No Regrets
Flexibility, job security and meaningful work spell satisfaction for career RNs

By Jane Futcher
February 14, 2002

Laura Wester, RN, was 7 years old and stuck in the ER with a nasty cut when she first considered becoming a nurse.

"I thought, this was kind of a neat place," said Wester, now 42. "I can remember thinking, 'This might be something I want to do.' "

One marriage, a bachelor's degree in science, three kids and 24 years later, Wester is a medical/surgical staff nurse at Sutter Health's Novato Community Hospital in Marin County, Calif. She has never seriously considered any career other than nursing, even though when she graduated from the College of Marin's nursing program in 1994, she couldn't find a job.

The nationwide nursing shortage quickly changed that.

Like many of this country's 1.7 million registered nurses, Wester is grateful to be working in an industry hungry for her skills, one that offers more career opportunities than other fields she might have entered.

But the "neat place" Wester experienced as a child has changed dramatically. Today's nursing workplace environment is fast-paced with heavy patient loads that plague hospital floors from Boston to Bakersfield.

"There's been a lot of impact in terms of managed care. Less autonomy, less freedom. Everything is more controlled.," said Howard Sambol, president of Career Crafting, an online job counseling and coaching service in Larkspur, Calif. "There are also politics that have affected the relationship with administration and management."

Sambol believes that many people-usually young women-enter nursing with a false impression.

"When young people get into the nursing profession or sign up for nursing school, I think they're sold a bill of goods, an ideal image of what a nurse is and what a nurse's job is," he said. "They get disillusioned later because the environment and working conditions that nurses actually have do not match up with that idea."

But, despite the obvious drawbacks caused by the shortage and managed care, most nurses NURSEWEEK talked with quickly pointed out the benefits of working as a nurse today.

Wester says the profession's flexible hours have allowed her to combine raising a family with performing work she finds rewarding: providing medical assistance to people when they need help the most.

"I think the main reason why many nurses would say they chose to go into this profession is the opportunity to help people," said Vicki White, RN, chief nursing officer at Marin General Hospital, a Sutter Health facility in Greenbrae, Calif. "It's helping people at a time in their lives that's meaningful and makes a difference."

White, who manages a staff of about 900, describes nursing as "the work of the heart."

"It's making the personal connection and applying the scientific process to the crisis," she said. "Sometimes, when you've had a terrible day, seeing one patient get relief from pain or seeing them come out of a cancer surgery or seeing a child that's had a good day is personally and professionally rewarding."

All of the nurses NURSEWEEK interviewed said hospital nursing's flexible hours are a key advantage of working in the field.

"Flexible hours are one of the greatest aspects of nursing," said Ruth Jenkins, Ph.D., RN, an associate professor at Barnes College of Nursing and Health Studies at the University of Missouri-St. Louis. "Days, evenings, nights, weekend options, plus various shift hours-eight, 10, 12, doubles [16]-these types of hours allow the nurse to work longer shifts, fewer days in a row. Weekend option allows nurses to basically work full time or enough time to qualify for benefits.

"In addition, some nurses use this option to be able to go back to school, still have time for family and be able to support themselves."

Although nurses who work in physicians' offices often have less-flexible hours than hospital nurses, Jenkins says job sharing, a practice increasingly accepted by physician employers, is beginning to give those nurses more scheduling options.

Maryann Ricardo, president of Praktica in Glendale, Calif., a company that matches physicians and nurses in career opportunities, believes nursing offers another kind of flexibility uncommon in other fields.

"What's exciting about nursing as a career is that it can accommodate a person, whether or not they want a career climb or a timeline, as their life shifts and changes," Ricardo said.

A "timeline" is how Ricardo describes a career in which breaks are taken "as they pass through life," such as childbirth and child rearing, travel and caring for aging parents.

Ricardo said many nursing students and new grads, as well as nurses who have retired, do not realize how many job opportunities exist beyond acute care nursing, something which she impresses upon new recruits.

"About 54 percent of jobs are outside the hospital environment," Ricardo said.

Some of those nonhospital jobs include case management, hospice and end-of-life care, correctional facility nursing, home health care and follow-up, public health nursing, rehabilitation, forensic and legal consulting, nurse recruitment, pharmaceutical sales, textbook writing, college and continuing education teaching, school nursing, traveling nursing and computer-related informatics.

There are also increased demands for nurse specialists in such fields as colostomy and skin care, diabetes, gerontology and pain management, Jenkins said, although she added that specialists often are the first laid off if the economy turns sour.

Jenkins also points to a budding new field called telehealth, in which two-way audiovisual equipment, including telephonic stethoscopes, blood pressure hookups, cameras and computers, are placed in patients' home with links to the nurse's computer screen.

(Learn more about Telehealth)

"This is live, real-time interaction, assessment, planning and intervention care," Jenkins said. It's motivated by the cost savings that result from keeping sick people safely at home and out of the hospital.

Jane Lawton, a divisional recruiter for GE Long Term Care Insurance in San Rafael, Calif., regularly hires nurses as benefits analysts, underwriters and insurance salespeople.

"We usually go after retired nurses or people who have said, 'I just can't lift patients anymore, I just can't deal with the stress of being in the emergency room or being in the ICU.' "

"There are lots of opportunities for anyone in the medical field because it's one of those fields that's growing by leaps and bounds," Lawton said. "The opportunities are really endless."

Holly Rauen, RN, is a former lay midwife whose income was unsteady when she performed home births. Now ob/gyn advice and triage team charge nurse at Kaiser Permanente San Francisco Medical Center, she says one of the greatest joys of the nursing profession is the steady paycheck.

Today, Rauen earns about $36 an hour and receives "good overtime."

"Nursing wages in the [San Francisco] Bay Area are not bad," Marin General's White said. "A full-time nurse working for a number of years can earn $80,000."

Rauen said the money doesn't always offset the physical and emotional stresses of clinical nursing. "It's not just hard work on your feet," she said. "Nursing, whether at a hospital or clinic, is incredible detail work. You really have to have it together as far as math goes. Your charting has to be impeccable. A patient's chart is a legal document."

Jenkins admits that, in recent years, working conditions, affected by higher patient-nurse ratios, greater responsibility and increased paperwork and documentation, have made hospital nursing positions more demanding. But she points to a growing number of perks now offered by some hospitals.

"More and more institutions are creating perks such as membership in exercise clubs at a reduced rate, use of in-house massage therapists at a reduced rate. Some offer clothes cleaning, and some are creating day care centers on-site, which can facilitate mothers breast-feeding and visits by fathers during their shifts."

Higher pay, scheduling flexibility and a growing range of career paths appear to be luring more men into nursing, with many gravitating toward management positions, clinical specialties and agency work, Jenkins said.

"The draw to agency work is the higher pay, fast pace of going to a number of environments and calling their own shots about when they will work. However, they are the first to be canceled should the census change or if the situation has enough of their own nurses available or willing to work doubles or extra shifts."

Rauen and Wester said they're glad that more male nurses are entering the field because they add balance to the workforce. Rauen also said male nurses allow for more gender-appropriate nursing care.

"Sometimes, one sex is preferable to another as a caretaker," Rauen said.

"Gender barriers have been knocked slowly down. In OB, it's almost weird to have a male nurse. The majority of the people who work in my department are women."

Uniforms are another perk that nurses say offer greater comfort and cost savings.

"I miss being in scrubs," said Rauen, who now wears street clothes and a white lab coat at her job. "They're like jammies. They're so comfortable...I think across the United States, there aren't too many nurses wearing starched white uniforms."

Like many nurses, Rauen says she'll stay in the field even if she changes jobs, locations, hours or specialty.

"Where there are sick people, there will be a need for some type of nursing," Jenkins said. "There will also be a need for nurses to keep people healthy. The nurse can carve out a means to meet their own interest and these needs."
Jane Futcher