Career Advice, Jobs

11 Things I Wish I Knew Before I Became A Nurse

Doctor's and patient's hand

From the bedside to the operating table, nurses are some of the most trusted professionals in healthcare—by a patient’s side during both the gut-wrenching and the joyous moments. In one day, a nurse can see dozens of patients, experience death and birth, and be charged with making life-changing decisions in seconds.

Dr. Josephine Ensign knows this all too well. She has been a nurse practitioner for more than 30 years, receiving her PhD in international health from Johns Hopkins University (thus giving her the doctor title). She has traveled the globe administering care to homeless teenagers and adults with one aim in mind, “to humanize health care, to cultivate empathy leading to action.” Her new book Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net ($16, recounts Ensign’s real-life experiences as a nurse who then becomes homeless and the 180-degree transformation she goes through.

Now an Associate Professor of Community Health at the University of Washington School of Nursing, Dr. Ensign shares her wisdom and decades of nursing experience with students and aspiring nurses.

Considering a profession in nursing? Her advice is essential. Here Dr. Ensign shares the 11 things she wished she had known before she became a nurse. Consider these lessons gleaned from her own backward glance at a nurse’s life.

1. Nurses are just as respected as doctors.

Throughout her career, Dr. Ensign has been pleasantly surprised to experience “How much in high esteem people hold nurses. People respect nurses.”

2. Nursing is not limiting.

Dr. Ensign notes that she initially didn’t realize the vast possibilities the field offers. At first, she thought nursing “felt retro,” but she’s found a “lifelong journey of learning.” She notes that friends and colleagues who are physicians have less flexibility in shaping their career paths. Dr. Ensign has had the chance to target her work to a particular population, build on her education, become an educator, practice her work internationally and cultivate a dual career as her literary efforts have garnered success.

josephine one copy
Ensign as a young nurse 1986 at the Richmond Street Center/Cross-Over Clinic.

3. Bureaucracy is a reality of the profession.

“The US healthcare system is still so fragmented, so frustrating, so focused on the business.”

4. Emotional challenges abound.

“Professional burnout” and “compassion fatigue” are emotional issues that healthcare providers face. Restrictions in the American system hinder professionals’ efforts to do what’s best for their patients. Dr. Ensign describes healthcare professionals’ resultant response over time as “moral distress due to system-level realities.”

[Related: What Other Nurses Say About Their Profession]

5. Ask yourself “Do I do well under pressure?”

Medical practitioners tend to have a strength in dealing with stress on the job. They are well-versed in identifying medical issues, and tend to recognize their own as well. Stress levels can be high, but medical practitioners work in a culture endeavoring to destigmatize mental health care to which they tend to have good access. She recognizes that there is still work to do, but that this has improved over the course of her career.  

6. Prepare for chaos.

“I wish I knew how crazy the healthcare system is. I was young and idealistic. But maybe if I would have known I wouldn’t have chosen this path,” Dr. Ensign says, laughing.

[Related: How to Prepare for a Nursing Job Interview]

7. Think beyond the hospital.

While Dr. Ensign initially had “no intention of teaching,” she’s mostly impressed her students who she refers to as “change agents.” She even found herself in a former student’s care during an unexpected trip to the ER, the ultimate test of trust for a medical educator and an experience she wrote about in her essay “Medical Maze.” Dr. Ensign expresses optimism about her students’ role in the future of medicine, but also concern for them in a challenging industry. She says, “In school students get a vision of utopia, but they don’t get enough support for how to deal with it when they run into barriers-how to stay true to themselves.”

8. Teamwork is more important than individual accomplishments.

Dr. Ensign emphasizes the importance of teamwork in the medical field. She notes that when new medical practitioners are starting out, feeling intimidated is appropriate. She reflects, “Someone who is scared or unsure, that is healthy. We don’t want someone to think they know everything. This is a team, and we need to make sure there is healthy team work.”

9. Know your boundaries.

“You need a certain amount of healthcare experience so you know what it’s like. This may not work for everyone, so there is a natural weeding out. We want people to know this is nursing. You have to be able to touch people.”  

[Related: How Much Does A Nurse Earn?

10. Listening is of the utmost importance.

Dr. Ensign notes that deep and thorough listening is at the core of a nurse’s role. She says this “motivational interviewing” allows a nurse to “sit and listen to patients and their families and to help them move towards a better place.”  

11. Rewards are plentiful. 

“The places that nursing can take you are surprising and rewarding. I meet former students or patients who will tell me something specific I did or said that made a difference. For me it’s a human thing. You never know what that seed will be. Our job is just to plant those good seeds if we can; working towards that goodness, that kindness. You don’t see it, but you trust in it.”

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