Labor Market and Career Information

Day Recovery Nurse
Steve Presley

	Introduction Steve Presley thinks that nursing needs a new name. When people hear the word "nurse," they may picture a woman in a white dress with a stiff cap on her head. But those days are long gone. Today's nursing emphasizes high-technology and hands-on medicine, which is attracting more and more men like Steve. Still, they comprise just seven percent of all nurses in the U.S. Maybe a new name could change that. Paramedic and Physician's Assistant are already taken. What could that new name be? While you think up a new title, think, too, about the exciting work that nurses do. Steve, who's been a nurse for eighteen years, should know. He's worked in Intensive Care, the Emergency Room and Cardiology (heart) testing. He has helped saved lives and brought people back from death. And he's helped people know in advance that they have a problem with their hearts while there's still time to correct it. Every day, Steve leaves work knowing that he's helped people stay alive. And the way he does his job makes a stressful visit to a hospital just a little easier for everyone involved. He is so professional, well-informed and helpful with patients and their families that they know they are in safe hands. If you've ever been interested in science, math, medicine and/or helping people, nursing might be the profession for you.

	What exactly do you do? I'm a registered nurse and my day is split into two different types of nursing. In the morning, we help people who are undergoing procedures related to their heart. In the afternoon, we help people who are recovering from various types of surgeries.

	Describe a typical day. When a patient arrives, I'll conduct a "head to toe" assessment, looking for anything unusual. I'll also start an IV--inserting a needle through which we can give the patient various medications. (IV stands for "intra-venous," which means "into vein.") I help the doctors determine whether the patient has any blockages in the blood vessels that could lead to heart attacks or strokes (when blood vessels get blocked or burst in the heart or brain). In one test, we insert a dye through a vessel in the groin (the upper thigh) that helps us take pictures of the vessel system. We also make sure that the patient's body's electrical system is working well. Because our patients have heart problems, you never know what can happen when you're testing them. If a patient's heart has an uneven rhythm, we sometimes need to shock it to get the rhythm back to normal. There are always cardiologists (heart doctors) on hand but the nurses have to know exactly what to do as well.

	What's the coolest part of your job? The coolest thing to me about being a nurse was helping to save children who were in or about to be in cardiac arrest--when the heart stops. That used to happen when I worked in the ER.

	What's your favorite part? My favorite part of my current job is working with doctors to intervene and solve problems in their early stages and prevent strokes and heart attacks.

	How do people react when they learn what you do? They say "That's interesting." It's not uncommon for a man to be a nurse anymore, so they're not necessarily surprised.

	Describe a funny or unusual incident that happened at work. When I worked in the ER, one night a fellow nurse came in as a patient. She had a kidney stone, which is very painful. The doctor prescribed medication to relieve the pain but it had a side effect of depressing (decreasing) the patient's breathing. Sure enough, her husband noticed that my coworker was starting to turn blue. The staff took care of her and in the end she was fine. The next day when I arrived, I read the communications book--which describes what's going on with each patient--as usual. That day the book said "Do not overmedicate your coworkers!" It was pretty funny.

	What's the part you like least about your job and how do you handle it? I don't like it when we have to aggressively treat elderly, chronically ill patients. We'll have patients who haven't opened their eyes or moved in months. They don't have any sort of normal quality of life anymore. But we have to go to any lengths to keep them alive. We're forced to be so aggressive, rather than just let the person die a natural death, by the threat of a lawsuit brought by family members. I guess some people want to keep their loved ones alive regardless of how painful or artificial that life is. Sometimes I think it borders on issues of right and wrong. I deal with it by doing my job. I'm just resigned to the fact that this is how it is and I know that I can quit any time I want. I also stay out of the issue. I don't try to influence the families one way or the other. If they ask me questions, I'll answer honestly about the type of life the patient may expect based on my experience, but I leave the decision up to them.

	How did you become a nurse? It was really by accident. When I got to college, I started studying Biology and got interested in a Physician's Assistant program. One of my professors suggested that I gain clinical (hands on) experience by working as a Licensed Vocational/Practical Nurse. I took his advice and after a year of training, I began working as a nurse. I decided that I wanted to become a doctor, so I got a Bachelor's degree in Natural Science, a Pre-Med program. When I didn't get into medical school, I chose to pursue my career in nursing instead. I got an Associate's degree in Registered Nursing and I've been an RN ever since.

	Why did you become a cardiology/day surgery nurse? I was tired of being an Emergency Room nurse. The drama you see on TV shows about ERs--the stab wounds and unusual diseases--really happens but it's only about five percent of the picture. Most of the time, the ER is just an extension of a doctor's office. Lots of times when people are really sick they can't get an appointment to see their doctors, so they come to the ER instead. We see a lot of people who are chronically ill and are having a particularly bad episode that we help them through. One of the things I really like about my current job is that it's not high stress, as the ER was. What we do is dangerous to a certain extent--patients might slip into cardiac arrest, for example--but we're so well staffed and well trained that we have the best opportunity for a successful outcome. When you're walking through a hospital and you don't see a lot of activity, that's when you know people are really doing their jobs. They've got things in hand. And that's how my unit is. My current position also gives me the chance to use a lot of critical thinking. The medications we use, for example, are complicated and dangerous, so I have to know what's going on and exercise good judgment.

	You have a Bachelor's degree in addition to an Associate's degree in nursing. Has it made a difference?? It makes a big difference. Not in terms of competency. Someone with just an Associate's degree might be a very good nurse. But when I'm applying for a job and I have that Bachelor's on my resume, it's just another point in my favor. If you're an employer and you have two good candidates, you're probably going to choose the one with more education. Having a Bachelor's shows the employer that you have tenacity to finish that degree.

	What pleasantly surprised you about your job when you first started? Working with doctors. Just to get where they are, with all their education and training, they have to be extraordinary people--they're like astronauts in a way. They're very intelligent and multi-talented. And some of that trickles down. I know working with doctors has raised my own standard of care. It's even raised the standards in my personal life. I used to build cabinets for a living and I'd work with guys who were just looking forward to getting their paycheck so that they could buy some beer. Doctors--at least the ones I've worked with--are interested in a lot more than that. They're constantly learning. They're trying to help people and their own profession and advance knowledge in their particular specialty, such as cardiology. It's been good for me to work with them.

	What disappointed you? I love my current job but in the past I've been disappointed by the high, sometimes unreasonable, demands placed on nurses. Because of the number of nurses working on a particular shift, hospital nurses usually work in state of high stress. They're constantly doing something from the minute the shift starts to the minute it ends. Working a shift as a hospital nurse is kind of like playing during the two-minute warning at a football game, when both teams pull out all the stops to win--except that it lasts eight (or more) hours a day, every day. There are very few professions that are so demanding. The head of a company who gets paid hundreds of thousands of dollars might have to work really hard to get the annual report finished, for example, but that's just a few weeks a year. S/he can have down time during the day when it's needed. A nurse can't. They say there's a nursing shortage but I don't believe that's really true. There are plenty of nurses out there but they're just not working as nurses any more. They quit because they don't want to work under those conditions. I'm lucky because in my current position, I have a little more balance.

	How has your job changed over time? It's been a progression for me in terms of the kind of nursing I do. I started out as an Intensive Care nurse, working with people who were severely ill. After three years, I switched to Emergency Room nursing. Twelve years later, I moved to my current position. That was about three years ago. I've been nursing for eighteen years, so I've seen changes in how we practice medicine because of new technology and new information about diseases and treatments. When I started nursing, for example, it was sometimes hard to tell if a person was having a heart attack or just a panic attack. It was kind of subjective. Today, it's very objective. We can run a blood test to see. It takes about thirty minutes and then we can have a better idea if people are having an attack and immediately treat them. That's a big difference.

	What are some of the most important skills and abilities needed for this job? Math, for the medications we use. Speaking, to communicate well with doctors, patients and families. And listening. Doctors don't like to tell you something twice. If they have to, you'll probably hear about it from your manager! Listening is very important.

	How much of that is learned and how much has to be natural aptitude? I think 80 percent of it can be learned.

	What information do you need to keep up in your field and where do you get it? Most of what we have to keep up with relates to standards of care. There's an organization that accredits hospital--certifying that a hospital meets certain standards so that people can know that the hospital is good. We have to make sure that we know of and meet all those standards, which can change over time. Since I work with heart patients, I also need to know what treatment the American Heart Association recommends. I get all this information from seminars and workshops that my hospital provides.

	What advice do you have for people who want to enter this field? Get into Critical/Intensive Care nursing immediately. It will give you skills that you can take to all types of nursing. It keeps your options open, whether you plan to work in a doctor's office or review medical records for an insurance company or law firm. It's just good to have.

	What do you wish someone had told you before you left high school that would've helped you with your career? Be careful about student loans! I have a son in high school now and I'm still paying off my own student loans. Student loans are not free, so have a plan before you go to college and try to take out as little loan money as possible.

	Quick Facts
	The Job in Brief
	Title:	Registered Nurse
	Description:	Help doctors test cardiology patients and help patients recover from day surgeries.
	Education level required:	Minimum for an RN: Associate's degree Steve's training: Associate's degree in Nursing and Bachelor's degree in Natural Science
	Equipment used:	Sophisticated heart-monitoring equipment
	Workload steady or fluctuating:	Steady
	Dress code:	Scrubs
	Work environment:	City hospital

	Demands on Worker
	Works hours (time and duration):	40 hours a week; day time/early evening
	Travel involved:	Score: 0 (1=never; 5=very often)
	Average stress level:	Score: 2.5 (1=none; 5=a lot)
	Amount of teamwork needed:	Score: 4 (1=none; 5=a lot)
	Level of self-motivation required:	Score: 5 (1=none; 5=a lot)

	Labor Market Information
	Employment outlook:	Employment of registered nurses is expected to grow faster than the average for all occupations through 2008 (at least).
	Typical Texas salary:	$37,215 - $45,485 a year