1. Paradisi, Julianna RN, ONC


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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 on the books.


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


Paid time-off varies from organization to organization. Some lump together vacation hours and sick leave hours, while others separate the two so that nurses accrue hours 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 lower rate than that of their colleagues hired earlier; this practice, called "tiered employment," can foster division between the newly hired and existing staff within units. 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 25 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 at a price.


How vacations are scheduled on nursing units varies too. On some, vacation requests are required at the beginning of the year, forcing staff to make plans while they cope with holiday plans, winter illnesses, and the accompanying short staffing 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. In this scenario, they risk not getting an adequate vacation at all.


On other units, nurses schedule vacations at will, with the caveat that enough nurses remain to cover staffing needs in a nurse's absence. During extreme periods of critical staffing needs, units can declare vacations on hold until further notice, curtailing the best-laid plans.


I'm not alone in having extra hurdles to leap when scheduling vacation time, because my husband works in health care too. In my experience, many nurses are married to other nurses or health care colleagues, and often their schedules conflict.


I finally accrued enough vacation time to take two consecutive weeks off from work. We headed south to the coast near San Diego, enjoying fish tacos, and yes, beer. Interestingly, at poolside we watched a father playing with his young daughter, who was bald in the way of a cancer patient. The child had no obvious venous access device, and swam like a fish, with surprising energy.


Her father stayed in the pool with her for a couple of hours. You could tell he would have stayed there forever, if that's what she had wanted.


We never really get away from the job, but that's another post. I still enjoyed every minute of our vacation, and my oncology nurse-related hallucinations have ceased.