Forget, for a minute, all the problems that have caused nurses to leave the profession, or at least to move out of direct care roles.

Although much of the media attention on the nursing shortage has focused on job satisfaction, or lack of it, nursing always has been a steppingstone to more careers than you can shake a stethoscope at. That's why experienced nurses say it's essential to know how to package your nursing skills in a career portfolio, assess your own personality and vocational preferences and learn from mentors how to make positive career changes.

Fay Bower, DNSc, RN, is a case in point. A former college president, Bower now is editing a series of books published by Sigma Theta Tau, consulting with lawyers on medical malpractice cases and chairing the department of nursing at Holy Names College in Oakland, Calif.

Too bad nobody's told Bower she retired a year ago.

Today's nurses work at the bedside and beyond. They've launched careers as entrepreneurs, writers and editors, consultants to lawyers and architects, educational leaders and hospital chiefs.

How do they do it? The word "mentor" comes up again and again. Dee Hicks, MS, RN, vice president of patient care services and chief nursing officer at Sunrise Hospital and Medical Center/Sunrise Children's Hospital in Las Vegas, began working at the facility as a floating med/surg nurse 32 years ago, fresh out of Oklahoma Baptist University. Today, she manages all the nurses at the 688-bed facility.

"I've always had great mentors," Hicks said. "The chief nurse at Sunrise when I started in 1969 always impressed me as someone who really cared about nurses and patients. She made rounds with the staff nurses and kept an open-door policy. And that's what I try to do."

A motivating factor
"I've been lucky; I have had a number of mentors-and not all of them nurses," Bower said. "My first mentor was a nurse, when I was in school 40 years ago. I was afraid of her at first, but only because she was so competent and held me to high standards. I learned to love her, and as I moved into other positions, every place I went I either looked for a mentor or someone stood up and took an interest in me.

"Yesterday I got an e-mail from someone I've never met but who had read something I'd written and wanted to know more. I guarantee you that relationship will continue. I'll end up helping her do whatever she needs to do because I believe in mentoring."

Ten years ago, Bower became first a friend, then a mentor to Cyndi McCullough, MSN, RN. At the time, Bower was president of Clarkson College in Omaha, Neb., while McCullough was president of its alumni association.

"She would constantly say, 'Save your money, you should have your own consulting business,' " McCullough recalled. "There were times I would think I couldn't possibly do this and she would say, 'Oh, for heaven's sake, go do it. You can't miss an opportunity like this.' "
That brand of mentoring, though often informal, can make all the difference between rapid career advancement and stagnation. McCullough said it never occurred to her to push herself educationally until a teacher put the idea in her head.

"I was in a diploma school and there wasn't anyone who said, 'Gosh, you should think of going on.' Later, I was working on my bachelor's degree and one of my instructors said, 'You need to get your master's degree.' That's probably why I did go to grad school."

Advanced practice, education and entrepreneurial or managed care positions are a few of the choices staff nurses can ponder, said Becky Rice, Ed.D., MPH, RN, deputy director of Colleagues in Caring, a nursing workforce project. (For more information about the project, see "Plugged In" in this issue.)

A talking book
Many hospitals now are working to empower nurses. As far back as 1987, administrators at Sioux Valley Hospital and University Medical Center, both in South Dakota, organized the staff into four different councils, each with its own senator: practice, performance improvement, educational and management. Senate briefings take place once a month.

E.J. Reid, RN, nurse director of the neonatal intensive care unit at Sioux Valley Hospital, said, "Living in the NICU is a very different environment from the adult world, so protocols don't seem to always fit. We can discuss the differences in the senate briefings. Everyone hears the same message once, which is great.

"We wanted the staff to take responsibility for their own practice, to make decisions," Reid said. "It's worked very well. One of the things that shared governance encourages is peer review, and I helped establish the concept of professional portfolios for nurses throughout the hospital."

Nurses at Sioux Valley combine their curriculum vitae and other professional background material in a hardbound binder.

Inside are their certificates, diplomas, awards, notes from patients and peers, and professional and even personal goals in reinforced plastic envelopes.

"It's a wonderful thing, a record," Reid said. "When they apply for other positions in-house, we ask that they bring their portfolios. It's not only a matter of pride, but it gives a manager a good history, a picture of the person. It's sort of a talking book, and it shows their work quickly. Sometimes people are shy in interviews, so the book helps them tell their story. They can also use it when they interview elsewhere."

A portfolio is much more than a résumé. Reid suggests including categories in a portfolio:

Know thyself
Another potential tool may be aptitude and assessment testing for nurses. Too often, a new graduate will arrive on the job only to be plugged into whatever unit needs staffing-regardless of individual interests or personality type.

Yet when Lynn Bodensteiner, RN, an instructional designer at DigitalMed, a provider of electronic health care services based in Boulder, Colo., surveyed nurses in two subspecialties-critical care and home health nursing-she found that they espoused markedly different values. Critical care nurses identified teamwork as their primary value, while home health nurses named autonomy and independence.

While a master's degree is widely considered the gateway to executive status, the truth is that many-perhaps most-nurses harbor no such ambitions. Kathleen Sanford, RN, vice president of nursing at Harrison Memorial Hospital in Bremerton, Wash., bemoans the difficulty in attracting good nurses into management positions.

While it is natural, perhaps, for an administrator to steer competent staff into administrative work, this practice actually may be doing "a disservice to the nursing profession," said Joann Genovich-Richards, Ph.D., MSN, MBA, RN, president of Sharendipity Enterprises in Sterling Heights, Mich.

"We tend to communicate that bedside nursing isn't important," she said. "If you're good, we encourage you to do something else, to move away from the bedside. But how else can you become a recognized clinical expert in that area?"

Karon White Gibson, RN, and Joy Catterson, RN, started their own home health care business in the early '70s, not to get away from bedside nursing, but to increase their autonomy and expertise. They also wanted to earn more money. That part took a while.

Four years ago, Gibson let go of her multimillion-dollar home health nursing business, in which she employed 400 nurses. Today, she produces three cable TV shows ("Karon White Gibson, RN Show," "Outspoken with Karon," and she co-hosts "The Senior Connection") that air in the Chicago area and in Palm Beach, Fla. The shows stemmed from a commercial she made for the business, which segued into a five-minute show called "Healthbreak."

Catterson exited the first business as her four children grew and needed more attention, but today she does marketing in Chicago for a home health care agency.

Gibson and Catterson tell their story in a book, Nurses on Our Own.

"I still feel I'm a nurse, practicing consumer education," Gibson said. "My life has given me so many opportunities I think other nurses should be exposed to. What other career could offer so many choices?"

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I'd do it all over again...

Nurses at St. Luke's Hospital in Chesterfield, Mo., entered a contest by completing essays on why they became nurses. Participants were asked to finish the statement, "If I had it to do over again, I'd still be a nurse today because …"

… Because nursing offers the flexibility with hours as well as opportunities that no other career can match.

Nursing is a challenging and rewarding profession because it offers a person the opportunity to work with people on a daily basis. There are many professions that require you to deal with people, but few jobs that let you heal, help and make a difference in other people's lives. Helping others is one of the greatest rewards a person can experience.

An old saying says, "I expect to pass through this life but once. If there is any kindness I can do, let me not defer or deflect it."

~CAROL GROTHA

… Because nursing has enhanced my life in so many ways. Some of them are:

 

… Nursing has offered me more opportunities than any other profession could.

As a beginning nurse, I worked closely with cancer patients and families. I learned that the more I gave to my patients, the more I received in return. I saw the ugliest side of life, as well as the most miraculous. I became a better person as a result of helping and watching my patients face difficult struggles.

Nursing has helped me to put things in the proper perspective. Being a nurse reminds you on a daily basis of what is really important in life.

In my present position as a nurse educator, I strive to help my fellow nurses to be the best that they can be. I always try to advocate for them. I am grateful for all that they do. Hospital nursing is demanding work. I am often humbled by the commitment that so many nurses have.

~JOAN MCCOURT

… Because no other profession on Earth causes such a profound impact on others.

Although nursing poses emotional, physical and spiritual challenges unmatched by other professions, I still marvel-after a quarter of a century of being a nurse-that I get paid to help people feel better. I am forever uplifted and inspired by those who endure pain and illness, and my profession constantly reminds me how blessed I am.

What other job offers more meaningful rewards?

~LOUISE NATION

… Because of all the wonderful people who have touched my life.

My nursing career has taken me down many roads. Some roads took me to places I had never imagined. However, my last destination as an oncology nurse has been the most rewarding. Our patients and their families are so nice, kind, brave and strong. They are a
constant inspiration to me to cheer them on as they battle their disease.

Four years ago, I was diagnosed with breast cancer. God blessed me with all these wonderful people whose battles now were a source of strength and encouragement for me. I have received much more than I have given and so many of the patients don't even know.

~JUDITH PAUL

… Because nursing offers a full continuum of service opportunities from bedside nursing, teaching, research, management, home health, counseling, etc. A nursing degree is just the "first door" to a profession that allows one to explore the full gamut of patient/family service opportunities.

I am a nurse today because I realize that I have a need to help others achieve and maintain their sense of equilibrium. When I first became a nurse, my focus was on bedside nursing, helping patients regain their physical equilibrium.

As time passed and I was exposed to other aspects of nursing, I became more interested in their educational comfort and sought a position in teaching that focused on prevention and early detection. While this was satisfying, I eventually refocused on the psychological and emotional equilibrium of those diagnosed with cancer.

Returning to school for a master's degree in counseling, I was ready to embark on the most rewarding opportunity of my nursing career. How fortunate I was to have become a nurse and realize that my nursing degree was the key that would open many other doors for me when I was ready to test new ground.

I have enjoyed the experiences each door offered, and appreciated the opportunity to explore other choices along the continuum.

~LYNN STADNYK, RN, LPC

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To order Nurses on Our Own, visit www.geocities.com/nursesonourown.
To find out more about Karon White Gibson's television shows or for general information, call (815) 773-4497.

Center Nursing Press books include: