Hot Jobs, Emerging Careers

Unlike many professionals these days, nurses can launch a job search with the confidence that they will find work–and quickly, at that. Thanks to one of the most severe nursing shortages in history, good nurses are in high demand all over the country. Hospitals, clinics, doctor’s offices, nursing homes and surgical centers are all looking for skilled clinicians from diverse racial, ethnic and cultural backgrounds who have a way with people and, often, specialized skills in areas like critical care, perioperative nursing and neonatal care.

But if you are in the market for a new job in 2004, or even a whole new career, look beyond the usual opportunities. Today’s hottest nursing jobs mirror important trends in American society: an aging baby boomer generation, growing consumer interest in fitness and holistic medicine, and advances in computer technology. The care delivery settings for these emerging careers vary widely–from the hospital room to the yoga studio–but they all share nursing’s traditional goals of caring for the sick and promoting good health.

“What makes each of us a nurse is a combination of skills and our capacity to give,” says Donna Wilk Cardillo, RN, a nursing career consultant and president of Cardillo & Associates in Sea Girt, N.J. “Nurses are multitalented and there are many ways to make a difference out there.”

Here’s a look at some of the most promising career growth areas for minority nurses in the new year and beyond.

Hot Career #1: Nursing Informatics

Angela Lewis, RN, found her niche in nursing the day she volunteered to be a “super-user” in the home health agency where she was working as a case manager. Her office was installing a new computer system and Lewis agreed to be a first-line user who would learn the system and then teach coworkers how to use it.

Lewis, who is African American, discovered that she loved learning the technology, sharing her knowledge and trouble-shooting problem areas for new users. She enjoyed it so much, in fact, that she asked her boss if she could do computer work full time. The answer was no, but the seed was planted: The experience set Lewis in motion on a new career in nursing informatics.

Demand for nurses like Lewis is high. More than 40 job ads were posted in a single recent month on the Web site of the American Nursing Informatics Association (ANIA).

Nursing informatics is a relatively new specialty that combines nursing, computer science and information science to manage and communicate data, information and knowledge in nursing practice. It pulls all this information together in a streamlined, computerized way to facilitate patient care and other clinical work in hospitals, physicians’ offices, surgical centers and other health care settings.

Job opportunities in this field vary greatly. One ad on the ANIA Web site sought an information systems clinical analyst with an RN or allied health background for a children’s hospital. Another sought to hire nurses to teach clinicians how to use information management systems and technology. A third wanted a systems analyst with a nursing background who could work on teams that implement computer-based OR information systems around the country.

While the opportunities are plentiful, nursing informatics is not an entry-level career. RNs who find work in this specialty typically have several years of experience and professional education in both information systems and nursing.

Lewis got her first informatics job by default when, as a nursing supervisor, she was tapped for an informatics coordinator role. Her previous experience as a super-user made her a shoo-in. Today she is project manager for clinical information systems at La Rabida Children’s Hospital in Chicago. Among other responsibilities, Lewis manages the information systems that clinical staff use throughout the hospital. Doctors, nurses, radiology, pharmacy–all are linked by a common computer system that helps them track and manage patient care, from ordering and administering a dose of Tylenol to sharing lab test results.

Nursing informatics specialists serve as high-tech traffic cops for all the information swirling around their facilities. This calls for a well-rounded, well-organized person with a big-picture understanding of how the different departments in a facility interact and a solid grasp of the way things get done.

It is not a job for the easily frustrated. Part of Lewis’s function is to ensure that information systems are running properly. If the system goes down, it’s her job to get it back up, sometimes amid frantic or angry clinicians who need access to crucial medical information. At times like this, she relies on her clinical experience to prioritize demands.

This is the primary challenge of nursing informatics: to be a facilitator between technical staff and clinicians. It means being conversant in the languages of both technology and medicine. It also involves educating non-technical staff on the use and merits of computerization.

Often, nursing informatics specialists’ role is to help people make the transition from old paper-based systems to today’s new “paperless” workplaces, says Lewis. “[You’re] part educator, part scientist, part interpreter,” she notes.

If the health care sector has been slow to adopt computer technology, it’s because some patient care advocates worry it could dehumanize the patient-caregiver relationship. But these concerns are at least as old as the stethoscope, which was viewed with similar suspicion in its infancy, argues Lewis, who is president of the Midwest Alliance for Nursing Informatics.

“There are still a lot of people who think that if it’s technical you lose the human touch,” she adds. “A lot of times clinicians feel that way about computers, but the reality is that computers can improve patient care and the delivery of health care services.”

For more information: American Nursing Informatics Association,

www.ania.org.

Hot Career #2: Fitness Nursing

Non-traditional career alternatives in nursing have always existed, but most new graduates still come out of nursing school with the traditional bedside image in mind, Cardillo says. They may be so fixed on that image, in fact, that they are reluctant to move into new territory.

Lori Radcliffe, RN, BS, CPT/CFC, wasn’t afraid to make that leap, although she says it took her some time to connect the dots that led her to open her own business. A lifelong love for fitness and sports, a degree in kinesiology, a short career as a standup comedienne and an RN license all come together in her company, “Jest” for Fitness & Food in Tinton Falls, N.J.

As a fitness nurse, Radcliffe, who is African American, helps her clients regain strength and vitality through exercise and nutrition. Working with a dietitian, she offers seminars, exercise classes, videos and audiotapes to people who are recovering from surgery, trying to lose weight or have chronic health problems.

For example, resistance training for osteoporosis prevention is one of her specialties. She also works with people who have lymphedema (swelling of the arm after lymph node removal), fibromyalgia and chronic fatigue syndrome. Some of her clients have gone through post-surgical therapy but are not yet ready for the gym. Certified as a personal trainer, fitness counselor and kickboxing instructor, Radcliffe offers them a bridge between therapy and regular fitness classes.

Some of her business comes from hospitals that are ramping up wellness programs. Because these programs prefer fitness instructors who have medical backgrounds, being a nurse has helped her get a foot in the door. “People say, ‘Why don’t you just do fitness [training]?’” says Radcliffe. “But I’m a nurse first. These doors wouldn’t open up for me if I wasn’t a nurse.”

As the link between physical fitness, wellness and disease prevention grows, hospitals are opening fitness facilities to respond to increasing demand, according to the International Sports Sciences Association. In addition, hospitals and HMOs are offering wellness programs on topics such as nutrition, stress management and exercise, and are opening fitness centers targeted to specific groups, like children and senior citizens.

Radcliffe, too, seeks out pockets of special need. For instance, she has found that nurses are often so focused on caring for others that they put their own health needs last. Some follow ill-advised diet trends. Others smoke or do not exercise. The nurses she meets through her work with hospitals are curious about how she stays fit, observing her during lunch in the cafeteria and peppering her with questions. Some have signed up for one-on-one fitness sessions with Radcliffe.

“Nurses are known not to take care of themselves,” she says. “They think they’re exercising because they’re pushing and pulling patients. [Starting an exercise regimen] is like anything when you first take it on. The hardest part is accepting that either you’re going to change or it’s going to be you lying in that hospital bed next.”

Through networking, Radcliffe has found a way to serve another population that faces barriers to fitness. She teaches a kickboxing class two days a week at a community center in an inner city neighborhood. Her initial group of four adult students has grown to a dozen in the year since the class began. Sometimes they bring their teenage children, many of whom already suffer from Type 2 diabetes.

According to various studies conducted by the Centers for Disease Control and Prevention between 1999 and 2001, 38% of American high school girls and 25% of boys do not get the recommended amount of moderate or vigorous physical activity. Twenty-eight percent of women and 22% of men over age 18 perform little or no physical activity, while 34% of women and 28% of men are obese. In recent years, the obesity epidemic has become a critical minority health concern. For example, the CDC reports that half of all non-Hispanic black women are obese.

“There’s no Gold’s Gym in the ’hood,” Radcliffe explains. “And they’re not going to walk [because the neighborhood is unsafe].” She adds that being African American helps her connect with the students in her class. “When you talk to people one on one, when they feel you care about them, [they’ll confide in you about issues like that].”

For more information: Aerobics and Fitness Association of America,

www.afaa.com; National Nurses in Business Association, www.nnba.net.

Hot Career #3: Holistic Nursing

For many years, American medical experts have relied primarily on prescription medications, surgery and other traditional Western practices to treat illness. But that tradition is slowly changing. Today’s health care consumers are looking for a broader range of options and are increasingly willing to try new approaches to wellness.

As a result, holistic medicine and nursing is an emerging field whose time has come. This blend of complementary and alternative healing methods, many of which are long-practiced traditions in Asian cultures, is starting to make inroads into the Western health care system. Today holistic nurses practice in a variety of settings, including medical offices, hospitals, wellness programs, fitness and meditation centers and their own businesses.

Unlike traditional Western medicine, with its focus on treating symptoms when and where they arise, holistic medicine treats the whole body as a system that works together, emphasizing harmony between body, mind and spirit to promote healing. It is an approach that Western medical practitioners are beginning to embrace, even at the most official level. For example, the National Center for Complementary and Alternative Medicine (NCCAM), a department of the National Institutes of Health (NIH), conducts clinical trials and research aimed at broadening available therapies.

Cancer patients, in particular, are seeking alternative treatments. In 2001, cancer was the second-leading cause of death in the United States and had an economic cost of $171.6 billion in medical bills and time lost from work. A recent NIH survey found that 83% of cancer patients sought alternative, non-mainstream medical solutions. According to NCCAM, some of the most popular of these alternative therapies are meditation and prayer, traditional Chinese medicine (TCM), herbs, vitamins, special diets, exercise and relaxation techniques such as guided imagery.

With their one-on-one patient contact, nurses are in a unique position to nurture people toward wellness using a holistic approach. Some of the key healing techniques used by holistic nurses include stress management, Ayurveda, massage therapy, Reiki, acupuncture, meditation, aromatherapy, exercise and therapeutic movement.

For example, holistic nurses who practice Ayurveda seek to remove the cause of a patient’s disease, rather than merely treating the symptoms. This may include the use of herbs, meditation, yoga and changes in diet. Reiki is a therapy that directs energy to the body to promote healing and relaxation. TCM is an ancient practice that looks for the underlying causes of imbalances in the body and tailors treatment to an individual’s physical makeup, using herbs, acupuncture and massage. Therapeutic Touch is a technique that balances energy flow in the body through human energy transfer.

This past summer, AHNA Past President Charlotte Eliopoulos, RN, served as the association’s representative on a liaison panel for the Institute of Medicine’s Committee on the Use of Complementary and Alternative Medicine (CAM) by the American Public. Unfortunately, she reported back to AHNA that the committee seemed to be more interested in “safeguarding the use of [dietary] supplements and establishing consistent credentialing of acupuncturists, homeopaths, naturopaths, massage therapists and chiropractors” than in “the significance of the [holistic] nurse in impacting the use of CAM.”

Eliopoulos also reported that the committee members “definitely viewed the touch therapies as ‘out there’ and off the radar screen for consideration. The fact that these are the therapies most widely practiced by nurses should give us concern when major policy influencers do not even acknowledge their value.”

Nurses who believe in the benefits of holistic health care must make their voices heard at the policy-making level or else “the CAM train will leave without us,” Eliopoulos argues. “It isn’t just about adding new therapies and products, but changing the philosophy and approach to health and healing. The larger issue is the development of a holistic paradigm of health and healing, not the continuation of a fragmented, illness-oriented medical model.”

For more information: American Holistic Nurses Association, www.ahna.org.

Hot Career #4: Gerontological Nursing

At first glance, gerontology does not seem to fit the profile of a hot, emerging career option for nurses. It’s been around for a long time and tends to be seen as, well, old-fashioned and unexciting.

But if this is your perception of what caring for older persons is about, think again. With the aging of the large baby boomer generation, and the fact that people today are living well into their 90s, the future of gerontological nursing is a busy one. The U.S. Department of Health and Human Services predicts that 5.7 million to 6.5 million long-term care workers will be required to meet the nation’s elder care needs in 2050, up from about 1.9 million such workers employed in 2000. This includes nurses, nurses’ aides, home health care providers and personal care workers.

Even today, gerontological nurses are already in great demand in ambulatory care centers, assisted living facilities, community centers and patients’ homes. Furthermore, the booming business of long-term care and assisted living facilities is bringing new opportunities to RNs who understand the complexities of providing health care to elderly people in these specialized residential environments. Many nurses are rising to corporate management positions within the companies that own these facilities, Cardillo says.

Still, the gerontology field has a reputation as a dumping ground for the very old and feeble. But for Carlo Sipaco, RN, this stereotype couldn’t be further from his experience as a shift supervisor for the Masonic Home of New Jersey, a nursing home in Burlington, N.J. Knowing his patients as individuals is the best part of his job, he says.

“We have about 300 residents and if they know you by name that means you did something for them to remember you personally.”

Working with elderly patients, many of whom suffer from chronic pain and loneliness, requires a can-do attitude every time a nurse steps onto the unit, Sipaco emphasizes. “If you don’t have patience, you have no business working in a nursing home setting,” he says. “[Patients] will come to you every day with the same complaint. If you don’t have the patience, that [behavior] is very annoying.”

Sipaco has found that the personal touch goes a long way toward minimizing the grumbling that stems from chronic pain. “Maybe that simple interaction with the patient will help ease the pain,” he explains. “Most of those depressions, most of those pains, can really be minimized by listening. Seeing a depressed [patient] smile after you’ve talked with them is rewarding.”

Because Sipaco was raised in the Philippines, where elderly people are honored and revered for their wisdom, caring for older patients comes naturally to him. But this same cultural tradition made it hard for him to delegate tasks to older nurses when he became a charge nurse in 1994, and he often ended up doing the work himself. That changed over time as he became more comfortable with American culture, he says.

Today Sipaco is one of two night shift supervisors for 11 nurses and 24 CNAs at the Masonic Home, where he has worked since 1991. He is using his position to nurture a new generation of caregivers for older Americans. As he puts it, “If I can influence them, especially the younger ones, the new graduates, to see the beauty of working with the elderly, then that’s very, very rewarding.”

For more information: National Gerontological Nursing Association,

www.ngna.org.