A Nurse's Battle with Burnout Sick of feeling overworked and underpaid, a 30-year nursing veteran wants to pack it in. Our advisers prescribe caution.
(MONEY Magazine) – ''Nightingales? It's sleazy,'' declares Gail Douglas, taking a drag on her cigarette. An operating-room nurse at Atlanta's Northside Hospital, Douglas, 50, is critiquing last season's controversial NBC sitcom about nursing students. For depicting them as nubile space cadets addicted to on-the-job sexcapades, the show drew so much fire from irate nurses' groups that it lost both sponsors and viewers and ended up being canceled. Reality had won the day, because anyone who has ever been inside a hospital knows that most nurses are serious professionals like Gail Douglas. In three decades on the job, she has worked in just about every nursing specialty -- ''general medical, pediatrics, intensive care, home health and now O.R.,'' she says. Along the way she married, had three daughters and divorced. But like most nurses, she never earned much: the $37,116 that she made during the past 12 months represents her top pay ever. Yet for the past 10 years Douglas has been the sole support of her family. , Now the worst of that grind is over: her older girls, Christy, 20, a bookkeeper, and Kathy, 18, a computer operator, help pay their way by working for a local carpet retailer. Neither one currently aspires to go to college. Youngest daughter Jennifer, 15, a high school sophomore, does want a higher education but knows that it'll be up to her to finance it. Sensing a future that's free of heavy fiscal responsibilities, Douglas has two goals: first, to halt a slide deeper into debt and, second, to change careers. ''I'll do anything that's not nursing,'' she says. ''Nursing's a dead end. You can't make the decisions, and if you want to advance you've got to move away from the bedside. Patient care is no longer No. 1, now that hospitals are run like businesses.'' Douglas is a forthright, blunt-spoken woman with an earthy, quick wit, an easy chuckle and a habit of sprinkling her speech with emphatic ''um hmmms!'' Her modest $80,000 ranch house in northeast Atlanta is casually furnished with mismatched pieces and unhung pictures that bespeak a hurried, harried existence. Nowadays the place is sans Christy, who recently moved out to share a house with friends (''Finally!'' gasps her mother. ''It's been a revolving door, um hmmm!''). With one less child living at home, Douglas was gradually able to add $250 to her puny reserve: split among credit union and bank savings accounts plus a whole life insurance policy with a cash value of $339, it totals a mere $1,139. Otherwise, she has only a guaranteed fixed annuity earmarked for her retirement, to which she contributes $162.50 of pretax salary each month under a deferred-compensation plan. Invested in government securities, it holds $5,045 earning 9.2% and will pay her about $8,000 annually when she is 65. Ticking off her scanty resources, Gail observes: ''Not much to show for 30 years, are they?'' Still, she is better off than many of the nation's 2 million registered nurses. She makes 15% more than the $32,160 that the American Nurses Association says is the average R.N.'s top pay. A 1988 survey by the association also found that only a fourth have retirement benefits. That's because 23% of U.S. hospitals don't offer pensions, and those that do often required up to 10 years' employment before the Tax Reform Act of 1986 shortened the time for vesting to a maximum of seven years. Yet even a steadily worsening shortage of nurses that has left 120,000 jobs vacant has not caused nursing salaries to rise dramatically. Douglas, for instance, can expect little more than cost-of-living raises annually -- ''and you've got to be perfect, perfect, perfect to get them,'' she says. Hospital administrators claim they can't pay more because as the population ages, a growing number of patients are covered by Medicare. Since the government- sponsored plan pays fixed rates for treatment, hospital revenues flatten. At the same time, nursing requires ever more stamina, technical know-how and ability to withstand pressure. For example, consider Douglas' routine on a recent morning. From her 7 a.m. arrival at the 455-bed hospital, she moved at top speed: into the locker room to change to scrub clothes, from plastic shoe coverings to shower cap, and up to an operating room kept chilly to prevent doctors from perspiring under the lights. There she set out surgical instruments (''There are two types -- what the doctor wants and what works best''); helped position the heavy operating table and X-ray machine; interviewed and wheeled in the first patient on his gurney; washed him; and took up her post at the surgeon's side. A hush fell, and for 20 tense minutes she deftly handed instruments back and forth to the surgeon while he implanted a chest catheter for chemotherapy. Surgery over, Douglas delivered the patient to the recovery room; buttonholed a salesman for a corridor conference about malfunctioning medical equipment; picked up supplies in pharmacies and stockrooms; sterilized instruments; and had a reassuring talk with the parents of the next patient, a five-year-old girl. The child, whose eardrums were to be drained, came quietly to the O.R. But when the anesthetist tried to slip the anesthesia mask on her, she suddenly panicked, struggling and screaming violently. Helping to hold her down until the anesthesia took, Douglas quipped, ''She's a wild woman,'' but the incident visibly shook the entire O.R. team. After the child was wheeled to recovery, Douglas tackled a sheaf of forms for detailing what procedures had been followed; stopped in the nurses' lounge to chugalug a Coke and join in the usual doctor-bashing (''they can be abusive -- you won't hear a good word about 'em from us''); and answered an urgent summons to restore the picture on a video-camera monitor that had failed in the midst of laser surgery (''I'm lodging an official complaint -- these are totally unsatisfactory working conditions,'' barked the surgeon as Douglas rushed in). By the time the camera was fixed, it was 11 a.m., the hour for her next operation. ''No lunch for me,'' she muttered, hurrying back to her own O.R. Though Douglas' hospital day ends at 3 p.m., she also moonlights, a practice common among nurses. Most find part-time nursing positions at other hospitals. But Douglas sought a change of pace as an all-purpose handyperson in a loose partnership with a friend, Charlotte Proctor. The two women relieve homeowners of such tasks as hanging wallpaper, carpentry, painting and landscaping. In a year, Douglas has cleared $2,000 and likes the work so much that she sees it as a second career. She is thinking of eventually moving with Proctor to the low-cost rural Midwest, there to live off the land and support herself by woodworking in winter and landscaping in summer. While not especially high, her freelance pay does replace some big bites out of her paycheck. Although she and the older girls get free health insurance from their employers, Douglas pays $1,612 a year for a policy for Jennifer. Another $480 is deducted annually for a $17,500 group term policy on Douglas' life. The hospital provides a death benefit equal to a year's salary at no expense to her, but she says she buys the supplemental coverage ''just so the house can be paid for in case I keel over before Jennifer finishes high school.''
But she is not earning enough to rid herself of some alarming debt. In the past year she spent $5,032, almost 12% of her income, repaying nonmortgage liabilities. Yet her consumer-loan balances still total $6,070, of which 82% carries steep credit-card interest. The largest amount is $3,100 at 18%, most of which she ran up for Christmas presents and on brief vacations to such resort spots as Panama City and Sanibel, Fla. The rest, she reports, ''is the girls -- I get a lot of 'Mamma, give me the credit card, I need to buy something.' '' Douglas also owes Sears $1,900 at 21% for furniture, as well as $1,070 at 14% on a credit union loan that went to buy Kathy a 1984 Dodge Colt. Whenever she can, Kathy gives her mother $50 a week in repayment. She misses many weeks, though, since her yearly salary is only $9,100. Technically, Douglas is also liable for a federal $4,000 PLUS loan (Parent Loan for Undergraduate Students) that financed a year of secretarial school for Christy. But Christy, who earns $10,400, is repaying the $3,750 balance at $50 a month. Even when she sends in only the minimum, Douglas spends $375 a month repaying consumer loans. The drain spurred her to shop for a home-equity loan ! that would at least allow her to get rid of her costly credit-card debt. But she is so much in hock that no bank would risk it. Because of her strained finances, Douglas has ruled out any possibility of funding Jennifer's education. Jennifer, an athletic girl who says in her soft voice that she likes ''any sport -- swimming, basketball, cross-country running, gymnastics if Mom could pay for it,'' is thinking of getting her higher education underwritten by joining the Air Force, and her mother has been urging her to investigate what programs it offers. Subsidized education is something of a family tradition, since Douglas' parents paid only $82.50 (''for my first uniform and books'') to cover her three years in nursing school. The daughter of a Saskatchewan postman and bookkeeper, she trained at Victoria Hospital's School of Nursing in London, Ontario. ''They didn't charge us tuition because we were used for labor,'' she says. Receiving her diploma in 1959, she moved to the States three years later in search of better pay. She worked in Chicago until a taste for travel led to a series of short-term stints at hospitals all the way from San Francisco to Atlanta. There she met and married Fred Harridge, an IBM field engineering manager (''which means computer repairman,'' she says), in 1968. The couple moved to Harridge's home town of Madison, a hamlet in north- central Georgia, and Gail switched to less strenuous home health nursing while the children were little. After her 1979 divorce she worked at country hospitals, but four years ago she sold her house and moved to Atlanta with the girls ''to get away from my ex-husband,'' she says. She does not intend to remarry: ''Everybody deserves one husband, and I've had mine.'' In the city, her wages initially fell from $12 an hour to $10, while her expenses rose by roughly 10%. So Douglas decided to train for a higher-paying supervisory job. Last year she began working toward a bachelor of science degree in nursing at Atlanta's Georgia State University, taking two courses at a low total cost of $525. But she is unsure about continuing, given her yen to leave the profession once Jennifer is out of high school. Even her hospital's revised benefits plan, which shortens the time required for pension vesting to five years, does not convince her that she should stay put. ''The most recent estimate for the maximum benefit is only 56% of my salary,'' she points out, ''and I'd have to work until 2003 to collect it. Um hmmm! I don't even want . to think about that.''
BOX: Bottom Line
Gail Douglas' first order of business is to eliminate the debt that has reduced her net worth to 39% of her assets.
INCOME Salary $37,116 Tax refunds 2,907 Freelance income 2,000 Interest 142
OUTGO Taxes $12,119 Mortgage 4,728 Car expenses 3,010 Consumer-loan payments 2,568 Credit-card payments 2,464 Medical expense 2,360 Food 2,300 Vacations, entertainment 2,000 Utilities 1,998 Pension plan payments 1,950 Clothes 1,920 Gifts 1,000 Home and mortgage insurance 953 Miscellaneous 840 Household repairs 700 Gail's education 525 Life insurance 480 Savings 250 Total $42,165
ASSETS House $80,000 Annuity 5,045 '87 Nissan Sentra 4,975 Personal property 3,000 Credit union account 500 Checking account 400 Cash value of insurance 339 Bank savings account 300
LIABILITIES Mortgage $48,000 PLUS loan 3,750 Credit-card balance 3,100 Charge account balance 1,900 Credit union loan 1,070 Total $57,820
NET WORTH $36,739
BOX: The Advice
DON'T BAIL OUT ON YOUR BENEFITS
-- THE PROBLEMS Getting free of debt, plotting a new career and planning for college financial aid
-- THE SOLUTIONS 1. Start to budget your way out of debt. 2. Stick with nursing. 3. Look into ROTC scholarships for Jennifer.
Gail Douglas and her three daughters recently met with Lewis Walker, an Atlanta certified financial planner, and Anne Sturtevant, director of Emory University's financial aid office, at Money's invitation. As Douglas murmured approving ''um hmmms,'' the advisers offered these suggestions: Clearing debt. Since Douglas has had no luck in obtaining a home-equity loan and still owes $1,070 to her credit union, she should use her own funds to pay off her debt, attacking the high-interest liabilities first. Walker thought she could best raise the needed cash by eliminating little expenditures -- a pizza dinner here, a movie there -- that she probably doesn't notice. To track them down, he recommended she start keeping a written record of her outlays as the basis for a budget. ''It sounds Mickey Mouse,'' he said, ''but it works.'' She should also avoid future debt by curbing her habit of using credit cards as an extension of income rather than the convenience they are intended to be. Nor should she lend her cards to her daughters for impulse buying. Switching careers. Given Douglas' lack of experience in running a small business, her notion of supporting herself by practicing a craft like woodworking struck the advisers as highly risky. Even if she managed to make a living in a field so unrelated to her training, she is unlikely to earn enough to accumulate the retirement funds that she sorely needs. A better strategy would be to build up her pension before going out on her own. She should work at the hospital for at least another five years. That way, she could collect half of her maximum benefit, or about 28% of her current monthly earnings. And when she does leave, she should explore entrepreneurial opportunities in health care, her area of expertise. For example, she might open an agency to provide home health aides. Funding Jennifer's education. The Air Force Reserve Officers Training Corps offers four-year scholarships, which include a $100 monthly stipend, at some 650 schools. In return, Jennifer would owe the Air Force about 10 hours of classwork a week, a month of field training between her sophomore and junior years, and four postgraduate years in the service. Her high school guidance counselor or a local Air Force ROTC unit can supply applications. Noting that Jennifer's grade-point average would have to be at least 2.5 for her to qualify for the ROTC, Sturtevant asked how well she was doing. When Jennifer admitted that her GPA is only 2.0 -- equivalent to a C -- Sturtevant urged that she hit the books harder. Because of her enthusiasm for sports, she could also apply to colleges that offer athletic scholarships for women's sports. A few weeks after meeting with the advisers, Douglas reported that her budgeting was working so well that she expected to have her $1,070 credit union loan off the books in a month. Jennifer had not yet requested any college aid information: ''She's too busy with softball,'' said her mother. Douglas still liked the idea of moving to a rural area and earning what she could woodworking. ''But I'd supplement it with part-time nursing,'' she said resignedly. ''It's hard to get the traces off an old war horse.''