Woman Seeking Advice: Why Should I Be A Nurse?

The email came a couple of weeks ago and I’ve been thinking about it ever since.

A woman who reads this blog -- Kate from the Philadelphia area – asked my advice about becoming a nurse. She is currently taking prerequisites to get into nursing school and has been accepted to an accelerated program because she already has a bachelor’s degree in music therapy.

“Nursing will be a second career for me,” she wrote. “I currently work with special needs children. I love it, but I have always been interested in the medical field as well. For the first time in 13 years, all my own children are in school full time and I have some free time on my hands.”

So Kate decided to return to school and pursue a career in nursing, but she is having second thoughts.

“I am worried about a few things,” she confessed.

“First of all, nursing jobs are in short supply in my area… It would be disappointing to spend money on a second degree and then not be able to find a job. Another thing that worries me is that I have talked to many nurses over the last year, asking them about their jobs. Most nurses I talk to are not happy in their work and discouraged me from going into the field. They felt underpaid, overworked etc. While I did find some that enjoyed it, the majority didn't. Any advice/opinions you could give me would be great.”

I was flattered that she asked, but I’m no expert on the job market.

I do know, I told her, that there are geographical pockets of nurse-unemployment as well as pockets of nurse shortages. I recently read that, despite all the jobs that are disappearing in this country, 22,000 health care jobs were created in the last quarter of 2009. Now all of those are not nurses, but certainly some of them have to be.

And there’s that onslaught of aging boomers that are going to need care, and all the boomer nurses that will be retiring, so all the experts are predicting that overall, there will probably be a nurse shortage in the coming years.

As for pay: on the whole, nurses are paid pretty well. One recent report said that the average pay for nurses is $62,000, but it didn’t specify whether that’s for hospital staff nurses or otherwise, or whether that figure reflects nurses with degrees or without. But in general, nursing is a fairly well paid profession, especially for those with degrees.

Of course, any nurse will tell you that no matter how well or how poorly you’re paid, you have to like the work. I cautioned Kate that nursing is not for wimps – especially hospital nursing – but there are so many other well paying fields open to nurses now that didn’t exist a few decades ago. The possibilities really are endless, and I told her that she has a leg up on other nurses for a particular job because she already has a degree and 13 years experience working with special-needs kids.

I’ve interviewed tons of nurses all over the country and there are plenty who absolutely love where they work – mostly because of the terrific camaraderie among co-workers. I told Kate that there can be great variances in work environments and that co-worker support can make all the difference in the world.

Lastly, I told Kate to figure out why she wants – or thinks she wants – to be a nurse. Is she just looking for something to fill her free time or does she feel the call?

What would you say to Kate if she asked you whether she should pursue a career in nursing?

Please share your thoughts.

Message from the Nurses in Haiti: Don’t Forget!

It’s been about five weeks since Haiti’s capital, Port au Prince, was leveled by a 7.0 earthquake. News of the city, its survivors and those who went to help has predictably faded from front-page headlines. In my local paper today, there were a couple of items in the News Briefs section, despite the fact that even more misery is likely to come.

The weather is quickly moving into the rainy season and health care experts in the area are predicting rampant disease because of the lack of shelter and sanitary conditions. I can’t even imagine…

I’m not surprised that we hear so little about the plight of the Haitians these days. Earthquakes and their immediate aftermath offer a lot of photo ops (“If it bleeds, it leads” television reporters like to say). I guess fever and diarrhea and just plain misery are not exciting enough to warrant hour-to-hour coverage. Once the media swarm has ceased, we’re left with a slow, infrequent hum of news coming from disaster areas.

But that’s always the way with cataclysmic events.

As the aftermaths age, the story and experience almost become non-existent for those who aren’t living it. I can’t help thinking, however, of all the nurses who volunteered their time, money and expertise to charitable organizations that either rushed into Haiti with aid or were already there helping the Western Hemisphere’s poorest country. How are they managing? How are they processing all the pain and sadness they are seeing? How are they dealing with stress of caring for orphans and misplaced children who are dirty, hungry and hurting? The parents who have lost their children? The people who have lost friends, home, everything?

It seems way too much to handle, and yet, nurses usually come through. And at least they’ll eventually return home to warmth and cleanliness. As one nurse said to me, “It’s not about us.”

I had the privilege of talking to some of the nurses who were either in Haiti post-earthquake or who had gone to Haiti and already had returned home. (Some referred to the Jan. 12 disaster as “the event,” as if saying “earthquake” was just too painful or would cause another one.) What surprised me, though, was the number of nurses and organizations that were in the country pre-earthquake. Two American university nursing school programs in this country had established sister nursing school programs in Haiti. For some time they have been sending nurses as teachers as well as economic aid.

Other American nurses were working regularly in clinics for women and children and were trying to raise the bar on the standard of care. As one nurse put it, practicing medicine in Haiti, even on the best day, is learning to do without. “That’s just normal operating procedure here,” she said. “Sometimes you have water and electricity; sometimes you don’t, but you learn to give care without those things.”

The other message, which ended most interviews, was a plea to keep reminding Americans and other economically well off nations that Haiti’s post-earthquake plight is going to last a long, long time. “The need is great and it will continue to be great,” the nurses told me. “Don’t let people forget Haiti.”

One additional comment: I’ve had to opportunity to read emails from an engineer and a building contractor who went to Haiti to provide advice and aid. They noted that in some areas, there are just too many volunteers of this type. “People are just standing around…” one wrote. “There just isn’t enough for them to do yet.”

That is definitely not the case when it comes to nurses.

In some instances, the only limiting factor for caring for the injured was the lack of ORs and other medical facilities, but there was never a shortage of things for nurses to do. Those who weren’t schooled in trauma care learned quickly and there were always people who, at the very least, needed consolation.

What have you or your colleagues done to get involved in helping Haiti, whether on the scene or from afar?

Is it possible to get “catastrophe fatigue?”

Do you think there has been enough media coverage on what nurses are doing in Haiti?

Has there been too much or too little overall coverage?

Tell us what you think.

Nurse Advocates: Can They Go to Jail for Doing the Right Thing?

If nurses had a water cooler and they had time to stand around it, they’d be talking about this story.

Anne Mitchell, RN, of Kermit, Texas, a town of 5,200 just south of the New Mexico border, reported Rolando G. Arafiles Jr., MD, to the Texas Medical Board because she believed that he was practicing bad medicine. Now Mitchell will stand trial for doing so.

Mitchell’s complaint said that Arafiles was improperly prescribing medications and performing improper surgical procedures at the 25-bed Winkler County Memorial Hospital (the county jail has 101 beds).

According to several media sources, Mitchell and a second nurse, Vickilyn Galle, RN (who has been dropped from prosecution), learned that Arafiles was e-mailing patients he had seen at the hospital, encouraging them to buy herbal products that he sells. He also performed some questionable procedures in the hospital’s emergency room.

Others noticed problems, too. Two staff physicians also lodged complaints against Arafiles with the hospital board, but the board failed to act. So in April 2009, Mitchell contacted the Texas Medical Board. She asked that it investigate Arafiles' care of several patients.

The board notified Arafiles that it had received the complaint and asked him to provide copies of the medical records. (To see a copy of the board’s letter, see http://www.casewatch.org/civil/mitchell/tmb_complaint.pdf.) The doctor complained to the local county sheriff and his friend, Robert Roberts, alleging harassment. Roberts credits Arafiles for saving his life when he had a heart attack; he also is a partner in the doctor’s herbal remedy enterprise.

Mitchell, who with Galle has lost her job at the hospital, has been accused of “misuse of official information,” a third-degree felony in Texas. It carries a maximum penalty of 10 years in prison and a $10,000 fine. She was fingerprinted and photographed at the Kermit jail, an experience she called “surreal” because you shouldn’t “go to jail for doing the right thing.”

In late August 2009, according to the Texas Nurses Association, the nurses’ attorneys filed suit in federal court alleging not only illegal retaliation for patient advocacy activities, but also civil rights and due process violations.

Mitchell’s trial began Feb. 8. The prosecutor rested his case by midday Feb. 10, and the defense began presenting its case. (Earlier in the day, the judged refused to give a “directed verdict,” which means the state failed to prove every element of its case beyond a reasonable doubt.) For a history of the case and updates, visit http://www.texasnurses.org/displaycommon.cfm?an=1&subarticlenbr=509#fightback.
Twitter followers can join the conversation @TexasNursesAssn, #WinklerRNs.
This story raises so many questions.
How can a nurse be prosecuted for following the tenets of the Nightingale oath? (For one version of the oath, visit http://www.accd.edu/sac/nursing/honors.html.)
What happened to whistleblower protection?
Will there be repercussions for Arafiles in regard to the action of the state board?
What are the consequences to Arafiles if Mitchell is exonerated?

Tell us what you think about this case.

An Answer to a Tough Question: How to Explain Death to Young Children

Nikki Aksamit is not a nurse, but she’s created something that many nurses may find useful: a book explaining death to young children.

If you work in hospice or palliative care, or are looking for explanations for why people and pets die, you may find some help in the book “Mommy, What Is Dead?”

I don’t know about you, but I’d rather be asked about the birds ‘n’ the bees than about the what and whys of death. This is the situation in which Aksamit and her husband found themselves when their family experienced a series of losses – an interrupted pregnancy, a family friend and a long-time pet.

“In an 18-month period, I was faced with explaining all of these things to my 4-year-old son,” said the Chandler, Ariz., mother of three. “I couldn't find any books that were specific enough, or age-appropriate to give him the answers I wanted him to have. So I wrote my own.”

The first loss came in 2007. Aksamit was six weeks pregnant when her car was hit. Although she was told at the time that the fetus was unharmed, she lost the pregnancy at three months.

Her oldest son, Rook, then 4 years old, “was very straight forward -- precise in his questioning,” she said. “My husband and I were grieving and we were at a loss for words. Rook wanted to know ‘Why can’t bodies live forever?’ A week later, I picked up construction paper and markers and came up with answers.”

Aksamit’s self-published book is a soft-cover with illustrations explaining death and dying and is aimed at preschoolers and young children. It presents her concept of the difference between body and soul and broad reasons why people and animals die. The author incorporates what she says are “the two most common beliefs as to what happens to the soul after death -- heaven and reincarnation.”

“Although they are incredibly perceptive, I think we forget sometimes that kids don’t comprehend things the same way that we do, Aksamit explained. “They think in much simpler terms, especially preschool children. We should give them the answers they need, in a way they can understand.”
Shortly after Aksamit finished the book, the family dog passed away, then a close friend of the family died.

“That one hit us really hard and Rook was asking questions. I went to the book and it explained that sometimes people are sick for a long time and their bodies just can’t be fixed.”

Nurses can preview “Mommy, What is Dead?” at http://mommywhatis.com and decide whether the book is suitable to pass along to family members who have suffered a loss.
Aksamit realizes, she said, that not everyone will approach this topic the same, and some parents may choose to avoid it completely, but, “I never wanted to shelter my kids. My parents never sheltered us from anything and I want to do the same for my kids.”

However, it is appropriate to bring explanations of death to the proper level.

“If it could help my kids, maybe it can help other kids, too,” said Aksamit, who has several hearing-impaired people in her family, and has written another book -- “Mommy, What is Deaf?”

Do you have an explanation you’ve used to explain death to young children?

What for you are the toughest questions and/or the most delicate issues to explain to kids?

How honest with children do you think adults should be about terminal illness and death?


Tell us what you think.

Body Scans: Preventive Medicine or a Precursor to Problems?

Maybe you’ve seen the fliers floating around your neighborhood, delivered with your newspaper, distributed at your church or dispensed at the local senior center. The headline on some iridescent colored paper, in bold black letters, might read something like “How do you know you don’t have a ‘silent’ tumor unless you look?”

These typical scare tactics are used to hawk total body scans using ultrasound.

In my neck of the woods, a company that does these scans offers three packaged deals from which to choose. Package #1 offers a “heart/stroke” scan for $275; Package #2 is the “cancer/organ” scan, also for $275; and for those who want to be really sure, there is Package #3, the full-body scan, which includes all of the above for $500.

The ads are often accompanied by testimonials from customers who say the scans saved their lives by finding tumors they never would’ve discovered until it was too late.

Ultrasound is a wonderful visualization technology and is used without controversy in many areas such as fetal imaging and pregnancy problems, musculoskeletal injuries, pediatric procedures and for many other medical problems. But criticism comes when companies with the machines – either stationary or portable – try to sell the idea of scanning “just in case” to the “worried well.”

Some experts say that ultrasound finds a lot of things that would never become problems, but once you find them, doctors are obligated to perform biopsies or other invasive procedures that carry risks. Others argue that the portable machines do not meet the standards of stationary scanners, and that technicians performing the portable scans are not qualified.

Still others find the marketing of these procedures unethical – like the fliers that are widely distributed in places where seniors gather. The fliers we recently received shouted in bold black letters that “A BODY SCAN Can Save Your Life!”

And, of course, scans cost money -- cash preferred. Insurance rarely covers scans unless they have been ordered by a physician for a specific reason.

I admit that it’s a hard call sometimes as to whether these scans are worthwhile or not. I’m sure my cousin would say that they are. He had a scan and doctors discovered a malignant tumor in his kidney for which he had no symptoms. Because they caught the tumor early, they were able to remove it and save the rest of the kidney.

But most of the time, doctors say, when patients bring the results of these scans into their offices, they feel obligated to order further tests, and most of the time these additional tests result in no negative findings. On rare occasions, the additional tests cause serious problems.

When people ask me whether I think getting a scan is a good idea, I tell them both sides of the story and that they have to decide for themselves.

Do you think that elective body scans a good idea?

What do you or would you tell people when asked?

Have you any type of scan without a doctor's order and has it given you peace of mind?

Tell us what you think.