Friday, February 8, 2013

Immigrant Nurse: Part III

This one's about me.

I am probably not the kind of nurse that you think I am.  That's right.  Surprise!  My area of specialization is none of these things.  Here's what usually happens when I meet people and try to explain "what I do":

"What do you do, Amelie?"

I'm a nurse.

"Like, in the hospital?"

No. I have a masters degree.

"Oh, so you're a nurse practitioner?"

No, not a nurse practitioner.  Nor a nurse anesthetist, nor a nurse midwife.

"Are you a CNS?"

Well, while I'm impressed that you even know what a CNS is, I regret to say that, as my nursing program did not include advanced pharmacology in my curriculum because it's superfluous to our actual work, I am not a CNS.  I took the same board certification test as for a CNS, but I'm not one myself.

"Oh.  Then... what are you?"

FREAKIN' AWESOME, that's what!... No, I don't really say that.
Always the question:  What, then, am I?  20 months into my 26-month graduate program, I realized, with other members of my small cohort, that we didn't really have any clear answer to this question.  In a desperate panic, I meditated and blazed through a couple of tubs of Trader Joe's Cats Cookies (For People), and by the wee hours had created... a Zoolander-themed Power Point. 

Oh, the profundity!  And there were 21 slides after these!
With characteristically questionable judgment, I shared this slideshow with peers in my cohort, our program chair, and the Assistant Dean of Nursing.  From what I hear, it's still making the rounds, now on its third generation of Advanced Community and Public Health Nursing Leadership and Program Development candidates.  Mildly clarifying and mostly fluff, it included a couple of definitions that are still the clearest, if not the shortest, way I've found to shed light on whatever it is that "I do".

Community Health Nursing: A field of nursing that is a blend of primary health care and nursing practice with public health nursing. The community health nurse conducts a continuing and comprehensive practice that is preventive, curative, and rehabilitative. The philosophy of care is based on the belief that care directed to the individual, the family, and the group contributes to the health care of the population as a whole. The community health nurse is not restricted to the care of a particular age or diagnostic group. Participation of all consumers of health care is encouraged in the development of community activities that contribute to the promotion of, education about, and maintenance of good health. These activities require comprehensive health programs that pay special attention to social and ecologic influences and specific populations at risk.

Public Health Nursing: The practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences.
Public health nursing is a systematic process by which:
  • The health and health care needs of a population are assessed in order to identify subpopulations, families and individuals who would benefit from health promotion or who are at risk of illness, injury, disability or premature death.
  • A plan for intervention is developed with the community to meet identified needs that take into account available resources, the range of activities that contribute to health and the prevention of illness injury, disability, and premature death.
  • The plan is implemented effectively, efficiently and equitably.
  • Evaluations are conducted to determine the extent to which the intervention has an impact on the health status of individuals and the population.
  • The results of the process are used to influence and direct the current delivery of care, deployment of health resources, and the development of local, regional, state, and national health policy and research to promote health and prevent disease. 

That's me.  My training and experience blend community and public health nursing skills, and I specialize in program development.  While hospital RNs assess, make nursing diagnoses, plan, intervene, and evaluate outcomes for individual patients, my job is to complete the same process, or pieces of it, for populations, using frameworks that support health promotion and disease prevention.  

What is a population?  Oh, goodness.  It could be anything, which is ill-defined and can confuse people.  Since public health nursing is more about preventing disease, my populations don't have to consist of patients.  It could be... maybe I work as a community health nurse, and want to improve outcomes or prevent undesirable outcome for all patients with diabetes served by my clinic.  However, it doesn't have to be a group of patients to be pertinent to health.  It could be a smoking cessation program for a population of employees working in a hospital, or it could be assessing need for doula support among a community of immigrant mothers living in rural Washington State.  I take the nursing process and apply it to a bigger picture.  I could work for a community health clinic on quality improvement projects, as I did in my most recent job.  I could assist with community-based participatory action research.  I've worked independently on community assessments for nonprofit education initiatives.  I've assisted in grant-writing.  I've written and implemented FIT-testing protocols.  I've drafted organizational emergency preparedness plans and written clinic safety policy and procedures.  Oh, the things I can do.   

Do I sound frantic yet?  Love me!  Love me!

I only had one cup of coffee today, I promise.
I ate several Trader Joe's Cats Cookies (For People), though!

Trader Joe's Cats Cookies (For People)... thanks, Houseguest!

haven't been shamming you.  I really did work as a psychiatric-mental health RN, and scuffed down dim nighttime hospital corridors during my stint as medical-surgical RN-zombie.  I chose to do "typical" RN work for a couple of years in order to solidify my direct patient care skills and learn more about the hospital environment and management structure.  I can transfuse blood, start an IV, give a vaccine, change a catheter, talk to teenagers about STIs, distract a manic, suicidal person long enough for the Haldol to arrive, and teach someone how to monitor their blood sugar and use insulin on a sliding scale... in Spanish, if needed.  Ta-da!

These things, though, although considered "fundamental nursing skills," are not what I'm best at doing, and not the best of what I have to contribute to the healthcare profession... shortages notwithstanding, and in my opinion until convinced otherwise.  Also... I don't like doing them.  Hate me!  Hate me!  I like people... I just don't like full-time bedside nursing.  It's not for me.  

My self-inflicted challenge is that I graduated from an atypical specialty area of nursing with no guidance for how to market my skill set, resulting in a fair amount of frustration derived from not being a nurse practitioner, nurse midwife, or other type of definable-in-thirty-seconds-or-less advanced practice nurse.  My challenge is getting employers past the "RN" that dominates the top of my C.V., and past the last two years of experience wherein my job title was "nurse."  For some of these employers, I'm pretty sure seeing those things is the written equivalent of me walking into a job interview wearing these pants:

I followed this man for a block, in the opposite direction of my destination.  Yes, I did.
For me, the healthcare shortage and nursing immigration mean that countries everywhere will need RNs, but I'm not the kind of RN for whom healthcare really clamors, nor do I want to be that kind of RN.  I and those of my tribe are the hipsters of the nursing profession.  Or the dirty margaritas.  I really should lay off the metaphors.  Maybe I'll keep writing about it until I figure it out.  Taking a breather from what other people want me to do, I've decided, is pretty nice.

In the meantime, this article provided some awesome labor market food for thought from a University of Pennsylvania business school.  Among other things, it talks about software-based hiring systems, the slow fade of HR departments, apprenticeship programs, and parents buying internships for their kids (aghast!).

Lastly, I found some interesting things on my flash drive from grad school.

This is the clinical where I walked out two weeks before the end of the quarter because the supervisor was treating the clients like dirt and I had to abandon my clinical partner and fill out a disciplinary form and do extra clinical hours but it was okay because the clinical hours were with my favorite faculty member and she helped me get my first nursing job.  No regrets.

My thesis/Scholarly Project.  Yet, somehow, they allowed me to graduate. 
Thank goodness that my fiance is an options trader.  Nobody understands what he does, either.

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