Photo by Julianna Paradisi/2017

At a neighborhood grocery store, I picked up a few items for dinner, one of which was a preroasted chicken still warm and juicy from the heat lamp display.

After ringing up the total, the checker began bagging my purchases. Before placing the chicken in a bag, she put a rubber band around the container to prevent it from accidentally opening, and then wrapped it in a separate paper bag as a further precaution against leakage.

I thanked her for the extra care. No one waited behind me, so we exchanged a bit of small talk. It was a weekend, and she asked if I had plans. “No, my husband and I work in health care, and it’s his weekend on,” I said.

“What area of health care?” she asked. I told her I’m a nurse and work with cancer patients. Expecting the cringe I usually get from laypeople when I say this, I quickly added, “It sounds sad, but I really love my work.”

Her face lit up. “I’m a nursing student! I’m taking exams to become a CNA so I can work with patients while I finish my BSN.”

Her news delighted me. I have strong intuition, and I felt sure she would make a terrific nurse. I congratulated her on her career choice, truthfully telling her that, after 30 years, I love nursing. “I love hearing that!” she said, smiling broadly.

Walking home with my groceries, I reflected on the grocery checker/nursing student. Our encounter brought back memories.

Entering nursing school as a young mother.

I couldn’t afford nursing school when I enrolled. I was young mother returning to school at a community college. During the application process, I interviewed with a career counselor who told me I had the right combination of intelligence and people skills to be a nurse. However, she questioned my choice of an ADN program. “With your SAT scores and GPA, why are you enrolling in an ADN program, and not a BSN program at the university?”

The university she named has a nationally renowned athletic program. Without sarcasm, I replied, “Because I don’t have the money. Unfortunately, I’m a woman going into nursing, not a collegiate athlete. Can you get me a scholarship into their BSN program?”

“No,” she said, with an understanding smile. “I can’t.”

I was categorized as a “nontraditional student,” which in my case meant returning with an incomplete college degree. I had left college to marry. I had been a child development major.

The ADN program cost $5 a unit: $15 a class, plus a lab fee for most of the courses. Textbooks were the most expensive investment, racking a sum of $200–$300 each semester, depending on the availability of used books.

Like the grocery clerk, I worked through nursing school. My previous units in child development qualified me for a teacher’s aide job at the on-campus child care center my daughter attended while I was in class or clinic (and after graduation, for my first nursing job on a pediatric floor). The summer of my senior semester of nursing school I worked as a cocktail waitress. In addition, I took out a student loan of a whopping $3,000.

Higher costs, higher expectations?

After graduation, as a new nurse I suffered reality shock like everyone, but I was grateful to have a profession, one that is respected and contributes to the health and well-being of others.

Contemporary nursing students might laugh, comparing the cost of today’s nursing education to mine. The local university where I live estimates the cost of tuition for a four-year BSN program at $50,000, a worthwhile investment, but one that would have excluded me from entering nursing school.

I was poor during the Reagan years. The ADN program was a path out of economic stress for my family and myself. Although ADN programs still exist, the pathway is closing as hospitals move towards all BSN staff, requiring the degree upon hire. I wonder how many fine nurses are lost to our profession because they cannot afford the ever-increasing cost of college?

Further, when students pay large tuition fees and invest so much time, their expectations of nursing increase. But nursing as a profession hasn’t kept up with these new expectations. Nursing takes more than it gives, unless you love it. It take our weekends, holidays, and sleep at night. It takes our meal and bathroom breaks. It demands our best in the midst of the near impossible. At the end of the day, nurses are measured by the mistake we made, not by the hours of accurate, compassionate care we delivered.

Nursing hasn’t changed much in the thirty years I’ve practiced, but the cost to become one has increased exorbitantly. To be clear, I support nursing education. Studies exist demonstrating that patient safety improves with overall higher nurse education levels. What I’m wondering is how nursing students manage the high cost of their education, and does this cost affect the choice to become a nurse or not?

It’s been several weeks since my encounter with the grocery checker/nursing student. As summer winds down and students prepare to return to school, I find myself wondering what will happen to her. I feel strongly that patients would benefit if this young woman can afford to become a nurse.