50 years, 9 lessons — 1 CNO on long-term nursing trends

Nancy Bisco, BSN, RN, has many life lessons to share after her 50-year career, most of which was spent in leadership roles.

Ms. Bisco said she knew she wanted to be a nurse when she was seven. She began her career as a candy striper and eventually became a nurse at Newark, N.J.-based Saint Michael's Medical Center in 1976. 

"It was the only hospital I applied to," she told Becker's.

After two years, Ms. Bisco decided she wanted to be a nurse manager. When her supervisors said she was too young, she resigned. They refused to accept her resignation and let her try being a manager. Two years later, she wanted to be a director, and after another brief resignation, she was given the role. She then transitioned to Columbus Hospital in 1982, where she stayed for 18 years in various leadership roles before returning to Saint Michael's in 2000.  

After a 50-year nursing career, Ms. Bisco retired as chief nursing officer, but she is staying on as a per diem nurse manager because "I'm not ready to leave my work family yet," she said.

Here, Ms. Bisco shares nine lessons she learned through her half-century career: 

Surround yourself with good people: "I always tell people to surround yourself with good people because then everyone becomes successful. That includes not only the people that report to me, but to physicians and others we work with. It's important to be very approachable, have mutual respect, a lot of open communication and never be adversarial even when they don't like the message I have to deliver." 

Figure it out: "I've always been open to taking on new challenges and opportunities to broaden my level of expertise. There were a lot of times where leaders would ask me to take over a project or unit that I had no experience with and I would just figure it out."

Some trends come back full circle: "Having longevity has helped me see the different highs and lows that have happened in nursing. When I first started working, we had licensed nurse practitioners and team nurses. As time went on, we evolved into primary nursing and drifted away from utilization of LPNs. Now, we have come back to using LPNs because of the nurse shortage. I saw it all evolve until it went full circle."

Invest the time in mentoring: "Many new nurses are not as well prepared, and it takes them longer to acclimate once they enter the field. That leads hospitals to using more agency nurses who don't have the commitment of employed nurses. That's why I opened up Saint Michael's to hire new grads again, which they haven't done for a long time, because nobody wanted to invest the time into mentoring and supporting new nurses. I encourage managers to embrace that attitude and I encourage new nurses to do an internship in as many hospitals as offer it, so when you enter the field, you have a good foundation and you're not overwhelmed, frustrated or scared."

We are not mind readers: "Don't feel that any question is a stupid question. We are not mind readers, we don't know if you're uncomfortable with something. Find someone to join at the hip with, a mentor, to help you learn and who you can bounce ideas off of."

There is no playbook for certain things: "The pandemic showed us that in some cases, there is no playbook. If you have good decision making skills and a basic foundation, you can get through so many challenges." 

The two things that irk Ms. Bisco: "Twelve-hour shifts irk me. When I first started, I would do five, eight-hour shifts. In that system, I really got to know the patients and their families. But the 12-hour shift disrupts that connection with patients because you don't always have the same patient and it can be days between shifts, which can mean the patient is gone by the time that you return. The other thing that kind of irks me is everybody's got their head in a computer screen and it's the patients that pay the consequences. Nurses are tied up in so much paperwork on the computer that they aren't by the bedside like they want to be and they are losing the opportunity for interactions with the patient and the ability to teach and console them. I get why there are more regulatory requirements, but I wish there could be a happy medium."

Don't lose that connection: "Don't become so fixated on the computer and machines that you forget the patient and their family. Never lose that sensitivity. It's okay to tear up with family members. It's okay to show you emotion and to build that connection with the patient. If you become so disconnected or callous you don't care anymore, then you shouldn't be in healthcare."

Take advantage of networks: "Being part of a system has been really important for me as a chief nursing officer because I could call other CNOs at our sister hospitals and run things by them, get recommendations for problems or just share and vent. It's really great to pick up the phone and have someone you can talk to and who you can share knowledge with. It's nice to know you're not out there alone."

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