The Pros and Cons of Nursing

Opportunities for Career Advancement

Advancement opportunities abound. LPNs can become charge nurses, particularly in long-term care facilities. However, most advancement opportunities exist for RNs. You can climb the administration ladder and become a nurse manager or supervisor, often without additional education. You can also pursue a graduate degree to move to the top of the heap and become a director of nursing or you can choose to become an advanced practice nurse. Advanced practice nursing requires a master's degree at this point, but the American Association of Colleges of Nursing raised the bar, and the doctor of nursing practice will be the required degree in 2015. You can also choose to become a nurse educator, which also requires additional education if you wish this to be your full-time career.

But advancement does not always mean moving up; you can also make lateral moves. Your nursing license allows you to move among nursing specialties. Six months to a year of acute care experience is often enough to get a job in critical care or emergency nursing. You can also literally move. Nurses who work with nurse-for-hire agencies can hospital shop and work at various locations, often making good money and getting to work the hours of their choosing. If that's not enough movement, you can become a travel nurse, which allows you to work at your own pace and make your own decisions. Travel nursing also allows you to work in your own hometown or hundreds of miles away.

Travel nursing was listed as one of the Top Five Hot Careers in Nursing by AllNursingSchools.com in January 2009. The other four were military nursing, forensic nursing, legal nurse consulting, and surgical nursing. As the demand for nurses rises, so does the realization of how nurses fit into less typical settings.

Salaries

The Bureau of Labor Statistics showed the median annual earnings of LPNs at $36,550 in May 2006, with the middle 50% of LPNs earning between $31,080 and $43, 640. The highest 10% earned more than $50,480, while the lowest 10% earned $26,380. Median salaries per job location in May 2006 were:

The Advance for LPNs 2008 LPN Salary Survey broke down salaries by state. Alaskan LPNs made top dollar at $29 per hour, but the survey creators advised that there were only four respondents from Alaska. LPNs in the Northeast fared best, with Connecticut LPNs earning as much as $25.28 per hour. States with the lowest hour rates included Alabama ($16.93), Nebraska ($15.75), North Dakota ($15.00), and Idaho ($14.67).

The U.S. Census Bureau's 2006 National Survey shows that RNs can earn about $15,000 more per year than LPNs. According to Allnursing schools.com, LPNs with 15 years until retirement can earn an additional $25,000 if they simply invest another 12 months in completing an online LPN-to-RN program.

For RNs, the Bureau of Labor Statistics reports median annual earnings of $57,280 in May 2006. The middle 50% of RNs earned between $47,710 and $69,850, while the top 10% earned more than $83,440, and the bottom 10%, less than $40, 250. Median RN salaries per job location in May 2006 were:

The Advance Salary Survey 2008 listed the average RN nursing salary at $56,785. Not all states participated, but of those that did, California had the highest state average at $71,474, followed by New York ($63,132) and Delaware ($61,679). The states with the lowest salaries were Alabama ($47,688), Maine ($46,127), and Tennessee ($43,820).

Advanced degrees mean higher salaries that vary per practice type. Advance for Nurse Practitioners 2007 National Salary Survey showed that the average NP salary was $81,397. Pay Scale Inc. had average salaries for nurse midwives and nurse anesthetists. Nurse midwives who were in practice for less than a year earned an average $57,767 and those who practiced 10 to 19 years earned $48,000 (yes, the more experienced ones earned less). Nurse anesthetists earn the most with those practicing less than one year earning an average of $113,728 and those in practice for 20 years or more earning $141,578.

Benefits

Most hospitals and other agencies offer sick leave, paid holidays, vacation time, shift differential, occupational health services, employee assistance programs, health insurance benefits, and retirement plans. Others also offer additional benefits or discounted services that include: short- and long-term disability plans, life insurance, long-term care insurance, tax-sheltered annuities, credit unions, and parking.

The nursing shortage has given rise to a wide range of benefits as an incentive to fill their mounting vacancies. Some of these include:

• Sign-on bonuses that can range from $500 to $20,000. These typically require that you stay employed at that facility for a period of time—the longer the time, the bigger the bonus.
• Tuition reimbursement. You can advance your education at little to no cost.
• Relocation assistance. This makes it easier for you to uproot your family to a new location.
• Housing assistance. Employment facility-owned housing can also cost less per month.
• Day care. Day care on the worksite or nearby decreases your out-of pocket expenses for child care.

Flexible Scheduling

The need for nurses has increased the availability of flexible schedules for both full- and part-time employees. Hospitals and other agencies often offer 4-, 8-, 10-, and 12-hour shifts and allow you to work weekdays, weekends, or both. Twelve-hour shifts sound, and often are, grueling. But working three 12-hour days per week usually means you are off for the other four days. Flexible shifts are especially helpful for working parents, allowing one of them to be available to the children at all times.

Opportunities for Self-Employment

Many nurses have struck out on their own, combining their nursing knowledge with business know-how. Some have their own businesses and even employ other nurses, while others are independent contractors. Practicing independently gives you more autonomy, more income, and more control over your professional life.

Making a Difference

You can help bring a baby into the world, hold a lonely elder's hand when she dies, breathe life back into a man who had a heart attack, lift a depressed person's spirits, or ease the pain of an injured child. Few careers give you the opportunity to impact on so many lives in so many different ways. There is no greater benefit than having a client thank you for making them feel better. As a nurse you can, and will, make a difference.

Cons

No job is perfect, and nursing is no exception. The job is demanding and challenging. Beginning salaries are high, but in most cases they plateau, creating frustration for experienced nurses. Hazards abound because nurses are exposed to infectious diseases, chemicals, and violence, and the hours can be long.

Nursing Is a Demanding Profession

Nursing is a physically and psychologically demanding profession, and the nursing shortage has increased these demands. Fewer nurses mean more clients per nurse and less time per client. Nurses are forced to work overtime, adding to their exhaustion, and the decrease in client contact creates frustration because nurses can't do what they were educated to do.

Shift work can cause adverse physical and psychological effects, including disruption in your biological rhythm, sleep disorders, health problems, diminished work performance, job dissatisfaction, and social isolation. Nurses spend much of their day on their feet, causing foot, leg, and back problems for many. Back problems can also arise from all the lifting that is required. Most of the latter problems can be minimized with good shoes, suitable hosiery, and proper body mechanics.

Nurses are there when bad things happen to people. Cancer, accidents, mental illness, violence, and death are but a few of the issues that nurses deal with on a regular basis. They also work closely with clients' families, and they often need to make critical decisions and deal with ethical dilemmas. While it's rewarding to help people through these tough times, it can also be psychologically draining. Unlike other healthcare professionals, nurses have an intimate relationship with clients, caring for their most personal needs—bathing them, helping them use the toilet. Nurses are also with hospitalized clients around the clock. Working with people at some of the most vulnerable moments of their lives makes some workdays difficult, and nurses must take steps to assure that this stress doesn't affect their professional, personal, or family life.

Potentially Dangerous Work Conditions

Nursing can be hazardous to your health, especially nursing in hospitals, clinics, long-term care facilities, and home care where nurses may come in contact with infectious diseases, toxic chemicals, potent medications, and hazardous waste. Nurses must observe strict standardized guidelines to protect themselves and others from disease and other dangers, including accidental needle sticks and radiation.

Emergency nurses care for victims and offenders of violent crimes, thus making emergency rooms dangerous places to work at times. Some emergency departments have round-the-clock police protection. All nurses work with victims of family violence—child abuse, intimate partner violence, and elder abuse, and all work with clients who have psychiatric disorders, even if that is not their primary diagnosis. Violence has become a concern in healthcare. But while the exposure to violence presents a disadvantage to nurses, it also has become an opportunity in the form of a relatively new specialty, forensic nursing.

Salary Ceilings

The starting salaries are excellent, but seasoned nurses often hit a ceiling where the only salary increase they receive is a cost-of-living raise.

Long Hours

Working just two or three days a week sounds fantastic, but 12-hour shifts can take their toll. Eight-hour shifts can grow into 10 or 12 with overtime, which may help financially but can be exhausting physically, especially if the overtime is mandated.

The pros and cons of nursing extend into the student experience. The life of a nursing student is quite different from most other majors. Time is at a premium, and practicum experiences can be life-changing, for both client and student.

Nursing Notes

Content with Compromise, by Isabel Roitman

I live in a house filled with 23 girls. Of the 23, 22 of them are not nursing students. To say the least, I am a minority. My life is a little different than theirs.

When the other girls wake up to the noise of pans clattering and the toaster ticking, they remember it's just me, making breakfast at 6:30 A.M. before my clinical rotation at the nursing home. They go back to sleep; I shove my half-cooked egg sandwich into my mouth and run out the door. I start my car, pick up my friend Rachel, another nursing student, and we make our way to the nursing home, rushing to make it in the sliding doors by 7:00 A.M. We meet our patient and by 9:00 A.M., my partner and I have given our patient a complete bed bath and fed her breakfast. By 10:00 A.M. we have dressed our patient. By 11:00 A.M., all the students meet in the conference room of the nursing home to debrief with our instructor. We share funny stories, sad stories, and shocking stories from the day; we reflect on our actions; and we give each other support. We say good-bye to our patients, leave the facility, and head over to campus for our next class that begins at 1:00 P.M. Although we'd all love to go back and curl up in our warm, comfortable beds, we continue our day. But then I remember that jumping on the college life bandwagon and skipping a class is not an option for a student prepping for the nursing field. It's not an option because what I learn today will save a life tomorrow.

There are times when I wake up and wish I could sleep in or wish I could stay up later chatting and laughing with my friends about nonsense. Sometimes I even wish I could forget the painful cries I've heard at the nursing home. Yet it never seems to escape me the grateful smile my patient had as we repositioned her helpless body, or the smile one of my friends had after I cleaned a cut of his, stopped the bleeding, and bandaged it. I also then remember why I decided to join this crazy life in the first place. Like the well-known poet and musician, Niccolo Machiavelli, once wrote, "the end justifies the means." I realize that my journey to become a nurse, although a great compromise at times, will eventually lead me to my dream.