In a Changing Health Care Landscape, Narrowing Options for Older RNs?

Christine Contillo, RN, lives in New Jersey and has been a staff nurse at a university health service in New York City for eight years.

Fork_in_the_road_-_geograph.org.uk_-_1355424I’ve been a practicing nurse for 36 years, working continuously while raising three kids. After first trying a few other jobs, I entered nursing expecting a profession that would give me emotional fulfillment, some flexibility, and a good wage. Nursing has fit the bill for me on every level.

Throughout my career I’ve made every effort to keep advancing my skills. I’ve earned annual continuing education credits as well as attended national conferences and gained two certifications. The titles I’ve held have included supervisor, coordinator, and nurse educator. For the last eight years I’ve held a full-time position that I love in a primary care in a medical home setting. There I’ve had both an independent and a provider support role. I’m adept at use of the EHR, vaccines, triage, finding and booking specialists, travel health, patient education, removing sutures and dressing wounds, among other things.

However, I have a 3.5-hour commute each day. As I get older, my time has become much more precious. With college loans for my three kids finally paid off and my husband’s full encouragement, last year I began to look for a job closer to home.

I envisioned something similar to what I was already good at, as part of a medical team somewhere nearby. When I had worked at the hospital years ago, we used to congratulate the nurses who left for “better” jobs, in a physician’s private practice or in a nine to five clinic position. Hoping to find something like that, I began to put out my feelers.

I started by asking my own physician in a very large practice what the nurses in his office did. I was stunned by the answer. “We got rid of all our RNs,” he told me. “They were too expensive. Now we hire NPs instead of RNs and can get a lot more work out of them.” (That is, they could write prescriptions, order tests, etc.)

That’s when I realized that all the women wearing scrubs and not in lab coats in his office, the ones taking histories, drawing lab work, and documenting vital signs, were unlicensed medical assistants. What about the patient care that I had always loved, and building relationships with the patients? Where could an RN like myself still do that?

My next clue that something was amiss was a full-page glossy ad in a magazine for a plastic surgery practice. It included 12 professionally done head shots of the employees there—two handsome surgeons, two PAs, an IT specialist, a receptionist, an office manager, an insurance specialist . . . but no one who claimed RN as a credential.

Finally I ran into a retired nurse with whom I’d worked a few years earlier. She told me that she and some other retired nurses were all volunteering at a local hospital. They worked side by side with RNs on the units, not getting paid but thrilled to still be using their skills and not affecting their social security benefits. Of course, I didn’t blame them for doing what they wanted to do, but I wondered if an indirect effect of this volunteering was to help the hospital meet it’s bottom line while still being short-staffed.

After a year of talking to headhunters and following up online job posting, I was only offered hard-to-fill hospital positions. What does all of this mean for us as a profession?

Older nurses who haven’t worked in a while but want to earn some extra money when their kids start college will need to acknowledge that nursing was always a hard job and now it’s even harder. The EHR, increasingly complex technology, more acutely ill patients on multiple medications, policies, protocols, quality improvement projects, and hospitals run like big business—it all adds up to a more challenging and stressful job that will take serious preparation.

Those relatively cushy office jobs seem to be gone, or at least very hard to find without a contact somewhere. (Younger nurses, too, will need to realize that if they want to leave the hospitals for workplaces with more flexibility, they’ll need to set their sights on it earlier. Insurance review, phone triage, home care, hospice, school nursing, medical device sales or pharmaceutical representation all require a certain set of skills that were probably not included in nursing school due to time constraints.)

Figure out what you need to learn and go after it or you’ll be struggling to prove to an HR department somewhere that you’re the right candidate for the job.

I’ve taken all the steps necessary over the years to advance my career and I would never say that I’ve been disappointed by nursing. In the end, though, that next job has eluded me. Probably I’ve been spoiled by working Monday through Friday for too long, or by my reluctance to come home late in the evening. Maybe if I’d done more med–surg and less mother–baby years ago, I’d feel competent to tackle home care, but now that possibility is frightening.

So for now I’ll probably keep the good job that I have, be grateful for it, retire a year or two earlier than planned and finally catch up on my housework. There are worse problems to have!

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2016-11-21T13:02:07+00:00 August 21st, 2015|career, Nursing, nursing perspective|4 Comments

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4 Comments

  1. Lois September 26, 2015 at 12:02 pm

    I understand and totally agree that the nursing practice has changed. We all acquired and practiced excellent skills that are no longer significant. I moved on to activities outside of nursing at the policy making level. Don’t misunderstand; I am still very interested in nursing and participate when and where I can. What I find most unfortunate is the waste of this treasure of knowedgeable, caring, valuable nurses who want to contribute to the field. Perhaps we should have a “specialty group” at conferences where older nurses can convene, develop a united message and create a job market. Just a thought!

  2. Suki Boydston August 22, 2015 at 10:02 am

    I was a direct-entry BSN 35 years ago, when they were starting to push BSN as the standard qualification for Registered Nurses. It is still being pushed- but one result is that Nursing has lost the entry-level jobs. And the deeply important but non-urgent (non-billable) jobs get lost, such as building relationships with patients, patient education, and care influenced by a broad background of knowledge of human development and needs

  3. christine contillo RN August 22, 2015 at 7:46 am

    Thanks Cynthia — I was wondering if I was alone out there.

  4. Cynthia Taylor August 21, 2015 at 5:58 pm

    Hallelujah! Finally someone who has observed the same thing I have found to be true! Since losing my job in May of 2014 due to “not keeping up” with the busy ER, I have had people look at me like I have 3 heads, when I tell them I cannot find a job. No, I cannot work 12 hr. shifts, but yes, I have done my fair share of nights, eves, and double shifts. I have been a working nurse for 40 years. It was not my idea to retire this early. But in order to survive, I have had to start pulling monthly funds from my IRA to augment my state pension check. I have experience in health department work, disaster management for the health dept., college student health, ER, I taught college level health classes, and started my nursing career in med/surg with intensive care patients (back in the dark ages). I have a masters degree in education, health emphasis, and a 3 yr. diploma RN. It is if I never had any of those experiences. In fact, I believe that nowadays, experience and longevity count for nothing. No one looks at those things. Loyalty means nothing and employers are only interested in the employee who can hustle the best to make money. Patient care be damned. They all say that the patient is at the heart of their care, but obviously they are not. A doctor once told me that the business office should never meddle in the medical and nursing care. He could not have been more correct. But it is too late now. And you are correct, that unlicensed care givers are replacing nurses. How sad! Nurses are being squeezed out, and forced to retire or retrain in some other vocation. No one wants or needs us!

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