Start Here! Recognize Your Power As A Nurse

Before nurses can maximize their career and earning potential, we must first fully embrace what power we have. And it's almost all the power. The Nurses Investing for Wealth blog starts here. 

Nurse with all the power. Photo by Luke Jones on Unsplash

​It’s easy. As a nurse, you can just quit whatever job you currently have and immediately find a new one. Any organization not recognizing this or your value doesn’t deserve you and you probably don’t want to associate with them either since it will only invite you a great deal more pain than necessary. Whether or not leaving your current position is a thing you do doesn’t matter. To get the most out of this career, you have to recognize your worth. Do you know the powers you already have? To fully maximize your potential as nurse, and get on your path to complete independence, financial or otherwise, let’s explore your powers

Power 1: You are licensed & certified

You are a highly skilled, licensed, possibly certified health care professional with unique skills to care for a certain population. Having a license to touch other humans is very unique. And being unique means it’s not easy to replace you. A person can’t come straight in from off the street and legally do the job you are doing. ​

Power 2: You are tolerant of danger & risk

Nurses are tolerant of danger and risk. Photo by Ömer Yıldız on Unsplash

​Nursing and health care work is dangerous and when you step into your work each day, you are accepting the risks that come with it. I have personally worked on a unit that was held up by gunpoint and my nursing colleague de-escalated that situation – not the police and not hospital security, a nurse! I’ve been hit, pinched, and sexually assaulted by patients on more occasions than I can count. My spouse who is a psychiatric nurse once came home with a black eye because he had his face smashed into a door by a patient. 

Physical and mental abuse is just one risk we face though. Another looming danger, especially currently, is contracting infectious diseases. It saddens me to write here that occupational COVID-19 infections have killed more than 3000 nurses around the world. This risk of death from occupational exposures is not new though. I have nursing colleagues who put themselves in grave danger by willingly caring for patients with Ebola, a disease without any treatment that carries up to a 90% death risk if infected. COVID and ebola are just 2 recent examples of infectious disease risk from our work environments. I have personally experienced needlestick injuries that thankfully didn’t turn into anything but could have put me at risk for contracting a bloodborne disease, particularly HIV and hepatitis C. 

These are some of my personal experiences across multiple workplaces and if you’re a nurse, no doubt you have your own stories. For nurses, occupational danger is an expectation and mitigating it is part of our role. Your ability to tolerate danger and risk, although stressful, is a power and if you’re not clear about why, then let’s take a look at your third power.

Power 3: You relieve a critical shortage area in exodus times

Nurses relieve a critical shortage area in exodus times. Photo by Vladimir Fedotov on Unsplash

You have a unique and difficult to replace skill set, you’re tolerant of danger and risk, and there’s a worldwide nursing shortage that’s getting compounded by an exodus of nurses from the field. The International Council of Nurses estimates the current nursing shortage to be about 13 million worldwide and current events (go away COVID!) are only making these numbers climb! So when you leave the profession, there’s no one to replace you. 

It’s probably not news to you that the nursing shortage is intensifying as our population ages, but the new player here, COVID-19, has really driven nurses to the brink. It’s being widely reported that nurses are leaving en masse to spend their time in ways that they most value, which, surprise (!), isn’t caring for strangers in a high risk environment risking their personal wellbeing and sometimes their lives. Even the best educational efforts to increase the numbers of new nurses entering the profession will not stop the exodus of experienced nurses who are leaving. This guarantees you infinite job security and an ability to demand what you need from your job. But let me tell you, this doesn’t mean that employers aren’t going to try to bully you into submission along the way. Power up!

Power 4: You have lifestyle choices

Nurses have lifestyle choices that provide more freedom than many other professions. Photo by Christine Roy on Unsplash

​Anyone who has ever worked shift work knows the unique challenges that come from covering a 24/7 schedule. If you have a partner that does shift work too, you know that it’s possible for you to go many days without seeing each other. Shift work causes a loss of connection with loved ones that seriously erodes a nurse’s wellbeing if not carefully checked. 

I once had an employer who tried to write a scheduling guideline stating that nurses would not be permitted to adjust their schedules based on “lifestyle choices.” This was an indirect response to my request asking for help with switching some of my shifts so I could align my own shift-working schedule with my shift-working partner’s schedule. I picked up shifts to fill open gaps in the schedule and requested that other less critical shifts be removed from my schedule that didn’t suit my schedule. Rather than approving this, my manager met this request with the forbidden lifestyle choice email to my entire team. I felt like a chihuahua dog with blood shot eyes that were half bulging out of its head that had just heard a knock on the door. 

I brought my concern directly to my manager, who was willing to meet with me only during her working hours of 9 a.m. - 5 p.m., not during my shift hours. She refused to let me drop any of the shifts – the ones I had asked to be dropped, or the new one’s I had picked up. As we talked it through she responded, ‘If I allow you to adjust your schedule, then I will have to adjust other people’s schedules to what suits them too. Then I will have an obligation to adjust schedules all day.’ The result was that I was required to work 36 extra hours in addition to my normal hours. I can say with great confidence that her ability to make the change would not have come close to 36 hours. It was clear to me that her primary motivation was to protect her own time only. 

In addition to the unilateral ‘lifestyle choice’ rule communicated in her email, she also issued several other restrictive scheduling changes without any collaborative effort with the ARNP team. This was particularly stinging given we all felt the effects of compassion fatigue taking hold as we were regularly trying our best to cover the 24/7 schedule and accepting overtime. 

This was disappointing, but unfortunately this is my common experience working with large healthcare organizations, particularly in the USA. You’d better believe I was prepared to leverage my nurse powers and I did. I applied for a different but similar job on the evening of the day that I had received the new rules. I received a phone call back on my application the following morning to set up a job interview 1 business day later. 

At the same time, I negotiated for my needs with my current manager, met with the union and our ARNP team and was unrelenting in my lifestyle choice requests. 

This is what my power in action looks like. This is the power available to you. Do not underestimate it. Ever.

When, not if, the time next comes that your employer attempts to take ownership of your life by attempting to micromanage your schedule, threatening you with a lack of work, declining your request for paid time off, or refusing a need to reduce the number of hours you’re working, I’m here to tell you that you don’t have to go along with it. You should not go along with it. Remember the nurse exodus, remember you’re relieving a critical shortage area, then negotiate (I originally wrote laugh in their face but negotiate seems more professional for the nurses that we are) for your best interests and use your power to become more resolute on your demands for better working conditions that meet your needs. And of course, always keep your eyes on the job market. There’s always going to be a job waiting for you.

Power 5: You are an Organizational Asset

Nurses are healthcare organization assets. Photo by Cory Mogk on Unsplash

​Health care everywhere, but especially true in the USA, is a business focused on customer service. As nurses, we don’t like to believe this. In our fantasies we are helping the population be healthier and live their most fulfilled and abundant lives. As nurses focused on health outcomes, we commonly confuse our fantasy with our work, meaning we commonly think that health is the same as healthcare. It’s not. When you separate these things, you will be able to see clearly the role you are playing in this system and that’s what I hope to help you with here.

I do not intend to reinvent the wheel here, so let’s just agree that we can define health loosely  as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. I took that directly from the leading authority on the matter, the World Health Organization. (Constitution of the World Health Organization. In: World Health Organization: Basic documents. 45th ed. Geneva: World Health Organization; 2005.)

Healthcare is not health. Healthcare is a service that maybe strives to help people toward health through delivery of medical and nursing services and products, however never equate your nursing service to someone else’s health. 

To shed light on this, let’s look at an example. I get occasional headaches. When I have an active headache, I am not at full health. I can achieve my full health through different treatment pathways. The non-healthcare related pathway I will usually try is to relax, drink fluids, and focus on self-care. Sometimes this is all I need for my headache to melt away to get me back to full health.

The healthcare related pathway I sometimes opt for requires me to purchase goods - a pain reliever, other times requires me to purchase services, like massage or acupuncture. I severe instances it might require me to seek emergency nursing and medical care along with specialty imaging and treatment. Those goods and services are what make up healthcare. And my health only comes from my own body. See the difference? 

The goal of healthcare may be an effort toward health, but it is not and should not be confused with health. We sell healthcare, but we cannot sell health. And this is important for nurses to understand because it means your service is an organization asset because it is being sold to earn money for large healthcare organizations. 

When you start thinking of healthcare in this way, it makes sense that healthcare organizations are brands and their sole purpose is to try to get customers (patients) to choose them to buy from. This is why hospitals spend so much money on branding, advertisements, sponsoring major events, and remodeling their facilities with fountains, and fancy birthing suites while at the same time saying there is absolutely no budget to support their critical nursing workforce. It might not feel good, but it’s important for you to see yourself as a money-making and reputation building tool for the healthcare organization you have chosen to give your time to in exchange for a paycheck. 

In business, quality and customer service is paramount. If your patient has an excellent experience, feels well cared for and like their needs are met (whether or not they are health related to their actual diagnosis) they are going to think more favorably on your organization. And this is the overarching goal of your employer so that more people will choose to do business with them.

This then makes nurses huge assets for healthcare organizations because 

1. Without nurses, care that is required to be delivered by a licensed provider cannot be delivered which would make the organization’s business model completely collapse.
2. Nurses have experience in empathizing, patient education and advocacy, family support, and problem solving which helps create a feeling of safety for their customers and this creates an excellent customer experience and reflects positively on the organization’s image.
3. Nurses make up the largest segment of the healthcare workforce, have the most contact with patients, and spend the most time with patients. This makes nurses great innovators and problem solvers for health care organizations, but most importantly from a business aspect, it also means that nurses are the most valuable members of an organization’s marketing team. 

When I first moved to Seattle, I worked in a large medical center in a high rise building on the 16th floor. All the patient rooms had large picture windows and the rooms on the south side of the building had splendid views of Tahoma ( Mt. Rainier). On Level 16 I regularly cared for folks who were recovering from major head and neck surgeries for serious invasive cancer treatments. The surgeries were severe, removing large parts of the face, tongue, and face bones. On one such occasion, I was helping a pleasant gentleman recover from such a surgery. As per usual, his face was so swollen that he had a tracheostomy tube in his throat to breathe through. For his case, he had part of his chest muscle cut out and grafted into his face to decrease his disfigurement so he had staples crisscrossing his chest and face to hold all of his wounds together. He was unable to swallow his saliva so it would run out of his mouth, but he didn’t notice because he didn’t have feeling in his new face that only a short time before had resided in his chest. We regularly dabbed at his face to wipe it off. 

Having a surgery like this is a testament to the miracles of modern medicine, but when people are in the early days of recovery, it’s hard going. I was tasked with making sure he was receiving the right amount of tube feedings that consisted of a brown milky liquid that smelled like canned dog food that I kept pumping through the tube that had been inserted through the wall of his stomach. I regularly checked the muscle flap by poking him in the new and old areas of his face and tongue with a cotton swab to make sure blood flow was getting to the area as expected. 

We were dealing with lots of head and neck fluids that were constantly threatening to block his airway, obviously there’s a risk for death when that happens, so to avoid that I regularly stuck a soft clear plastic tube into his throat through his tracheostomy to suck those phlegmy fluids out. With a new tracheostomy, talking was mostly impossible since the air that would normally get forced from the chest during the contraction of the diaphragm up the throat and past the vocal cords before coming out of the mouth in the audible shape of words would now simply bypass and blow straight out the hole in his neck. If I was close enough, I could feel the damp chest breath on my cheeks and nose that smelled weakly like morning breath. When that happened, I would try to focus intently on his lips which would inevitably move to talk, a habit his body had normalized throughout the 60 years of his life, and I would try to read his lips, sometimes with success, but often with failure. After too many failed guesses, he might capitulate and write it on a handheld size dry erase board that we provided to aid in communication. So reading handwriting became the next challenge.

This gentleman and I had worked together for a few days, and I had helped him move into this private more spacious room on the south side of our building that evening. I was aware that he hadn’t yet looked in the mirror and that he wa nervous to do that. On this crystal clear Seattle evening, as the sky was turning pink, I angled his bed so that it was facing out the picture window and as the sun was setting in the west, Tahoma loomed in the distance and glowed pink. It was in this moment of beauty on a summer evening that all the hospital noise had become drowned out and it was just he and I. I handed him a mirror and there in the room, the pink light flooded in onto his scarred face as he took a look in the mirror he saw his face on the backdrop of the glorious pink Tahoma and he winced. Then he stared and eventually he turned to me and lipped words to me that he looked horrible. I had nothing to say. We took this moment together. I stood quietly in support by his bed, looking at Tahoma and the city that skirted the hospital just below and it struck me as bizarre that people out there were just going on with their lives like any other day.

Your power as a nurse is your presence. Your presence and your body is an organizational asset in and of itself. Understanding this, you can understand why a nurse’s happiness and wellbeing is an organization’s responsibility if they want to maintain their reputation. The very last thing an attuned healthcare organization should want is for a nurse to leave. When that happens, they are losing their most highly valued customer service agents who can provide experiences that no one else is prepared to deliver. 

Power 6: You are union eligible

Nurses have power in their unions by having a collective voice. Photo by Ehimetalor Akhere Unuabona on Unsplash

If you aren’t in a union, you are cheating yourself. If you are a nurse like me, you may have heard messaging in university along the lines, ‘because nurses are professionals, they should not be part of a union.’ For this message alone, I think I deserve at least a 50% refund on my tuition because this is plain wrong.

I have held unionized and non-unionized nursing positions. My personal experience screams that my pay, working conditions and rights protections are far better when I have union backing compared to when I don’t. 

I wasn’t always a true believer in unions. Aside from my university’s inculcation, I didn’t much appreciate the fees I was paying from my paycheck each month to a nebulous organization that I rarely had any interaction with. When I moved to New Zealand in 2002 to live and work, I discovered that nearly every worker in the healthcare industry, regardless of their professional status, was unionized. In addition to the nurses’ union, which more than 90% of nurses belonged (compare that to 20% in the USA), there was the doctors’ union, the hospital administrators’ union, the midwives’ union, and so on. Yes, I was surprised to learn that poor little physician interns were unionized, and, no, it wasn’t legal for them to work 36 hours straight because it was considered a serious safety issue for the physician and also the patients they were serving. Duh, but 36 hour shifts are a standard in the USA where physicians are largely non-unionized.

I came away from my time in New Zealand a much more enlightened nurse on the affect of good social policy on general social welfare. Not only had I experienced excellent working conditions and culture, I was relieved of stress of having to deal with management who was constantly changing and morphing my job description, work expectations, and demands on my unpaid time. There were clear boundaries and everyone knew what they were and the union was leading the way to define them.  

Unions are very much for any professional group but corporate America has been highly successful in convincing laborers that this isn’t the case. Here’s my best personal example. I took a nurse practitioner job with a corporate healthcare organization in Washington State. Washington does have one of the highest unionized nursing workforces in the USA, but this job was not a unionized position. At my interview my soon to be manager said, “This isn’t a unionized position.” 

“Okay.”

“It’s not a union eligible position.”

"Okay." 

“That’s not ever going to change.” 

Getting skeptical now, “Umm… okaaaay?”

What I didn’t know, was this was a salaried position within an organization where a subsegment of the organizational nursing and nurse practitioner workforce were already unionized with an collective bargaining agreement. The job really interested me, and I took it. 

I was very lucky that I worked with an excellent team with an extraordinarily ethical manager who I always felt (mostly) had my best interests at heart. However, some of the things I experienced working for this billion dollar company included my hours being cut back with minimal notice and very low pay that didn’t come close to matching the nurse practitioner bargaining agreement. 

It would be years before I fully realized how low the pay was and it took leaving and returning to the organization years later in a fully unionized position. Can you believe that my pay in my unionized position with the exact same organization was more than double my pay in my non-unionized position?! 

In this scenario, I fell into the non-union trap. ‘Take this non-union job that you really want! You will like it. We will raise your pay when we can through merit. You will have the ability to negotiate on your own behalf. You will not have to have a union negotiate for you which will negatively impact your ability to rise above.’ 

Corporations have been very successful at convincing workers and even nursing educators that negotiating individually on behalf of their own best interests is the best way to get a step up. However, let’s get out of that fantasy! Think about it, you with your one small voice may be successful at negotiating a pittance of a pay raise, but do you really think you’re going to double it? Do you think your request for PPE can be honored? And if not, what option do you have? What if you get COVID or any workplace injury that leads you to take time off work or, worse,  lose your job? Who will ensure you get covered for sick leave and protect your rights? If you’re on your own, you have the option of buying your own PPE, hiring your own lawyer, and fighting your own fights with your one voice. But with a union, you will have the option of having all your nursing colleagues be informed of the situation, learning that they have the same frustrations, and accessing a paid advocate and lawyer to promote and advance your concerns while legally holding your organization accountable. 

As nurses, our responsibility is to our patients. Our time spent on work should be prioritized on caring for our patients, not feeling miserable from our working conditions. And when misery arises, we cannot individually hold multi-million and billion dollar organizations accountable. And this, my fellow colleague, is why your power is in your union. If you are in a position that’s not unionized, time to do that or weaponize your other powers and look across the street.

As a nurse, you have many powers, but there are weaknesses all nurses have that repeatedly take us out at the knees, and I need to be frank with you about it. We'll talk about those in a future post.

Do you have any other powers as a nurse? I'd like to hear them. 

Share your comments with me about your powers and how you leverage them down below, or with other nurses investing for wealth in our Facebook group, or on Instagram @nursesinvestingforwealth.