The Second Career:

Florence at Fifty-Eight?

by Bonnie Boehme

An Angel of Mercy—Me?
Think nurse: Florence Nightingale (the “mother” of modern nurses, the most famous of all nurses), Clara Barton (founded the Red Cross), Dorothea Dix (championed humane treatment of the mentally ill), Walt Whitman (wait—wasn’t he a famous American poet? yes, but also a volunteer Army nurse during the Civil War). So, how do I, a 58-year-old empty nester, fit into this illustrious lineup? I may never truly do that, but I have completed the first part of the journey toward becoming a caretaker of body, soul, and spirit; a ministering angel—in short, a nurse.

Why such a strenuous and serious undertaking at the twilight (well, maybe late afternoon) of my life? This was not something I had dreamed about as a child or even as a young adult, although my cousin and I did play hospital quite frequently, performing “open-heart surgery” on poor Raggedy Ann and Andy. Despite the medical proclivities of my family (my dad was a cardiologist and my sister is an RN), I was drawn to the humanities. I earned an MA in English literature, and I was going to be a college professor, or some such creature. Medicine had never entered my mind. Well, I ditched the idea of becoming a college professor after getting the master’s degree under my belt, and I went to work in publishing. I have remained in publishing for 36 years—through marriage, child bearing, divorce, child rearing as a single parent, and empty nesting. I will probably always have my hand in publishing; at this point, it’s in my blood, too deeply ingrained to relinquish. So how in the world did nursing come about?

Awakening at Twilight to Reality
As in most areas of the business and employment world, publishing has seen its share of change—the explosion of technology, buyouts by foreign companies, shifting priorities. It stood to reason that any company I worked for was bound to feel the pinch. In the winter of 2009, the pinch became a personal affront, and I was “laid off” until more work came in. Now, this turned out to be only a matter of a few months, but the vulnerability factor was the cold, hard smack of reality. I did not like feeling “unemployed” for even a brief time. I started thinking that perhaps I should “double arm” myself—I should learn how to do something else. After all, the only providers for this household were me, myself, and I. “Me” had done a decent job of bringing in a living wage for a number of years, but now “myself” had to step up to the plate. “I” might have to rally at some point, as well.

I considered many options. Teaching was the first alternative career that popped into my head. I had some experience there, having taught English in college as I worked toward my master's degree. I soon dismissed that idea, however—teaching jobs were not that plentiful, and I would need to get a new teaching certificate if I moved to another state. I had also considered ultrasound technology, which had good future prospects. But either the education options here in Augusta County, Virginia, were too sparse or the distance to travel was too far. So, I went on the county technical college website and looked for ideas—cosmetician, dental assistant, practical nurse—and practical nurse caught my eye. I had been working in medical publishing and found that the subject matter interested me. I was not squeamish. The cost (about $4,000) and time frame (18 months) were just right. Maybe most important, I had come to Virginia to take care of my mother. I cared for her during the last 18 months of her life, and I was right there with her as she exited this world, which I came to regard as a gift. I felt that I could handle and would enjoy caring for others in that way, as well.

What did I have to lose? I could certainly work full-time and get through 18 months of school, right? So I applied to the school in March, and then took a standardized entrance exam. In addition to filling out a routine application form, I needed two written references from people who could attest to my “fitness” for nursing. And I had to have my high school transcripts sent to the nursing school. At first, I panicked. Would my high school even have my transcripts, 40 years later? I had visions of the transcripts chiseled onto a clay tablet and stored in a dark cave somewhere far from my alma mater. Actually, the process was quite easy, and the high school still had all of my records!

Then the waiting began. It was only two months, but it felt like two years. In the middle of May, I received my acceptance letter. I was ecstatic; instead of just thinking about it (a failing to which I readily admit), I was really doing something to make myself more marketable. The work was not yet over, however. I was required to have a physical and dental examination, a criminal background check, a drug screen, and a set of fingerprints taken. Wow—was I applying for a job at the FBI?

Books and Teachers’ Dirty Looks
Finally, in September 2009, the real fun began. Nursing school! I had not been in school for 34 years . . . was I ready for this? My sister had convinced me that I would sail through the program to become a licensed practical nurse (LPN). She had done just that more than 30 years ago and then had gone on to become a registered nurse (RN). She thought I could do this with my eyes closed. However—and I mean a big however—the coursework had changed in the intervening years. What used to be the LPN program was now more like an RN program, and the RN program was now more demanding than ever. In sum, the 18-month program proved to be far more rigorous, challenging, and time-consuming than I had anticipated.

I think the rude awakening came with the first test. Remember studying for tests, and cramming all that learning into a brain already brimming with too much information? Nursing school tests are different. Sure, there is some regurgitation of facts, but the tests largely measure something else altogether. That is why the class groaned a bewildered collective “Huh?” when we took our first test, as we realized that many of the questions seemed to have nothing to do with what we had just studied.

What was going on here? Critical thinking, that’s what. Yep, that is a major focus of nurse’s training these days—viewing a situation or patient from several angles, thinking outside the box, problem solving on many levels. So now we knew what was expected. Sure, we had to learn anatomy, physiology, and the spectrum of ills the flesh is heir to; how to take vital signs; how to give intradermal, subcutaneous, and intramuscular shots; and so on. But we also had to learn how to think like a nurse!

From that point on, after every learning module, a few students would leave or be “dismissed.” We started with about 40 students in our class, and at graduation in March 2011 we numbered just 19—about the going rate for nursing schools in general. (Only about half of those who enroll in nursing school graduate.) Shades of Agatha Christie’s And Then There Were None. . . The paranoia level rose a bit, and we listened for any whisper of whose head might be next on the chopping block.

Program Notes and Dipping Toes in the Water
Here is how the program was set up. For the first 10 months, we had nothing but academics, and I mean academics. Sometimes we would rip through a 500-page book (in this particular case, nutrition) in three weeks and have a final exam on its content. We studied nursing history and current nursing practice, anatomy and physiology, dosing calculations, medication administration, nursing arts (with “labs” during which we practiced on each other—giving shots, taking blood pressure, learning surgical and medical asepsis, and so on), and nutrition. In July 2010, we began the clinical phase of our training. We still had academic courses, too: maternal-child nursing; pediatrics; mental health nursing; and pharmacology, the study of drugs and medicines But now we also had to travel to clinical sites two or three days a week. We did rotations at a state mental hospital, the local community hospital (pediatrics, maternity, dialysis, surgical suite, medical–surgical floor), the nursing home, doctors’ offices (I went to an internal medicine practice), as well as day trips to the Virginia School for the Deaf and Blind and to the Daily Living Center, an adult day-care center.

Of all the rotations, I most enjoyed the surgical suite (even though it was freezing in there) because the surgeons were really great about letting us be “up close and personal” in the surgical zone, although we did not cross the sterile field. I also really liked the mental hospital, even though it was a little scary at times, and I found dialysis engaging. Why did I like these rotations? First, I think I am a “closet” pathologist—I love the gory little details. I liked seeing what a tumor looks like; it’s just plain interesting. And I liked the idea of taking decisive action (I’ll say!) to fix people up, even if it does involve scalpels, retractors, lasers, and the like. The mental hospital fascinated me. I loved reading the charts and learning about the patients’ histories. Psychiatric nursing stands apart from a lot of other nursing. Medication administration figures largely into it, of course, but so does learning how to navigate the waters with people whose thinking may be not what one is used to. I liked dialysis because the nurse is involved with patients on a long-term basis. Over the course of years, you can get to know the patients, and they can get to know you. I also found that whole process absorbing. Think about it—a patient’s entire supply of blood is basically going through a washing machine cycle! I should also say that the doctor’s office was pleasant, but I could see that type of work becoming routine very quickly.

Getting “Crowned” and Moving On
One more person was dismissed during the clinical phase—the only guy left in our class, and he got the ax with only about two months to go. Students may be dismissed for academic reasons, as I indicated earlier. Anyone who does something unethical or against school policy may also be asked to leave. I think this guy may have had a couple of complaints from the clinical sites he visited. The bottom line is that you must keep your nose clean, no matter what it takes.

The Graduates. The author is in second row, third from right.

After a celebratory dinner at one of the fabulous restaurants in Staunton, The Mill Street Grill (best beef and pork ribs ever!), we gathered in my visitors’ hotel rooms and chatted until much later than they were used to. After breakfast at the Cracker Barrel the next morning, the Philly/Jersey contingent departed for home, and I was left to reflect on my next move . . . which, of course, was studying for and taking the nursing boards. No license, no nursing career—it’s that simple. And one had better be serious about taking the test; each attempt sets you back $200. So, I purchased some review books and studied for a few weeks. Then I, along with two of my friends from school—Renee and Elisabeth—traveled to a test site in Roanoke, Virginia, for the big day. We arrived the night before because the test was at 8:00 am, but none of us slept very well; we just wanted to get it over with.

The LPN licensing test consists of 200 questions in completely electronic format. But what’s interesting is that if you are doing either very well, or very poorly, the computer shuts off after 81 questions. For all of us, the machine cut off at question 81; we either knew it or blew it! We had been given a phone number to call for our results, and the next day we found out that we had all passed! Eventually, we learned that all 19 in the class passed on the first attempt. Hurray for our teachers, stringent though they were at times.

Use It or Lose It
Some of my classmates had started to work before they even got their licenses (indeed, you may do that for a limited period), but I had not. Now, I thought, I had better get some “real nursing” under my belt. In my particular area of Virginia, the pickins’ aren’t as plentiful as in other places, as far as jobs are concerned. The beauty of nursing, though, is that there is an incredible array of job choices. A nurse can do anything: work in a hospital or doctor’s office, provide home health care (which looms large in the future), be a traveling nurse (and get big bucks), become a cruise nurse, or use his or her medical skills on an American Indian reservation.

But I was in the Shenandoah Valley at the moment and had to get some experience, which meant either doctors’ offices or long-term care. Some of my friends were working at the nursing home where we did our clinical rotation. I applied there in May and was hired for part-time work—7 p.m. to 7 a.m. every other Saturday and Sunday. In August, that changed to every Friday (11 p.m. to 7 a.m.) and every Saturday (7 p.m. to 7 a.m.), a grueling schedule that I continued until about mid- to late-January 2012. I have since cut back and am cutting back further, for reasons I shall now explain.

Stethoscope in hand, head crammed full of proper procedures, and nerves as frayed as the hem of my coziest old nightgown, I did my three (yes, three—that’s all) days of clinical orientation on Unit 2 of the nursing home. That’s the time I spent becoming familiar with the policies and procedures of the specific facility, as well as getting to know the residents. This nursing home has three units. Unit 1 is a dementia/Alzheimer’s unit; if the residents are fairly quiet, it’s not a bad assignment. Only about 22 residents live there, and if they all go to sleep early and stay asleep, the night shift can be a piece of cake. Units 2 and 3 have about 46 residents each. Unit 3 often has more acutely ill patients, although that distinction has blurred over the past several months. Unit 2 has also had some pretty ill and compromised people of late, such as one man who had a fracture of C2, the second cervical vertebra, which usually results in paralysis below the neck. It was a miracle that this man had no permanent paralysis, but he has had a rough and long haul to recovery and has had to endure many unpleasant procedures, both in the nursing home and at the hospital.

The long-term care facility in general has undergone some changes in recent years. No longer is it necessarily a “retirement” home. Sure, such residents are there, but it has also become like a step-down unit from the hospital, with postsurgical patients, rehab patients, and generally debilitated persons occupying the beds. At this point, at least in my eyes, the “resident” becomes a “patient.” This means that care is necessarily more intensive. The nurse must contend with feeding tubes (some patients are fed directly into the digestive tract, bypassing the oral route), colostomy/ileostomy bags, intravenous antibiotics, and all manner of orthopedic devices. Add to that people suffering from terminal illnesses who require a great deal of pain medication and attention, as well as confused people or those with dementia who are at high risk for escaping (thankfully, alarms for such people are available) or falling (much more of a problem).

Now, superimposed on all that, we have, during night shift, two CNAs (certified nursing assistants—formerly called “nurse’s aides”) and only one nurse per unit. So as a brand-new nurse, every time I worked a shift, I had responsibility for 46 trusting souls from 11 p.m. to 7 a.m. It scared the living daylights (or . . .nightlights!) out of me. Things weren’t too bad when the shift was quiet—some pain medications to administer and a couple of other complaints to address. But when the situation went haywire—falls, “sendouts” to the hospital, people near death or dying—the night shift became a nightmare. Fortunately, experienced nurses on the other units were usually available to help.

The situation has continued to spin out of control at this particular place. The staffing is chronically short, supplies aren’t always available (time is limited enough to do the care, let alone run all over the facility to try to find a catheterization tray or a nasal cannula for oxygen delivery). As the exodus of employees began, especially since last fall, the “mandates” started in earnest. A mandate occurs when the person coming on duty has called out (sick or otherwise) and no one is available to fill the spot. If you happen to be ending your shift, you haven’t really ended it—you must stay until another nurse comes to relieve you. Now, I would not mind it, except that if I have already been there 12 hours and I have to stay another 4 and then a couple beyond that to get paperwork done, it kind of wears me out. On one occasion I ended up being at the facility for 18½ hours! I found myself starting to cut corners (like not wearing gloves for certain procedures—I know, that is bad). And I really began to worry about making some horrendous blunder that could cost me my license. The stress was definitely not worth it, and the job not at all what I envisioned for myself. I thought back to the 18-month blur of schooling, when I was more tired than I had ever been in my life, except for the first year of my son’s life, and decided the risk of working at such a place was simply too high.

So, what’s a body (especially an older one) to do? This particular body decided to cut way down on the work at the nursing homes and to once again concentrate on publishing to pay the bills. At the same time, I decided to focus on getting an RN, which opens more doors. Many hospitals hire only RNs, and even hospice nursing usually requires RN status. Right now, I am working on “prerequisites,” and I currently have my year of anatomy and physiology, as well as the one required semester of developmental psychology, under my belt. Chemistry will happen this fall.

A Good Decision
Am I glad to be a nurse? Yes, I am. Let’s face it, nurses are still in short supply, and it appears that trend will continue for a while. It is nice to know that I have a backup plan for employment. Beyond economic considerations, though, I like the idea of helping, healing, and bringing comfort and a little reassurance to those who are ill. For example, in my training time in the hospital, I took care of a young man from Arizona who needed an emergency appendectomy while attending a business conference here in Virginia. I must admit, I was very attentive because he was about the same age as my son. Before he was discharged, he gave me the biggest hug and thanked me for being so kind to him. And, despite the “down” side of the realities of long-term care, I have experienced some high points there, as well. I remember how a man whose wife was dying thanked me for taking such good care of her and for spending time with him at her bedside, explaining what was happening to her. I also recall with pride how one male resident suggested that I “teach” my colleagues how to give shots, since mine were so good—that is, as painless as possible!

So, as I have ruminated on what brought me to this juncture in my life, I think that maybe the gentler side of my nature was merely bubbling to the surface. Or perhaps, as psychologist Erik Erikson says about this middle-late adulthood stage of life, we choose between generativity (reaching out to others, giving, and teaching) and stagnation (stuck on disappointments and letting self-absorption take charge), and I have opted for generativity in the form of nursing. What particular slice of nursing will land on my plate is still “TBD.” Very likely it will be hospice, but, then again, it might be dialysis, mental health, public health, nursing research, or . . . see what I mean about choices? In any case, Florence’s lamp in hand, I have set my feet upon this path. Where it will take me remains yet a mystery, but, hey, I have always loved a good mystery!

Bonnie Boehme is an editor/writer, LPN, and once-upon-a-time singer who grew up in Haddonfield, NJ. She holds a BA and MA in English and is currently working toward an RN. She is the proud mama of a wonderful son, Geoff (flown from the nest and working as a chef in Philadelphia), and she now has an assortment of cats and dogs to mother. At present, she calls Waynesboro, Virginia, her home. Her most cherished ambition (besides putting her nursing skills to good use and one day becoming a grandmother) is to write literate, “thinking women’s” romances . . .