Nursing offers flexible, rewarding careers

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. Careers in nursing provide work that is meaningful and rewarding. And today, especially, nurses are in high demand. Joining me for a look of the rewards of this career is Scott Jessie. He holds a master's degree in nursing from Upstate's College of Nursing, and he has more than 20 years experience in the health care field. Today, he's a member of hospital leadership, serving as Upstate's chief nursing officer. Welcome to "The Informed Patient," Mr. Jessie.

Nurse Scott Jessie: Thank you, Amber, for having me; excited to have a conversation with you.

Host Amber Smith: Nurses really are at the heart of patient care. And I don't think the health care system could operate without them, but the importance of the role comes, at least potentially, with a lot of pressure. Does the profession naturally attract people who are good at working under pressure?

Nurse Scott Jessie: I think the profession attracts a really wide variety of people, and I think that's the beauty of the profession, honestly. There is a lot of pressure in some kinds of nursing, for sure. It can be very, very intense, and in other different types of nursing practice, maybe a little bit less so, and I think that gives a lot of different people options when they get into the career. I do think you have to definitely be a committed and caring person. I think everybody who gets into nursing at the base level likes to work with people, likes to help people.

That's why they do it. It is a such a difficult career, if you didn't like to do that, I don't think most people would last very long, to be honest. The pressure comes and the pressure goes; it depends where you work. The pandemic made the pressure relentless, honestly, for a lot of nurses for a long time. We're still in it, right? The last two years have been, professionally, the most challenging thing I have ever done. I daily make comments like "I never thought I would ask somebody to do that," "Oh, I'd never thought I'd make a plan to have to react to that." The pandemic brought forward what we all learn about in school, all health care providers learn a little bit about it in school, but none of us in our lives, no one alive ever lived through a pandemic, so it was all theory, and we had to put that to practice essentially overnight. So the pressure for that was tremendous. Day to day, however, it depends. I mean, everybody knows health care is stressful, whether you work in a physician's office where you see an awful lot of patients a day, or you work in the emergency department or an acute care med-surge unit taking care of patients, patients' lives are in your hands. It's a high-responsibility position. It's stressful. It is beyond rewarding, and I think that's why people do it and go through that stress, because if there was no reward at the end of that, I don't know if you would willingly stay in such a stressful spot. But yeah, it is stressful, it's challenging, and I do think people who get into it, I don't know if they're all great at dealing with pressure initially; they learn that over time. I think what they do realize, or come to the profession with often, is the ability and acknowledgment that they need to be flexible. Our day's never the same, no matter what we do, and you have to be able to pivot, and that's really important.

Host Amber Smith: So, someone who enjoys helping others, maybe high school student or college student who likes science classes. Is that important, to like science or biology or chemistry? Do you need to have that ability and interest?

Nurse Scott Jessie: I would say yes and no. We end up getting nurses with all different kinds of backgrounds and degrees. We have a lot of nurses, ultimately, who end up going back to school after they've earned a bachelor's in something else, for example, and end up in the health care profession. Science: I think naturally you have to be an inquisitive person to be a nurse. You have to like and understand how the body works. That's really important from that perspective. I, 100% agree in the science piece. Do you have to love chemistry? Maybe not so much. I can certainly tell you a lot of nurses would say they didn't love their chemistry classes, but you have to have some basic understandings. The amount of knowledge that you need to be a nurse is tremendous in reality. We take care of all ages of patients under all circumstances and all disease types. And the number of medications, for example, that are available has grown exponentially over the years.

And you have to know how they work and how they interact. And we, thank goodness, have tremendous partners in pharmacists who help us with those things, but at the bedside, you're the person giving the medication, nobody else is, and you have to know the risks and the safety concerns and how they interact, and if it's the right medication, and so, yeah, science is very important. Excellent communication skills are very important. Being a people person is very important. So, science is key, good, broad background is really important, I think, for people who are interested in getting into the field, though.

Host Amber Smith: Well, let's talk about what attracted you to nursing. When did you decide you wanted to be a nurse?

Nurse Scott Jessie: I wasn't going to be a nurse. That was not my career plan. In high school I got a scholarship to go to Syracuse University for electrical engineering and go into the Air Force. I was very excited about that. I did go to Syracuse for my freshman year. I did not enjoy electrical engineering very much; it turned out not to be my favorite thing. And I was struggling with boy, could I do this as a career? So I went and talked to the Air Force, and they had given out scholarships by degree types because they need certain people in certain roles, and I said, can I change to a different specialty of engineering?

And they said all the slots were full. And I had a friend who had just become a nurse. And I said, what about -- SU still had nursing at the time -- and I said, what about nursing? I would be interested in that. And they said those slots were full. So I made what was a very difficult decision as an 18-year-old to walk away from the scholarship and potentially that whole career path and finished my freshman year and moved home and went to community college at Cayuga Community College in Auburn.

Nurse Scott Jessie: And, I was a little, like, I don't know what I want to do. I got a degree in criminal justice. And, while I was interviewing for a position as a police officer, I decided to apply to nursing because I had several friends at this point who had gone into the nursing program at CCC, and I joined the program.

I was also involved in my volunteer fire department, was an EMT and had some exposure that way. Getting involved in that solidified for me that health care was the career path that really was right for me. I got into the nursing program, stayed in the nursing program. It was the best decision I ultimately ever made, although it was difficult at the time, and CCC was a fantastic place to get my entry into the program. I had wonderful experience, and obviously it has worked out well for me over my career.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith, talking with Scott Jessie, the chief nursing officer at Upstate. We've been talking about nursing careers, so I want to let listeners know that they can learn about educational options at Upstate by visiting upstate.edu/con -- short for College of Nursing. Now in general, what's involved in the educational training of a nurse? I'm assuming there are classes in anatomy and physiology. What else?

Nurse Scott Jessie: There's definitely anatomy and physiology, pharmacology, there's hard, basic science classes: chemistry, biology, math, common requirements that are typical in a lot of undergraduate degree programs at base level. And then there's other things that are very nursing focused and obviously the clinical program, and experiences for school, but population health, public health nursing, pharmacology, things like that that are very specific, patient assessment, things like that.

Depending on what kind of degree program you're in, if it's an associate's degree or a bachelor's degree program, the length of time varies, but a lot of the core courses are very much the same in either program. And at a minimum, you have to have an associate's degree to be a registered nurse in New York state, but you can enter nursing with a bachelor's degree as well.

Host Amber Smith: So talk to me about the difference between an LPN and an RN. Do you start out as an LPN and then become an RN?

Nurse Scott Jessie: So LPN programs, traditionally in some schools, I think some even high schools still have LPN programs through like a BOCES-type program. The LPN program is, a lot of the materials are the same, but it's not as completely thorough as the registered nurse program.

It's shorter normally. Some nursing programs -- I don't know if they still do this in associate's programs -- when I got my associate's degree, they did let you test out to take your LPN license, if you chose to, while you were still in the program. I did not do that. A couple of my classmates did.

Nurse Scott Jessie: But, a lot of common material, but there's more material and more intensity to the associate's degree program. And obviously the bachelor's program, different licensure exam, more responsibilities in the registered nurse role. but both roles are tremendously helpful in the health care system. They're partners, they collaborate, and we need more of both.

Host Amber Smith: So how many years does it take to become a registered nurse? What's the shortest period that you might be able to do it in?

Nurse Scott Jessie: The quickest that I'm aware of that you could do it if you were full-time in an associate's degree program would be two years. That often includes some summer classes. It's an intense course load.

I was lucky because I had already had an associate's degree, so I was able to focus mostly just on my nursing courses and a couple of science classes. So I was able to go somewhat part-time, which made it easier because clinical and school was hard and I needed to work. I had a life, too. So it was hard. The quickest really, though, would be the two years. There are some three-year accelerated bachelor's programs, and most are four years, depending on which path you choose.

Host Amber Smith: And is it half classroom work and half clinical, or at what point do you start seeing patients as part of your training?

Nurse Scott Jessie: Sure. In associate's programs, you start pretty early in your first semester with patient contact because you have to. I don't know the exact requirements on hours, currently, but there are a specified number of clinical hours you must reach in the programs. And in the associate's degree programs, it's pretty early on. Some bachelor's degree programs wait a little bit of time before people start engaging clinically, and they focus on some of the other coursework and some incorporate that right from their first year all the way on through, and they have clinicals all the way through the program. It kind of depends on where you end up at school.

Host Amber Smith: I'd like to learn about what types of jobs are available to nurses. Let's start with hospital-based positions. What's typically involved in those?

Nurse Scott Jessie: Sure. On the hospital side, obviously there are tremendous opportunities in nursing. We here at Upstate are very lucky, in that, in our region, I'll put in a little plug for us, in our region, we offer essentially every kind of nursing that there is, and that is something that perhaps not all of the hospitals in our area could offer from a career perspective.

So you truly can come here, start in one place, spend a 30-year career here and do dozens of different kinds of nursing if you wanted to, in reality. We offer all the normal, routine, general nursing roles. We have all of the specialty roles. Our hospital does all of the specialty care for the region: We're the trauma center, the burn center, the children's hospital, we're a stroke center.

We have all of those options to use. So if you want to start out as a "med-surge" floor nurse taking care of medically ill and post-op surgical patients, and that's where the majority of people do start their career, we offer that. If you want to work in a very advanced operating room, we offer that. If you want to work in a trauma center emergency department, we offer that. We offer everything for children. That certainly is something that is unique. No other hospital in our region does children's care like we do, and we're the only children's hospital in a long radius of Central New York. So we offer all those specialties. On top of that, we offer a lot of ambulatory care. We have a lot of ambulatory (outpatient) clinics of all different types and specialties, so we have nursing positions in all of those areas, as well. We're really lucky in that way. We offer essentially all of it. There's rarely a time when someone asks us about a specialty, and we have to say, oh, we don't do that here. There's very little that we don't do. We're lucky.

Host Amber Smith: So a nurse who maybe works in the operating room and does that for a few years, could they potentially switch and go into ambulatory care or something different?

Nurse Scott Jessie: Yes, again, it's the beauty of nursing. We are not locked into any kind of specialty. Once you get your nursing license, and especially after you've had a couple of years of just good, solid experience, there's really not much you can't do. We have people move around all the time into positions, go to ambulatory, change specialties, go from a medical-surgical floor to the ICU (intensive care unit), for example. And in particular, especially in ICU, we have multiple ICUs in our hospital, way more that most other facilities. It's part of being the type of hospital that we are. We get a lot of transfers for specialty care. So we have neuro ICU, medical ICU, burn ICU, surgical trauma ICU, cardiothoracic surgery ICU, pediatric ICU.

That's not common in a lot of hospitals. So again, a lot of specialties, a lot of choices, and people move around to different things over their career.

Host Amber Smith: Are they typically eight-hour shifts or 12-hour shifts?

Nurse Scott Jessie: That's a magic question in nursing. A lot of people like 12-hour shifts -- a lot. We offer 12-hour shifts. We offer eight-hour shifts. There's definitely people who don't want to work 12-hour shifts, and we do definitely make sure they don't have to, when we give them eight-hour shifts. The flexibility is nice, though, because obviously your schedule can be quite different if you do 12-hour shifts. You work the same amount, but you're here less days in a pay period, which is great from a work-life balance, a family balance, going-to-school balance, things like that.

So it's nice in that there are options for that. Across the organization, in multiple different areas, people have choices.

Host Amber Smith: Can you give me a ballpark about how much nurses working in hospitals in New York state can expect to earn starting out?

Nurse Scott Jessie: Sure. I do think it's a little bit geographic dependent, obviously. People down in New York City area, large metropolitan areas, have higher pay scales. It costs a lot more to live there.

We are lucky it's a fairly low cost of living up here in Central New York. Typically, in our area, I think most hospital-based nurses start out in the low- to mid-$60,000, bordering on $70,000, range, and salary varies based on years of experience, degree type, things like that.

And often there's a stepwise increase over a number of years, probably topping out, for base pay. and I'll explain that in a second, for base pay, probably in the mid-$90,000 range for full-time work. On top of that, a lot of hospitals offer shift differential for working off shift, which obviously increases that base pay.

Some hospitals offer additional pay for location pay or geographic pay, which could also increase that. The health care market, uh, has had itself turned upside down with the pandemic, though, and pay scales for lots of jobs in health care and outside of health care have changed significantly, which is part of the workforce challenge right now.

One of our biggest challenges is travel nursing. The popularity and need for travel nursing has exploded during the pandemic. So that's when a nurse usually leaves their home area and goes and takes a committed assignment, usually a 13-week assignment in some hospital, somewhere. They work with a company who places them, and they get paid very, very well to do that.

The pandemic has increased the rates the travelers make significantly, and the demand for travelers has exploded by hundreds of percentages over the last two years because of hospital staffing challenges. So I think many hospitals and health care systems nationwide, and you see this in the literature, are all looking at their salary structures, they're reassessing what they need to do to make sure they can be competitive in their markets, get people in the door and keep people. That's important. Remember we talked a little bit earlier about the fact that nurses can do lots of things, and that's true. And there's lots of nursing jobs that are outside of hospitals, too, along with other health care jobs that are outside of hospitals. So, we compete for the same people. It's hard to compete and we have to stay competitive.

Host Amber Smith: Do nurses have to get licensed in each state where they work? If they go with a traveling company, do they have to go through certification and licensing in every state that they travel to?

Nurse Scott Jessie: Yes, essentially you have to either go through the process or go through what's called reciprocity to get a license in any state that you work in. The only circumstance I know of that that's not true, I believe, is the VA system, because they're federal. And if you have a license in some state, you can work in the VA.

I believe that is still the truth, but yes, normally there's a licensure process. A lot of nurses actually travel within their own state. Up or down the Thruway, for example, to Rochester or Albany.

Host Amber Smith: Well, let's talk a little bit about the jobs beyond hospital-based jobs that would attract nurses. I wonder if a nursing background is helpful to have for other related careers?

Nurse Scott Jessie: Sure. My answer to that would be a resounding yes. There's lots of actual nursing jobs outside of hospitals, for sure. Physicians' offices, clinics, insurance companies, things like that, but the nursing background really is very adaptable.

We talked about people need to be flexible in this profession, and I really do believe that. You can do a lot with this kind of education and training. You can teach, for sure. There are nurses who go on to have legal careers. There are nurses who go on to write for a living, to be consultants, to be speakers, educational offerings like creating or owning your own educational company and traveling around the country, offering continuing education seminars, things like that. So, there's a lot that doesn't have to be directly tied to the health care profession, but once you're a nurse, you're a nurse. That's in you; it's who you are.

It's going to be there no matter what you do, but it makes you better at all the other things you do, in my opinion. I'm biased, obviously, but I I really do think that's true. There's really no limit. Really kind of exotic examples: There are nurses who work in the entertainment industry and provide reviews of scripts and things like that. Medical consultants for shows for accuracy. Really, it's limitless what you could do with your degree. It's just really a valuable profession across the country, and we are still the most trusted profession in the nation and have been for a very long time.

Host Amber Smith: You mentioned continuing education. What are those requirements like for nurses? And that just means once you're a nurse, you still have requirements to stay up to date, right?

Nurse Scott Jessie: Every state's different, and there's two, different kinds of versions of this. For your license in New York, you have to do a small amount of continuing education that's focused mostly on infection control practices, I believe that's every four years. In some states you have to have a certain number of continuing education credits every time you renew your license. That is not required in New York. However, what is required for continuing education, if you're certified and we push very heavily for our nurses to be certified, we have, I believe we are up over 750 certified registered nurses at Upstate, which is a tremendous amount.

When you're certified, you do need continuing education credits to maintain your certification. That number and what those are varies by certification, but every type of certification requires them to some degree.

Host Amber Smith: Let's talk a little about advanced training options. What's available for nurses, and where can that take a person? Because you have advanced training.

Nurse Scott Jessie: Again, a lot of options Your bachelor's degree really starts to open your doors in the nursing profession. If you want to do things other than bedside care, that's usually always a requirement, uh, for jobs like case management, some leadership and management jobs require that. We're a magnet organization, so it is required our nurse managers all have to have a bachelor's or higher in nursing. That's part of magnet standards. But when you want to start to do some other options, there are plenty of them in nursing. you can get your advanced education and degrees and become a clinical nurse specialist. You can become a nurse practitioner in a variety of different types of nurse practitioner roles. There's a lot of them now. You can go on to other types of specialties, a certified registered nurse anesthetist is an advanced practice nurse. They function similarly to anesthesiologists. That is a specialty nursing can go into it. You can become a certified legal nurse consultant. You can become a forensic nurse. There's a lot. There really is a lot of options. some require formal advanced education and degrees, some require certificate programs, but there are plenty of choices, and there's good options to find them.

At our own College of Nursing, we have nurse practitioner programs, we have a doctor of nursing practice program. There are tremendous opportunities for people. We have a great tuition support policy for our staff as well. So we put a lot of people through school.

Host Amber Smith: It's nice the way you describe such flexibility, because it seems like this is a profession that might work for a person at different life stages. They could work full-time hours when they're young and energetic. And is it something that you can do as a part-time sort of thing as you're nearing retirement?

Nurse Scott Jessie: Yeah. We have a lot of staff who are full-time, and we have a lot of staff who are some degree of part time.

It is a very flexible profession from that perspective. It's flexible for a wide variety of lifestyles for people who have kids, for people who don't have kids, people who are going to school, people who are not, there's a lot of ability to be flexible there. And even at those flexible positions that the pay is fairly competitive, and often, much more than you would make in other types of part-time employment.

We also give benefits for our part-time staff. We give tuition benefits for our part-time staff as well. So I do think that is one of the draws to the profession, aside from the flexibility of choice of work, the amount of work that you choose to do, you can be half time, three-quarter time, per diem (by the day) -- there's a lot of options. I've even had some nurses over the years who worked for me, who only worked in the summer because they were teachers, and they would come over their summer break, and they worked as a nurse and filled in for people who were taking summer vacation. It was a win-win for everybody. It was wonderful.

Host Amber Smith: We've heard doctors complain that they don't get enough time with patients. Do nurses have those same complaints, or do nurses generally get more face time with patients?

Nurse Scott Jessie: Yes, they have the same complaints. It is hard with the pace of work to ever really have, quote, enough time in any of the roles in health care, I believe that to be true. The biggest barrier, honestly, with time with patients, is both how sick people are and how much of a workforce we have available. That's one.

The other is interfacing with technology and patients at the same time. We use a lot of technology in health care, right? If you've had the need to be a patient in the hospital, for example, I'm sure you've seen nurses and doctors rolling around carts with computer screens on them. So we do all of our documenting. We don't use paper anymore. We used to use paper all the time. So we use computer screens; well, the computer screen can be right between you and the patient, for example, right?

We don't want to talk to a computer screen; we want to talk to patients. So you have to make conscious efforts to find ways to stay connected to the human touch. That's what nursing is about. That's what it's always been about. And taking a minute or two out of a crazy, hectic day and literally going into a room and sitting and talking to that patient is sometimes the most meaningful thing that happens for that patient throughout their whole stay.

And I'm going to be honest, it's one of the most meaningful things that happens to the nurse, too, because we really do value that human connection. We don't have connections to computer screens. We do connect with people. And we talk about that a lot because it's very busy in health care. Everyone knows that; the pace is intense. But we are taking care of people. We're not building widgets. We're taking care of people. And that's what it's always going to be about. So we go out of our way and find the ways to make those connections. And we have to; it is ingrained in who we are. Physicians are the same way. I know they want to spend more time with their patients. It's difficult. It's very difficult.

Host Amber Smith: Well, thank you so much for making time for this interview.

Nurse Scott Jessie: Absolutely. Thank you.

Host Amber Smith: My guest has been Scott Jessie, Upstate's chief nursing officer. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at upstate.edu/informed. I'm your host, Amber Smith, thanking you for listening.