Careers in Nursing Specialties

CAREERS IN NURSING SPECIALTIES

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CAREERS IN NURSING SPECIALTIES DERMATOLOGY AND VASCULAR ADVANCED PRACTICE REGISTERED NURSE (RN) WHAT HAPPENS WHEN YOU ARE SICK OR INJURED AND NEED MEDICAL ATTENTION?

You go to a doctor’s office, or a hospital emergency room, or a community clinic. In most instances, the first professional you will have contact with is a nurse. In a growing number of cases that do not need a doctor’s attention when a nurse specialist is on hand, it is that nurse who can handle the medical problem with a diagnosis and proper medication, just as effectively as the doctor. A good portion of today’s news headlines are devoted to medical and healthcare issues. Scientific breakthroughs in DNA and gene

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therapy, surgical procedures, medications and equipment, are resulting in dramatic advances in medicine. New technology is out front leading the progress with discoveries of new and different ways to treat injury, disease and illness. In healthcare, change has become a constant, and the 21st century promises to be full of exciting surprises. Nowhere is this more evident than in nursing, where change is having a positive impact on the way healthcare is delivered. The role of nurses in healthcare has been expanding for the last quarter of a century as nurses are now considered front line providers in treating patients, working collaboratively alongside physicians and surgeons, conducting research and teaching. The most pronounced change is in the area of specialization in nursing. From anesthesia to trauma and many other specialties, nurses are completing the basic education, and then continuing to train for specialties they are suited for and have interest in. It usually requires additional education in school plus on-the-job training. Many nursing specialties have their own associations and publications. Many have certification programs and ongoing educational programs for additional credits. These nurses all begin as Registered Nurses (RN), registered in the state where they work. Some nursing specialties have been around for many years, but recognition and respect has been hard to come by. Today’s nurse is a savvy healthcare professional whose knowledge and skills are beginning to gain greater appreciation and recognition by the medical profession. Many studies in recent decades clearly show that nurses and nursing, especially in hospitals, are essential to the health and welfare of patients. This report will highlight two nursing specialties that have been taking center stage: Dermatology Nursing and Vascular Nursing. Twenty-first century living and the environment has created a huge rise in skin cancers and diseases, and problems in blood vessels, vein and lymphatic systems. This report is part of an ongoing series on nursing career specialties. Ask your counselor or librarian for other nursing specialties Careers Reports or visit Careers Internet Database at www.careers-internet.org.

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IMPORTANCE OF NURSING TODAY PEOPLE HAVE BEEN NURSING THE SICK AND WOUNDED IN SOME FORM SINCE THE

first human fell ill or was injured. Modern day nursing started in the mid-1800s, and it has evolved into a professional healthcare career complete with education, training, registration and certification. Nursing is the largest healthcare occupation, and one of a handful of careers projected to have the largest number of new jobs through at least the first decade of the 21st century. There are more than two million nurses working in hospitals, medical centers, primary care clinics, HMOs, public health agencies, nursing homes, mental health agencies, hospices, insurance companies, corporations, educational and research settings, and private practices across the country. But the aging of the nursing workforce has caused a crisis in the profession. Healthcare organizations from coast to coast are feeling the effects, as studies are revealing a growing shortage of available nurses that is detrimental to the nation’s health. Nursing has always been a good profession for both women and men, but now the many specialties has given nursing the respect it deserves and heightened its professional standing. Just like the general doctors before them who became board-certified specialists in a chosen field, nurses are answering that same call and attaining credentials in the same specialties as physicians and surgeons. These professionals are not “assistant doctors” in their specialties, but function collaboratively with doctors and often independently in directing patient care, patient assessment, patient education and other duties. If you are considering a career in nursing, then also consider a specialty for your future. Two excellent prospects are dermatology nursing and vascular nursing.

Dermatology Nursing This is a multi-faceted nursing specialty, as dermatology nurses treat patients with a wide range of skin conditions including melanoma, psoriasis, acne and burns. They also treat conditions that affect the hair, nails and glands. Because conditions of the skin cannot easily be hidden, especially in the face area, this nurse specialist must not only treat the medical condition but also recognize the emotional impact on the patient and render a sympathetic response with options for more assistance.

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Dermatology nurses must play a pivotal role in educating patients and their families about their particular ailment and what treatment may be available and how it will work in their case. Skin problems can affect every age from babies to seniors and their cause can be a well-known diagnosis such as too much sun or a reaction to a certain food or chemical, or an initial mystery that will require tests, medication and therapies to pinpoint. Because every patient has an individual ailment and special treatment plan, the work is never routine or boring. Because dermatology is such a broad-based field of medicine, nurses can choose to specialize within this specialty. There are nurses who only take care of patients with skin cancer, while others might specialize in assessing the reasons behind allergic reactions, and still others work in a burn clinic. Children can present particular challenges because the dermatology nurse has to make sure that the marks on the skin are dermatological in nature and not child abuse. Some situations are complex and troubling, and this nurse specialist needs to look at the whole picture and determine the proper procedure within the guidelines of the law and medical ethics. Dermatology nurses must have strong interpersonal abilities because many dermatology conditions are chronic and nurses may see the same patients on an ongoing basis for years. They must connect with patients, especially children and teens, so they can deal with problems of body images and changes as the patients age. Psoriasis is a good example of a condition where there is no cure as yet, so it is up to the nurse to convince patients that keeping up with the treatment and medication is truly in their own best interest and staying the medical course can only produce positive results. Dermatology nursing has its challenges and rewards. While many skin diseases and conditions cannot be cured, they can be treated and controlled and the dermatology nurse will work collaboratively with the doctor to give the patient their best efforts for a better image and life.

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Vascular Nursing Vascular nurse specialists also have a variety of duties, including caring for patients with diseases of the arteries, veins and lymphatic system, treating patients with spider vein problems, possibly saving the life of a patient with an aortic aneurysm. Blood vessels have been called the train tracks of the body as they travel everywhere. They can be troublesome as people grow older and life expectancy increases. Vascular diseases and conditions are numerous, and they are serious. Some of the better known include blood clots, strokes, venous ulcers, deep vein thrombosis, thoracic outlet syndrome, carotid artery disease, wound complications, atherosclerosis and varicose veins. If any of these or other vascular diseases remain untreated, they can cause gangrene which generally means amputation, weakened blood vessels that could rupture without warning, and chronic disability and pain. Many vascular diseases and conditions are preventable because they result from smoking, overeating and too little exercise. Vascular nurses play an important role in educating patients on such symptoms as high cholesterol, diabetes and hypertension, and what a healthy diet, daily exercise and no smoking can do for the health of the body. These professionals often take an active role in community awareness programs by arranging screenings and health education fairs to promote the early recognition of problems, which goes a long way toward prevention and recurrence. New technology has had an impact on the entire medical profession, including vascular surgery. Today, many procedures are less invasive and patients can be sent home the same day or with just an overnight stay in the hospital. Lasers is one technology now used to treat varicose veins. Another cutting-edge procedure uses new technology to plug up the blood vessels that cause uterine fibroid tumors. Vascular nursing is also involved with a new and growing field of interventional radiology that may be used in a vascular crisis where other treatments will not work. Vascular nurses are Registered Nurses, and an increasing number earn master’s degrees and become certified in the specialty. They can become advanced practice nurses or nurse practitioners who diagnose and treat illnesses, infections and injuries, write prescriptions, give full physical examinations, and perform other duties formerly handled only by medical doctors.

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The best part of this nursing specialty is that patients can be cured of their vascular problems if they follow a better, healthier lifestyle. This is also a frustrating part of the specialty, when nurses see that problems can be corrected but patients are lazy with regard to quitting smoking, eating healthier foods, and doing some form of exercising every day. That is why educating patients and their families and communities is a top priority of vascular nurses.

Expanding Employment Prospects Healthcare in general and nursing in particular will be promising career options for the foreseeable future. The population is not only aging but living longer and will continue to have more medical problems and needs as opposed to their younger counterparts. The US Administration on Aging has said that the number of people 65 years and older will increase to over 53 million by the year 2020 and continue to increase. Just a few years ago in 1996, this number was about 34 million. An older population means more doctor visits, more complicated procedures, more intensive care, and more hospital stays. There will be more chronic and acute illnesses. All this signals a need for more nursing care just when there is a nursing shortage across the country. More than half of the nurses practicing in the United States are 45 years and older, which means they will be retiring in coming years. This figure is alarming to those in the healthcare field because nurses continue to be the backbone and front line for healthcare. Almost every aspect of healthcare service involves some form of nursing care. Nursing is one of only a handful of occupations that is projected to have the largest number of new jobs according to government experts. In fact, a nursing shortfall of some 800,000 nurses is predicted by the year 2020. Nursing specialists, including dermatology and vascular, will be among the most sought-after in the profession because they treat a large number of senior citizens.

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NURSING HISTORY THERE HAS BEEN NURSING IN ONE FORM OR ANOTHER HAS BEEN WITH US SINCE

the first humans inhabited our Earth. Archeological digs have unearthed medical tablets suggesting how illnesses were treated in ancient times. Pre-Christian cultures stressed good hygiene as a means of staying healthy. Egyptians set rules for proper diet and bathing practices. Babylonians treated illnesses with diet, rest and enemas. The Chinese relied on their belief in spirits and demons. In ancient times the ill were usually cared for by priest-physicians and so-called medicine men. In early Christian times, there was an attempt to have a more dedicated group of individuals to care for the poor and the ill. These groups were made up of women in the community and they wore religious clothing for easy identification. They were idealists serving God and performed menial tasks as penance for sinning. In Europe, throughout the Renaissance and the Reformation, medical care and treatment did not improve much even though there were great advances in the arts and sciences. The modern concept of nursing would not take hold until the 19th century. A well-educated, cultured Englishwoman named Florence Nightingale, who had worked in public health on behalf of the poor, especially women, pushed for significant changes in treating the sick. She initiated hospital reform during the Crimea War (1853-56) and established the first school of nursing after the war. She set standards for nursing care and public health. By 1898, there were schools of nursing in the United States, in the states of New York, Massachusetts and Connecticut. Nightingale died in 1910 and her influence is still felt today. During the early 1900s, nurse specialties took form. Waves of immigrants living in cramped conditions needed a more knowledgeable professional who could deal with the many health problems of the new Americans. Public health, obstetrics and anesthesiology were among the first nursing specialists. Others followed throughout the decades, and by the 1970s, nurse specialists were becoming the norm. Many of these specialties became important enough to establish their own associations, journals, newsletters and other literature, certification programs, and national and international conventions.

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The Dermatology Nurses Association was established in 1981, and the Society for Vascular Nursing was established in 1982. Both specialties have worked hard to raise the bar on professionalism that not only validates their members’ education and expertise, but also enhances recognition from the medical profession and the public. Both specialties are strong and will grow, making continued contributions to healthcare and nursing for the foreseeable future.

WHERE YOU WORK THERE ARE WORK OPPORTUNITIES IN BOTH SPECIALTIES IN ALL 50 STATES.

Nursing is a universal a career as you will find and the work is done in medical facilities and doctors’ offices and pharmaceutical companies and research laboratories and schools of nursing and medicine. From hands-on nursing to research and generating new knowledge in the specialty to teaching, there are opportunities in major cities and smaller communities and every size in-between at: Hospitals and major medical centers Community and primary care clinics Retirement complexes and nursing homes Single and group practices of physicians and surgeons Pharmaceutical companies Insurance companies and pension plan offices Medical research laboratories Teaching at nursing and medical colleges and universities.

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WORK DUTIES THE TWO NURSING SPECIALTIES COVERED IN THIS REPORT INVOLVE HANDS-ON

work. Both dermatology nurses and vascular nurses take care of patients in a variety of settings. Taking a patient’s history, patient education on a particular condition, conducting patient examinations, dispensing medication to patients and so much more, these specialists work with and for physicians and surgeons. They view each patient as a new individual and become familiar with the particular illness, disease or condition so that an appropriate regimen can be created that will work for that patient. There is never a one-size-fits all in these specialties. The nurse must take into consideration the age and physical and mental condition of the patient; other conditions the patient may have as well as other medications; the lifestyle of the patient and setting realistic goals with regard to smoking, drinking, diet and exercise; and whether the ailment is life-threatening.

Dermatology Nurse The dermatology nurse wears disposable gloves when examining the skin or scalp of a patient. Some skin conditions are contagious and disposable gloves protect the patient, the nurse and the doctor. It is not unusual for nurses to use several pairs of these gloves in examining different parts of the face and body. The age of patients can range from newborns in hospitals to senior citizens in nursing homes. Skin afflictions have no age barriers. They treat a wide variety of skin afflictions such as psoriasis, acne, melanoma and burns, plus conditions affecting the hair, nails and glands. Conditions can range from mild to severe and if left untreated some, like melanoma, can be fatal. Here is where the dermatology nurse is very important in educating the patient to the seriousness of the condition and eliciting the patient’s full cooperation in the treatment process. Serious skin afflictions rarely affect only the patient, but usually involve families and sometimes colleagues at work and good friends. This nurse must possess a special understanding of the anxiety and even depression of the patient and work to allay fears and set a treatment course that will impact both the physical and mental condition. They also involve families and friends in the treatment process.

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They advise patients on what to expect from treatments, how to use their medication and to recognize if the condition gets worse. They must encourage and motivate patients to stick with the treatment plan, especially children and teenagers who may not understand the importance of taking their condition seriously. Also, in children, it is important for the nurse to distinguish between a skin affliction and possible abuse and then take appropriate action. Most dermatology nurses are RNs and acquire a great deal of their specialty training while they work. The Dermatology Nurses Association, the American Medical Association and other medical groups hold seminars and give workshops on various dermatological conditions. The dermatology nurse who becomes certified or earns a master’s degree is able to diagnose, treat and prescribe medication. Some go into research while others teach.

Vascular Nurse The vascular nurse has many challenges and many rewards. Many vascular afflictions are life-threatening and most can be cured. That perhaps is the biggest frustration of this professional in knowing that so many of their patients’ conditions can be fatal, but can also be cured by lifestyle changes. Smoking, eating foods that are fatty, have too many calories and are high in cholesterol, and being a couch potato can be disastrous for many people. From teenagers to senior citizens, Americans have an obesity problem that is costly in terms of loss of life, work productivity and healthcare costs. Vascular nurses can improve the lives of their patients. They educate their patients in hospitals after vascular surgeries, in doctors’ offices and clinics as they treat vascular conditions, and in communities as they participate in awareness and wellness programs to promote healthier lifestyles and to help people to recognize early symptoms of a variety of vascular afflictions. This education is particularly necessary if the individual comes from a family with a history of heart problems, obesity, high cholesterol and more. This multifaceted specialty offers nurses great opportunities to make a real and positive impact on the lives of people they treat and educate. This is crucial not only for younger people, but for an increasing older population where acute and chronic diseases of the vascular system are on the rise. The focus is the complex network of blood vessels that circulate blood and go to and from the heart and lungs. Left untreated, vascular afflictions can become critical and fatal. 11

New technology is improving care and a number of procedures are now done with minimally invasive techniques, such as lasers, that allow patients to go home in a day or two, and return to work earlier. Vascular nurses are RNs and many come to this specialty from their hospital experiences either in the operating room or in intensive care units. A growing number of these professionals are earning an advanced degree and taking certification in order to have an even greater impact on patients’ lives. The vascular advanced practice nurse is a new to the 21st century healthcare provider who has a master’s in nursing and is now a prominent part of the interdisciplinary team that treats vascular patients. They direct and participate in the comprehensive care of assessing and defining appropriate interventions in patients with vascular diseases. The Society for Vascular Nursing is an important resource for this specialty, working with other professions to address the needs of patients with vascular diseases and establishing research-based standards for the specialty of vascular nursing.

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NURSING SPECIALISTS TELL YOU ABOUT THEIR CAREERS I Am a Dermatology Nurse in a Doctor’s Office “I have been a nurse for almost eleven years and have just celebrated my seventh year in this office with two doctors who are dermatologists. When I started there was just one doctor and his nurse was retiring and I worked under her for a year before taking over. The doctor was also looking at his retirement in about ten years and wanted to bring in an associate who would eventually take over the practice. This was accomplished a little more than three years ago. We hired another nurse, have a receptionist who makes appointments and keeps patients in the outer office happy, and a secretary who takes care of the bills and statements and private insurance and Medicare. The office is very busy. We see patients Monday through Thursday from 8 am to 4 pm, and on Saturday from 9 am to 1 pm. On Friday both doctors, who are associate professors at a major medical school, hold dermatology classes, lecture, and work with students. I work from 7 am to 5 pm Monday through Thursday and alternate the half day on Saturday with the other nurse. The receptionist and secretary do office work on Friday and they alternate the half day on Saturday. The doctor who started this practice gained a good reputation over the years in helping teenagers with their skin problems. Afflictions of the skin, especially around the face, neck and hands can be devastating to a young person. They are growing physically and emotionally, and a prominent condition that can easily be seen usually has a bad effect on their attitude, relationships with family and friends and their school work. I walk a fine line in what I say and how I say it. Every teenager, male and female, is different in handling a skin affliction, be it acne or psoriasis or another problem. Some can talk about it openly, while others cannot even look you in the eye as they dodge sometimes embarrassing questions. I work hard to put them at ease and let them know that they are not alone and that 13

many of their peers are having the same skin problems. The most important aspect of this is to impart information about their condition and to educate them as to proper care that may also include diet. In these instances, I am a teacher in every sense of the word. We also see adults with melanomas as both doctors can remove some small skin cancers in the office. We treat patients with scalp and nail problems. We handle only minor burn problems and refer major burn cases to other dermatology specialists. I take histories on new patients, change dressings, remove sutures, give shots, explain the medications and demonstrate proper use especially if it is a salve, and make sure they understand what they can and cannot do for whatever period. That includes showering, swimming, not wearing certain types of clothing that could irritate a skin condition, and possibly diet restrictions. I was recently certified to treat certain cases with ultraviolet lights or lasers. After I graduated from nursing school and passed the exam to become a Registered Nurse, I went to work in a hospital and gained good experience. I was thinking of zeroing in on a specialty when I contracted a rash and had to see a dermatologist associated with the hospital. It was an interesting and informative experience, and I talked with the doctor about dermatology nursing. He suggested some additional coursework and a few good workshops and then put me in touch with the doctor I now work for who was looking for a nurse to replace the one that was retiring. I had a good year of watching and learning and making mistakes and correcting them. I love my work and the people I work for, and work with. The job is hard and there are days that I never seem to come up for air, but I am helping people deal with medical problems that are so important to their lives. Right now I am very happy with my work. The office is the right size and I am in charge. I have already had a few offers to move to a larger practice and take on more responsibility, but I married two years ago and we are expecting our first child in four months. I intend to take the first three months off after the birth, but want and need to keep working. I do have options and that is fine, but for now I am happy where I am.” 14

I Am a Dermatology Nurse With a Pharmaceutical Company “One of the most positive aspects of dermatology nursing is realizing how far we have come in helping people with varied and serious skin conditions. I have been a Registered Nurse for almost 30 years, and it has been exciting to watch the results of new medications and be a part of new attitudes in relation to patient treatments and a new awareness of healthcare providers. Today we know how heredity, diet, the environment and other factors affect our skin. A prime example is the risk of too much sun on our skin and the rise in skin cancer cases. I started out as general practice Registered Nurse working in several hospitals and learning about a number of medical specialties. I was drawn to dermatology when I went to work in a community clinic used by a diverse population of immigrants where English was the second language. New surroundings, foods, the environment and other factors always bring medical problems, and most of our patients were young children and teenagers with a variety of skin afflictions. Most mothers spoke very little English and while we were a bi-lingual staff, the seriousness of medical conditions can get muddied in the translation. Another nurse and I started an awareness and wellness program and held an open house twice a month to encourage people to come and ask questions of our bi-lingual staff about their families’ medical problems and how the clinic could be helpful. We discovered that more than half of the questions involved skin problems that ranged from mild to serious. I talked with dermatologists associated at the hospitals where I had once worked and they advised me on some educational materials and a particular course at a nearby college that would be helpful. Within two years I was devoting myself to dermatology nursing. After almost a decade of clinical practice, I needed to move on to another challenge. On occasion some of our patients would participate in a clinical trial for a new skin medication at a pharmaceutical company known for its skin medications and 15

treatments. They were looking to add several Registered Nurses to their staff and wanted one to be a dermatology nurse. I applied and was accepted. This is totally different from what I had been doing, which was hands-on dermatology nursing in a clinic or hospital. Now I run clinical drug tests and follow the volunteers who participate in the test, as well as track their physical and mental reaction to the drug. In these tests, some patients get the test drug and some get a placebo so we can better check for a drug’s efficacy and possible side-effects. My nursing career has been interesting and varied and I am not sure where I will go next. I am here for at least another four years in overseeing tests for new dermatology drugs. There are also other career options I can explore here.”

I Am a Vascular Nurse in a Hospital Surgical Unit “I have been a nurse in the same medical center for the last decade and a vascular nurse for almost four years. I came to nursing after my two children were in school all day and I earned my degree and became a Registered Nurse in my mid thirties. I was able to get my first job at the hospital that was close to our home and I have stayed and been very happy. After doing normal rotations in the medical center for several years, I found myself on the surgical floor and caring for patients with vascular problems, before and after surgery. Vascular diseases cause too many fatalities in this country and the most frustrating part is the fact that most conditions can be corrected if people would only adopt healthier lifestyles including no smoking, less fat and cholesterol in their diet, and more exercise. It seems a simple enough recipe for better health, but its easier said than done for the patients. Until a few years ago, the majority of patients with vascular problems were those in the sixty-five and older bracket. But the new reality is that we are seeing much younger people in their forties and fifties with heart and artery problems that lead to heart attacks, strokes, blood clots and many other complicated vascular diseases. My work deals with the circulatory system and the blood 16

vessels that carry blood throughout the body. In essence, the arteries carry blood away from the heart and the veins return it. So any condition that affects the circulatory system is serious and sometimes deadly. After closely monitoring patients post-surgery or in-patient treatment and seeing to their diets, exercise and medication while in my care, my next most important role is that of educator. So much of the illness I see could have been prevented with healthier lifestyle choices. Arteriosclerosis is a good example where the build-up of fat and cholesterol, called plaque, will narrow the artery causing less blood to flow and eventually lead to a blockage. Getting my patients to change their eating and exercising habits is a definite challenge and one that I welcome. We have a number of in-hospital programs for patients as well as reading materials about vascular disease. Some patients continue coming to our programs on an outpatient basis and they usually seek me out to let me know how well they are doing. This is my reward. I did my job well and it paid off. But not everyone heeds the warnings. I feel like I am making a real contribution to my patients and hope to continue doing this work for some years. Eventually I would like to go into the intervention side of this specialty in the hopes of keeping more people out of the hospital.”

I Am a Vascular Nurse in Research “I come from a family of healthcare professionals who happen to have a history of heart and other vascular problems. We were all made aware of our hereditary problems at an early age, and good diet and exercise has been a part of my life since my teen years. My father and his brother are physicians, and I followed an older sister and two cousins into nursing. My mother is in healthcare administration. For almost a dozen years I worked for a cardiology practice where four doctors specialized in a variety of heart problems and conditions. It was an eye-opener and early on I had the notion of going into research. I entered a master’s degree program part time while I was working. When I finally earned the degree it was 17

a major accomplishment and one that I knew would eventually get me into a research position. I was very focused on learning absolutely everything I could about vascular diseases in younger people as I wanted to research how the lifestyles of people in their twenties and thirties will affect their lives in later years. Three years ago I heard about a large grant for a vascular research program in the medical school connected with a major medical center. The grant included a component for vascular nursing and its importance in the field. With the support and recommendation of the cardiologists I worked for, I applied and was hired to be part of a team that would research the long term effects of diet, smoking and exercise starting with teenagers. I became part of the team a little over two years ago and I am realizing one of my goals and dreams. Vascular research from a nursing perspective is a relatively new concept. It seems such a natural pairing to me. After all it’s the nurses who have the most contact and spend the most amount of time with patients either in a medical office or in a hospital. And, many patients find it easier to talk with the nurse than the doctor. We are on the front line of healthcare, and research will be critical to the advancement of nursing and the healthcare field, as well as to professional accountability. Part of my work is identifying problems that would face vascular nurses in their work. I help collect data on the vascular patient population and then help evaluate the findings. Right now we are concentrating on the over fifty population, but the next phase will start with a younger population and eventually we will get to the teenagers. It will take time to make conclusions and suggestions, but this could turn out to be a major breakthrough for vascular nursing. I am very excited to be a part of this effort and look forward to making a real contribution to the field of vascular diseases in general and vascular nursing in particular.”

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PERSONAL QUALIFICATIONS NURSING IS AN HONORABLE CAREER. IT IS ALSO A TOUGH CAREER. FROM THE

emergency room to the operating room, and from the doctor’s office to the research laboratory, nurses provide the knowledge, support, specialization, organization, understanding, energy and responsibility. Sometimes underappreciated, but always ready and willing, nurses in all specialties are indeed unique healthcare professionals. Knowledge Nursing is medicine and medicine is knowledge. From the common cold to complicated surgeries and every condition in-between, nurses must know the body anatomy, a wide range of illnesses, diseases, medical conditions and problems, and medications and treatments. Specialties, such as dermatology nurse and vascular nurse, require extensive knowledge about the illness and condition and how to best respond. Support Nurses provide the support that makes patient care work. In a sense, their career is a calling as they dedicate themselves to healing and educating. In all of healthcare there is no better all-around medical support person than a nurse. Whether its in the hospital or in the doctor’s office, nurses are the front line of patient care as their work supports all other medical and technical healthcare efforts. Specialization Specialization has changed the medical profession including nursing. Because people are living longer there is a concerted effort to make their extended lives healthier and more productive. Specialization for the dermatology nurse and the vascular nurse means a more knowledgeable and supportive role in treating these conditions well beyond what was once general nursing care. Organization Nurses sometimes refer to their work areas as organized chaos, but be assured they know the where, what, why and how of everything they do. Organization is an integral part of nursing because a crisis with a patient that can arise in seconds. This is true in doctor offices as well as in hospitals. All information is recorded and all files, whether computerized or on paper charts, is organized with the latest information on condition and medication on top. Disorganization can lead to problems and endanger patients. 19

Understanding Nurses are known for their TLC and have a better understanding of what patients are going through then most other healthcare professionals. They spend more time with patients and get better feedback about illnesses and conditions and how patients are handling their pain or recovery. Dermatology nurses and vascular nurses require great understanding as patients have illnesses and conditions that can affect their appearance or be life-threatening. Being a sympathetic listener can be as beneficial to the welfare of the patient as their medication. Energy Nurses need boundless energy from their college years throughout their careers. Standing for long periods of time in operating rooms, making rounds in doctor offices or on hospital floors, takes a great deal of stamina. In addition, it can be physically and emotionally tiring to take care of ill or critically ill patients as it may take all the nurse’s energy to make that extra effort for someone who needs it. This is a very demanding career in many ways and it requires a high level of energy. Responsibility Above all, this is a career of responsibility. Lives are at stake. Places of work are hectic and the nurse is probably juggling many tasks at once. The nurse must always be aware of what is happening and why. Sometimes decisions must be made quickly and the sense of responsibility must never leave the nurse. Too many depend upon the nurse to be there and to do the right thing. Responsibility overrides long and demanding hours, bruised egos, grouchy patients and colleagues, and personal feelings.

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NURSING’S GOOD POINTS NURSING IS A WONDERFUL AND RESPECTED PROFESSION. A RECENT GALLUP POLL

said that the public again voted nurses “number one for honesty and ethical standards” of various careers. It has challenges and rewards and is never boring as no two days are the same. You help patients deal with simple as well as life-threatening health situations as you become part of their extended families. You work in modern, well-lighted offices and medical facilities and get to use the latest technology relating to patient care. Your colleagues are also respected healthcare professionals and your combined knowledge makes a difference to the patients you care for. You read serious professional materials, attend conferences and seminars, and exchange information with your peers. It is an ongoing learning process that helps advance your career. The work is demanding and hard and tiring, but the challenge of getting a patient through a crisis and the reward of seeing them go on with their lives is priceless. You are making a difference in the public’s health, patient by patient, and whatever it takes you are prepared for whatever comes next.

NURSING’S NOT SO GOOD POINTS A NURSING CAREER HAS ITS DOWNside. Nurses are not always appreciated

by doctors and other healthcare professionals who don’t recognize their accomplishments. Everything becomes a crisis and every patient thinks the particular illness or condition is critical and wants special attention. Patients do not listen when you give them good advice about their condition or illness, and then when they do not get better they blame the nurses and other healthcare professionals. The technology changes so fast that you barely have time to become familiar using one piece of equipment when a new one is introduced and then procedures have to be changed. And you are pulled in different directions with rules and regulations that have little to do with patient care. The amount of paper work is overwhelming as you must fill out lengthy forms for every little thing and that takes time away from patient care.

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The work is hard and you are on your feet too much. The money is okay but there are not enough hours in a shift to take care of everything and everyone.

EDUCATION AND TRAINING EDUCATION AND TRAINING, IN VARYING DEGREES, ARE A MUST FOR ALL CAREERS.

If a nursing career interests you, and you are further interested in the specializations of dermatology and vascular nursing, then you must first study to become a Registered Nurse. The best path to that goal is to get a Bachelor of Science degree in nursing (BSN). The BSN nurse is preferred because this professional is better prepared for a broader role in expanding healthcare opportunities according to the American Association of Colleges of Nursing (AACN). The BSN course of study covers all healthcare settings – critical care, ambulatory care, public health and mental health – as it prepares the nurse to be a skilled provider, manager, designer, and coordinator of care. The curriculum offers scientific, humanistic, communication, critical thinking and leadership skills including specific coursework and on-site clinical training in non-institutional settings outside the hospital usually not included in diploma or associate degree programs. The BSN degree is also a stepping stone to advancements in case-management and supervisory positions. In fact, there are more than 600 programs across the country that provide a bridge for the diploma and associate-degree nurses to earn their BSN as more healthcare employers require or prefer the baccalaureate degree. There are also master’s degree programs in nursing, as well as doctorates. These are for the nurse professional who wants to advance to a higher level of nursing practice, research, and teaching. Nurses with an advanced degree are in demand as expert clinicians, clinical educators, nurse executives, research assistants, and health policy consultants. The American Association of Colleges of Nursing has almost 600 accredited member schools of nursing in all 50 states and the District of Columbia, Guam, Puerto Rico and the Virgin Islands. The colleges and universities are in large cities and small towns. For example, the State of Illinois has over 30 accredited schools of nursing across the state.

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The AACN website www.aacn.nche.edu lists all the colleges and universities by state, and you can connect to all the schools to view their program, requirements, costs and more. Nurses must also be registered in the states where they will practice. The National Council of State Boards of Nursing www.ncsbn.org will have the listing and website for your state. In addition, there are certification programs such as the Dermatology Nurse Certification (DNC) that require you be a Registered Nurse, have a minimum of two years of dermatology nursing experience as an RN, and have a minimum of 2000 hours of work experience in dermatology nursing within the past two years in a general staff, administrative, teaching or research capacity. An exam will determine your certification. The field of nursing is an ongoing mix of education and training. New technology, new medications and treatments, and continuing research breakthroughs dictate the need for nurses to stay on top by reading materials, attending conferences, workshops and seminars, and exchanging information and views with peers. Nurses are involved with medicine on the cutting edge as well as basics of patient care.

EARNINGS POTENTIAL YOU CANNOT GET RICH BEING A NURSE, BUT YOU CAN EARN A GOOD SALARY WITH

good benefits. And, money should never be the reason you go into any career, but rather the satisfaction, challenges and opportunities. It is important to know that you can make a good living being a nurse. While there are no recent figures available specifically for dermatology nurses and vascular nurses, there are salary figures for the nursing profession in general. The median income for all nurses is about $50,000. Salaries always reflect the area of the country you are working in, the size of the healthcare facility and your responsibilities. Salaries tend to be higher on either coast and in most larger cities. Hospital staff nurses earn a median of about $37,500 with supervisors earning a median of almost $40,000. Nurses in doctors’ offices can earn annual salaries anywhere from $25,000 to $45,000, depending upon the size and location of the practice and the responsibilities you have.

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Specialties such as Clinical Nurse Specialist and Nurse Practitioner earn a median of over $40,000 and $45,000 respectively. As nurse specialists become more prominent and earn greater respect for their expertise and experience, their salaries will go up appreciably. For example, nurse anesthetists have a median income of over $75,000. The nursing shortage is so critical in certain areas, especially in hospitals, that employers are offering many perks including signing bonuses.

OPPORTUNITIES WITH OVER 100,000 NURS ING POSITIONS VACANT, AND THE UNITED STATES

government projecting a shortfall of at least 800,000 nurses by the year 2020, the job opportunities for future nurses is excellent. A recent survey by a nursing association found that nursing school enrollment is increasing over 10 percent a year. That translates into about 10,000 new nursing students enrolled in entry-level bachelor’s degree nursing programs. Hospitals, medical centers and clinics will probably have the most job openings for the foreseeable future. These are very good settings for learning the basics of the profession. Most nurses who have gone on to specialize started their careers in hospitals and clinics where the opportunities for learning abound with a cross section of the population, different age groups, and a wide variety of illnesses, diseases, surgeries, medications and treatments. Nurses also work for pharmaceutical companies, managed care and insurance companies, rehabilitation and long-term healthcare facilities, and in the military. One of the fastest growing areas in healthcare is the home care industry, and nurses are setting up their own businesses in home care nursing. There are also nurses who specialize in hospice care and there are a few degree programs in hospice care. Nurses teach and conduct research. There are thousands of healthcare facilities across the country in every state. In large medical centers, small community hospitals, and primary care and community clinics, nurses are needed and sought. There are also thousands of doctors’ offices ranging from a single doctor practice to a multi-doctor practice. From big cities to small towns, nurses can have their pick of healthcare facilities and find work opportunities where they want to live and maybe raise families. 24

GETTING STARTED BEFORE YOU CAN BECOME A DERMATOLOGY NURSE OR A VASCULAR NURSE, YOU

have to become a Registered Nurse (RN). The National Student Nurse’s Association website at www.nsna.org has a number of articles and other information on becoming a nurse, how to begin and more helpful data. Also, Johnson & Johnson Health Care Systems has an informative and helpful website www.discovernursing.com that includes a section on dermatology nursing. Your school and public library also has many books on general nursing and some specialties for you to peruse. It is very important that you read everything you can about the career you are interested in to be sure that it is for you, and that it matches your talents and interests. The more you know the better your decision will be. Nursing requires an initial commitment of education and training and then an ongoing commitment to helping others heal and understanding their problems. As a nurse you will have the responsibility of being there and caring for every patient, no matter how sad and difficult it may be. Are you sure this is for you? That is why you must learn and read everything about nursing before you make the commitment. To reinforce your decision it is then important to talk with professionals in the field. The nurses in the doctor’s offices you and your family have visited is a good place to start. Or nurses working in a nearby hospital or clinic. Be sure to call and make an appointment. Nurses must plan their day around patient care, but they are always willing to set aside some time to talk about their work in particular and career in general. Take a list of specific questions you want answered. Check out the websites of various schools of nursing and ask for additional material they can send you. Talk with your school counselors and teachers, and perhaps invite nurse specialists to visit and discuss what nursing means to them and answer questions from the class. Family and friends can be helpful when making important decisions so be sure to seek their perspectives. Choosing a career will be one of the most important decisions you will make in your lifetime. It must be done with care and knowledge. While nothing is ever written in stone and you can always change your career direction, the more you know the more comfortable you will feel about your decision. If nursing turns out to be for you, then you will have made a good decision. Good luck! 25

ASSOCIATIONS  American Academy of Nurse Practitioners

www.aanp.org  American Association of College of Nursing

www.aacn.nche.edu  American Nurses Association

www.nursingworld.org  Dermatology Nurses Association

www.dnanurse.org  National Council of State Boards of Nursing

www.ncsbn.org  National Student Nurses’ Association

www.nsna.org  Society for Vascular Nursing

www.svnnet.org

PUBLICATIONS  American Journal of Nursing

www.nursingworld.org  The American Nurse

www.nursingworld.org  Dermatology Nursing

www.dnanurse.org  Journal of Vascular Nursing

www.svnnet.org  NurseWeek

www.nurseweek.com  Nursing Spectrum

www.nursingspectrum.com

COPYRIGHT Institute For Career Research 2009 CAREERS INTERNET DATABASE www.careers-internet.org 26