Nursing Offers a Wealth of Niches

Nursing Offers a Wealth of Niches
By Linda Sussman
CNC Correspondent

The face of health care is changing and with it the role of the nurse.

Today, there is a shortage of qualified nurses on all levels and that shortage is expected to grow exponentially in the next few years. Nursing has always been a cyclical profession, but this time there just aren't any new sources for people in the pipeline , according to Laurel Eisenhauer, associate dean of graduate programs for Boston College School of Nursing.

This current shortage has been building in just the last few years. As older nurses retire at an earlier age, and the number of ill people and their level of sickness increases, the need will be harder to meet.

"We need to be flexible and make conditions and benefits as inviting as possible to attract and keep our nursing staff," said Joyce Russell, director of hospital-wide education at MetroWest Medical Center.

Changes in medicine and health care are creating opportunities at every level.

"The biggest challenge now is how we will integrate the delivery of nursing care within a cost effective system,'' said Donna Mae Donahue, director of the Massachusetts Nursing Association Career Center. "It is an extraordinary time for nurses as they are becoming more equal in the delivery of health care."

Today's students are being snatched up upon graduation and the call has been going out to train new nurses. You can't just decide tomorrow to be a nurse, because there is special schooling of at least 18 months and then candidates must pass a licensing examination.

The face of these students is also changing. Nursing has always been an overwhelmingly female profession, one of the few professions that has historically welcomed and trained young women after high school. Many were trained in "diploma" schools attached to a hospital. In the last generation that has changed. More men are choosing nursing careers and initial training is usually done within a school setting.

The majority of today's nurses are trained as registered nurses (RNs), receiving either an associate's degree or completing their baccalaureate degree.

"This prepares you for entry level nursing," says Judy Beal, associate dean and professor of nursing programs at Simmons College. The state board showed 103,898 licensed RNs in Massachusetts in 1998. Becoming a licensed RN is just the beginning. The first year is very formative as you begin to integrate the many complex pieces of care giving in a chosen setting, she explained.

The other licensed nurse category is licensed practical nurse (LPN). They have had less theory and training than RNs and, under the Nurse Practice Act, are limited in what duties they can perform, according to Judy Boyko, CEO of the Natick Visiting Nurse Association.

"They can't open cases or supervise home health care aides," Boyko said.

In 1998 Massachusetts had 23,103 licensed LPNs.

"They do the basic and transitional patient care in the hospital," said Russell.

Advanced training and graduate programs are also available to RNs. One of the most popular programs trains nurse practitioners to be part of a primary care medical team and also to go on and train future generations of nurses. A fast-track program can turn out a graduate nurse practitioner on a master's level with five years of study, said Beal.

At the other end of the spectrum, MetroWest Medical Center has what they call their patient care associates. A PCA need have no nurse training, just an interest. They partner with a nurse and train to help in the hospital setting.

A high number decide to go on and train as RNs," said Russell.

Today's new nurses are also older with many transitioning from other careers.

"The average age of beginning nurses is now 28, not the 18-year-old of the past," said Russell. Many of the nursing programs offer special accelerated training for these older individuals. Called direct entry programs, an applicant has a bachelors degree in another field.

"In three years they can get a masters degree and certification as a licensed RN and nurse practitioner," said Beal. Many of these students come from related science fields.

"Students need to know nursing is a profession, not just a job," said Beal.

"Nursing is all about caring," according to Russell.

However you also have to be able to handle the science. Nurses facilitate transitions as an individual moves from healthy to sick and then back to health, explains Donahue. "Nursing and medicine are very different practices."

One attractive aspect of nursing is that there are so many different settings and specialities to work within, as well as different age and illness populations.

You can work in a private homes, offices, within a hospital setting, rehabilitation or long term care facilities. And while some choose to work nine to five, you can also arrange your schedule to work other shifts, nights and weekends. Russell notes that if she couldn't have worked alternate shifts while her family was young, she would have had to give up nursing for some years. "With so many skills and settings involved it is easy to fit your likes and dislikes into the nursing profession," said Beal.

Nursing can also be a very stressful career, especially as health care changes.There is quite a bit of nurse burnout today and many nurses are looking to change their specialty area. "Nurses often feel they don't have sufficient control of their professional environment," said Donahue. "They are under tremendous pressure to keep all the pieces together."

"Lots of nursing work is invisible," said Eisenhauer. That may be on the surface, but "one of the feel good sides about being a nurse is that people value nurses and nursing," said Donahue. "Great trust is placed in nurses."

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