NursingCenter’s In the Round

A dialog by nurses, for nurses

Gender pay gap in nursing – are male nurses worth more?

clock March 25, 2015 16:53 by author Lisa Bonsall, MSN, RN, CRNP

The salary gap, in general, is upsetting. For some reason, I just didn’t expect it to exist in nursing. In a profession that is predominantly female (according to a 2011 census report, only 9.6% of nurses are male), it really never occurred to me that such a discrepancy in pay was realistic. The results of recent research published in the Journal of the American Medical Association demonstrate that pay inequality not only exists in nursing, but is quite significant.

Here are some highlights from the research letter, which looked at two large data sets (the National Sample Survey of Registered Nurses [1988 to 2008] and the American Community Survey [2001 to 2013]) to assess salary trends by gender:

  • Male RN salaries were higher than female RN salaries every year, with an overall annual difference of $5,148. 
  • In ambulatory care, the salary gap was $7,678; in hospitals, it was $3,873. 
  • With the exception of orthopedics, male nurses out-earned female nurses in every specialty with the gap ranging from $3,792 in chronic care to $17,290 for nurse anesthetists. 

Like many others, I find these results discouraging. However, I am hopeful that nurses will be encouraged to speak up about our worth and engage in salary negotiations. I also am hopeful that employers will recognize these inequities and examine their pay structures. 

What’s missing in this research is the reason for this gap in pay. Care to share your thoughts on this? 

The Interspersing of Nursing: A Geographical Look at the Demand for Nurses

clock February 6, 2015 05:33 by author Lisa Bonsall, MSN, RN, CRNP

Use the infographic below to learn about the demand for nurses in the U.S. This was created by Adventist University of Health Sciences Online RN to BSN program.

Adventist University of Health Sciences

The American Nurse Project

clock April 25, 2014 01:25 by author Lisa Bonsall, MSN, RN, CRNP

During a discussion with several nurses last night, we acknowledged the importance of nurses having a passion for the profession, and how this passion makes a difference in patient care. When I view the trailer for The American Nurse: Healing America, I feel the passion in the voices of those nurses featured. I can only imagine the impact that viewing this entire feature documentary will have. It premieres during National Nurses Week and I am really looking forward to seeing it! 

In 2012, Carolyn Jones, a photographer and filmmaker, traveled across the United States documenting the work of nurses. Her book, The American Nurse, was published that year and includes portraits, interviews, and biographies of nurses she encountered on her journey. An interview with Jones reveals her passion for this project, despite not being a nurse herself. She states, “Nursing is real. I'm fascinated by how a nurse can help all different people, even people that have committed terrible crimes, with the same compassion that they can treat a friend.” She learned a lot during her conversations with nurses and her journey is bringing our important work into the eyes of the public. For that, I am grateful. 

I will leave you with this powerful quote from the mission of The American Nurse Project: 

“At some point in our life each of us will encounter a nurse, whether it be as a patient or as a loved one. And that one encounter can mean the difference between suffering and peace; between chaos and order. Nurses matter.

I hope that many of you will get the opportunity to see this film. You can find a list of theaters here. I look forward to hearing what you think! 

More Nurses are Advancing Their Education

clock December 7, 2012 05:37 by author Lisa Bonsall, MSN, RN, CRNP

“Learning is one of life’s most essential activities.” — Annie Murphy Paul

Enrollment in all types of professional nursing programs increased from 2011 to 2012, according to new survey data from the American Association of Colleges of Nursing. These findings are based on data reported from 664 of the 856 nursing schools in the U.S. with baccalaureate and/or graduate programs.

The survey also saw a 3.5% increase in entry level Bachelor of Science in Nursing programs. The number of students enrolled in RN-to-BSN programs increased by 22.2% from 2011 to 2012, which, according to the AACN, signals a growing interest for baccalaureate-prepared nurses from both nurses and employers.

"AACN is pleased to see across-the-board increases in nursing school enrollments this year, given our commitment to encouraging all nurses to advance their education as a catalyst for improving patient care," said AACN President Jane Kirschling in a press release. "As the national voice for professional nursing education, AACN is committed to working with the education and health care community to create a highly qualified nursing workforce able to meet the expectations and challenges of contemporary nursing practice."

A few other interesting survey findings:

  • Enrollment in master’s and doctoral degree programs increased “significantly.”
  • Survey data indicated an 8.2% jump in enrollments for nursing schools with master’s programs (432 institutions reported data).
  • Doctor of Nursing Practice programs saw a 19.6% enrollment increase (166 schools reported data).
  • Baccalaureate nursing graduates are more than twice as likely to have jobs at the time of graduation than those entering the workforce in other fields.
  • Graduates from master’s degree programs (MSNs) were most likely to have secured jobs at graduation (73%).

"Momentum is clearly building for advancing nursing education at all levels,” Kirschling said in a press release. “Given the calls for more baccalaureate- and graduate-prepared nurses, federal and private funding for nursing education should be targeted directly to the schools and programs that prepare students at these levels."

"Further, achieving the Institute of Medicine’s recommendations related to education will require strong academic-practice partnerships and a solid commitment among our practice colleagues to encourage and reward registered nurses committed to moving ahead with their education."

This post was written by Erica Moss, who is the community manager for the online masters in nursing programs at Georgetown University.

Getting back into scrubs

clock October 15, 2012 03:59 by author Lisa Bonsall, MSN, RN, CRNP

I think that every nurse I know has a story about jumping in to help during an emergency outside of the work setting. I’ve had several over the years, the most recent being this past summer while out with my kids. It was an evening out at the park, close to dinner time, so it wasn’t very crowded. Suddenly a young boy ran from the swings holding his head. His mom (or another caregiver – I’m not certain what the relationship was) was seated at the next bench, not very far from me. She started to scream and cry.

I could see the blood coming down the little boy’s neck and quickly ran over to help. Fortunately I had a towel in my bag since we had just come from the pool. As I approached, the mom/caregiver stepped away crying and fell into the arms of another woman who was there. I quickly assessed his head (it was a pretty big gash) and held pressure with the towel while lowering him to the ground where we sat and waited for emergency medical services (EMS) to arrive.

All the while, my own children were watching in fear. After the EMS team arrived and took over the boy’s care, which included a trip to our local emergency department, we collected our stuff and headed toward the car. I reassured them that the little boy would be okay and that he might just need some stitches. The conversation that ensued with my one son went something like this:

Me: “It’s a good thing there was a nurse around, huh?”

My son: “There was?”

Me (shocked): “Yes! Me!”

My son: “Oh yeah…I forgot you’re a nurse. You're more of a ‘typer’ than a nurse though, mom.”

The conversation went on a little longer, but I must say it was as if something just hit me right then. I’d recently been considering getting back to patient care, but hadn’t even begun to look into job opportunities or refresher courses in the area. This brings me to my reason for sharing this story…

I’ve been away from bedside nursing for more than 10 years and have a few questions for anyone else that took a similar “hiatus” and then returned to patient care.

1. What steps did you take to prepare for a return to bedside nursing?
2. Did you return to your prior place of employment or a similar unit, or did you start over in a new area or with a different patient population?
3. How easy or hard was it making the transition?

Please share your story! I look forward to any advice you may have for me!

Thank you J

Dear New Nursing Graduate...

clock June 14, 2012 03:36 by author Lisa Bonsall, MSN, RN, CRNP

Dear New Nursing Graduate,

Welcome! What an exciting time for you! I realize that it probably is somewhat of an emotional and stressful time as well. My sons just “graduated” from elementary school and through all the events and ceremonies, I was reminded just how special these milestones and traditions can be. Probably the biggest one for me was finishing up nursing school and entering the “real world.”  

So, first let’s get out all of the stress that you are probably feeling right now. These were my top 3 sources of anxiety, if I remember correctly…

1. Leaving the security of school with instructors who guided me and classmates who supported me. I did find other mentors and formed another support network rather quickly and you will too! Get to know other new nurses during orientation. Be receptive to learning from more experienced nurses and other staff.

2. Facing the NCLEX exam. How could I possibly know all that I was expected to know? I did, and you do too (but don't stop studying!)

3. Encountering a discouraging job search. I had to be persistent and open to options that weren't my first choice.  Remember that any job can serve as a stepping stone to your dream job.

I recall hearing over and over again how the “real world” of nursing would be so different from nursing school. How can you make the transition a little easier? Here’s some advice:

  • Never stop learning! Learn from other nurses, other disciplines, support staff, anyone around you! Some of my most critical skills and communication techniques I learned from my very first preceptor – a nursing assistant who had been working on the unit for more than 20 years! Take advantage of the knowledge and experience of those around you. Really listen to advice and observe how others do and say things. You may not want to emulate all of what you see, but you can learn from it.
  • Keep up your education! I know you just finished school, but there is so much more to learn and things in healthcare are always changing. Attend inservices and maintain your continuing education requirements. Also, when the time is right, consider getting certified in your specialty and think about going back to school.
  • Ask questions! This goes hand-in-hand with learning and education. Chances are, if you have a question, someone else is wondering the same thing. Don’t assume – get the answer or find out how to get the answer. Then share it with others.
  • Join a nursing organization! This is a great way to stay informed and network with nurses who have similar interests.
  • Take breaks! Remember to take breaks during your shifts. Also, be sure to enjoy “non-nursing” time with family and friends. One of my favorite nursing tips is "Nursing is a 24/7 operation that requires teamwork - do your best to prioritize and work safely & pass on the rest."

A last word of advice is to not forget this feeling of uncertainty and stress, as uncomfortable as it may be. This will help you when students or new nurses are on your floor. Welcome them and treat them with respect. Share your knowledge with them, even become a preceptor. They’ll thank you for it.

Best of luck to you as you make this transition!

What is shared governance?

clock August 11, 2011 10:27 by author Lisa Bonsall, MSN, RN, CRNP

There are certain words and phrases that are used frequently in nursing and medicine – sometimes so frequently that we lose our understanding of their true meaning. Or sometimes, we may not have really understood them at all.

For me, “shared governance” was one such phrase. In the past, if someone had asked me what shared governance meant, I would have had some difficulty explaining it in great detail. Sure, I would have answered that it’s a model for nurses to work together and manage themselves, but beyond that, I’d have been at a loss.

That is, until, I did some reading. Now I feel better prepared to discuss shared governance and its role in nursing. Here’s what I’d say now:

Shared governance is collaboration, whether in scheduling staff, educating new staff, or implementing evidence-based practice. It involves teamwork, problem-solving, and accountability, with the goals of improved staff satisfaction, productivity, and patient outcomes. It is working together to make decisions that affect nursing practice and patient care. It is working with other disciplines for the good of the patient. It is collaborating to improve nursing practice. 

Allow me to share the following excerpt which I found very enlightening:

The structure is shared governance; the process is professional nursing practice; the outcomes are positive productivity data.1

Is a shared governance structure in place where you work? Have you been involved with implementing shared governance? I'd love to learn more; it sounds like the ideal working environment, but I'm wondering - does it truly exist?

1. Church, J.A., Baker, P., Berry, D.M. (2008). Shared governance: A journey with continual mile markers. Nursing Management, 39 (8).

Second-career RNs

clock January 3, 2011 16:11 by author Lisa Bonsall, MSN, RN, CRNP

Change is not usually easy. Nurses who have made nursing their second (or third or fourth…) career deserve much recognition and respect. Imagine being an expert accountant, someone who people seek out to answer their financial questions and meet their needs, and then starting over from scratch in a new environment, with new people, learning new skills and knowledge.  Imagine returning to the novice role after already having travelled that path of novice to expert. Remember those days of care plans and clinicals, searching for a job, and then starting work in an unfamiliar unit or facility. Now imagine doing it all over again. A bit overwhelming, isn’t it?

In the January/February issue of Nursing Made Incredible Easy, Sally Jo Borrello, MSN, RN, CTTS, takes a closer look at the second-career nurse.  She reminds us that while individuals pursuing nursing as a second career are usually adult learners who are more serious and confident than their younger counterparts, they still face the same long hours of studying and class preparation. Many are also sacrificing personal and family time to obtain their degree.

The author goes on to share tips for experienced nurses to mentor second-career nurses. Building a mutually respectful and trusting relationship is key. Remember that this mentee is bringing his or her background and knowledge to the relationship also, so be open to learning quite a bit yourself. Use positive feedback to support and guide this student or new nurse.

Are you a second-career RN or currently pursuing nursing as a second career? Please chime in with your thoughts and experiences!

Warning of vaccine administration errors

   Recent news about pertussis outbreaks that have resulted in infant deaths is causing serious concern in the healthcare community. Back in August 2006 and again in July 2010 the Institute for Safe Medication Practices (ISMP) issued a warning about confusion of Adacel and Daptacel which are vaccines for the prevention of tetanus, pertusis, and diptheria. ISMP explained how administering the incorrect vaccine to infants can result in ineffective immunization leaving babies vulnerable to infection. The IMSP Medication Safety Alert from July 1 2010 reported that "Part of the problem is that the official names of the products are very similar although stated in different order on the labels. One of them, diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP), is sold under the brand names DAPTACEL and TRIPEDIA (Sanofi Pasteur), and INFANRIX (GlaxoSmithKline). This formulation is for active immunization of pediatric patients 6 weeks through 6 years of age. The other vaccine, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap), is sold under the names BOOSTRIX (GlaxoSmithKline) and ADACEL (Sanofi Pasteur), and is meant to be used as booster shots for older children, adolescents, and adults."

   This is back to school season and vaccines are on the minds of parents, schools nurses, pediatric nurses and NPs. This is a perfect time to review our procedures for prescribing and administering childhood vaccines to ensure that the correct vaccine is ordered and administered each time. For more details on the recommended vaccine schedule, go to the Center for Disease Control and Prevention website at

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