New Careers in Nursing

Krista Brown decided to become a nurse after spending two years as a community
health volunteer with the Peace Corps in Togo, West Africa. Working side by side
with a nurse-midwife, Brown was impressed not only with how well respected the
nurse-midwife was, but also by how easily her skills translated to another country
and another culture.



"I wanted an opportunity to combine my interests in social work and counseling and
be able to really help people on a one-on-one basis," says Brown. After returning
to the United States, Brown, who already holds an undergraduate degree in
international relations from West Chester University in Pennsylvania, applied to
the Johns Hopkins University School of Nursing where she is pursuing a Bachelor of
Science in Nursing with the assistance of the Peace Corps Fellowship Program. Brown
hopes to become a nurse practitioner, work in an emergency room, and eventually
return to Africa as a Peace Corps medical officer. "I've finally found a niche that
combines everything I want to do."



It's only coincidental that Brown has since learned what a good career choice she
has made. "This is a great time to be in nursing," she says. "There are so many
openings and opportunities." Brown is entering nursing at a time when the
profession is beginning to see shortages, especially in specialized areas such as
operating rooms, labor and delivery, emergency rooms, intensive care units, and
high-risk pediatric units.




According to the American Association of Colleges of Nursing, its 500 member
colleges--which offer both bachelor's and master's degrees in nursing--reported
enrolling 5.5 percent fewer nurses last year than in 1997, the fourth consecutive
year in which a decline was observed. A report sponsored by the American
Organization of Nurse Executives, a subsidiary of the American Hospital
Association (and conducted in collaboration with the Department of Health and
Human Services and the American Nurses Association) indicated that this nursing
shortage "appears to be a new and different type." "Previous shortages," the report
read, "have been about sufficient numbers of nurses, while this shortage appears to
be about an increased demand for nurses with competence, skills, and experience to
meet patient demand for care in a changing health care system."



A number of reasons have been given for the current-and projected--nursing shortage,
including demographics. The average age within the nursing population is 45; many
of those now working will be retiring in 5 to 10 years. Within the past two decades,
women--who still make up the majority of the nursing profession (although the
numbers of men entering the field are growing and have now risen to 10-15 percent
nationwide)--have had more career choices than they once did, including becoming doctors.



Barbara R. Heller, Ph.D., dean of the University of Maryland School of Nursing,
points to several other reasons for the nursing shortage, including an "older and
sicker" population. "As we live longer," she explains, "we're going to see more
chronic health care problems and more frailty. We can expect more and more health
care services for the elderly, including primary care, chronic care, and intensive
care." Because many of these patients are going to be more acutely ill, Dr. Heller
adds, there is also going to be a higher level of skill knowledge required of nurses
to manage the technological advances in the health care professions.




"There are so many opportunities and challenges now," says Dr. Heller. "Nursing can
attract the best and the brightest." Whereas once nurses plied their trade primarily
in hospitals, the changing scene of health care is now giving rise to increasing
opportunities in different settings, from community health centers to long-term care
facilities to home health agencies and more. And within nursing itself there are
increasing numbers of options such as telenursing (triaging patients over the telephone),
case managers, and outcome managers.



With the nursing shortage have also come increased opportunities for traveling
nurses who work from three to six months at understaffed hospitals across the
country. The nurses are paid not only their hourly wages, but also benefits,
and expenses for rent, utilities, and travel.



"All nurses are going to play a significant role in the changing health care
environment," says Dr. Heller, "especially in an atmosphere in which prevention and
health promotion is stressed." Dr. Heller sees nursing as a lifelong career with
growth opportunities, career mobility, flexibility, and attractive salaries.
An acute care nurse practitioner, for example, can earn approximately
$70-$75,000, nurse-midwives (UM is beginning a midwifery program in the fall)
from $60-$80,000. To attract qualified nurses, many hospitals are also offering
a signing bonus.



With an increasing need for managerial skills, nurses are expected to combine
business skills with patient care--the additional knowledge results in higher
salaries, says Dr. Heller, adding that UM is also offering joint programs with
the University of Maryland-College Park and the University of Baltimore so that
nursing students can obtain both an M.S. in nursing, along with an M.B.A.




Like Krista Brown, who is 30, many students now choosing nursing have been out in
the world for several years and are coming back into the classroom. In Brown's
class, says Linda C. Pugh, Ph.D., R.N.C., director of professional education
programs at Hopkins' School of Nursing, the average age of the students is 28,
and the class includes former bankers, lawyers, sales professionals, and
approximately 30 returned Peace Corps volunteers. At the University of Maryland,
50 percent of the nursing students come in with a bachelor's or master's in
another field, says Dr. Heller, adding that it's a very heterogeneous class,
with more men, more cultural diversity, and more career changers who are
looking to be in a more people-oriented or service-oriented profession.
"These are smart, educated, committed, and very career-oriented individuals,"
says Dr. Heller. "At one time nursing was a job-now it's a career."



In addition to the increasing numbers of job openings, which are predicted to
continue well into the millennium, people are attracted to the intangibles nursing
is now providing--interdependence with other professionals, more independent
decision making, more critical thinking, and leadership and management opportunities.
"Nurses are much more autonomous and independent than they ever were," says Dr. Heller.



"Nursing is such a wide open career now," adds Hopkins' Dr. Pugh. "There are so many
possibilities that weren't available even 10 years ago." The growth in nursing
opportunities is being seen across the country, but is going to be especially
strong in this region, says Dr. Heller, who calls health care the "economic
engine of this state."




Another bonus that Dr. Pugh points out is that becoming a nurse is an
affordable--as opposed to medical school--way to work within the health care profession,
but she is quick to point out that it shouldn't be seen as a lesser alternative.
"Nursing is very different from medicine," she observes. "In nursing we work with
people directly...we're much more involved with people on a one-on-one basis. Nurses
want that people contact, they want to be critically involved in people's lives."



Marie Stokes, like Krista Brown, a senior at Hopkins' School of Nursing, was a
pre-med student at the College of the Holy Cross in Worcester, Massachusetts,
when she started re-thinking her career choice. "Did I really want to spend
eight years becoming a doctor," she recalls asking herself. "Doctors don't
spent as much time with patients as I wanted to spend." Stokes changed gears,
received her undergraduate degree in psychology, and then applied to Hopkins,
in large part because of the number of students who already had degrees in
other fields as well. Stokes hopes to become a nurse practitioner
(a master's level nurse with more specialized training) and is interested
in working in critical care, taking care of patients when they are at their
most vulnerable.



Like Krista Brown, Marie Stokes did not choose nursing because of its career
opportunities, but she is encouraged by the positive outlook. "It's a flexible,
portable career," she says. "You can find a job anywhere in the country. And
you can move from specialty to specialty, or from patient care to administration
to education...the opportunities are tremendous."



Written By: Carol Sorgen