There’s a myth out there that most nurses work in hospitals. While it’s true that more than half of all nurses are employed by hospitals, nurses also provide healthcare in some unexpected locations, from homeless shelters and prisons to football arenas and camps. Often described as both an art and a science, nursing is a profession that reflects the varied passions and interests of its dedicated workers. As the largest component of the healthcare professions, nurses serve with a strong commitment to patient safety even as they work in roles that range from airlift nurse to professor, from telemetry specialist to hospice supervisor.
“Nursing is in our genes,” explain mother-daughter nurses Terry Fulmer and her daughter Holly, 26, a Boston College graduate student who is studying to be an adult nurse practitioner. The special bond that exists between these two nurses is part of “the intimacy and privilege of the professional role,” says Terry, “and can only be understood by those who are nurses.”
While Terry, 59, is dean of Bouve College of Health Sciences at Northeastern University, she continues to be inspired by her daughter, who works 12-hour shifts on a gynecology-oncology floor, where many of her patients are devastatingly ill. “She loves her patients, and they love her. She makes me proud to be her mother every day,” says Terry.
Holly is grateful that her mother understands the intense devotion that nursing requires. “Nursing is sometimes very emotional. Certainly, nurses can have tough days taking care of individuals who are very sick and whose prognosis is dim. You want to make a difference, even when that is the case. Nurses have the opportunity to be there, to comfort and communicate with patients,” says Holly, who plans to be an adult gerontology nurse practitioner with a focus in palliative care.
Numerous studies have shown that patients fare worse when there is inadequate nurse staffing on a care unit. Problems can include more complications, poorer health outcomes, less satisfaction, and greater chance of death. A recent study on nurse staffing links inadequate personnel with increased patient mortality.
Even though more job growth is projected in nursing than in any other occupation through 2018, the gap between the supply of nurses and the rising demand for healthcare services continues to widen. A growing number of hospitals are competing for a small pool of skilled critical care nurses as an aging population of nurses leaves the workforce. Recruiters are enticing candidates with signing bonuses, tuition reimbursement, scholarships, student-loan repayments, and even finder’s fees to employees who bring in new nurses.
Erin Tansey, a senior nurse recruiter at Brigham and Women’s Hospital, says that the nursing profession has adapted to become more worker-friendly, encouraging career growth and adjusting hours to fit lifestyles. “This flexibility of full-time, part-time, or per diem hours gives RNs the opportunity to attend school, raise a family, or pursue other interests while working,” says Tansey.
Many nurses have used the flexibility that the nursing profession offers to explore their own interests and evolve their career as life needs change. Deb Gately, 65, started working at the Newton-Wellesley Hospital intensive care unit after she graduated from Boston City Hospital nursing school in 1968. A few years later, Gately felt she wanted a broader view of the world and returned to college, earning a bachelor’s in political science at Wellesley College. Gately continued to work full time while trying to break into healthcare politics. She then switched to part-time after having her first child, working a day-night rotation because it allowed her to be at home in the evening with her daughter. The rotating took its toll, and she left bedside nursing to work with her husband who had a law practice.
A few years later, Gately switched gears again, taking a new role with United HealthCare and later Boston Medical Center, solving billing and payment issues. Today, she is a nurse case manager for Brigham and Women’s Hospital’s bone marrow transplant unit, working with patients on obtaining drug authorizations and discharge planning. “Having worked in so many different but challenging environments has allowed me to practice nursing back and forth among the worlds of healthcare, law, and business,” says Gately, who added that the education and the skills she developed as a nurse served her well in all of these spheres. “Knowledge that nurses acquire translates well in many different environments. I have spent a lifetime living that belief,” she says.
While Gately’s story is typical—many nurses work full time then part-time, change careers, or try multiple jobs in one organization—others go on to become advance practice nurses (APRNs). About 250,000, or 8 percent of all RNs, hold this title as nurses who have earned a master’s degree with an area of specialization, such as nurse practitioner, certified nurse midwife, or certified registered nurse anesthetist.
One of these nurse practitioners is Christine Berté, who has an unusual niche: She developed her practice to specialize in pediatric and adolescent medicine within the juvenile correctional system.
For 13 years, Berté worked at the Bridgeport Juvenile Detention Center in Connecticut, where she established a primary care medical office for youth in the facility. “I never expected to have a career in juvenile detention medicine but it turned out to be perfect for me,” says Berté.
Her journey in this field started when she saw an advertisement for a nurse practitioner to “work with adolescents in a satellite medical setting” of a hospital. She loved teenagers and already had experience doing an extra rotation at an inner city, high-school-based health center. That was almost two decades ago, and now Berté has practiced in various juvenile detention facilities in Connecticut, including currently at Hartford Juvenile Detention. She’s also a professor at Western Connecticut State University, where she passes on her long knowledge of nursing to other aspiring nurses.
“If I had listened to some of my colleagues who were also looking for jobs at the time, I never would have tried working in a juvenile detention facility. They wanted to know if I was concerned about my safety or fearful of taking care of these kids,” says Berté. It was a huge responsibility providing physical care to the detainees—who also had all the typical turmoil that teens often have—as well as many behavioral challenges that impacted their physical well-being. “I was very glad I had a solid nursing background behind me before taking this job because I was very autonomous from the beginning and needed to rely on my ‘nursing gut’ for my diagnosing,” says Berté.
The profession continues to evolve as nurses position themselves as leaders who will dramatically influence the quality of healthcare, whether as a nurse practitioner, like Berté, or in informatics, hospice management, medical device sales, patient safety coordination, or as an overseas nurse. Both the Affordable Care Act and the Institute of Medicine’s (IOM) Future of Nursing report, two legislative cornerstones, identify nurses as key players for coming healthcare transformation in the United States. As nurses work to improve patient health, coordinate care, and reduce healthcare costs, it’s no wonder that nursing continues to be ranked as the nation’s most trusted profession.
Indeed, last year, Americans voted nurses the most trusted professionals in America for the 13th time in 14 years in the annual Gallup poll that ranks professions for their honesty and ethical standards. And nurses are proud of this professional integrity. “At the end of the day, I always feel honored to be a nurse,” says Holly of Brigham and Women’s mother-daughter team. “It’s incredible to be a part of patients’ lives and have them let me in when they are at their most vulnerable.”
Her mother Terry agrees. “Nursing is such an amazing career with so many varied opportunities. The chance to help a person who is seeking health information to stay well or helping those who are suffering and need comfort—it is a true privilege to be able to be a part of the profession.”