It has been refreshing for a change to read some readers’ opinions that were not from 21-year-old new grads, or those eternally "warm and fuzzy" types. We’ve read enough "save the world and pamper your patient" opinions to choke a moose. It’s high time nurses address the real issues with real clout.

We can maintain the desire to be quality nurses concurrent with taking a hard stand regarding income, staffing and working conditions. First, however, nurses need to be brave and accept some of the psychological reasons why we make peanuts in relation to our education. An honest understanding of the actual barriers to what nurses want is essential if real gains are to be made.

I have not seen anyone courageously address one of the major problems we face as nurses: our own psychological persona as a group. There are exceptions to the rule in nursing, just not enough. Choosing not to address this facet of our professional lives will ensure that our dilemma will continue until foreign nurses, or a new type of nurse, replace us.

It’s time nurses cared for themselves just as MDs, pilots, electricians and other professionals do. That’s not selfish, it’s common sense. This is especially important for single-income nursing households.

I won’t go over much of the available data as to why we are in the predicament we’re in, but a cursory review reveals that nurses in the workplace are overly passive, tend to not work well together, have a difficult time agreeing on a course of action and, at times, seem capable of standing up for themselves only in the break room and not the boardroom.

The "let’s save the world" warm-and-fuzzy nurses who refuse to stand up for themselves are part of the problem, not part of the solution. They can save the world and get paid what they’re worth if they would join the fight and assist the rest of us to make our careers more fulfilling. Nursing will never improve unless a unified and forceful voice in your facility emerges. Until that time, we’re howling at the moon.

Don’t kid yourself for a second: Hospital and other facility CEOs are fully aware psychologically of why and how they can manipulate nurses to maintain their profit margin. Their lip service does not pay your bills, nor improve your career satisfaction. The occasional pizza and doughnuts are appreciated but do not substitute for better conditions or higher pay. It’s time nurses see beyond these distractions.

While we struggle, CEOs are buying new beach houses in Costa Rica from the bonuses they received for keeping the largest expense in check. They know how far nurses are willing to go to make their point before they retreat. They are experts at making nurses feel guilty by implying they do not have the resources to improve the nursing world, when in fact they could find a way—even if it means increasing the cost of some services.

Do you think any Delta pilots are losing sleep because their pay raises may slightly increase airfare? I am generally not a union supporter, but this is why unions can be important for nurses. Generally speaking, nurses need someone to organize and focus on the goals necessary to improve our career satisfaction. Nurses themselves do not get it done.

The warm-and-fuzzy crowd says, "It’s not right for nurses to unionize or strike," even though MDs are joining unions like lemmings. If your facility’s nurses can stick together and bypass unions, all the better. But let’s be serious and use real-world examples.

How far do you think an employer could push a steamfitters, electricians, teamsters or rail union? Not far and not for long. Are you sensing a trend here? These job fields are primarily male-dominated. Groups of men simply will not accept no for an answer for long. Nurses are 95 percent female. Generally speaking, nurses have accepted no for an answer for all of my 20-plus years in the field. This partly is related to the idea that for a sizable number of nurses, it’s "just a job," "extra income" to augment the husband’s salary, or a job one may leave for a pregnancy and return to later.

Too many nurses are content to allow burnout to complete its cycle, or to simply leave the field rather than fight to improve job satisfaction. What a waste of our time and money for our education!

Another reality check is that a person who has enough of an IQ to complete a quality course in nursing is likely capable of being successful in other fields. How many engineers are forced to regularly work rotating shifts, forced overtime, forced to work holidays, and on ad infinitum?

A self-made multimillionaire acquaintance, who is familiar with what it takes to be a good and educated nurse, has said that nurses rightfully should make about $75,000 a year given the stress, exposure to disease, cost of education, working conditions, hours and the serious responsibilities of the career. He lists numerous business executives who make six figures with a mere fraction of the responsibility of a floor nurse!

Only a handful of career fields affect our fellow humans as intimately as a nurse. A brief lapse of focus may result not only in someone’s death, but also the termination of your means of making a living via license revocation. Civil penalties in court also can follow. Yes, one lapse can cost you the tremendous time and expense you expended to complete your education. Bet you can’t name too many other occupations where this potential exists.

Obviously, nursing is a serious business; we are just not reimbursed congruent with this fact.

If you are a nurse because your subconscious mind "needs" positive reinforcement from nurturing, or you are seriously codependent and nursing is another outlet, you would benefit all nurses by doing some serious self-inventory and growing beyond those frailties. If you went into nursing to make ends meet and help people, try thinking of a nursing world where you were reimbursed congruent with the job’s demands.

Dance around the issues as you prefer, but these are the realities of our situation. There are not many real leaders in nursing, and those few are getting tired of dragging dead horses to the trough.

So decide: Are you part of the problem, or part of the solution? Now is the time to act during a nursing shortage to maximize the volume of your voices, as well as the hearing acuity of your CEO or administrator. Get activated yourself, and energize those comatose nurses around you as well.

And remember to "get it in writing." Speak now or forever hold your peace.