The Unspoken Nursing Hierarchy and Why It’s Garbage

by | Jun 23, 2020 | Podcasts, Nurse Life, Professional Development for Nurses | 1 comment

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The Unspoken Nursing Hierarchy and Why It’s Garbage. By the time we leave nursing school, most of us have a hierarchy of nursing roles ingrained in our minds-- that you should want to work your way “up” to the ICU and also go back to school to become a Nurse Practitioner. Well in this episode we are talking about why that hierarchy is garbage and some of the interesting and valuable nursing jobs that you may not have learned about in nursing school. #FreshRN #FreshRNPodcast #shownotes #nurse #nurses #newnurse #nursehierarchy

Who You’ll Hear

Kati Kleber, MSN RN– Nurse educator, former cardiac med-surg/stepdown and neurocritical care nurse, author, and speaker.

Chelsea Klekamp, BSN RN – Experienced bedside nurse, Nurse Residency Program Coordinator. 

Amber Nibling, MSN, RN, NE-BC, NPD-BC, AMB-BC – Experienced bedside nurse, former Clinical Director of Education, current Senior Director of Clinical Learning at Orlando Health

What You’ll Learn

  • Make your nurse heart sing
  • More than ICU and NP’s
    • Research
    • Certifications
    • Home Health
    • Community Health
    • Education
    • Leadership

The Unspoken Nursing Hierarchy and Why It’s Garbage

What we leave nursing school thinking…

  • You should be striving to work with the highest acuity patients.
  • You are finally a successful and accomplished nurse once you become a Nurse Practitioner.

The truth is…

  • It’s OK if you don’t want to work in the ICU.
  • It’s OK if you don’t want to become a Nurse Practitioner. 
  • It’s OK to not know what you want to do right away!

Do what makes your nurse heart sing.

  • It’s something unique to you– no one else can tell you what the answer is. 
  • When considering a career move
    • Ask yourself: is this something I really want? Or is this something I think I’m supposed to want to do?
    • Do some self-reflection to discover what you truly have a passion for and where your strengths lie. 
    • Figure out what you want your ideal day-to-day to look like (schedule, amount of patient contact time, etc.)
    • Practical considerations of different career paths (cost of education, job market, etc.) 
  • If you don’t want to work in a hospital at the bedside, that’s OK! Nursing is such a diverse field, you can make an impact in a variety of different ways.
  • There is no area of nursing that is greater than or less than the others.

There is more than just the ICU and nurse practitioners!

  • Research
    • As a new nurse, you can join the shared governance council at your facility or conduct performance improvement projects on your unit
    • Terminal degree would be a Ph.D. to work as a Nurse Scientist at a facility or doing research at the university level
  • Certifications
    • Examples: Sexual Assault Nurse Examiner (SANE), Trauma Nurse Specialist (TNS), Med-Surg (CMSRN), Critical Care (CCRN)
    • A way to dive deeper into your area without investing the amount of money required to go back to school 
  • Home Health or Hospice
    • Very individualized, one-on-one care
    • Going into patient’s homes, working with them and their family, often frequently and for an extended period of time
  • Community Health Nursing
    • Caring for a whole community
    • Big projects with nursing/healthcare as the foundation 
    • School nursing
  • Nurse Librarian
    • Helps students or staff find research articles for papers, projects, or policy development
    • APA extraordinaire 
  • Patient safety and quality of care
    • Ensuring regulations and requirements are being followed/met so that the organization gets reimbursed correctly
    • Preparing the organization for Joint Commission or DNV evaluations
    • Monitoring the use of restraints or suicide precautions and ensuring proper documentation
    • Evaluating incidences of HAPIs, CAUTIs, CLABSIs, etc. and ensuring preventative measures are being implemented and documented appropriately
    • Keeping up to date on state regulations and facility policies
    • Track incident reports finding trends that may require a systems-level solution
  • Education
    • Master of Science in Nursing Education, or can teach with MSN, DNP, or Ph.D. in Nursing
    • A clinical instructor or academic professor
    • Unit educator
    • Nurse residency program coordinator or coach
  • Leadership
    • Unit supervisors and managers
    • House supervisor/administrator
    • Director of Nursing (DON) or Chief Nursing Officer (CNO)

Final thoughts

  • Even if you know you want to do something other than bedside nursing, there is still value in doing 1-2 years of bedside nursing to learn and gain experience. It also gives you a foot in the door to explore nursing opportunities within your organization. 
  • When you take a new job, give that job time. Two weeks, or even two months, is not enough time to determine whether a job is a good fit. 

Remember that once you’ve graduated nursing school, you’ve made it to the beginning of the journey that is your nursing career. Don’t feel pressured to find your #1 perfect dream job right away! All the experience you gather on the way to your dream job is valuable.

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Picture of Kati Kleber, founder of FRESHRN

Hi, I’m Kati.

Kati Kleber, MSN RN is a nurse educator, author, national speaker, host of the FreshRN® Podcast, and owner of FreshRN® – an online platform created to educate, encourage, and motivate newly licensed nurses in innovative ways.

Connect with her on YouTube, Pinterest, TikTok, Instagram, and Facebook, and sign-up for her free email newsletter for new nurses.

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