Congratulations, you're becoming a new member of the nursing leadership team. Your mentors and role models have done all that they can to prepare you, now it's up to you to "seize the day." You're about to embark on a great adventure, one that will lead you in many directions. As a nurse leader, you'll have many opportunities, some of which will require you to step out of your comfort zone. As you choose the direction in which you intend to go, the best advice I can give you is to choose the area that you're most passionate about. I've found that in my own career, I was at my best doing something I truly loved and had the passion to do.
Lessons learned over a 40-year career
I started off on a 40-bed orthopedic unit where the RN in charge was also the charge nurse for the pediatrics unit. As the charge nurse, I went from one unit to the other every hour. While working on the pediatric unit, the first time that a physician told me to insert an I.V. into the scalp vein of a tiny baby, I knew pediatrics wasn't for me. While on the orthopedic unit, we only had one surgeon; his motto was "buy your son a motorcycle for his last birthday." I grew to hate the devastation of young lives caused by motorcycle accidents. I still remember how some of my first patients were injured body and soul by the accidents they experienced. Although I enjoyed the orthopedic unit, the staff, and our surgeon, I was working evening shift, had a new baby, and wanted day shift.
Opportunity knocked in the form of an index card posted on the wall in the staff lounge with the following note: "Needed 7-3, 1-North (locked psychiatric unit) RN." I thought, "How hard can it be to be a psychiatric nurse?" (Free advice: Think carefully when you decide to change units.) So, I was transferred to the 60-bed psychiatric unit.
I didn't necessarily love getting up at 4:30 a.m. to be on duty by 5:30 a.m., but it was day shift. Being the new kid on the block, I was chosen as the medication nurse for the whole unit. Twenty of the rooms on this unit had double-locked doors. On my second day, in my haste to administer everyone's medications on time, I unlocked the door to a room and didn't notice that the second door was already unlocked. An experienced psychiatric nurse would have recognized this as a significant event. When I looked up to see the patient, she was behind me. I'll never forget the words she said to me as she grabbed me, slammed me against the wall, and lifted me off my feet. "Did you know I could break your neck and no one would ever know I did it, do you believe me?" she said. I remembered learning about using an appropriate therapeutic response, and I thought I probably needed to use a reflective technique. I said to the patient through my chattering teeth, "Yes, ma'am, I believe every word you're saying." Meanwhile, I was reaching for one of the panic buttons that was on each of the walls in the room. Thank goodness, my brief orientation to the unit had included those buttons. The next thing I knew, I was lying on the bed with the patient and about 10 other people on top of us. This career choice lasted 6 months.
After moving to southeast Alabama, I worked orthopedics for 2 years, then transferred to a medical-surgical unit. I remember the first time the surgeon prescribed doxorubicin for one of his mastectomy patients. I had never heard of the drug and never seen anything that red in an I.V. infusion. I couldn't imagine that we were going to actually administer this to the patient. So, I asked him, "What is this and what is it for?" He said, "Well, if it doesn't kill her, it might possibly cure her." The patient had just returned from Texas and was undergoing experimental chemotherapy. The physician said that I would need to call Texas to see how fast we needed to infuse the drug. This was 1979 and there wasn't an oncologist on our staff. There were no computers, not many drug books, and no classes on how to mix chemotherapy. One of the next cancer patients I remember vividly from this time was very nauseated. One night when I was back on evening shift, the physician came into the room with a couple of rolled-up cigarettes. I thought to myself, "This man has lung cancer, is dying, and this doctor is giving him another cigarette." But when the man lit up the cigarette, the aroma was like a burning rope. Yes, it was marijuana. The physician picked up confiscated marijuana from the local sheriff's department. He was one of the few physicians who had prescriptive rights to administer this drug.
I was hooked-strange drugs, strange treatments, and physicians who cared deeply for their patients. I had found my passion in oncology. When the hospital decided to open an oncology unit, the director of nursing asked me to become the head nurse. I was very fortunate to be the first certified oncology nurse at the hospital. I fell in love with the patients and my fellow staff members who laughed and cried with them and their families. I found joy in seeing my patients, months after their chemotherapy, when they had hair. One "not so nice" response I remember very clearly. There was a chemotherapy patient who had a case of anticipatory nausea whenever she saw me. When I saw her in the grocery store one day, she became nauseated and vomited in the middle of the frozen food section. Today, treating cancer patients has progressed to include biological response modifiers, angiogenesis drugs, and gene therapy in addition to the three modalities of surgery, radiation, and chemotherapy.
Because I loved oncology nursing so much, it was hard to leave when I took the job of vice president of patient care services and CNO. In my role as a CNO, I had the opportunity to see nursing as a business. Nurse leaders must have not only a caring heart, but also a business mind. A nurse leader on a typical nursing unit is running a small business. Most of the budgets on these units are worth $500,000 to $1 million. He or she is hiring staff, juggling schedules, handling conflicts, and still finding time to administer medications, listen to patients' fears, help families make decisions for a loved one, and then go home to care for his or her own family. And let's not forget national patient safety standards, regulatory requirements, insurance carriers, and all of the other governing forces that both help and hinder our ability to care for our patients.
The best advice? Share you story and support each other
Over the course of your leadership career, you'll touch many people's lives, and many of your patients and staff members will touch your life. As you lead your teams, you'll be a different person a year from now than you are today. I think your nursing leadership experiences will make you an even better person than you are now. Cherish each experience and learn from each opportunity.
I've shared a few of my stories with you; you should also share your stories with each other. As you start your journey in nursing leadership, you'll have many stories to tell. The most important thing you can do for other nurses, and future nurses, is to remember your stories and tell them. Your stories can influence changes in practice and policy, bring meaning to difficult situations, and be a way to learn from shared experiences.1,2 Stories highlight both the art and science of nursing.3
Always support each other as you keep growing in your roles. Continue to learn something new every day that will aid you in the care of patients. Advance your education by earning that bachelors, masters, or doctoral degree. Become certified in your specialty. Then share your knowledge, write that article, and do research. Participate in professional nursing organizations. Attend national conferences. Stay involved in the profession. Let your voice be heard as an advocate for our future patients. And don't be satisfied with the status quo. If I can leave you with one more thought, it would be the words of author Vicki Corona: "Remember that life is not measured by the number of breaths we take, but by the moments that take our breath away."4
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