN, MSN, MBA, CPNP, chief programs officer for the American Nurses Association.

How do you get there?

New nurses should start thinking about continuing their education much earlier than before. “We are finding it is in everyone’s best interests to identify promising people who want faculty careers and get them started more quickly,” says Raines.

One of the new educational trends is a direct route to a PhD for many nurses. “Many of our doctoral programs are admitting post-baccalaureate students directly into PhD programs, as other disciplines do,” says Raines.

This means doctoral students graduate from their terminal degree program, for example, at age 30, rather than 45, she says.

The professional doctorate, or doctor of nursing practice (DNP), also is an option for nurses set on a faculty career. Adopted by the AACN in 2004, the DNP is a career option for nurses with experience, Raines says. “Many of these [DNP] students are interested in clinical teaching positions,” she says.

There also are many possibilities for nurses who want to continue up the clinical track but do not necessarily want to teach. Clinical nurse specialists, certified nurse-midwives, or nurse anesthetists are examples. The most popular track at many educational institutions is for nurse practitioners.

“The popularity of master’s degree programs for nurses reflects the idea that nurses want to open up their options,” says Sharon Fleshman, senior associate director, career services, at the University of Pennsylvania.

These nurses may be looking for clinical challenges, but they also want to continue practicing with the holistic approach nursing offers.

“As RNs begin to get clinical experience, some of them feel they want more autonomy, a little more involvement with decision-making and diagnosis, and the ability to establish relationships with patients in a way that they can’t as a staff nurse,” says Fleshman.

Nurses may add JD, MBA, or EdD to their names, but while they may not work in a clinical setting, they are still nurses.

“Whether working with computers in nursing, in forensic investigations, as a pharmaceutical sales representative, or as a quality assurance coordinator, each nurse brings something special, something compassionate, some healing touch to someone, somewhere,” she says.

Successful Career Strategies for New Nurses

Tips to get one's career off to a good start from Sharon Fleshman, senior associate director, career services, at the University of Pennsylvania School of Nursing

• Network — Contact the alumni association of your nursing school
• Join and become active in professional associations
• Strive to excel in clinical work
• Establish a solid reputation of professionalism
• Take on leadership opportunities — precept nursing students, act as a mentor, supervise projects, join committees
• Keep abreast of healthcare issues

Getting creative

The nursing career path has surely evolved. Just as there are many more career options for nurses just entering the profession or with some experience under their belt, specific opportunities, like job-sharing and shorter shifts, recently have become available to retiring nurses.

Hospitals are getting creative to retain nurses who are thinking about retiring and to lure back nurses who already have retired.

“One of the factors that is creating the nursing shortage is the retirement of this huge swath of nurses from the baby-boomer generation,” says author Annette Vallano, RN, MS, CS.

In researching the fifth edition of her book “Your Career In Nursing,” Vallano found many new opportunities for the older nurse so she expanded her chapter on the mature nurse.

“Older nurses can be mentors, teachers, or do lighter kinds of work, like doing admission assessments only, for example” she says.

The mature nurse can do a “part” assignment, Vallano says. For example, a part assignment may be a two- or four-hour work shift compared to an eight-, 10-, or 12-hour shift.

Plus, part assignments entail different shift work than what the traditional staff nurse with a full patient load would have. An assignment could involve transporting patients for testing, which allows a nurse with a full load of patients to stay on the floor.

“This spreads out resources better,” says Vallano. “It is like a job share, but a very sophisticated job share.”

Schumann offers other alternatives for mature nurses. “There are ambulatory clinics where an older, more experienced nurse, is an asset,” she says. “A cardiology clinic might be a good transition for a critical-care RN, for example.”

Some OR nurses may find that working in a free-standing surgery center may be easier “because of the shorter hours, and they are not open seven days a week,” Schumann says.

Other older nurses transition well to hospice and palliative care. “It’s a little easier to manage,” Schumann says. “They may be driving from visit to visit instead of walking the halls, and the hours tend to be a little shorter.”

Hospice and palliative care settings are good options because mature nurses are experts who have good assessment skills and have good people skills in relating to patients and families. “They find that it is a good niche for them,” Schumann says.
For nurses who wish to stay in the acute care setting, options such as medical record review, discharge planning, and case management require less walking and more time on the phone, plus more paperwork.

Cardillo praises nursing as a profession because of its longevity. She advises all nurses to “do what they love,” no matter where they are and no matter how old or seasoned.

“You have to find what makes you want to get up and go to work in the morning,” says Schumann.


The Ultimate Career Guide for Nurses: Practical Advice for Thriving at Every Stage of Your Career
— Donna Cardillo, RN, MA

This book takes you step by step through career development and advancement, as well as personal development.

Cardillo offers nurses ways to reenergize their nursing career by getting the most out of their current position, identifying their transferable skills, and deciding what they want to accomplish in the future. She offers tips on writing a winning resume and how to interview like a pro, as well as how to overcome challenges and when to take career risks.

Your First Year as a Nurse: Making the Transition from Total Novice to Successful Professional
Donna Cardillo

Cardillo offers the new nurse ways to “ensure a healthy first year” by knowing how to get the perfect job; create a unique patient-centered style of nursing; develop positive relationships with physicians, patients, and other nurses; deal with conflict and adversity and avoid burnout; network; enhance education; and become a leader.

Your Career In Nursing: Manage Your Future in the Changing World of Healthcare — Annette Vallano, RN, MS, CS

Vallano offers valuable advice for updating and upgrading clinical skills, profiles of real nurses who have adapted their careers, and practical business tips for entrepreneurial and freelance nurses.

Earlier editions are available now, with the fifth edition due out before the end of the year.

Michelle Paolucci Peebles, RN, MSN, is a freelance writer. To comment, e-mail editorNTL@gannetthg.com.