From PhD student to PhD candidate

I am excited to announce I am now a PhD candidate! I have waited for this moment for three long years. For anyone who doesn’t understand the significance of advancing to candidacy, let me explain. To move from being identified as a PhD student to being identified as a PhD candidate, I had to 1) submit a 20- to 30-page paper at the end of my first year of study, 2) complete two years of full-time coursework, 3) write the introduction, theoretical framework, literature review, and methods chapters of my dissertation, and 4) successfully defend my dissertation proposal to members of my dissertation committee. Advancing to candidacy gives me the green light to begin my dissertation study. It is the first of two important rites of passage, the second being successful defense of my dissertation.

Many in academia and research fields recognize PhD(c) as a title for those who have advanced to candidacy. This distinction is equivalent to “all but dissertation” or “ABD,” an informal title given to PhD candidates. I love the term ABD because it accurately describes the status of PhD candidates as those who have completed every requirement for the PhD, except the dissertation.

Milan Ivosevic/iStock/Thinkstock

When I began my PhD studies, I looked forward with excitement to the point in my program where I would move from student to candidate, because I knew that, once I advanced to candidacy, I could use PhD(c) as part of my credentials. Listing PhD(c) in my credentials would let the world know I had successfully completed two-thirds of my PhD program and that I was on the final leg of the PhD marathon. I knew enough not to list PhD(c) too early, lest I offend those who had already advanced to candidacy. Improper use of credentials is a major pet peeve of mine (see “The 5 no-nos of alphabet soup”), so I have been patiently waiting for the day I could update my credentials.

In the weeks leading up to my oral qualifying exam, it dawned on me I wasn’t required to use PhD(c). I also recalled that using MSN(c) in the last semester of my MSN program had felt strange, as though I was claiming the degree prematurely. I thought, therefore, long and hard about whether or not I now wanted to use PhD(c) as part of my credentials. I even looked for other authors’ opinions on the matter. In doing so, I came across an interesting Advances in Nursing Science blog post on the subject of proper credentialing, and that sealed the deal. As much as I once looked forward to writing PhD(c) behind my name, I finally decided I would not use this distinction.

First, I tend to be very traditional when it comes to special occasions and ceremonies. I don’t open Christmas gifts before Christmas morning. I don’t think brides and grooms should see each other on their wedding day prior to the ceremony. I don’t wear white skirts, white pants, or white shoes between Labor Day and Memorial Day. I’m a traditionalist at heart. For the same reason, I don’t want to use the PhD(c) designation.

I don’t want to become comfortable seeing PhD behind my name until my PhD degree is hanging on my wall, and hope that waiting to update my credentials will motivate me to continue working hard toward graduation. In addition to holding off for tradition’s sake, there are a few other reasons why using PhD(c) might not be in the best interest of a candidate.

PhD(c) isn’t recognized by some of the entities that matter most. Several professional organizations and publications, including the Honor Society of Nursing, Sigma Theta Tau International, do not permit use of degrees in progress when listing credentials. It makes sense. Why would these organizations allow us to use credentials we have not yet earned? If I chose to use PhD(c), I would constantly have to revert back to my former string of credentials, which lists MSN as my highest earned degree. I see that as extra, unnecessary work. So, instead of complicating things and taking the chance of listing unacceptable or unacknowledged credentials when submitting a journal article or conference abstract, I’m choosing to keep it simple. I’ll update my credentials when I am no longer a candidate, but a full-fledged Doctor of Philosophy.

Finally, it is widely estimated that 50 to 60 percent of PhD students never complete their PhD. While it is unclear how many PhD dropouts are ABD, what is clear is that ABD is a means to an end—an end some people never reach. PhD programs, like all other academic programs in higher education, have time limits. Most programs require completion of the terminal degree within seven to 10 years of starting the program. Even if a person has advanced to candidacy, he or she can be asked to leave the program if progression toward final defense takes an exorbitant amount of time. I’m not superstitious, scared of jinxing myself, or fearful I will be put out of my program for taking too long to graduate, because I’m only at the start of my fourth year. I just recognize PhD(c) is a status symbol, not a real credential.

I am proud of myself for reaching this milestone in my education, and I will continue to refer to myself as a PhD candidate, ABD, or, as I’ve heard a few nurses say “PhD, little c,” but I will not include PhD(c) with my credentials. There is something special about a person who has earned a PhD. It is, indeed, an honor. I don’t want to use a credential I have not yet earned. Instead, I want to save the joy of updating my credentials for the moment my PhD is actually conferred. I want to wait until my committee members refer to me as Dr. Montgomery before replacing “MSN” with “PhD” in my alphabet soup.

I feel no less accomplished or excited to advance to candidacy not using PhD(c) than I would feel if chose to update my credentials now. Nor do I fault people who choose to use PhD(c) as one of their credentials. It’s a personal choice. I choose to wait.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Maternal-child health nursing in Indonesia

During winter break of my previous academic year—for those of you in the southern hemisphere, “winter” break at UCLA is in December, not July—I had the amazing opportunity to travel to Indonesia to see, firsthand, the work of front-line maternal health workers. I wrote about my experience as a guest blogger for the Frontline Health Workers’ Coalition. The experience was so much more extensive than what I was able to capture in that blog post, so I am sharing more of my experiences here.

Two things I noticed in Bandung, West Java, Indonesia resonated with me more than anything else: use of text messaging by puskesmas (government clinic) staff and the traffic.

I am a lover of technology and an advocate for use of mobile technology in health care, so I couldn’t have been more pleased to see posters on puskesmas walls with instructions for texting patient-referral information to the local hospital. Clinic staff members said that lack of hospital staff to respond to the SMS gateway (the text messages used to refer patients to hospitals) was a large obstacle for them. Still, use of mobile technology among Indonesian nurses is an important step in health care delivery. I may be a bit biased, as my own research focuses heavily on mobile technology, but that’s OK.

Herianus/iStock/Thinkstock

The other very noticeable thing was the traffic. As a resident of Los Angeles, California, USA, I am used to traffic. My daily activities are scheduled around high traffic times. I decide what time to wake up based on anticipated traffic. I group errands so I don’t have to deal with traffic more often than necessary. I know traffic. However, I had never before experienced the type of traffic I saw in Indonesia. What should be an hour-long drive took us more than three hours. Motorcyclists bobbed in and out of lanes, all the while transporting women and children without helmets. It wasn’t just the public that had to deal with traffic. Ambulances sat in traffic with us. Sirens were on, but many of the cars on the road either wouldn’t move over or had no place to move to. It was no surprise that puskesmas staff members reported transporting patients to hospitals as one of their biggest obstacles.

Nursing practice of midwives in Bandung is very similar to practice of labor and delivery nurses in the United States. Here, we have critical events team training (CETT), where we use simulation to practice handling emergencies. In Bandung, the Expanding Maternal and Neonatal Survival (EMAS) program administers similar training.

EMAS focuses on three areas of maternal health and three areas of neonatal health: eclampsia, postpartum hemorrhage, maternal sepsis, low birth weight, neonatal sepsis, and neonatal asphyxia. Clinic and hospital participants of EMAS are selected based on the number of deliveries and maternal-fetal deaths at each facility. Staff training occurs in the home facility. Staff members are given modules and are responsible for training themselves, based on the notion that, if training occurs away from the home facility, midwives won't know what to do when they go back to their home facilities. I love this teaching philosophy!

As participants in the program, puskesmas staff members are taught what to do during maternal or neonatal emergencies. The program helps increase midwife confidence in caring for high-risk women until the patients can be safely transferred to the hospital. Checklists help in emergencies, and they understand that it is within their scope of practice to administer medications such as antibiotics and magnesium sulfate. Just like American nurses, the Indonesian nurses I met use the Neonatal Resuscitation Program (NRP) model during neonatal emergencies. They also give intramuscular Methergine and intramuscular oxytocin during postpartum hemorrhages. Puskesmas nurses said they were grateful for the increased confidence they have as a result of knowledge provided by the EMAS program.

The EMAS program, which is beginning to bridge the gap between clinics and hospitals, encourages ongoing mentoring and quarterly training. The relationship is mutually beneficial for puskesmas and hospital alike. A memorandum of understanding between clinics and hospitals allows sick patients to be referred to the closest hospital. According to puskesmas staff members, the best outcomes of the program are better clinic management and use of texting to enhance communication between clinics and hospitals. EMAS has strengthened the network among physicians and midwives. Midwives are no longer afraid to call physicians, regardless of the time of day or night, an issue some U.S. nurses continue to struggle with.

The puskesmas nurses told me that their greatest motivation was desire to save the lives of mothers. I could tell by their love for continuing education that this was, indeed, true. I had to travel all the way to the other side of the world to realize that nurses everywhere are one and the same. We may have different cultural practices and slightly different patient-care procedures, but we all cherish good outcomes. Going to Indonesia made me feel part of the global nursing profession. For the first time ever, I felt as though nursing was bigger than what I have known it to be in the United States. Nursing for me is now a global endeavor. Almost a decade after graduating from nursing school, I have a clear understanding of the importance of nursing practice, both inside and outside of my country.

I hope to continue traveling internationally to meet other nurses and gain better understanding of how they practice. There is so much we can learn from each other, so much knowledge and love to share. I am honored to be a member of the Honor Society of Nursing, Sigma Theta Tau International (STTI). When I was inducted into STTI, I had no idea I would someday travel the world meeting nurses and writing about them, an honor I do not take lightly.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Visiting the library

I recently visited a couple of my school’s libraries—UCLA’s Charles E. Young Research Library and Louise M. Darling Biomedical Library—to check out a few books. In doing so, I realized how long it had been since I last searched through library stacks for a book. Awestruck by the significance of the occasion, I took a picture of book stacks and posted it to my Instagram account.

There was a time when going to the library was normal. As an elementary-school student, I learned all about the Dewey Decimal System and how to use the card catalog to search for books. My class frequented the library to check out and return books. In high school, I studied in the library of California State University, Long Beach. I’d sit there for hours, having given my mother instructions to pick me up in the afternoon. Oddly enough, as a college student, I never studied in the library—only as a high school student. Go figure. However, during the summer months between my freshman and sophomore years in college, I went to the library almost weekly to check out books.

I took a picture of book stacks and posted it to my Instagram account.

I read a lot that summer. Reading for pleasure gave me respite from assigned readings for my summer anatomy class. During my sophomore and junior years of college, I worked in a campus satellite library—the Multicultural Resource Center. Filling my childhood and early adult years are great memories of school and public libraries. The Internet changed all that.

I can count on two hands the number of times I checked out a library book as an undergraduate or graduate student. In fact, before my PhD program, the last time I remember going to a library was during my junior year, and that was to visit friends who worked there. During my MSN program, I never once stepped foot in a library. To be honest, I couldn’t tell you where the library is at California State University, Dominguez Hills—or if one exists at all.

The few times I have visited UCLA’s Biomedical Library, I have been reminded of the joys of going to the library—the smell of books; the short-lived anxiety of searching for a single literary work among thousands of collections; the thought of who may have read this book last. What were they studying? Where did they read it? What did they think of it?

Going to the library was once a staple of the educational experience. Today, it is quite possible to earn a college degree without ever reading a book. As use of technology continues to increase, part of me is beginning to miss the good old days—the days when I either had to visit the library or have no references to cite for a paper (two or three libraries if a needed book was checked out); the days when I wrote papers by hand and went to the computer lab to type them up; the days when the Internet was but a mystery and information wasn’t handed to me on a silver spoon. Those were the days!

Today, I wonder if students are actually getting a college education or simply earning a degree. Getting an education entails so much more than simply adhering to guidelines spelled out in a syllabus and receiving a grade. For me, getting a college education meant sitting in a lecture hall full of people I didn’t know and becoming friends with some of them as a result of our shared experience. It meant engaging in meaningful discussions in a small class section, then hanging around after class to continue the discussion with the professor and a few other students. It meant searching the stacks in the library, hoping—and praying—to find the book I needed. For me, that was what getting an education was about.

Have we lost the magic of the college experience? Are technological advancements removing the very things that made us feel like students? Is technology becoming more of an educational hindrance than a help? I don’t know the answers to any of these questions but, as someone who loves everything about higher education, the thought that I am even posing these questions makes me a little sad.

I want future generations to know the joy of visiting the library—not simply downloading books and articles from Google Books and online research databases. I’m not saying we should return to the days of typewriters and Wite-Out—yes, I also remember those days—but there is a special feeling associated with frequenting a university library. I can only hope today’s educators are encouraging students to experience that feeling.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

10 tips for using Twitter in nursing

I recently attended the 2014 AWHONN Convention and was overwhelmed with joy by the conference’s use of technology. In addition to increased use of technology in the general and breakout sessions, I noticed a large increase in the use of social media—specifically, Twitter. As an avid user of Twitter, I posted more tweets, using the conference hashtag, than any other member of the Association of Women’s Health, Obstetric and Neonatal Nurses. Many of my tweets were retweeted and marked as favorites by members of AWHONN, members of other nursing and government health groups, and journals. By the end of the conference, several nursing colleagues asked me to help them set up Twitter accounts, because they wanted to tweet as well.

I am not shy about my love for Twitter. I encourage all of my students and coworkers—really any nurse I know—to utilize this social media platform for professional advancement. I first created a Twitter profile in the months preceding entrance into my PhD program, because I wanted to increase my professional presence on the Internet and social media websites. In addition to setting up a Twitter account, I became more active on LinkedIn and created a professional page on Facebook. Since then, however, I have focused my attention primarily on Twitter, because I have found it the most appropriate social media platform for professional development.

Although many use social media to stay connected with family and friends, my use of Twitter is all about connecting with other women’s-health professionals, nurses, and researchers. (I use other social media sites to connect with family and friends.) Because my research focuses on high-risk sexual behaviors, I follow many national health organizations that tweet information related to unintended pregnancy and sexually transmitted diseases. As I scroll down my Twitter timeline, I am constantly considering new information to add to the literature review and methodology chapters of my dissertation.

rvlsoft/iStock/Thinkstock

I also use Twitter for interacting socially with other PhD students and health care professionals. I have made several cyberfriends on Twitter, and I have met some of them at nursing and research conferences. Others, I may never meet in person. We encourage one another in our research efforts, celebrate accomplishments, check in with each other if long periods of time pass, and hold one another accountable for goals we want to achieve. I also check #PHinisheD and #dissertationdefense to gain inspiration and to congratulate newly minted doctors of philosophy.

Since more of you are using Twitter, I want to share a few tips to make your social media experience more beneficial to your professional growth.

Tip #1: Remember that you represent nursing. Whether or not you identify yourself as a nurse, you represent nursing and every other registered nurse. I like to remind my students that being a nurse is like being a member of a sorority. Once you are accepted into our ranks, you represent us at all times, so be careful what you post. Your pictures, statements, and interactions with others—whether or not your account is public—can shine a magnificent light on the profession or act as an unfortunate damper. I promise not to make you look bad. Please give me the same respect.

Tip #2: Interact with others using an interdisciplinary approach. While it’s nice to follow nurses on Twitter, follow other health care professionals as well. Our physician, public health, research, and health educator colleagues are gems. The information they post may not always apply directly to your role as a nurse, but it may be useful, nonetheless. Some of the most intriguing and inspiring tweets I have seen come from non-nursing colleagues.

Tip #3: Interact with health care consumers. Besides interactions that occur between health care professionals, interaction with patients or other health care consumers is also important. Just as health care providers follow the Centers for Disease Control and Prevention (@CDCgov) and researchers follow the National Institutes of Health (@NIH), consumers also follow these and other organizations. Instead of wording your tweets only for other nurses, also interact with the general public. There are hundreds—if not thousands—of support hashtags used by health care consumers. They use these hashtags to connect with one another, but they also appreciate information from health care providers. Tweeting information to consumers helps ensure that the public receives accurate information from licensed professionals and is not simply passing around old wives’ tales or anecdotal information.

Tip #4: Make use of popular hashtags. Using hashtags will not only enrich your Twitter experience, it will enrich the experience of others as well. Twitter creates a list of tweets using the same hashtags and separates tweets into two categories: popular tweets and all tweets. This allows Twitter users to see what others are saying about content at hand. Some of the hashtags I often use include #thePhDlife, #nursesrock, #nursingstudents, and #womenshealth. I encourage you to follow hashtags of importance to your practice or area of research. I also use hashtags to categorize my tweets. I am the only person on Twitter who uses #thePhDlife. Sometimes, when I need a little inspiration or want to revisit my PhD journey, I go down the list of tweets filed under #thePhDlife. You may want to create your own special hashtag so you can do the same.

Hashtags are also helpful when attending nursing conferences or other large meetings. For instance, I tweeted heavily during the AWHONN conference using #AWHONN14, and, by observing others using the same hashtag, met several people I would otherwise not have connected with. It also allowed many people to get to know me. As I walked the halls of the convention center, I often heard “Hi, Tiffany!” from nurses I had never met before or “I’m really enjoying your tweets” from others. Tweeting at conferences is easier and more meaningful than taking notes. I can always refer back to my tweets to remind myself of important information shared at the conference. Besides taking notes for my own benefit, I get the chance to share what I am learning with the world—in real time!

Tip #5: Mark favorite tweets for future reference. Marking a tweet as a favorite (by activating the little heart at the bottom of a tweet) adds it to your favorites list, a list automatically generated by Twitter. I go back to my favorites every few months and review the list. It’s always nice to be reminded of important tweets posted in prior months or years. It’s like taking a trip down memory lane.

Tip #6: Participate in Twitter chats. Twitter chats are an exceptional way to interact with others on Twitter. Some Twitter handles are dedicated specifically to weekly or other regularly scheduled chats. Others will schedule and hold chats related to specific content. These chats—heavily advertised—are well attended, even though only a few actually participate. Twitter chats allow users to participate in real-time conversations with government agencies, health care organizations, and other health care entities. If your facility or educational institution has its own Twitter handle, consider holding a Twitter chat for patients, students, or other consumers. To initiate a chat, just let people know the hashtag you will be using, set a date and time, and make sure someone is available to moderate the session and respond to tweets using your hashtag. (Consider using two people to handle these work-intensive tasks.)

Tip #7: Find opportunities to mentor novice nurses and nursing students. I have used Twitter on many occasions to communicate with nursing students. Sometimes, I tweet tips to help them navigate the troubling waters of nursing schools. Occasionally, I interact with students and new grads after they reach out to me. Less frequently, I read a tweet, using a specific hashtag, or see a tweet on my timeline that inspires me to reach out to the author of the tweet. I have yet to have a negative experience in my dealings with nursing students or novice nurses on Twitter. They are always gracious and appreciate any wisdom I have to share. I encourage other, more seasoned nurses to also reach out to newer nurses. You have a wealth of knowledge from which we can all learn. Don’t be shy about sharing your experiences and wisdom.

Tip #8: Stay up to date on current practice. By following certain government health agencies, I am alerted to the newest research, practice guidelines, and population data. Whenever a new report is published, there is a tweet about it. Usually, the authoring organization tweets, and many other organizations retweet the information, or tweet similar information of their own. Twitter was established to serve as a newsfeed, and many people still use it for this purpose. Breaking news—health-related or otherwise—hits Twitter before local news stations or public radio. Folks often wonder how I stay up to date on women’s health issues. My answer is Twitter.

Tip #9: Create lists of your favorite tweeps. In addition to the favorites list generated by Twitter, you can create your own lists. My lists include: Women’s Health, mHealth, Nursing Info, Healthcare Legislation, Nursing Publications, Schools of Nursing, Teen Pregnancy, Nursing Orgs, and Healthcare Info. As I follow various Twitter handles, I place them in the appropriate groups. If I want to know what’s going on in which nursing schools, for instance, I open my “Schools of Nursing” list. This prevents scrolling down a timeline on which I could potentially see tweets from everyone I follow (more than 850 different Twitter handles). If you are going to use Twitter for professional reasons, I strongly encourage you to create lists. It saves times and helps with organization.

Tip #10: Engage in the Twitterverse often. Every now and then, I will come across a tweep I haven’t seen on my timeline in ages. To truly get the most out of Twitter, you have to access the site often, because information is posted constantly. If you wait days or weeks between logging on to the site, you will miss important content. Don’t feel that you have to tweet constantly, however. Some people—we call them lurkers—tweet very infrequently, and there is nothing wrong with that. Just remember, when you aren’t tweeting, you’re depriving others of your knowledge. Even if you have nothing to say personally, you can retweet interesting tweets you come across. You can also tweet online articles, pictures, and websites.

I hope to continue seeing a growing presence of nurses on Twitter and other social media platforms. Engaging with nurses across the country and around the world is something we couldn’t easily do 20 years ago. Today, we can learn from nurses and other health care professionals on every continent. Social media is here to stay. It’s time to embrace it. My Twitter handle is @TMontgomeryRN. I hope to “see” you around the Twitterverse!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

For the people, not the fame

I recently read an article about a researcher in India who has made great strides for women’s hygiene in that country. “The Indian sanitary pad revolutionary,” by Vibeke Venema, writing for BBC World Service, is a long article, but one I encourage every researcher to read. After learning of the unsanitary and oftentimes embarrassing hygiene practices of many Indian menstruating women, Arunachalam Muruganantham initiated his own research about sanitary pads and how to produce them inexpensively.

Although he had no formal education, Muruganantham learned what he could about women’s sanitary habits and developed a research question. His work on this extremely taboo subject cost him his family and friends. His community also ostracized him but, after years of working toward his goal, his commitment paid off. Today, his invention, a machine that manufactures sanitary pads, has helped to improve the health of women in India and many other countries. Although he could have made a great deal of money with his machine, he decided, instead, to help more women. As a result, his creation has led to entrepreneurial jobs for women and increased health education in the communities they serve.

Intellistudies/iStock/Thinkstock

Once I started reading the article, I couldn’t stop. I was inspired by Muruganantham’s commitment to his research. Being ridiculed didn’t stop him from finding answers to his research question. Being abandoned by his wife and mother didn’t stop him, either. (They later came back.) He didn’t allow his lack of formal education to make him feel unqualified to conduct his studies. What stands out most to me is his desire, above all, to help the women of his country. Although he could have become wealthy by selling his invention, he chose, instead, to use his invention to improve the lives of those for whom it was created. This, in my opinion, is exactly how research should be.

How many researchers can honestly say they would continue to do what they do if there was no notoriety or financial gain involved? If funding dried up or if others did not understand your reason for asking an unusual research question, would you continue to investigate? How many of us truly do what we do for the love of the work and the people we help and not to secure our place in the Ivory Tower? Muruganantham’s research was not conducted for financial security and material gain, but as a way to empower and advance—economically—women in his country and around the world. If we learn one thing from this story, it should be the lesson of selflessness.

In my own research career, I never want to forget the most important aspect of any study—the people who will be helped as a result of my findings. I’ve never been one to seek knowledge simply for knowledge’s sake. Learning something I didn’t previously know is great, but applying that knowledge to improving people’s health is more important. In the grand scheme of things, changing lives through research is more important than any six-figure salary, corner office, or national award. It’s all about the people; it should never be about the researcher.

Receiving credit for hard work and adhering to intellectual property laws are important, but we must get out of the habit of keeping research tools and findings in the hands of only a few. We must stop trying to build extreme wealth by charging exorbitant amounts for use of research instruments and interventions. If we uncover a way to address a certain health issue in a specific population, we should disseminate our findings widely, not simply among colleagues who attend national or international research conferences. We could all stand to apply to our research the kind of compassion, care, and concern that Muruganantham demonstrated for the women for whom he created his machine.

As the knowledge base of nursing research continues to grow, we should always remember we are nurses first, then researchers. The Nightingale Pledge reminds us that we are to “practice [our] profession faithfully … and devote [ourselves] to the welfare of those committed to [our] care.” While I can’t speak for colleagues in other disciplines, nursing research should never be about money or fame. It should always be about the patient, or, in our case as researchers, the participants and the populations they represent. We should do our best to ensure that our findings are implemented in a way that will help those most in need. When in doubt, ask “What would Muruganantham do?” He provides a wonderful example of remaining committed to the people for whom his research was conducted. We should all be so lucky to have our research touch so many lives.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Dreams don't have expiration dates!

All my life, I’ve been a planner. Seriously, I plan everything! I remember, as a college freshman, sitting in my friend’s dorm room a few days before school and planning out each class I would take from then to graduation. From the course catalog, I determined everything required to earn my diploma, and I made a list that included each class and the semester I would take it. I also left a space for the grade I would receive. (After every semester, I updated the grade column).

I also made a table, with academic years listed vertically and semesters horizontally. Listed inside each square of the grid were the classes I planned to take that semester. I did not deviate from the plan. In fact, I liked it so much I created similar course plans at the start of my MSN and PhD programs.

When I began my PhD program, I was given a four-year fellowship. Thanks to the fellowship, I was able to go from working full time to working one day per week, so I could focus more completely on school. (My MSN program was at a California State University, much more affordable than a school in the University of California system, and I had continued to work full time. I knew, going into the PhD program, however, that I could not afford to pay my way through school as I had done with my MSN.) Because my PhD fellowship was funded for only four years, I made my course plan accordingly.

As with my BSN and MSN programs, I wrote out my course plan before the first day of class and, for the first two years, I stuck with the plan. But once my courses were complete and it was time to write my dissertation proposal, I experienced something that had never happened before—I deviated from the plan!

This deviation was not a welcome surprise. I was moving off course and did not like it. I thought it would take me only a few months to write the first four chapters of my dissertation. Instead, assuming I defend my proposal in June as planned, it will have taken me three times that long. Moving my proposal defense back introduces the possibility of moving my dissertation defense back, ultimately delaying graduation. Aware of the implications of not sticking to my original plan—postponed graduation date, dried-up funding, disappointment in myself—I had a huge problem on my hands.

Thinking about my inability to stick to my original plan made my writing suffer. My thoughts were clouded by questions, such as “How will I be able to pay for another year of school?” and “Will I look like a complete failure if I don’t stick to my plan?” Because I had told friends and family that I planned to graduate in 2015, I was also weighed down by the prospect of shame, associated with graduating later than planned. I have never made a plan for my life that I was unable to follow through. If I didn’t manage to graduate in four years, I thought I’d be letting myself down.

neilhalli/iStock/Thinkstock

Then I had an epiphany. I realized that, for me, earning my PhD is not a goal; it is a dream. I don’t view goals and dreams equally. Goals are generally attached to completion dates, but dreams are not. Dreams don’t have expiration dates; they expire when you do.

This glimmer of hope came after months of beating myself up for not sticking to my original plan. I reminded myself that fewer than 1 percent of people have a PhD, and I began to ask myself questions, such as “What matters more, when I graduate or the fact that I will graduate?” and “Who is going to care that I graduate a year later than planned?” As I contemplated answers to these questions, I had to remind myself that obtaining a PhD is not a goal to check off on my five-year plan (yes, I have a list of those goals, too). Obtaining a terminal degree is bigger than that. Getting a PhD is not a goal to be achieved; it’s a dream to be actualized.

I began to ponder reasons for plans and deadlines. Many times, we are held to a deadline, and, if it isn’t met, some sort of disciplinary action or negative reinforcement occurs. This led me to ask more poignant questions: “If I am unable to complete my PhD in the planned time, will I be punished? Am I going to leave the program? Will I call it quits because I didn’t live up to my expectations?”

The questions were sobering, but as I thought about them, I realized how silly I was being. Am I crazy enough to let go of a dream simply because it may not come to fruition in the time planned? Of course not! I may be a stickler for plans and organization, but I’m no fool. It would be foolish of me to believe that the hard work of earning a PhD loses its significance if I don’t graduate within the time originally planned.

I also had to remind myself that life has a funny way of working things out. Things about which I have no knowledge may happen. Who’s to say there isn’t a another predoc fellowship or postdoc opportunity out there with my name on it, one not available had I stuck to my original plan? Although I may not be where I thought I would be, as it relates to the progress of my dissertation proposal, I believe I am where I am supposed to be. Dates and deadlines cannot hinder my belief that things will work out in my favor. My faith includes faith in timing. I wholeheartedly believe things will happen when they are supposed to happen.

As it stands today, I may still graduate in four years. But if my plans are interrupted and four years turn into five, it won’t be the end of the world. I’m sure I will always be a planner, but I’m learning that it’s OK to go with the flow, sometimes. Some of the things we want out of life are too big to attach to specific dates. Our dreams should not be limited by our desire to see them actualized by a certain time. Having a plan is never a bad idea, but allowing things to progress organically is OK, too.

Today, I am committed to working diligently and letting the chips fall where they may. Instead of creating expiration dates for my dreams, I’m going to chase them until I catch them—whenever that may be.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

When to start. How about now?

With the beginning of another year, announcements of resolutions are plenteous with many talking about things they are giving up to embrace the “new year, new me” mantra. Intentions to exercise have been renewed, thoughts of going back to school for another degree are proliferating, and there are enthusiastic discussions about new and exciting places to travel. Yet, for the first time ever, I’ve noticed a lot of pushback against New Year’s resolutions.

Many of my friends and followers have expressed, via social media, a shared opinion of resolutions: They are pointless, bound to be broken, and nobody wants to hear them. In recent weeks, this backlash against New Year’s resolutions became so apparent I had to ask myself why some people hate resolutions so much.

Unfortunately, my own track record reveals a plethora of good intentions and broken resolutions. Still, at the end of each year, I am thankful for the newfound wisdom I have gained from mistakes made the previous year, and I look forward to the fast-approaching new year.

The future you are dreaming of is right in front of you!

In attempting to understand why some are so against the changes that come with a new year while others, including me, look forward to each new year, I realized that what I’m actually looking forward to is a new beginning. The opportunity to forget what is behind me and focus wholly on tasks before me is, well, liberating. I enjoy the building excitement I feel as the current year winds down and the next one is on the horizon. I relish contemplating the endless possibilities that a new year holds. I delight in looking back over all the accomplishments, moments of clarity, and even disappointments I have experienced in the previous calendar year. So, I don’t understand why so many people have jumped on the bandwagon to oppose new beginnings.

As I thought more deeply about my own habits, with regard to new beginnings, I noticed a pattern that is probably not unique to me and my quirky ways: I only want to begin at the beginning. Any time I consider change, whether large or small, I want that change to occur at a time representative of a new beginning. For me, that’s typically the beginning of a new season, a new month or a new week. Whenever I want to do something new, I plan to begin the first of the month, or on Sunday, the first day of the week. To me, it just makes sense to let the old play out fully before beginning again at the beginning. In my mind, beginning in the middle of the week just doesn’t make sense, and I have spent many years convincing myself that, to begin anywhere else, other than at the beginning, just doesn’t feel right.

As a PhD student, I’ve allowed this disdain for starting in the middle to add to my list of reasons to procrastinate. Conversations I’ve had with myself go something like this: Yes, I know I need to begin writing the next chapter of my dissertation proposal, but I’ll wait until the beginning of next month to begin. … Sure, today is Wednesday and I don’t have much to do, but I’ll wait until Sunday to call that potential recruitment site. … It’s Friday, so let me end my week the way I want, and I’ll get to my schoolwork again bright and early Monday morning. Before replaying these conversations in my head, it hadn’t dawned on me that, while beginning only at the beginning is great if you have a 100 percent track record of following through, if you’re like me and you come up against a stumbling block every now and then, waiting for another “beginning” can result in loss of valuable time and momentum.

Many times after a fresh start or new beginning, an unforeseen event occurs, and we have to begin again. Instead of looking for the next universally recognized starting point—a new week, a new month, a new year—we should utilize the small fresh-start opportunities we have on a more regular basis. We don’t have to wait for the new year to make significant changes in our lives, because we are constantly given the opportunity to begin something new. If you are like me and you like to start everything at the beginning, start at the beginning of the next hour, or better yet, the beginning of the next minute. Every 60 seconds, there is a chance to begin again.

Do you have an idea for a new research project? Why wait until the beginning of the next month, quarter, or year to start? Why not start now? Have you been thinking about going back to school? Look into your options today! Why wait until the end of the summer or the beginning of the fall to research potential programs or begin working on the program application? Some programs have rolling admission dates, so don’t wait—get to it! While working on the unit, your patient, co-worker, or unit manager may say something to you that really gets under your skin. Begin again! Don’t spend the rest of the shift upset because of what happened in the past. (Yes, with each new minute, the prior minute is, technically, the past.) You can choose to begin again, and you can do it now.

My fresh outlook on new beginnings has helped me see how much time I have wasted waiting for opportunities to begin. Every day, hour, minute, and second provide adequate opportunities to begin. There will never be a perfect time to change bad habits or implement new and innovative ideas, so, instead of filing these thoughts in our mental Rolodexes as to-do items for another season, or worse, as potential resolutions for 2015, let’s do them now!

It’s never too early to begin. Don’t allow setbacks to knock you off the road to your dreams. Don’t waste precious time waiting for another opportunity to pick up where you left off. Let’s stop waiting around for new weeks, months, and years to celebrate new beginnings, and, instead, commit to seeing the possibilities that each second, each minute, each hour holds.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Broaden your horizons!

Before attending graduate school the first time, I contemplated where I should obtain my master’s degree. My original plan was to obtain my MSN at San Jose State University (SJSU), the same school where I obtained my BSN. It made sense for several reasons: The school was local; I was already familiar with the campus climate and politics; and, most importantly, I had established a rapport with the nursing faculty.

My plans took a back seat, however, to life’s twists and turns. As fate would have it, I ended up leaving the Bay Area of Northern California and coming back to Los Angeles, in Southern California, prior to submitting any applications, and I ended up enrolling in a school—California State University, Dominguez Hills (CSUDH)—that wasn’t originally on my radar. My choice to attend CSU Dominguez Hills was one of convenience. I quickly learned, however, that fate was doing its job, and what I thought was a choice of pure convenience taught me the value of broadening my horizons.

What I thought was a choice of pure convenience taught me the value of
broadening my horizons.

Having attended San Jose for my BSN and Dominguez Hills for my MSN, I was certain I would attend yet another school for my PhD, and I did—the University of California, Los Angeles, better known as UCLA. After being accepted by UCLA, I thought my educational journey had reached its last stop. Boy, was I wrong! As I began my second year of doctoral studies, postdoc seemed to be the new buzzword. Almost everyone, it seemed to me, was either suggesting I plan to commit to a postdoctoral program or asking what schools I had in mind for my postdoc. Continuing on as a postdoctoral fellow was the last thing on my mind until I began to understand the benefit of such a program. Faced with having to make a decision about where to apply for a postdoc, I chose, once again, to look at programs associated with institutions not on my list of alma maters.

Now that I have attended three universities in pursuit of three degrees, I encourage everyone I can to attend a different school for each degree. My rationale is simple: You want to make your network as wide as possible and learn from as many different scholars as you can. Each school has its own philosophy on teaching, learning, and education. I don’t think it’s beneficial, therefore, to become too attached to any one institution, because you inadvertently miss out on the opportunity to partake in other educational experiences. I’ll use myself as an example of someone I regard as having a well-rounded education.

I attended SJSU for undergrad and had the opportunity to experience a teaching-intensive university. While some of my professors may have participated in research, it was not their main focus. I was in a teaching institution, and my instructors were dedicated educators and clinicians.

When I enrolled at CSUDH, I knew my experience would be different because, although the school is another California State University and a teaching-intensive institution, the master’s program was completely online. The experiences associated with earning my BSN and MSN degrees were as different as night and day.

Now, as a student at UCLA, a Tier One research university, my experience is vastly different from the experiences I had at the teaching universities. Research is the top priority at UCLA; that is no secret. Opportunities to participate in research training, work on grants, write publications, and work as a teacher’s assistant are unparalleled. Had I stayed at SJSU for my MSN and enrolled in its DNP program, I would not have had the amazing experience of obtaining an online degree or studying at a world-renowned research university.

Aside from the educational experiences one has as a student, there are also the connections you make with classmates and faculty members. If you attend the same school for your undergraduate, graduate, and doctoral degrees, you may have different classmates (unless everyone else has the same mindset as you and doesn’t change schools), but you will probably have the same faculty members, and chances are their teaching philosophies won’t change. Neither will their networks.

As a student, you want to be exposed not only to colleagues and faculty members within your university, but also those with no connection to your university. One way to increase this exposure and your potential networking opportunities is to attend professional conferences, but another way to create strong networks with many nurses is to develop relationships with faculty members from various schools.

As you branch out and expand your network, your potential connections grow exponentially. It’s like having a Twitter following. The more people you follow, the more information you’re bound to come across. It has nothing to do with the people you are following, per se. It’s more about their following and with whom you become connected while using them as an intermediary. No one in the Twitter-verse would follow the same 30 people and refuse to expand their network because of the convenience of following just 30 people. Use this same sort of thinking when considering schools for obtaining your next degree. You want to be connected to as many people as possible.

While earning all of my degrees at the same school may have been less expensive, less time-consuming, and much less of a headache, I cannot adequately convey the benefits that learning from three sets of faculty, being exposed to three different institutional ways of thinking, and being connected with new mentors from three universities has provided. Some of the most rewarding professional relationships I have are with nurses with whom I struck up a conversation after introducing myself as a student of Professor X or a past TA for Professor Y. It’s not always easy to be the new student at a large (or small) university, but think of all of the potential connections there are to be made. Think of all of the new people you will meet and the places you will potentially go!

The point of networking is to create a proverbial net that, when cast, covers a vast amount of space. Don’t hinder your opportunity to network by staying within the same four walls for all your days as a student.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International (STTI).

The 5 no-nos of alphabet soup

When I was in nursing school, one of my professors made it very clear that, no matter what areas of nursing we decided to go into, we would all be nurses. She also made it clear that, regardless of how many nursing positions we accepted away from the bedside, we would still be nurses. For this reason, she said we should always list RN behind our names before any other credentials—to show that we are nurses before anything else and to reduce workplace incivility among colleagues—ADNs vs. BSNs vs. MSNs, etc.

Because of that professor’s instruction, I wrote my name and credentials that way for years, until that fateful day when a well-respected colleague told me I was doing it wrong. I let him know why I listed my credentials in the order I did, but he didn’t let up. Because I completely respected him and his viewpoint, I decided to do a little research and found he was right.

Even before I realized I was incorrectly listing the pomp-and-circumstance letters behind my name, I had a real issue with the massive dissension those letters create among nurses. Rather than become too irritated by the squabble, I decided to joke about it and refer to the collection of initialisms that follow nurses’ names as “alphabet soup.”

The more letters the better, right? Not necessarily.

Look at websites that list names and credentials of more than a handful of nurses, and you will often find the letters behind names listed in various orders. The nursing profession does not mandate the “proper” way to list credentials. As with many of other areas of nursing, there is no consensus. Observing the inconsistencies this has caused in the alphabet soup that follows some nurses’ names has given me many a hardy laugh. I have literally seen it all. Below are my nominations for the five biggest no-nos when listing nursing credentials.

No-no #1: Listing your RN license first

While the rationale for why RN should be listed first made complete sense to me, most “how to” guides will tell you that the alphabet soup has a certain order—and for good reason. List your highest degree first, followed by your license and, lastly, a credential identifying a specialty you have, if any, in nursing. The rationale is simple: List your honors in the order they are most secure. In other words, you list your degree first, because it is the least likely credential to be revoked or taken away.

The credential that identifies certification in a specialized area is listed last, because it has to be renewed regularly, and you may either lose the certification, decide to let it go, or become certified in another area. The certification credential is more fluid than the others; one year you may have it, the next year you may not. With regard to your license to practice nursing—your RN credential—that’s listed second, because it’s more stable than a certification, but not as stable as an academic degree.

No-no #2: Listing every degree you ever earned

It's completely unnecessary to list within a string of credentials every degree hanging on your wall. I have seen some nurses list an associate degree followed by a nonnursing bachelor degree, followed by a bachelor of science in nursing degree. Here’s the thing: Your highest degree is the only one that truly matters. While it’s nice to write your life story in alphabet soup, that’s what résumés and curricula vitae are for. Some people rationalize that if they had a nonnursing degree prior to obtaining a nursing degree, it should be noted. Well, my thought on that is simple: If you are working as a nurse, unless that other degree is higher than your nursing degree, it is not essential to list it behind your name. If people want to see your nonnursing degrees, they can look at your résumé.

No-no #3: Listing more than one nursing license

This is probably the no-no that bugs me most. If you are an advanced practice nurse (APRN), we know you are a registered nurse, so there is no need to list both your RN license and your APRN specialty. It is also not a good idea to list APRN as your license, because there is no APRN license in nursing; the license is based on your specialty. When looking at your credentials, people don’t want to know that you are an APRN; they want to know what type of APRN you are. APRN is an overarching category that encompasses various types of nursing licenses—certified nurse midwives (CNMs), certified nurse anesthetists (CRNAs), nurse practitioners (NPs), and clinical nurse specialists (CNSs). Also, listing both APRN and your specific APRN license—as in “Your Name, APRN, CNM”—is not only redundant, it’s unnecessary for the aforementioned reasons.

No-no #4: Listing more than one specialty certification

You may want to list all your certifications in the form of alphabet soup, but why not leave something for people to learn about later? Really, you only need to list one certification. Which certification you choose to list is completely up to you. I tend to think that nurses should list their most honored certification, the one that requires the most work to maintain, or the one that is most prestigious to other nurses.

For instance, if I were a fellow of the American Academy of Nursing (FAAN), I would list that and not my inpatient obstetrics certification (RNC-OB) from The National Certification Corporation (NCC). Also, it is important to remember that some certifications can be combined with your license, while others cannot. For example, women’s health nurse practitioners who have been certified can list WHNP-BC, in place of WHNP, and still include another certification in their alphabet soup. However, nurses who are certified as advanced forensic nurses need to list both their licenses and AFN-BC.

Nurses should be careful to list only those certifications that are nationally or internationally accepted. For example, although most labor and delivery nurses are required to maintain fetal-monitoring certificates issued by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), this certification should not be included in our credentials. To help distinguish between certifications that are credentials and those that are not, answer the following questions. If you answer yes to each one, you have a certification that can be listed as a credential.

• Did you have to pay extra money to obtain the certification (not to take a class, but to submit an application and take the test)?
• Did you have to take a test similar to the NCLEX-RN to obtain this distinction?
• Do you have to earn more CEUs than other RNs to maintain the certification?
• Do you have to show proof of CEUs or retake the certification examination to maintain the certification?
• Does the certification come from a national or international credentialing organization?

If you are still unsure, look for the proper way to list the certification on the certifying organization’s website. If no instruction is provided for listing the certification with your other credentials, it’s probably not the type of certification that should be included in your alphabet soup.

No-no #5: Listing non-specialty certifications

Unfortunately, I have seen nurses who list advanced cardiac life support or other required patient-care certifications among their credentials. What’s worse, I have even seen BLS—yes, as in basic life support—listed as a credential. Clearly, nurses who do this do not understand that a credential is a degree or certification that’s above and beyond anything required to work with their patients.

If you aren’t sure whether or not you’re certified, you probably aren’t. Certifications require an application process that is completely separate from each state’s nursing-license application process, and there is a test that must be passed. Such certification tests are similar to the NCLEX-RN, but they are each given for very specialized areas. A number of certifications can be found on the American Nurses Credentialing Center, while other certifications developed specifically for women’s health nurses, pediatric nurses, and nurse educators are found at The National Certification Corporation and the National League for Nursing, respectively.

As nurses, we have fought long and hard to receive certain distinctions based on our education. I agree with nurses who believe it is important to let others know of our commitment to our profession and our commitment to meet and maintain the highest level of distinction in our areas of expertise. However, to do so, we don’t need a list of letters behind our names that is long as the alphabet itself. I’ll use myself as an example. here:I list my credentials as “MSN, RNC-OB, C-EFM.” This lets others know that I have a Master of Science in Nursing degree. I am a registered nurse, certified in inpatient obstetrics by the NCC and with additional certification in electronic fetal monitoring, also from the NCC (this in addition to my AWHONN advanced fetal monitoring certificate, which is not listed among my credentials).

I encourage RNs to give a great deal of thought to their alphabet soups and list only: 1) their highest earned academic degree (in other words, it shouldn’t be an honorary degree), 2) one nursing license (with certification, if appropriate), and 3) one nationally or internationally recognized specialty certification. Not only is this the proper way to cite your nursing credentials, it also keeps members of our profession from looking like egotistical credential fanatics who only maintain certifications so we can list them behind our names.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

The ministry of nursing

I recently heard this quote: “Your job is what you’re paid for; your purpose is what you’re made for.” I absolutely love this! I recognize that not every job involves work about which one is extremely passionate. After all, there are times when we have to do what we have to do in order to pay bills and keep our heads above water. But those are just jobs. Without a doubt, nursing is a profession and a unique health care discipline, but for some it may be simply a job.

When I first became a nurse, I couldn’t understand how any nurse could not love working in the profession. I thought it was a slap in the face of nursing to work in a position that calls for a caring, nurturing disposition, yet hate what you do. I began to realize, however, that some of my colleagues had either been working so long as a nurse that, even though they didn't love what they were doing, they didn’t want to change careers, or they had become accustomed to a lifestyle they didn’t want to give up. For them, nursing had become nothing more than a job! I looked at these colleagues and thought, “I could never be like that.” Then it happened to me!

After working nights, full time, for almost 5 1/2 years, I had gotten to the point where I hated my job—the nurse bullying and management manipulation, the favoritism shown by the charge nurse for certain nurse buddies, the feeling that I was just an employee about whom upper management did not care. It was more than I wanted to deal with. I had to get out. Nursing was no longer my passion; it was simply that which provided my paycheck. This was a problem for me. I don’t believe in doing anything I am not passionate about. Quite honestly, I spend far too much time working to have a job I hate. I knew something had to change!

I took a day-shift position, away from the bedside. It was the best move I ever made in my nursing career, not because of the change in duties, but because of what my chief nursing officer said during employee orientation. She observed that she was not a nurse in the nursing profession, but rather a nurse in the ministry of nursing. That one statement completely changed my outlook on my place in the nursing profession.

I was reminded that my desire to become a nurse was what had driven me to college in the first place. Had it not been for that desire, I don’t know that I would have gone to college. Seeing nursing as a ministry with a purpose refueled my passion for the profession; not ministry in the sense of providing spiritual guidance but as a vehicle for helping others achieve their absolute best. In addition to caring for patients, I began to see nursing as a way for me to encourage others to use the opportunities provided by the profession to get out of poverty, obtain a good education, and step into leadership roles. 

If you have come to a point in your career where you no longer feel the same passion for nursing you once did, I encourage you to change your view of the profession. Instead of viewing nursing as simply a job, view it as a wonderful opportunity for intellectual growth. Find avenues within the profession that allow you to use the gifts or talents you have. Look into new job opportunities and career advancements. Consider returning to school. Share with others how nursing has provided freedom to travel, meet new people or care for interesting patients. See the profession as a way to leave a legacy in this world. As a nurse, the work you do is not about you. It’s about the people you care for, inspire and encourage. In short, it’s about the ministry of nursing.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.