Labor Market and Career Information

Licensed Vocational Nurse
Cindy Graham

	Introduction Chances are, you've probably seen ER. The popular TV series reveals the drama, excitement and occasional tedium of a city hospital emergency room. Cindy Graham, an Emergency Room Nurse in Texas, has lived that life for almost as long as the show's been on the air. So the question must be asked: Does Cindy watch ER? The answer is no. I've seen it once or twice but that's it. I think I know too much to enjoy it. Part of it's accurate and part's far-fetched. It turns out that the reality of being an ER nurse is more interesting than any TV show can reveal. You have to be able to deal with so many different people and circumstances. That's one of the things that Cindy loves about her job. I've done some OB (obstetrics, i.e., helping deliver babies) and I've worked in a federal prison, Cindy explains. But I keep coming back to the ER. It's like an addiction. I love the fast pace and never knowing what will come in the door. Three patients with chest pains can come in back-to-back and no two of them will be the same. If you like to help people, perform a wide variety of tasks and work in a rapidly-changing environment, the career of ER nursing may be for you. And with that kind of experience in your pocket, your future is wide open.

	What exactly do you do? I'm a licensed vocational nurse in a city hospital emergency room. I help doctors, registered nurses and other LVNs treat patients who arrive at the hospital by coming in themselves or being delivered by the Emergency Medical Services team.

	Describe a typical day. When I first arrive, I get the report from the previous shift's nurses, explaining how each patient is doing. I read each patient's chart and make sure the proper lab work has been ordered and received. I generally try to see what has been done and what needs to be done. Then I visit the patients and ask if they need anything, how they are feeling and so on. I explain who I am and what's going on with their treatment. If they're in pain, I let their doctor know and give them pain meds (medications). I re-assess them about thirty minutes later to be sure the medicine's working. A lot of time it's a waiting game for the various labs and tests. We're here to figure out what's wrong. If people need long-term care, they don't get it in an ER. That's not what we're about.

	What's the coolest part of your job? I get to see some really fascinating things. One day, for example, a guy came in with a really bad cut what we call a laceration on his wrist. He and his friend had gotten into a fight. He punched his friend, who was standing in front of a window. When the friend ducked, this guy sliced open his wrist on the window glass. It might sound strange, but it was really cool to see all the ligaments and tendons in his arm. You learn about anatomy and all that in nursing school but to actually see it on-the-job is pretty cool.

	What's your favorite part? Helping and teaching people.

	How do people react when they learn what you do? They look at me like I'm crazy. They wonder why I do it. I guess they watch the TV shows and think we're all just hanging out with the doctors. Most of my friends are teachers or work in some business. My job's a little different from theirs.

	Describe a funny or unusual incident that happened at work. A lot of what I've seen I can't repeat! We did deliver a baby in the ER one time. Usually that's something that happens on the OB/GYN unit and we don't like to do it down here. It was the mom's fifth or sixth baby, though, and she just didn't get to the hospital on time. I had worked OB before but it'd been a while. Luckily, everything turned out fine.

	What's the part you like least about your job and how do you handle it? I don't like grumpy patients or drunk people. To deal with it, I just have to try to stay positive and understand that they don't want to be here in the ER. I just remind them that I'm trying to help and I'm doing the best I can. I ask them to be patient and not yell at me, although inside I want to yell back at them.

	How did you become an LVN? When I started college, I didn't know what to do. A friend of mine said she was going to apply to nursing school and asked me to go with her. So I did. I'd been a nurse's aide before and I was concerned that being a nurse would be the same. She said it was different and it is in many ways. I got my license after a year of taking required courses (pre-requisites) and then a year of nursing school.

	What pleasantly surprised you about your work when you first started? All the different fields nurses can go into. You're not stuck in an ER or medical/surgical unit in a hospital. With other careers, you have to keep doing the same kind of thing in the same environment.

	What disappointed you? The pay. I thought nurses got paid more. Registered Nurses (RNs) do get paid more and I've got a few more courses to take before I can become an RN. I'm married now and have kids and that's taken precedence over my career. One good thing about the nursing profession is that you don't have to go to a college to get to the next level. You can take courses from private organizations, too. You only have five years from when you take your last nursing course and when you go back to become an RN. There is an at-home learning program, though, that enables you to wait ten years. That way those of us who put our careers on hold to be parents can keep advancing.

	How has your job changed over time? I've seen advances in nursing and medicine. Today, for example, we can give stroke patients medications that reverse the effects of the stroke if used within a certain number of hours. It's amazing and it wasn't around when I first started. I've also changed where I've nursed, though I keep returning to the ER. For a while I worked in a prison after getting sick of the ER. It offered good money and benefits. I worked the graveyard shift the only nurse at the medium-security part of a prison. I served about 2500 people. Some nights nothing happened and some nights it was like being back in the ER. I'd see heart attacks, drug overdoses, knife wounds, you name it. I'm back in the ER now, though!

	How have you changed over time? I've reached the point where I don't care what other people think. Now I think: This is me. If you like me, fine. If you don't, fine. I think nurses need to be that way so that they can advocate for their patients and stand up to doctors. If a patient is in pain, for example, the nurse needs to wake up the doctor at 2am to ask for a prescription or for the doctor to come in. Doctors are not happy at that time of night! But the nurse has to be willing to call anyway. The nurse also has to be willing to stand up to members of the patient's family. Several times we've had a patient with DNR (do not resuscitate) orders and someone in the family doesn't want to honor it. He or she will keep pushing us to try to keep the patient alive. As a nurse, you have to stand up for the patient and his or her wishes. I've also grown professionally When you're first out of nursing school, you have to prove yourself to other nurses but I've been doing it for seven years. My fellow nurses know and respect my work and that feels good.

	What will LVNs be doing ten years from now? We'll see more advances in technology and in medicine. We'll also see more computers. We already use an automated system to get medicines. We type in the patient's ID, our own ID and password and what medicine is needed and the med drawer opens up. It's like a soda machine for medicine. Other facilities are already going to computerized charts, so computer skills definitely help. I think we may eventually have all patients' records on computer and won't need to call their doctor's office anymore. Who knows if that'll happen.

	What are some of the most important skills and abilities needed for this job? Good communication skills, both oral and written. A nurse has to communicate with patients, doctors, other nurses and families. You also have to have some compassion. You don't have to be able to diagnose illnesses; that's what doctors are for.

	How much of that is learned and how much has to be natural aptitude? I think anyone can learn communication but some people are just gifted with it.

	What information do you need to keep up in your field and where do you get it? I need to know the newest technologies and medications and treatments for different diseases. I learn these by attending training classes that the hospital sends us to. I'm also a member of the Emergency Nurses Association. They produce a magazine and I read it and other nursing magazines.

	What advice do you have for people who want to enter this field? I think it's a great field to go into and we need lots more people to become nurses. You've just got to study and get good grades.

	What do you wish someone had told you before you left high school that would've helped you with your career? Don't stop at an LVN! Go ahead and go all the way to an RN before you get married. Because now that I'm married and have a child, it's really harder to go back. I never believed it when people told me that but now I see that they're right. I thought, "I'll just work a while. I'll go back." Well, it's seven years later...

	Quick Facts
	The Job in Brief
	Title:	Licensed Vocational Nurse
	Description:	Help treat patients in a city Emergency Room.
	Education level required:	Vocational training; license required
	Equipment used:	SURE-med, IV start kits, blood pressure machines, syringes, crash cart
	Workload steady or fluctuating:	Fluctuates seasonally. Respiratory patients in winter and trauma patients in summer.
	Dress code:	Hospital scrubs
	Work environment:	Emergency room of a big-city hospital

	Demands on Worker
	Works hours (time and duration):	7am-7pm, 3 days a week BUT you have to punch in at 6:45 and leave at 7:15. But if you've got a CPR in progress when it's time to leave you can't.
	Travel involved:	Score: 1 (To classes. Have ridden with EMS and seen what paramedics go through. The unit I rode with was on call for 24 and off for 48 hours. May be as serious as a stabbing or as stupid as a toothache. You'd be surprised.) (1=never; 5=very often)
	Average stress level:	Score: 3 on average. Depends on what day you catch me. (1=none; 5=a lot)
	Amount of teamwork needed:	Score: 5. It's always teamwork. If I can't get the IV started, I ask for help and vice versa. (1=none; 5=a lot)
	Level of self-motivation required:	Score: It's got to be a 5. You've got to be able to say this needs to be done and what we've got to do. (1=none; 5=a lot)

	Labor Market Information
	Employment outlook:	The Licensed Practical and Licensed Vocational Nurses occupation is expected to grow about as fast as the average for all occupations through 2010.
	Typical Texas salary:	$25,722 - $31,436 a year