Pat Marjavi, RN, raised two young children and two teen-agers as a single mother and a nurse. She usually worked three per diem shifts a week, often at night. As her two toddlers grew and went to school, she worked more day shifts so she would be home when they were. After her children were older, she switched to evening shifts, which allowed her to work as a home-birth midwife-she calls herself a "spiritual midwife"-in addition to her hospital work. It hasn't been easy, she said, but she doesn't see how she could have done it at all had she chosen any other career.

"If nursing is a good career for moms with partners, it's even better for single moms," said Marjavi, a labor and delivery nurse at Kaiser Permanente Medical Center in San Francisco. "It was hectic, but the nice thing was that for most of my career, I've worked three times a week. You have the freedom to do that in nursing."

In an era in which women privately worry and publicly debate whether it is possible to be a great parent and pursue a successful, meaningful career, many nurses have been doing both for some time. According to the National Sample Survey of Registered Nurses, a little more than half of the nurses surveyed had children living at home and about 20 percent had children younger than 6.

Flexible hours, the ability to switch to part-time work, a variety of shifts and myriad career opportunities from home health to teaching make nursing an ideal profession for women and men who have or plan to have families.

As they would with any other career, nurses who want to advance in the profession and take time off to have a family must think ahead and plan carefully to balance their personal and professional lives, nursing administrators and educators say. They must stay involved by attending meetings, staying in touch with mentors and supervisors, and keeping abreast of what is happening in the workplace.

Although flexible schedules are great, Marjavi and other nurses say they would like to see more support and understanding of their family needs from employers. Some hospitals are recognizing these needs-and hoping to recruit and retain staff-by offering "working parent shifts," on-site day care and even family service departments that arrange to wash employees' cars or pick up their dry cleaning.

Women have pondered the best way to balance work and motherhood since the days when they carried babies on their backs while picking berries or planting crops. But the topic has gained intensity in the last 20 years, as women have risen in professions previously closed to them, such as medicine, law and business.

In her controversial book, Creating a Life: Professional Women and the Quest for Children, economist Sylvia Ann Hewlett argues that too many women believe they can devote themselves exclusively to their careers until their late 30s or early 40s, then have a family. For many, she says, it is biologically too late.

Yet her research also shows that women who start their families early often struggle to maintain their position in a corporate career. Many companies offer no part-time or flextime options for returning parents.

Karen Drenkard, MSN, RN, has a friend who worked in the marketing department of a large corporation. After her child was born, she wanted to return to work part time, but the company told her it had no part-time position for her.

"Friends look at me and they're envious," said Drenkard, chief nurse executive at Inova Health System in Falls Church, Va., and mother of three children, aged 8, 13 and 14. When her first child was born, Drenkard resigned as administrative director. She spent seven years working part time, first as an off-shift supervisor for five or six evening shifts a month, then in quality performance and improvement.

When her youngest child entered kindergarten, she went back to work full time. "What other career can you juggle part-time and full-time work with what your needs are?" Drenkard asked. "I think we have to share the good news about nursing, and it's a big news story that there's all this flexibility."

A nurse's education also comes in handy in raising a family. Nurse parents say they have used their healing skills and expertise for a variety of childhood illnesses and accidents, both for their own children and for those of neighbors and friends.

Karen Buenaventura, MSN, RN, who recently graduated from the nursing administration graduate program at UCLA, said her desire to have children was an important part of her decision to become a nurse 16 years ago.

"I knew that I wanted to have a family, and having a career in nursing would allow me to have the time to be with them when they were small," said Buenaventura, who works in the neonatal intensive care unit at a Southern California hospital and has four children, aged 4 to 13.

She worked two day shifts a week, one weekend day and one weekday. Her husband, a civil engineer, covered the weekday by working four days a week. During part of that time, she worked in home health. Then she went back to neonatal intensive care, intending to work full time and become an expert. At this point, she discovered she was pregnant with her fourth child.

"Sometimes you have to change your plans," Buenaventura said, and nursing let her do that. She briefly considered leaving the profession, but later decided she wanted to stay and make a difference as an advocate for nurses. To do that, she said, she needed to understand the administrative and political side of nursing, given the nursing shortage and turbulent health care climate. She decided to pursue a graduate degree in nursing administration.

Now, she and her husband have arranged their schedules so that she gets the children ready in the morning and drops them at school, and her husband picks them up and takes care of them in the evenings until she gets home. Whatever administrative job she takes, she said, "I would prefer a schedule with some flexibility. I am more productive when I can keep my work and family life balanced."

Melissa Blome, RN, a staff nurse in labor and delivery and postpartum at Bryan LGH Medical Center East in Lincoln, Neb., and the mother of two children, aged 5 and 1, has chosen to work full time. She works three 12-hour shifts a week, usually a mix of nights and days. Her children stay in day care while she sleeps and her husband works. Some parents keep their children home and just don't sleep, she said, but she can't do that.

Blome said she spends more time with her children than she would if she worked full time in an office, and her hospital offers on-site child care for employees, which helps a lot. "You have to be very organized and you have to have a helpful family," she said.

The flexibility and variety in nursing were a huge attraction for Lisa Pak, GN, a new graduate and staff nurse at Brazosport Memorial Hospital in Lake Jackson, Texas. Originally Pak, who has an undergraduate degree in premed, wanted to be a doctor. But she also always planned to have children.

"I didn't know how I could be a mom and have a career as a doctor," she said. "I think I would be caught between my career and my kids. With nursing, you can do both."

She was impressed by her nursing school professors who worked for years as nurse practitioners, then decided to teach, partly so that they could spend more time with their young children.

She and her fiancé are thinking about having children within the next three to five years, she said. She plans to work part time, keeping up her skills, then maybe eventually go to law school and become a nurse attorney. But those plans could change, she added. "You have so many options in nursing."

When he lost his job as a manager in a heating and air-conditioning company, Mark Barnett, RN, of Midland, Texas, decided to go into nursing in large part because it would allow him to help care for his three children, aged 3, 9 and 11. He and his wife, who is also a nurse, want to try home schooling and plan to arrange their work schedules to make that possible, he said.

"There are enough positions out there so that I can find one that will allow me to work around the family," he said.

Barnett, a recent graduate, works in the emergency department at Medical Center Hospital in Odessa, Texas. After he receives his bachelor's degree, he likes the idea of working at least part of the time as a traveling nurse, taking 13-week contracts in places such as Colorado or Florida, where he can bring his family along to go skiing or to Disney World. His wife also has suggested camp nursing as a working family vacation.

"If we're both nurses, we can do rotating shifts and still have the money to pay for it," Barnett said. "It has to be work, but work can be fun."

Making a plan-even one that changes later-is important for nurses who decide to switch to part-time or per diem work while they raise young children if they want to keep up with their careers, said Donna McNeese-Smith, Ed.D., RN, associate professor at UCLA and coordinator for the nursing administration graduate program.

"Nurses can jump back in quite well if they have the right education and experience," said McNeese-Smith, who raised three children while working as a nurse. Even nurses who leave the profession for a while can return to it, she said. "But, without question, their careers are delayed."

She recommends nurses think about what they want from their career and build their part-time résumés accordingly. For instance, nurses who plan to return to the bedside should keep up their clinical skills. Those who want to work as administrators might want to take off-shift supervisorial positions. Nurses who always wanted an advanced degree may decide to go back to school with a schedule that matches their children's preschool hours.

"Employers don't look at your résumé to see if you've been working full time," she said. "They look to see how much experience you have."

Part-time workers usually don't have as much involvement in organizational planning as full-time workers do, she said. They are less apt to serve on committees or move into higher management positions.

During the years Drenkard worked part time, she made sure to attend important meetings, read reports and keep up with what was happening at her hospital. "I believe that if you are a part-time worker, it's incumbent upon you to stay committed," she said. information is available, but you have to work a little harder to get it."

Although nurses say that having a partner or spouse to help with child care is invaluable, some know of single mothers who have successfully juggled a nursing career and family with little outside support. Many nurse parents, both single and with partners, said they would welcome more support from their employers.

Marjavi said she and other mothers did not dare call in to say their children were sick. Instead, they lied and said they themselves were sick. Buenaventura said her employer was good about things such as letting her leave early to pick up a sick child from school, but sometimes she felt some co-workers thought she didn't take her job seriously because she worked part time.

"It's much nicer if you don't have to play games," Marjavi said. "Hospitals do have to be supportive of nurses as mothers. It makes it better for the hospital, because then we feel like we're valued."

A number of hospitals are realizing that recognizing the needs of working parents and supporting them is a great way to recruit and retain staff. Turnover among families enrolled in the on-site child development program at Bryan LGH Medical Center is 2 percent, said Julie Fischer, employment coordinator and nurse recruiter at the medical center.

"It's become a huge retention factor for us," she said. So much so that the center plans to expand the child care service, which has a reputation as one of the best in the area, Fischer said. She uses it herself and loves it. "I would think twice before I would pursue another job outside of the organization," she said.

The child care center is part of the hospital's family service program. The program offers a variety of employee perks from discount tickets to referrals for tutors and elder care to services that change oil, wash cars and pick up dry cleaning for people who would rather spend their free time with friends and family.

"People tend to say, 'Really?' when I tell them about it," Fischer said. "They can't believe we would go that far. It's kind of the frosting on top of the cake."

Besides offering flexible shifts, on-site child care and a referral service for summer camps and other programs, Inova Health System works with employees to find them work and a schedule that will meet changing personal and family needs, whatever they are, Drenkard said. Working Mother magazine recently listed Inova as one of its top 100 employers, she said.

"We want nurses to work at Inova for their whole careers," Drenkard said. "We're trying to be really accommodating to parents. We're very respectful of people who need to work part time," whether they're taking care of children, going back to school or caring for elderly parents. "It's a longer relationship than just trying to fill positions."

Drenkard is among a growing number of nurses who believe the profession should be actively selling itself as a great career for parents-one that offers important, interesting work, but recognizes family and personal needs as well.

"I think what people want is productive, meaningful work, but I'm not sure they're willing to give up their lives for it," she said. Nursing not only offers meaningful work, but also the salary, medical expertise and flexibility to raise a family. "I think nursing really stacks right up there," she said.

She doesn't have to sell Blome, the Nebraska nurse, who is expecting her third child. "I am right where I want to be," Blome said. "This is my goal-being married, having children and having a job [in] obstetrics, which I love. I'm very happy and very grateful for what I have."

Contact Cathryn Domrose at kaguilar@well.com.