Now is the time!

“You cannot solve problems with the same level of thinking that created them.” — Albert Einstein

It’s April, and I can only imagine the collective sigh of relief heard around the country. Those of us in the Northeast region of the United States—the New England and Middle Atlantic states—can finally be assured that our snowplow and shovel days are over. Clinic closures and school cancellations are unlikely and, thank goodness, the darkest days are behind us. Summer vacations for those of us who reside in the Northern Hemisphere are being planned, and, though we’re a little more than three months deep into the New Year, it actually feels like a new beginning.

April, for me, marks the beginning of planting season. As a gardener, I’m poring through seed catalogs and testing the quality of my soil to determine if it needs a few cups of nitrogen here or there to even out the acid-alkaline imbalance. I’m checking Farmer’s Almanac predictions to get a sense of just how hot and dry the growing season will be. I’m thinking about what I want to eat this summer and whether or not I want to stay on the tried and true path, growing what is familiar to me, or be a bit more bold and ambitious with heirloom seeds and varieties yet untried.

I’m checking my compost—a pile of rich, dark soil filled with worms and their egested casts, perfect for growing. And most importantly, I’m thinking about ways to improve irrigation. With an early start and late finish most days of the week, and hot temperatures sure to come, I can hardly imagine having enough time to make sure each crop row gets thoroughly watered to ensure that all of my hard work pays off with delicious meals composed of my own plantings.

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Interestingly, April also marks the convergence of two observances critical to our nation’s health: National Minority Health Month and National Public Health Week (6-10 April). Both are times of sowing new ideas for harvests of better health.

National Minority Health Month

Spearheaded by the U.S. Department of Health and Human Services’ (HHS) Office of Minority Health, the theme of this year’s National Minority Health Month—“30 Years of Advancing Health Equity”— commemorates HHS efforts, mobilized by findings of the Report of the Secretary’s Task Force on Black and Minority Health, commonly referred to as the Heckler Report, to eliminate health disparities among racial and ethnic minorities. Despite significant advances in medical science and disease-awareness campaigns, health disparities continue across racial, ethnic, gender, and socioeconomic lines.

Incidence rates of noncommunicable diseases such as diabetes, hypertension, and kidney failure remain disproportionately higher in African-American and Latino populations, and the United States continues to have an infant mortality rate that is higher than 25 of its wealthy counterparts. According to an alarming report in the Washington Post, in which data from the Centers for Disease Control (CDC) is analyzed, “A baby born in the U.S. is nearly three times as likely to die during her first year of life as one born in Finland or Japan. That same American baby is about twice as likely to die in her first year as a Spanish or Korean one.”

National Public Health Week

While we observe National Minority Health Month, the American Public Health Association (APHA) is marking—this week—National Public Health Week with five days’ worth of shifting themes that also emphasize the importance of addressing health disparities.

Monday kicked off the week with “Raising the Grade,” which, in an attempt to understand the overall state of America’s public health, examined public health data. Tuesday’s focus on the social determinants of health, particularly “zip code” health inequities, opened doors for very necessary conversations about ways in which health care access and services differ from neighborhood to neighborhood, city to city, thus further marginalizing the already marginalized. Wednesday and Thursday offer opportunities to discuss means for building a stronger public-health infrastructure through engaged leadership, interdisciplinary collaboration, and partnerships. And Friday will mark the 20th year of APHA’s National Public Health Week with a celebratory remembrance of major achievements in public health.

Nurses on front lines
No matter the setting in which we find ourselves, nurses are, more often than not, on the front lines of the very health delivery systems that are central to these week- and month-long observances. Nurses are the first and last points of contact for direct and indirect care. We are responsible for educating the largest segment of the health care workforce in the United States. For these reasons—and more—it is our responsibility to not only tune into these observances but to establish a direct relationship between public health and clinical practice.

By now, most of us have read the headlines about police shootings, tensions between local police and civilians, and spousal abuse at the hands of prized athletes. Tragedies all, it is time to speak publicly about the psychological toll that violence—particularly structural violence—has on individuals and whole communities. It is time to speak publicly about powerlessness and disengagement as a result of rape, abuse, repeated exposure to violence, and lack of protection and justice for victims of violent crime.

Those of us in clinical practice who know firsthand the financial struggles our patients have paying for medicine, healthy food, and the most basic necessities must give voice to the harsh realities of poverty and the social determinants of health. No more can we remain silent about the existence of food deserts—entire communities bereft of access to quality food markets but with easy access to the cheapest and most nutrient-poor foods one can imagine. No more can we ignore the roles of poor literacy and numeracy, placing blame for nonadherence on our patients without examining our responsibilities as providers to properly identify these deficiencies and to treat them as we would any other obvious health condition.

Now is the time

Knowing that these issues exist—and will continue to exist long past the five days in which we observe National Public Health Week and the 30 days in which we observe National Minority Health Month—underscores the importance of planting ourselves now in the events and discussions that are forthcoming. Now is the time for checking the soil and telling the truth about root causes of health disparities and inequities. Now is the time for collaboration, planting seeds of ideas that are bold and creative and getting out of silos that use outdated methods and theories that won’t solve new and more complex problems.

In the words of Einstein: “You cannot solve problems with the same level of thinking that created them.” Now is the time for improving irrigation, for ceaselessly watering, through advocacy and lobbying for improved and long-overdue health policies, seeds that will germinate into healthy “plants.” There is no better moment than the present to say what needs to be said and to do what needs to be done. Now's the time and the season, because, in the words of a treasured public-health colleague, at the end of the day all policy is health policy and all health is public health.

In late 2014, Angel Shannon was elected to serve on the Maryland Community Research Advisory Board (MD-CRAB) at the University of Maryland Center for Health Equity. “The overarching goal of MD-CRAB is to make a meaningful contribution toward the elimination of racial and ethnic health disparities by building trust between minority communities and health science researchers.” To learn more.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Trading places

The conversation started simply, the way most conversations with my patients do.

Me: Good afternoon, Ms. Jones, Mr. Jones. What can I do for you?

Son (Mr. Jones): I’m worried about my mother. I know we’re here for her regular blood-pressure checkup, but I think she’s depressed and want to know if she can just get a little medication for it today.

It was late afternoon, the time of day when most clinicians struggle to gather their last bit of steam to make it to the day’s end. It was my first time meeting Ms. Jones (not her real name) and her son—a visit I now say was sheer serendipity. The story was pretty straightforward.

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Ms. Jones was 79 years old, widowed, and slightly forgetful, but not so much as to be a threat to anyone else’s safety or her own. She and her husband, an electrician, had raised three successful children, the eldest of whom lived nearby and had come with her for her checkup. She had a short list of basic medications: a daily aspirin, a pill for blood pressure, and a calcium-with-Vitamin-D tablet for her bones. While I could have easily stuck to the script of the scheduled visit and given into what Mr. Jones asked for, the body language and distance between mother and son demanded something more.

Me: OK. Well, how about we talk about what’s going on?

Mr. Jones: She’s depressed. She just doesn’t want to go anywhere anymore. She doesn’t want to do anything anymore, and it’s just not like her. I know she needs medication. I think most people do at this age.

There’s an old saying that, between two people, there are always three sides to every story: his side, her side, and the right side. His side was that, when it came to family functions that she had, for years, enjoyed and even helped plan, his mother’s answer lately was a resounding and resolute “No!” When it came to exercise, such as taking Zumba classes at the local senior center, her answer was “No.” And when it came to get-togethers with neighbors in the community, her answer again, quite predictably, was “No.” All in all, her days were starting to add up to nothing; and nothing, in Mr. Jones’ estimation, meant depression. He and the rest of the family were sure of it.

Her side was quite the opposite. Her days did add up to something. Every morning she got up and made breakfast, the same way she had done for all 36 years of her marriage, even though, now, she was only cooking for one. After breakfast and maybe a Sudoku puzzle or two, she crossed the street and headed to the nearby park. If she remembered her container of day-old bread, she would feed the birds, and if not, she’d simply sit, quietly reminiscing through one or another memory of her husband, the children, and their old friends. From time to time, she might bring along her crocheting, if the weather was nice.

By 2, before school let out, she’d start making her way back to her apartment to catch her favorite afternoon game shows on cable TV. Sometimes, depending on how good the reception was in her apartment, she’d pull out her “transistor” radio and tune into the AM station, where she’d find a treasure trove of nonstop, swing-style jazz. In her mind, and in that soft afternoon space, she remembered every skirt that had swung too high when they danced, every kiss that had lasted far too long. It was true she had no interest in get-togethers, no desire to go to the senior center for exercise classes, and surely no interest in community goings-on. No matter what it looked like to the rest of the family, and whether they believed it or not, it didn’t add up to depression, and there was nothing more that she wanted to hear or say about it.

Despite popular opinion, clinical care of elderly people is not much different from that of any other population. There are signs and symptoms to listen for, specific tests to order, and treatment options to consider. There are medications to prescribe, and adverse reactions and side effects to monitor. What makes older members of society unique, however, is their vulnerability.

In a world dictated by 15-minute slots, addressing vulnerability as a clinician is no easy task. Helping relatives understand the very natural changes associated with aging takes time and skill. What was missing in this equation was the third side. Mother and son were in the midst of trading places, and they needed help in finding balance. Ms. Jones needed to acknowledge the validity of her son’s concerns. Mr. Jones needed to understand differences between true depression and natural developmental changes. And, to pull this off successfully, I needed to carefully set the stage.

Me: Ms. Jones, so what is it that you don’t like anymore about the family get-togethers, and why don’t you want to go?

Ms. Jones: I just don’t want to. All they do is gossip and talk about stuff I don’t care anything about.

Me: Who are “they"? And what do they talk about?

As Ms. Jones explained it, “they” were a series of husbands, wives, grandchildren, and great-grandchildren whose lives centered around Facebook announcements, Instagram photos, and round-the-clock text messages, transmitted via a bunch of gadgets they never seemed able to put down. They danced to music that was nothing more than noise, as far as she was concerned. And what little conversation they did have always centered on speculation about celebrities, politicians, and issues that had nothing to do with their day-to-day lives. While Ms. Jones had always been in reasonably good health—with the exception of the blood pressure—many of her lifelong friends had not been so lucky and had long since passed away. The people at the senior center weren’t people that she knew, had any relationship with, or even cared about. In a word: Every moment spent with any of them was a moment disconnected from the life she once knew.

As with most clinical visits with adult children and their senior parents, the remainder of our time was centered around helping Mr. Jones remember the passage of his own developmental stages so that he could better understand his mother’s—stages marked by his pulling away from family, outgrowing certain interests, losing friends, and making new ones. And, of course, there was the inevitable post-college experience of starting a family, with a life full of new interests, passions, and opportunities to make memories of his own.

We talked about the sadness associated with outliving friends and finding oneself alone in a world entirely different than one has known. Rather than concluding all that his mother needed was another medication, we talked about activities and outings that might help her remain connected to fond memories she seemed determined to hold onto. Surely trips to museums and libraries, where time stands still, would be far more therapeutic than any pill could ever be.

Slowing down long enough to trade places with our seniors is not only good clinical care; it’s a much-needed act of compassion. Our task as nurse practitioners is to remember that our work is far more than pumping out prescriptions on demand. It’s holding space for discussion and clarification. It’s ensuring that the care we give, particularly for older adults, is safe and sensible. And more than anything, whether we understand it or not, it’s about protecting the health of those who are most vulnerable and honoring their right to hold onto a personal meaning of life.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those the promote products or services will not be posted.

Dancing between two worlds

This month, I celebrate one full year of nurse practitioner practice and 22 years of professional nursing. It’s quite apropos to pause and reflect on what this year has meant personally and professionally. What do I love? What do I hate? What have I learned? If I had it to do all over again, would I? And if I could, what would I change?

To be a nurse practitioner is to dance between two worlds. In one world, you function within the societal framework of a nurse—read caregiver—and are expected to be available and attentive to the full spectrum of needs presented by the person in front of you. Those needs almost always include a level of psychological comforting and emotional reassurance, inherent in your training but rarely expected of providers in other disciplines. To do what nurses do best—assess, diagnose, plan, intervene, and evaluate—responding to those needs takes time and a degree of emotional availability.

In the world of the NP, you are a provider, expected to be broad in your base of knowledge, swift with your diagnosis, accurate with your treatment, and timely with your follow-up. Patients come to you not to be your friend or have cozy conversations, but for your knowledge of how to cure a condition. In other words, they come to you to get it right. In modern medicine, which follows an airtight business model that requires a certain number of visits per day with built-in cost and overhead controls, the nurse practitioner has minutes—if not seconds—to get the dance right.

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This past year has been a steep learning curve for me. Despite all I know of nursing, there has been the business of medicine and the field of medicine to figure out. The business of medicine involves mastering ICD-9 coding (International Statistical Classification of Diseases and Related Health Problems) and E&M coding (evaluation and management) to ensure that, in addition to diagnosing appropriately and specifically, you are billing accurately, based on what your services are worth for a particular visit. Not only are there legal ramifications for over- and underbilling, there is also the concern of financial insolvency when professional salaries and expenses exceed income. Like it or not, that’s true for all aspects of American health care, with the exception, perhaps, of those whose services fall under charity. A visit for COPD, hypertension management, or follow-up on diabetes is clearly not the same level of service that a nurse practitioner provides to a healthy person who comes in for an allergy-medicine refill or treatment of an uncomplicated sore throat.

This year has also been one of redefining things I thought I knew well, like time management. When I was an ICU and trauma nurse, there were a million tasks to be completed over the course of a 12-hour shift, and, invariably, they always got done. When I worked as a community-health nurse, there was the task of coordinating my care with that provided by other disciplines to which I referred patients, such as social workers, the local pharmacist, physical therapists, and others. As an NP, I have many more irons in the fire, including, but not limited to, test results, medication refills, consult reports from other providers, patients’ phone calls, provider- and insurance-company phone calls, forms to be filled out and signed, and all the ping-pong you can possibly imagine in an eight-, sometimes nine-hour, day. Without strong time-management skills and knowing how or when to turn the clock on and off, many NPs run the risk of burnout before they even get started.

In the past 365 days, I’ve learned what I’m really made of—and what I’m not. In the beginning, it’s easy to crawl under the safe, protective wings of a preceptor and tap into his or her knowledge and strengths. It’s easy to kick the diagnostic can down the road to a specialist to figure out. It’s very tempting to avoid the hard work of figuring out what’s wrong and why. But I’ve learned that the best gift I can ever give myself is honesty. My greatest strength is not what I know, but knowing what I don’t know. In the NP world, there is no place for faking it ‘til you make it. Knowing what I don’t know and asking questions, even at the risk of embarrassment, is a safeguard against making potentially critical mistakes.

Above all else I’ve learned is the rule about rules. Throughout my NP program, emphasis was always placed on knowing and understanding nationally recognized, evidence-based clinical guidelines, and I learned the rules about caring for patients who will present, across the lifespan, with a wide variety of diseases and conditions. What I didn’t know, as a student, is that, in actual clinical practice, I would quickly learn that guidelines are just guidelines—recommendations for practice by experts in a particular area. Sometimes, you stick to them by the letter, and sometimes you simply can’t. In population health, where time, access, and a patient’s insurance plan govern what can and can’t be prescribed or ordered, the nurse practitioner has to have a comprehensive knowledge base of the rules and know when it is safe and reasonable to break them.

In light of the Sisyphean experiences of my first year in practice, the question looms: Would I do it all again? My answer is a resounding yes.

As an advanced practice nurse, I have a much broader range of competencies upon which to position my career. In graduate school, I had the good fortune of working as a graduate teaching assistant, which gave me skills in adult education I did not have previously. With those skills in hand, I received, immediately after obtaining my master’s, an invitation to join the outstanding faculty of my alma mater, Penn State University College of Nursing. Not only is it an honor to teach, but, more specifically, I get to teach on a topic I’m deeply passionate about—family and community health—which is a pleasure.

As an advanced practice nurse working, every day, on the front lines, I am now part of larger discussions that pertain to health care policy and which shape the future of nursing and public health. I have the skills to conduct my own research on issues about which I care deeply, including vulnerable populations, health literacy, cultural competency, food security, and nutrition.

Clinically, I am able to deepen my knowledge in the subject areas I enjoy most: diabetes management and women’s health. What do I love? Simply stated, being an educator to my patients. Every day I get an opportunity to set the record straight. From myths about STDs to misconceptions about colonoscopies and mammograms, every appointment is a living classroom that promotes better health.

What would I change? Nothing at all, because to change any one thing would be to change everything. Every experience I’ve had, in nursing and in life, has been a paving stone leading to this moment.

Every day is different in the life of a nurse practitioner. These differences mold my career into new shapes I’m continually proud of. What will never change is my commitment to being an advocate for my patients, a steady voice for my community, and a teacher for the growing number of nurses coming behind me. What’s next for the coming year? Stay tuned.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. That that promote products or servicds will not be posted.

Beyond credentials: Cultivating authentic leadership in uncertain times

“Leadership is lifting a person’s vision to high sights, the raising of a person’s performance to a higher standard, the building of a personality beyond its normal limitations.” – Peter Drucker

Twenty years ago this May, I stood at the far end of a crowded hallway that was alive with students in starched white uniforms, light flashes from clicking cameras, and the collective sighs of relief characteristic of new graduate nurses. There we were in alphabetical order—porcelain nursing lamp in one hand, fresh red rose in the other—anxiously awaiting the moment of pinning that granted us official status as nurses. Ahead was the auditorium, where we would be met by faculty and hear final speeches on leadership and the nobility of the nursing profession. The specifics of the messages offered that evening are long gone, but what remains is my vision of one faculty member, in particular, who embodied authentic leadership without ever speaking a word on what it meant to be a leader.

Angel Shannon, 1993

A young, soft-spoken woman of few words, she balanced a full-time teaching schedule at the junior college with four young children, a husband, and full-time enrollment in a PhD program. Always impeccably groomed, she was known amongst students as a natural mentor in whom you could confide without fear of admonishment or embarrassment. To her, every mistake was forgivable. Indeed, every transgression was an opportunity to learn, even those that others may have considered of sufficient offense to warrant prompt dismissal from the nursing program. She viewed nursing not as a job but a noble profession, and she believed in the philosophy of nursing and the nursing process—ADPIE (more on that later)— as tenets for meeting the challenges of everyday life.

In the clinical setting, she demanded that we be “prepared for anything,” as there is no way to foresee the change or crisis that can completely make void the best laid care plan. From tasks as simple as making a bed to those requiring more critical thinking, every nursing intervention either added to or subtracted from the collective patient experience. The ability to memorize the chemical makeup of a medication was nice, she said, but no more impressive than displaying compassion by wrapping an arm around the shoulders of a grieving mother or inconsolable child. Raised in the Caribbean, this faculty member had a palpable sense of community and lived by the dictum of working together, urging us to study together and draw upon the collective wisdom of our cohort rather than traveling the difficult road alone. In a word, she was the kind of nurse leader many of us aspired to be.

Over the years, much has been written about leadership and timeless questions still remain: Are leaders born, or do they develop over time? Are good leadership skills innate, or can they be taught? In a rapidly shifting economy, in the face of globalization and amidst constant health policy reform, what skill sets do future nursing leaders need? Aside from credentials and long lists of certifications, what are the personal—and sustainable—attributes of great leadership? A few thoughts come to mind when considering these questions.

1. Great leaders are great listeners.

Hearing is not the same as attentive listening. Hearing is simply a neurological response to the presence of sound. Attentive listening evokes memory, conjures up compassion and helps convey the message that the concerns, opinions, and ideas of another are not only heard but understood and valued. Whether engaging an individual or a group, great leaders value the credibility and trust that is gained through paying attention and listening deeply.

2. Great leaders are lifelong students.

The pursuit of a doctoral degree is not for everyone and certainly not necessary for every career path, but education and advancement of skill sets are. Whether through formal higher education or self-paced, continuing education, great leaders teach and lead from their own wellspring of knowledge and experience, driven by the personal satisfaction and fulfillment that comes through sharing knowledge with others.

3. Great leaders are eternal optimists.

Every experience is an opportunity to learn and grow, even suboptimal experiences that we view as contrary to our well-laid plans. The job that went sour, the research proposal that wasn’t funded, the unit project that fell flat despite endless hours of meetings and hard work—all are opportunities to gain new knowledge and refine processes for the next time around. Great leaders learn from the past, operate in the present, and focus on the future to improve the chances of team success and avoid repeating costly mistakes. (It’s a process we nurses know as ADPIE—assess, diagnose, plan, intervene, and evaluate.)

4. Great leaders tap human potential.

Desmond Tutu, one of the greatest leaders of our time, once said, “A person is a person through other persons.” Every member of a group matters and, whether they know it or not, has something of value to contribute. Great leaders learn from others. They tap the sparks and tiny flickers of possibility that burn deep on the inside of every individual, nurturing potential rather than harping on limitations and deficits. As individuals learn and recognize their own strengths, they are better prepared to work collectively, nurturing the strengths and potential of others.

5. Great leaders are resilient.

Resilience, by definition, is the power or ability to return to original form or position after being bent, compressed, or stretched; the ability to recover readily from adversity and the like. In other words, resiliency is the ability to “bounce back.” Great leaders are those who anticipate adversity and accept change as a natural part of living. Great leaders are flexible in the face of uncertainty and ambiguity, recognizing that rigidity to fixed rules negates one’s ability to overcome adversity, obstacles, and setbacks. Always committed to growth, great leaders learn—and teach others—how to “go with the flow.”

The faculty member I’m referring to in this post later earned her PhD in nursing and went on to become a pillar of strength, not only at the junior college but in her community, embodying the kind of authentic leadership skills required of nurses in these uncertain times. For those of us who are advanced practice nurses, it is just as important in this era of rapid change to maintain ownership of our profession and develop vision for the scope of our practice as it is to collect credentials—not only for ourselves, but also for the communities we serve and represent.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

So you want to be an NP?

No pessimist ever discovered the secrets of the stars, or sailed to an uncharted land, or opened a new heaven to the human spirit.  — Helen Keller

“I want to be a nurse practitioner. I’m going back to school!” As soon as I spoke the words, I felt their weight and intensity.

We were a group of night-shift nurses—weekend warriors, we called ourselves—commiserating over all that seemed to be missing, not only on our unit but in our careers. We were a mixed bunch. Some, fresh out of nursing school, were dismayed by their new reality, an overwhelming set of responsibilities that hardly matched the “Grey’s Anatomy” image of nursing. There were no organized Code Reds with a well-scrubbed physician yelling “Stat,” nor was there a faculty preceptor to lean on. Some, much older, reminisced about the “good old days,” when nursing didn’t involve complicated EMR systems, committee meetings and unit-based research projects.

As soon as I made my declaration, questions and rapid-fire judgments quickly followed. How? With what resources? Why? Who in their right mind would want to take on student loans, late-night studying, clinical rotations and research papers at this stage in an already established career?

These questions, common for nurses who feel the urge to pursue graduate studies, are surely valid. Graduate school is expensive, requires self-directed study and ongoing individual assessment of learning style and learning needs, and it demands focus if one is to successfully juggle multiple tasks, set priorities, and meet deadlines. More importantly, especially for aspiring nurse practitioners who will incorporate unpaid clinical rotations into their schedules, graduate school usually requires students to reduce their employment workload, which lowers personal income over the course of the program.

Bedside nursing has tremendous perks, not the least of which are shorter workweeks; open and continuous opportunities for overtime; and casual “uniforms,” the cost of which pale in comparison to the professional wardrobe required in corporate settings. However, advanced practice nursing has its own share of perks, including opportunities for leadership, scholarship and management, as well as regular work schedules and potential for independent practice.

The barrage of who, what, where, why and when can lead to doubt, worry, and complete derailment of one’s quest for professional and personal growth. Success requires not only a leap of faith but the parachute of careful planning. The following are five key considerations for the journey to becoming a nurse practitioner.

1. Do your research.

Nurse practitioner programs are not all created equal. Speak directly to program directors and admission counselors about the number of credits required, the average length of time for completion, and graduation rates. Assure that the program holds solid accreditation and sufficient faculty-to-student ratios. Check national ratings for each school and the length of time the program has existed. Investigate the experience levels of the program’s faculty members, to ensure you’ll be learning from experienced nurse practitioners, rather than novices. Beware of new programs “awaiting accreditation” and lacking a track record. Speak with other nurse practitioners you know, to be sure you understand the role and responsibilities of a nurse practitioner. Consider “shadowing” an NP for a day or two, to get a clear picture of what the career path entails.

2. Assess your needs.

Carefully consider your learning style and weigh the options between traditional on-campus programs and those designed for distance learning. While distance learning may offer convenience, it also requires discipline, strong commitment, and strict time management. There is no one to hold you accountable for showing up to class, viewing lectures, reviewing content, and reminding you of deadlines. It is very easy to fall behind or become distracted by everyday life responsibilities, family and work obligations, and unexpected emergencies. Because traditional on-campus programs require a reduced employment workload to accommodate classes, clinical rotations and exams, you may need to line up additional financial resources to replace lost income.

3. Create a financial plan.

Add up all costs for the program, including tuition, books, clinical supplies, fees, parking, and commuting costs. To help offset these costs, investigate existing scholarships, graduate assistantships, grants and nursing education loans. When creating your budget, allow a reasonable amount for unplanned expenses such as car repairs, fluctuating gas and commuting costs, and household repairs that may occur. Realistically decide how many hours you will be able to work each week and compare this figure to current expenses. If attending graduate school requires you to move to another city, fully investigate the complete cost of living in the new location. Will you need a car to get to school and clinical sites? Is reasonably priced, safe housing affordable? What are average costs for utilities? Your NP studies will prove difficult enough. Inadequate income will not only create stress; it will distract from the time and focus needed for your studies.

4. Rally support.

If you have a spouse, significant other, or children, be sure you have their support early on in the decision-making process. In all fairness, these are the people who are going to be most affected by your decision. They will endure your late-night studying, early-morning clinical rotations, and perpetual absence at family events and affairs. Openly and honestly explain the time and financial commitments you’re planning to take on. Be realistic about the time you will need to study and the help that others will need to provide for day-to-day household management. If you are an adult learner with children, be sure to include extended family and friends in these discussions, and ask for their support as needed for carpooling and assistance with after-school activities. Once in the program, be considerate of their time, and remember to thank your “village” for helping you succeed.

5. Make your decision and stick with it.

If everything aligns properly, stick to your decision and move confidently in the direction of your passion. Equipped with your research and careful planning, beware of pessimists and naysayers who lack the insight you now have. No matter which direction the economy turns, graduate education in nursing will always yield a high return, and there will always be room for new nursing leaders who seek out opportunities for professional growth and advancement.

Consider every minute and every dollar spent an investment in yourself. Opportunities for nurse practitioners are endless and include such specialties as clinical research, global health, teaching, consulting, independent practice, and much more. Take your leap of faith with passion and optimism!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.