However, the traveling could get old, and I HATE hospitals and having to deal with docs. Plus, it involves a lot of follow-up calls, both the night before and morning of. I’ll be the “visitor”… on foreign turf.
My manager warned me to not let the RNs on the unit boss me around and have me do things other than what my purpose for my visit is: apheresis, not the unit RN’s duties. (Oh, did I mention that this manager rocks?)

However, I just got an offer for an interview for a Home Healthcare Therapeutic Dialysis RN for the same company! Home health is my passion and I’ve been dying to get a job in home health. Same positives apply for this job, except that dialysis isn’t as cutting-edge, and I won’t get that “acute care exposure” that a newer grad so “desperately” needs.
Plus, if something goes wrong, I’ll be all alone. At least with apheresis, I’d have the help of the unit staff. Would I get bored with dialysis? Maybe. But, I guess the same could go with apheresis.

Can anyone give me any insight on what each position encompasses, and which would provide me with the most clinical skills, knowledge base, experience, and challenges (but not too challenging, lol)? I want to make the right decision–I HAVE to. This has been a horrible year, job-wise, and I need to pick the wise career.

Through my trip to Africa, I was reminded how important participating in service projects is to your career. Whenever you give to others, you return to your profession a different person. I learned valuable lessons, like depending on other nurses–something we sometimes lose sight of in our day-to-day jobs.

It was like we jumped out of a plane as strangers, popped our parachutes, and clung to somebody. Suddenly, that somebody becomes your family over the next two weeks, because you’re in a strange place where you have to be vulnerable and trust one another.

I also learned that I often take for granted the knowledge and supplies we have access to in the United States to provide exceptional care. In Africa, they just make do.

Even if you don’t ever make it overseas to someplace like Africa, I’d say that if you’re going to make nursing your career, you need to give back to your community in a service capacity. In fact, many hospitals and health care centers have clinical ladders through which nurses can acquire higher level of stature and pay if they become involved in community service.  If you don’t have community service under your belt, it’s difficult to climb that ladder. They’ll send you back, and say, “Get involved and come back next year.”

You can begin finding places to plug in by looking in the local newspaper and on the Internet for community service nursing opportunities. Often nursing journals have updates and ads, too. A number of nurses with whom I worked found out about the trip through a journal where an ad was published.

Some nurses go to their home churches and ask to implement wellness programs. Play on your strengths. If you’re a labor and delivery nurse, for instance, you can offer your phone number through your church as a resource for pregnant women. Or if your focus is geriatrics, you can be a point person for the aging population.

But don’t make a service project so big that you’ll never embark on the journey. Keep it simple. And remember there are opportunities right outside your door. Start by offering a half of your day once a month at a shelter or a public health center, for instance. Or ask to organize a health awareness project in your child’s classroom. Work with other nurses to sponsor a one-day health event. Think out of the box.

A side benefit of being out in your community is that you raise public awareness about how important nursing is to our society.  So, don’t be afraid…go serve!

But the job has big payoffs, according to Julia Muennich Cowell, PhD, RNC, FAAN, and Professor and Chair of Mental Health Nursing at Rush University in Chicago, IL.

To recognize the pluck and passion of public health nurses, the VNA Foundation developed the Super Star in Community Health Nursing Award, of which Cowell is a panel member.

Recently we spoke with Cowell about the unique opportunities in public health nursing and why so many public health nurses are truly superstars:

What are some unique benefits of community/public health nursing?

You experience much more independence than you would in a robust acute care setting. There’s also a lot of freedom and opportunities to be creative. With that comes a lot of responsibility.

More creativity and independence, really?

Typically, when you consider community and public health nursing, the nurses are often the sole healthcare provider in a community agency. One of the Superstar finalists this past year was the only nurse at the American Indian Center, where she developed and implemented programming and health promotion around diets and physical activity. Another finalist was a school nurse who created an organization for high school students to be introduced to health professions. Part of the program included a trip to the state’s capital where the legislature was going to talk about funding school-based health centers.

Did you experience that independence as a public health nurse?

I began as a staff nurse in public health nursing in Cincinnati, Oh, and we provided health services to families in the neighborhood: mothers with new babies, school-aged children, and the elderly. I remember in the first year of my practice, I discovered a child was being abused in her family. Part of my role was to report that, of course, to the protective services. I then had the opportunity to follow that through the court proceedings and placement into a foster home where health services were coordinated.

Do public health nurses have a greater opportunity to develop relationships with patients?

Absolutely. That’s one of the big differences from hospitals, especially with stays shortening (now patients are often discharged within 24-36 hours). Nurses often do not get to see patients recover from an illness or really have an understanding of what kind of information they might need to take care of themselves at home.

Community health nurses have long-standing relationships with their families.

Why is there an award to honor community, public health nurses?

Because there’s a huge nursing shortage, and the shortage in the community is even larger than in hospitals. This is partly due to the fact that the pay in community health jobs is not as high. I also think nursing students are seduced by the media’s representation of high-tech, fast-paced nursing in hospitals. Think about it: The television shows all focus on acute hospital scenarios, with a team of peers having a blast.

But it takes a special person to be a public health nurse—one who is committed to health promotion, health maintenance, and continuity of care. It is a calling.

What are the traits of a public health nurse “superstar”?

We look for excellence in nursing care, specifically nurses who are creative, innovative, patient, sensitive to patient and population needs, insightful about tailoring nursing interventions, and are client advocates.

Honestly, to be a client advocate, it often means that you exceed the call of duty. Work odd hours. Take on a host of jobs. You have to be very flexible.

Do these high demands lead to discouragement?

Many nurses in community and public health nursing are there because it is a vocation as well as a profession. They become very skilled in facing adversity, whether it’s in the work place or with a patient population. As professionals, they often create solutions that take care of whatever the problem is that they’re facing.

To nominate a nurse for the 2007 VNA Foundation Nurse Super Star in Community Nursing, click here:
http://www.vnafoundation.net/whatsnew/superstar_downloadform.htm

It’s a conundrum: How could the recipient of the VNA Foundation’s “SuperStar in Community Nursing Award”—a $25,000 prize—get the axe a mere few days later?

Sally Lemke, who was a nurse practitioner in Chicago’s Cook County healthcare system, became a local celebrity when this unthinkable scenario played out–and the media made her story headline news. With a nursing shortage looming, it seemed surreal that one of nursing’s VIPs would be canned.

Despite the drama of losing her job—and the constant challenge of not being respected as a nurse practitioner—Lemke remains devoted to the nursing profession and her patients. In this first part of a two-part exclusive interview with RealityRN, Lemke shares what it takes to excel as a nurse and how to persevere through the discouragement.

RealityRN: So what are the characteristics of a nurse “superstar”?

Sally Lemke: A superstar nurse not only fully understands the contributions nurses bring to health care systems, patient care, and communities as a whole, but also goes above and beyond to make sure those contributions are made.
A superstar nurse always looks for a better and more efficient evidence-based way of doing something and for ways to complement and enhance the services of colleagues. Most importantly, a superstar nurse is always going that extra mile for her patients.

Each year, the VNA Foundation honors a community health nurse who stands out in three areas: clinical care, client advocacy, and innovation and creativity. I agree that excellence in all of these areas is what all nurses should strive for.

What do you love about the nursing profession, specifically your role as a nurse practitioner?

My role as a nurse practitioner allows me to fully and holistically care for those I work with. Bringing nursing philosophy into the exam room during direct patient care visits enhances the actual physical care provided to the patient. Nurses and nurse practitioners are trained to actively listen to their patients and understand the alterations in their physical well-being. They also learn to see their patients as part of their families, communities, workplaces, and cultures.

What are your greatest obstacles as a nurse practitioner?

Unfortunately, there still is resistance to advanced practice nursing, especially NPs, who practice direct patient care. Despite the fact that nurse practitioners have been proven time and time again in solid research studies to provide care of equal quality to that of physicians (and, mind you, with higher patient satisfaction), there are still some physicians who feel we are not qualified to do the work we do.

This is evidenced by the backlash against the store-based urgent care centers where NPs are fulfilling a needed niche in our faulty health care system: affordable quality urgent care when you need it, in your community, with a referral to a primary health care provider for ongoing health maintenance.

Have you ever wanted to give up?

I have been in a position where little value was placed on my advanced skills and degree. Several years ago I held a position as a direct patient care NP at an institution which did not provide me with the same nursing and support services that MDs received, simply because I was a nurse! I was not openly welcome at provider meetings and was expected to attend the support and ancillary staff meetings.

However, if a physician called off that day, I was expected to see that provider’s caseload in addition to whatever was on my schedule for the day—all without any help from the nursing or other support staff!! Needless to say, I moved on as soon as I could! I didn’t want to give up, but I knew it was time to find a place that valued all that I had to offer.

Where have you felt valued?

I can honestly say that in community health settings, I have never experienced skepticism regarding my skills and qualifications. Community health settings are great places for nurses to feel valued and needed–and they are viewed as an integral part of the health care system at large.

What keeps you going despite the discouragement?

Clearly, it’s the sense that I know the patients are the ones who count. Getting the feedback that you have made a difference in someone’s life usually puts the frustrations to rest. Knowing a baby stayed in a belly two weeks longer and wasn’t born premature; that a teen mom decided to breastfeed; or, that someone came back for needed care because she said she felt like she could trust you and talk to you: those are the things that make me love nursing and help me work through the frustrations. This work is very fulfilling for me.