Nursing offers many options

Back in 2002, Bob Bassett was working as a retail store manager in Elko when the business went bankrupt. He looked for work at large companies in the area that seemed like a sure thing, such as Walmart, Pepsi and Dolly Madison, but there just wasn't much there. Finally he decided to entirely change direction and get his associate's degree in nursing -- a different kind of customer service, you might say.

He worked on the medical/surgical floor of Northeastern Nevada Regional Hospital in Elko for a year and went on to get his bachelor's degree. Then the opportunity came to work in case management, coordinating care for patients. He did that for five years before taking a new position as the hospital's infection-prevention specialist a few months ago.

Now Bassett, who is 50, runs a one-man department writing infectious disease prevention policy for the hospital in a job that allows him to be "an instrument for change and an advocate for patients," he said.

"That's the advantage of nursing, there's so many opportunities," he said. "You can work in schools, for an insurance company, for a hospital ... there are a lot of directions to go and in different areas."

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Judith Alewel had been away from nursing for about a decade to raise her three children when she decided to step back into the profession. She enrolled in the nurse-refresher program at the College of Southern Nevada and spent two semesters as a full-time student taking online courses, doing hands-on clinical work and finally a preceptorship at a local hospital.

Nevada requires all nurses who have been away from the field for at least five years to complete a refresher program.

"I really, really missed nursing, in fact it was probably one of the hardest adjustments I've ever had to make ... so I was thrilled to be able to get back in," she said

"The instructors completely understood that it was a little intimidating being out of the field, especially for so long," she added.

It was hard work, she said, like cramming three or four years of knowledge into two semesters. And while the basic nursing skills had not changed, new technology made other aspects of the field quite different, including the onset of computerized charting, new medications, changes in intravenous procedures and different protocols for things such as heart attacks and strokes.

But Alewel, a one-time cardiac nurse and instructor at a community college in Oregon, graduated from the refresher program in 2010 and, not long after, was hired as a CSN nursing instructor.

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Unlike a lot of fields, nursing provides the opportunity to change direction. It can come in the form of additional on-site training, continuing education, advanced degrees or by taking the initiative at the workplace in a profession with both varying specialties and the continual need to adapt to advancements in medical care.

In some cases it can even mean starting all over again.

The concept of nurses honing and repackaging their skills, and the ability of employers and nursing schools to meet those needs, may, in fact, become even more important because of current trends in nursing.

One of them is based on the fact that more veteran nurses are putting off retirement or getting back into the field because of the recession, according to local nursing educators. It's often these experienced nurses who are reassessing their jobs and looking for a different path.

"Many nurses who work part time have gone to full time and many nurses who were full time and who wanted to retire, because of the economy, their spouses or partners may have lost their jobs and with the economy they haven't retired, they've continued working," said Shirlee Snyder, dean of the school of nursing at Nevada State College.

Another trend is the current push to advance the education level of both new and existing nurses in the United States during the coming decade, according to local experts. This is based on recommendations made in a recent report by the Institute of Medicine called "The Future of Nursing: Leading Change, Advancing Health" which looked at the current state of nursing and ways to transform the profession in order to provide better care for a changing population.

The report advised that 80 percent of all registered nurses have their bachelor's degree by 2020, and that the number of nurses with doctorates double within the same time frame to meet the future need for instructors and researchers.

Some states already have started to move in this direction, looking at ways to implement changes in nursing education and changing state requirements.

There are already what are called "RN to BSN" programs in Southern Nevada which allow registered nurses to get the college credits to attain their bachelor's degree. One of them is at Nevada State College, a program which has seen significant growth during just the past few years, according to Snyder. Total enrollment three years ago was about 50 but current enrollment is closer to 250, and between 40 to 50 students are being admitted each semester, she said.

The courses focus on subjects such as professional nursing, nursing leadership, research, informatics, pharmacology and community health, Snyder said. A baccalaureate degree not only makes a nurse more marketable, particularly at many hospitals that are making it a priority to hire those with their Bachelor of Science in nursing, but it can sometimes lead to higher pay and advancement into positions such as charge nurse or department manager, she said.

Leslie Smith, a charge nurse in the intensive care and cardiovascular units at Carson Tahoe Regional Medical Center in Carson City, started the college's online RN to BSN program over the summer. It had been 12 years since Smith had taken a college course so she admits to feeling like a "fish out of water" in the beginning. The idea of being savvy enough on her computer to take the classes online also was a little daunting.

"But it surprised me how quick I was able to pick it up," said Smith, who is 38.

So far her coursework has taught her about the trends in community health care, including computer-based care, phone triage and urgent-care facilities. As she continues the program, Smith believes it also will show her how to better educate her patients.

The advanced degree, she said, will result in a 5 percent increase in pay, but the long-term goal is to get her master's and become an acute-care nurse practitioner in a hospital, a job that will let her provide a broader spectrum of care and give her some autonomy, she said.

"I absolutely love what I do and I'm not trying to get away from taking care of patients at bedside, I'm just trying to further my education and take care of my patients better," she said.

Smith's advice for other nurses thinking about furthering their education is to just take that first step.

"It's absolutely nothing to fear. We are our own worst enemies. ... I said there's no way I'm smart enough but I wish I would have done it years ago. It has been eye-opening on how many opportunities there are out there," she said.

Touro University Nevada also offers a RN to BSN curriculum as well as a master's program. Among the benefits of getting a master's are the ability to go into teaching, nursing administration or become more valuable to employers looking for additional expertise and the ability to lead, according to Susan Michael, director of the school of nursing.

"Many hospitals require a master's if you're going to work in a specialty in a hospital, as a coordinator of critical care, for example, or oncology," Michael said. "So they're looking for these master's-prepared nurses that have the extra training and leadership, and extra training in evidence-based practice and research to help lead the other nurses in best practice."

Michael said that there is a shortage of nursing educators across the country, including Southern Nevada, and teaching requires at least a master's degree to "get you in the door." Many of today's veteran nurses looking for a change may find that teaching is a welcome alternative after years in a profession that can be very physically demanding, she added

"You can see on the floor of the hospitals, many times, nurses who are just natural teachers and you really need to be a teacher to be a nurse, truthfully, because you're working with patients, you're educating them about medications, activities, diet, and so if you really like that kind of focus, then you'd really want to be a nurse educator," Michael said.

Touro also was the first school in Nevada to adopt a doctor of nursing practice degree, which focuses on nursing practice as opposed to emphasizing research, said Mary Brann, Touro's school of nursing assistant director and graduate coordinator. Those in the doctoral program can choose among three areas of emphasis -- leadership, policy or information technology, she said.

The school has had students from as far away as Alaska complete the program which includes online study as well as on-site intensives. Some have become educators, worked to improve nursing practice in the community, or both, she said.

The "both" includes Scott Lamprecht who had been a nurse for 21 years before going back to school in 2005 to get his master's and doctorate degrees at Touro. During his graduate work he started research on sudden cardiac arrest among adolescents and went on to do his dissertation on screening adolescents for cardiac arrest.

Lamprecht's studies, including what he calls his "hands-on" doctorate which focuses on putting the most current medical knowledge into practice, opened the door to opportunities such as advocating for the American Heart Association and testifying before legislators in both Nevada and Washington D.C. His work is one reason Nevada is required to have life-saving automated external defibrillators in places such as high schools, shopping malls and casinos.

Now he teaches at Touro and has an independent education company called Complete Medical Consultants in Henderson.

"So you talk about people doing mid- to late career, that's me, and it's just snowballed from there. Six years ago I was a staff nurse, now all the other stuff has happened and it's been a very interesting, interesting ride," Lamprecht said.

"Nursing school is one of the most difficult things I've ever done but by far has been the most rewarding thing I've ever done," he added. "It's not for people just looking for a paycheck. It's a profession, and you have to be committed to it."

Often the chance to change course is already found at the workplace. Sunrise Hospital and Medical Center, for example, provides tuition reimbursement for those seeking advanced education outside of the hospital.

Barbara Fraser, the hospital's director of education, notes that she has nurses enrolled in nurse practitioner programs, others seeking master's degrees and one that recently attained a doctorate. The hospital also has agreements with colleges for discounts on tuition of, for example, 10 to 20 percent, she said.

Also, most hospitals already offer their own training in some form or another for those wanting to change specialties.

"At hospitals, say someone works on a medical surgical unit for adults and now they want to go to pediatrics, they typically will provide in-service or continuing education training for people making that type of transition," Michael said.

And never underestimate the value of taking the initiative.

Bassett noted that one of his fellow nurses recently was asked to help the hospital write a policy on preventing patient falls, and this led to positions as assistant director of the medical/surgical/pediatrics unit and a job heading up the hospital's education department.

"I think everybody needs to have the opportunities to challenge themselves and do new things. ... If you're not growing, you're basically stagnating"