The Quandary of Scheduling Vacation Time for Nurses

Illustration by the author; all rights reserved Illustration by the author; all rights reserved

While shopping in a grocery store, I passed a display of craft brew beer that caught my eye. The sign read Hospice Beer! After a double take, I saw on closer inspection that the label actually read: Hop-Slice Beer.

I realized I was badly in need of a summer vacation. Fortunately, I already had one scheduled on the books.

Summer is a traditional time for vacations, but often not for nurses, for multiple reasons.

Paid time off benefits vary from organization to organization.

Some lump vacation hours and sick leave hours into the same bank, while others separate the two so that nurses accrue hours into each per pay period. Paid vacation time accrues slowly when it’s used for paid sick time.

Further, after accepting a new job, nurses may find that as the newbie they accrue vacation and sick leave hours at a rate lower than their colleagues hired earlier; this practice, called tiered employment, exists within many industries outside of health care, whether they’re union or not. The practice can foster division between the newly hired and existing staff within units. Newer hires accrue less benefits for the same amount of work as their peers. The practice is a double-edged sword, however. It also means it’s cheaper for employers to hire new nurses than appease those with seniority.

After twenty-five years working continuously for the same health care system, I found myself in a similar position: a structural reorganization necessitated that I be hired by another organization. After working there for a year, I returned to the first organization as an oncology nurse navigator. The transition resulted in my accruing vacation time at the same rate as a newly hired nurse, despite 25 years of previous service.

I love my work, and I was happy to return to the organization. It was my choice. But it came with a price.

How vacations are scheduled in nursing units varies too.

In some, vacation time requests are required at the beginning of the year, forcing staff to make plans while they cope with holiday plans at home, along with winter illnesses and the accompanying short staffing that occurs with it at work. For many, thinking about a summer vacation in the midst of this melee is daunting, and so they don’t schedule vacation time, leaving it to chance when they finally do request time off.  In this scenario, they risk not getting an adequate vacation at all. […]

July 25th, 2016|career, Nursing, nursing perspective|0 Comments

The View from the Other Side: When the Daughter is a Nurse

I knew where we were heading and it scared me. I didn’t want to have to think about decisions that would have to be made in the not so distant future. I didn’t want to be a nurse; I just wanted to be the daughter.

Flowers_in_the_field_(5832054482)I knew Marie was special the moment I met her. Her home was one where all were welcome, the coffee always hot and fresh, the house filled with family and friends, and everyone left with a full belly. She freely shared her opinion, whether or not a person sought out her advice.

I knew Marie for nearly 30 years. She was my mother-in-law. She was also my cheerleader, proud that I had come so far in my nursing career. She told everyone I was a nurse and often referred to me as her daughter rather than specifying that I was her daughter-in-law.

Fiercely loyal and loving of her large family, she always put their needs before hers. I worried about her because she smoked and rarely visited a doctor. With regard to health, she believed in the notion that if it ain’t broke, don’t fix it. But slowly, health problems began cropping up. After a hospitalization for heart failure, she was diagnosed with COPD and hypertension.

Still, she lived life much as she always had—until she had a stroke. After the stroke, she lost the vision in one eye and the full command of her body. But in reality she lost much more. She could no longer drive and became dependent on her husband and children for things she once did freely and independently.

Her helplessness made her sad and angry, despite our assurances that we were a family and would do this together. And we did for the next 16 months, an exhausting cycle of hospitalization to rehabilitation to home and back again as her health deteriorated.

My father-in-law tried to do it all. He needed help, but he refused—the cost, the stranger in the house, the feeling that he was supposed to do all this himself. My sister-in-law visited him every day and would help her mother and father with the day-to-day things that constantly need attention. I visited regularly as well, taking charge of what I did best—medicine, doctor appointments, assessing whether or not she was stable, and cooking her favorite meals.

Navigating the endless appointments, the medication regimen too complicated for anyone but a nurse to figure out, watching my father-in-law struggle that his beloved wife was not the same, and the ups and downs with her health took its toll.

I knew where we were heading and it scared me. I didn’t want to have to think about decisions that would have to be made in the not so distant future. I didn’t want to be a nurse; I just wanted to be the daughter. […]

The Debriefing: A Forced Pause After an Unexpected Clinical Loss

Illustration by Barbara Hranilovich for AJN Illustration by Barbara Hranilovich for AJN

The Reflections essay in the July issue of AJN is about the brief required debriefing of a medical team after an all-consuming struggle to save a patient.

The Power of Paperwork” is written by Amanda Anderson, an experienced nurse who is new to a supervisory role. She remains closely attuned to the emotional experiences of nurses and physicians. Leading her former colleagues as they huddled to examine what might have been done differently with a particular patient, she tells us, she found that her “suit and heels provided no armor.”

Sometimes bad things happen for perfectly obvious reasons. If you don’t turn an incontinent patient, he will develop pressure ulcers. If you don’t always verify your patient’s medication against the order and identifiers, you will likely give the wrong drug to the wrong person at some point. The factors involved in such errors can be complex, of course, but remain fairly easy to trace.

Sometimes, though, people just die. We don’t know why, and if we find out, it’s usually not reassuring. The thoughts that follow these deaths—what if I… ?, should I have… ?, we might have…—can move in unforgiving cycles that take months to silence.


June 27th, 2016|narratives, Nursing, nursing stories|0 Comments

Not a Nurse but Her Mother Was, and Now It Really Matters

June_Refl_Illustration Illustration by Lisa Dietrich for AJN

The loss of Emily Cappo’s mother, a competent and supportive parent and an accomplished nurse, leaves an enormous gap in her daughter’s life. Then her own son gets sick.

Cappo writes about these events in “I’m Not a Nurse, But My Mother Was,” the Reflections essay in the June issue of AJN.

Without her mother to turn to for help and guidance, Cappo has no idea how she’ll handle the situation. “There I was,” she writes,

the nonmedical person in my family, the person who hated blood and needles, being thrown into a situation demanding courage, stamina, and role modeling.

But we rise to the situation that presents itself, if the stakes are high enough. Cappo discovers what many nurses already know: the nurses who care for her son make all the difference in his care, and provide her with essential support as well. […]

What a Nurse Really Wants

Lois Corcoran, BSN, PCCN, is pursuing a master of science in nursing degree and works on a cardiac step-down unit. Although Nurses Week recently ended, we felt that this short, honest post sums up the way a lot of nurses seem to feel.

via flickr creative commons/by you me via flickr creative commons/by you me

I have been a nurse for 18 years. I went to nursing school when I was 33 years old, a year after I’d completed treatment for Hodgkin lymphoma. I was a single mom, newly divorced, trying to make my way.

Becoming a nurse felt like my calling. I was passionate about it. I had been through so much, and I knew I had a lot to give back—I wanted to be with patients, holding their hands, giving them the reassurance we so desperately want to hear when we are going through ill health. I knew that I could be that nurse. I felt that my cancer had been the portal to this realization, opening my eyes and heart to what patients need.

Eighteen years later the truth of my life as a nurse is a little more complicated. It’s not that my original soul’s calling isn’t still there, deep inside me. I still feel a close connection with my patients. I still take the time to be present with them, hold their hand, look into their eyes, and speak to them in a calm, respectful way that lets them know I am here.

But today, this is done at a higher price. It costs the hospital more money because I often have to forgo my lunch break and stay later at night to finish up the required aspects of nursing such as charting. This is okay with me, though I am paying a higher price as well as I watch my body break down, my joints and muscles aching.

For me, however, this is not about Medicare reimbursement, or length of stay, or outliers. If this were what’s motivating me, then who would really be caring for the patients? They’d be left without an advocate. Each shift starts with a silent prayer for the strength and the patience I need to care for my patients. Each shift ends with a silent prayer thanking God that I have made it through a shift and made my best effort. My patients get more of me than anyone else. […]

May 19th, 2016|career, Nursing, nursing perspective, Patients|9 Comments