Wendie A. Howland MN RN-BC CRRN CCM CNLCP LNCC has decades of experience in the health care field. She is a graduate of Boston University, Boston MA (Bachelor of Science, Nursing), and the University of Washington, Seattle WA (Master in Nursing, Physiological/Critical Care, thesis program, award for research).

Following years of critical care experience, she now has more than a decade of experience in catastrophic case management and life care planning so she has a wealth of knowledge to share those interested in pursuing a career in nursing.

How did you first come to be interested in the health care field and at what point did you decide to pursue it as a profession?

My brother and sister were very severe childhood asthmatics back before the useful drugs we have today. From a very early age I was always aware of physicians, nurses, hospitals, and medicines in big brown bottles. I went to many of their doctor appointments. Our GP gave me old medical magazines to read in the waiting room and it interested me. In high school I took summer jobs in the local hospital, one year as an x-ray darkroom tech, then two in the OR/ER/Central Sterile Supply. I got to observe and participate in many different aspects of care, and decided to go to medical school. Then I was surprised to discover that I liked what nurses did with people more than what doctors did. Everyone told me I was too smart to go to nursing school, but I said that people needed smart nurses, too. So when I went to college, it was for nursing.

“Wendie A., CNA and Nursing expert”

Wendie A. Howland MN RN-BC CRRN CCM CNLCP LNCC has decades of experience in the health care field. She is a graduate of Boston University, Boston MA.

You started out as a nursing assistant; can you describe what kind of work you were doing?

As it turned out, I took a year off from school after my first year and had to support myself. I saw an ad from a city hospital saying they would train nursing aides (this was before there were certifications) and employ them, so I applied and was accepted. After training they placed me in a 26-bed geriatric women’s ward, built in the 1800s, an open ward with curtains between the beds and sinks at the ends of the room. I worked 3:30-12midnight with one RN. We never had more than one or two ambulatory patients at any given time, and most often, none. It was intensive basic nursing care– bathing, feeding, turning, skin care, dressings, range of motion, treatments, and what psychosocial support we knew how to give. Our patients were mostly poor, with few resources outside the hospital, so we worked hard to get them ready for discharge. Looking back on it now I realize that the RN needed far more help than I was trained to deliver, but she saw that I was a quick study and I found myself doing what would probably be called LPN work, except delivering medications. When I returned to college a year later, I kept on working 3 shifts a week and all of my vacation time.

At what point did you decide to pursue your Bachelors and then ultimately your Masters in Nursing?

I went straight to college from high school. I always intended to get a degree from the beginning, although it was not nearly as common as it is now because so many hospital diploma schools of nursing were still open. Associate’s degree programs were just getting started.

Online education was unheard of, and would have been ridiculed if proposed. How can anyone learn nursing sitting at a computer? You can’t.

As I went along in my career, I had many opportunities to help teach new hires, students, and other nurses. I realized I had a talent for it and learned that if I wanted to teach formally I would have to have a master’s degree. I had been seven years in critical care, largely open heart surgery, at that point, so I took a program in cardiovascular/pulmonary physiological nursing with a sort of minor in teaching. My program required original research and writing a thesis, so I also learned a great deal about doing and evaluating research. This has been invaluable throughout my working life, because as a profession we must rely on evidence-based practice and research to give the best care to patients, families, and communities.

What lead you to shift from patient care to your current role as a life care planner?

More serendipity. My clinical specialist job was closed by the hospital so I took what I thought would be a temporary job in work comp insurance case management. That temporary job led to 18 years of progressive experience with disability management, care coordination, insurance carriers, attorneys, vendors, and other resources, and that led me, eventually, to life care planning. What are some of the most rewarding aspects of your job?

There are two spheres here, one personal, one professional. Of course I get a lot of satisfaction assessing a catastrophic patient situation for needs and putting together a comprehensive plan that outlines everything needed for care and safety for a lifetime, or helping an attorney office obtain funding for such a case. It’s also personally satisfying to find that my whole professional life has given me the skills to be successful.

I am also very pleased to find myself heavily involved in my professional organization, helping to develop standards that will apply to every RN doing life care planning and editing our professional Journal. I work with wonderful, intelligent, expert, energetic colleagues with great pride in nursing and the power the RN license bestows upon us. In many ways, leaving the bedside has made me even more of a nurse than I ever thought possible, by putting me in a position to give back to the profession.

What are the most challenging aspects of your job?

Keeping up with new technologies, medications, surgeries, and equipment for rehabilitation and long-term care needs is never-ending. Fortunately, I love learning about new thing, I’m good at research, and my colleagues are always willing to share information and resources, so that’s helpful. I’m an independent businesswoman. As any small business does, sometimes we have to wait to be paid for our work. Sometimes business is fast and furious, sometimes it’s slow. We roll with it and keep smiling.

Looking back, would you change anything about your career path if you could do it all over again?

I don’t think so. I never anticipated being where I am today– for one thing, this kind of work didn’t exist when I was in college or for years afterwards. I thought I’d be in critical care forever. Then I thought perhaps I’d be in the insurance arena until I retired. But now, knowing everything I know, I am in exactly the right place, and I would never have been able to do it without everything that came before.

Any words of wisdom that you can offer to students who are considering a career in the Nursing field?

I do a fair amount of online teaching in an online nursing forum, so I hear a lot about the contemporary student experience. I hear what their challenges are, and how they decide to face them. It’s great staying in touch with nursing education in this way. This is what I tell them:

1). Ask every single nurse you see why s/he does what s/he does, and more importantly, why s/he doesn’t do what s/he doesn’t do. Some people love OB or pedi (many students think they will); some folks will tell you precisely why they hate them. Some will rave about the opportunities that case management or legal nurse consulting give you now that they are older and their knees and backs don’t want to do bedside care anymore. Some will tell you about occupational nursing, working with the working population in a company or industry, or teaching, or the many kinds of rehabilitation nursing (sports, brain injury, children, ortho …) or addictions or public health. Students who train in SNFs and hospitals don’t see any of this, but they need to know it’s all out here for them, and more.

2). Get your BSN as fast as you can, directly. Why? Many people say that all RNs are the same, all nursing programs have the same clinical hours requirements (not true), we all take the same NCLEX exam, we all get paid the same (also not really true), so any difference in educational preparation is just fluff, not “real nursing for bedside care.” Ah, so short-sighted. Suppose you learn you have a gift for leadership in a few years– but when the opening comes up, it’s BSN only. Or you fall in love with a high-risk public health OB clinic– BSN only for public health nursing. Or you think the hours of a school nurse would be really perfect now that your kids are finally in school– BSN only for school nurses. Or you do a field trip to cardiac rehab or a diabetes educator’s practice, and get really into the idea of nurse-led health care for these special populations– BSN only. Or you want to be a nurse midwife– that’s MSN, and you need the BSN first. See where this is going?

I know that it is very, very tempting to think that it’ll be easier starting with an LPN or ASN, get licensed, and then finish your BSN, perhaps in a “bridge” program, once you are working and earning money. The problem that almost every student discovers is that your first years of work as a nurse are stressful, filled with learning and hard work, and nursing school is hard, too– you won’t be able to do it all at once, especially if you plan to have some (any) sort of life/family. Some plan to finesse this by taking an online BSN or even RN-to-master’s program, thinking that this will be easier and less expensive. Nothing is farther from the truth. Online programs are very expensive, people get in trouble on the loans they push, and the “classes” aren’t like sitting at your computer surfing websites.

And many programs, especially the online and trade schools, are not accredited nationally; even if you can graduate and your state approves the program so you can take and pass NCLEX, you may find that another state will not license you, because your program was not nationally accredited. This comes as a huge shock to their graduates every year.

Nowadays with the increasing emphasis on the BSN it’s my opinion that nobody should waste time on an intermediate step– go directly to the accredited, brick-and-mortar (and live patient) BSN and be done with it.

3). Prepare for nursing school. Take all the math and science courses you can get your hands on. You WILL need them and use them. Nursing requires the ability to solve puzzles, plan independently, and think on your feet. The days of “only following doctor’s orders” are long, long gone. Nurses are autonomous professionals with reason to be proud and strong. We need you out here.

You can follow Wendie on Twitter: @howlandhealth