"I will wake up in the middle of the night to answer a phone," she said at her home after a Saturday shift. "And the phone's not ringing, because that's what I've heard all day. There's so much stuff on you."
One thing that's "on her" is the knowledge that a serious mistake could take away someone's life, along with her own livelihood. "Yesterday, we had a patient go bad, and it was horrible," she said.
The woman, who was flown to another facility, wasn't her patient, but Waugh said "it is very stressful, because that's your license, that's a life, that's someone's mom, sister, loved one, so you're trying to do everything you can do."
Compared to other fields dominated by women--teaching, home health care, retail sales--nursing is well compensated.
The 2.6 million registered nurses, RNs, in the United States--over 90 percent female as of 2011--make an average of almost $68,000 annually, according to the Bureau of Labor Statistics in 2012.
Licensed practical nurses, LPNs, are the lowest paid at slightly over $40,000, and there are fewer of them, roughly 720,000.
There are only about 100,000 nurse practitioners nationwide and their annual income averages over $90,000.
In West Virginia those numbers are lower, but at an average salary of $54,500, RNs make almost 50 percent more than the average worker in the state. Waugh, 28, makes between $45,000 and $50,000 annually.
Waugh said that many nurses she knows are breadwinners. "If there is a nurse and their spouse isn't a nurse, more than likely the nurse is the breadwinner," she said. Her husband, a pipe fabricator since 2006, makes about $16 or $17 an hour.
Teacher vs. Nurse
Waugh said that as a child she wanted to become a teacher or a nurse. While she often played teacher to her younger brother, she also played nurse to her ailing grandmother, setting her pills out on trays.
Teachers, she decided, made too little for someone like herself, who didn't want to ever ask her parents for help. "If you are a single female . . . are you going to be able to live comfortably on that salary? That always made me nervous. I wanted to be self-sufficient."
But nurses' higher pay comes at a physical price.
Fifty-six percent of nurses reported musculoskeletal pain caused or exacerbated by work, a 2011 survey conducted by the American Nurses Association found.
In 2010, the Bureau of Labor Statistics found that RNs take an average of seven days off of work a year due to nonfatal work-related injury.
That morning, as the nurses worked and chatted, two discussed back injuries and pains sustained at work. Waugh said her own back had been "killing" her after work earlier that week. "I mean, you're picking people up off the floor, you're turning patients, you're pulling them up in a bed and you're putting tons of lug and tug and wear and tear on your own body, trying to save someone else's."
And there are other on-job risks. "I've been kicked, I've been hit, all this week" by patients, she said, but "it comes with the job."
The American Nurses Association survey found 11 percent of respondents had been physically assaulted at work in the past 12 months.
Waugh and her husband have loans to pay--about $15,000 in all--for the expenses they racked up for her to earn her bachelor's degree, which also included the RN license. They also had to buy a special nutritional formula for her son, now 4 years old, which cost about $50 per small can, adding to costs. Because Waugh wasn't working while completing her degree, they also paid for more expensive insurance through her husband's job.
Waugh expects to be debt-free in a few years.
New Perspectives Coming
Currently, nurses only need an associate's degree to earn an LPN or RN license.
But Aila Accad, president of the WV Nurses Association, said that eventually all nurses will likely need a Bachelor of Arts, which she said will broaden the perspective of new nurses coming into the field.
Waugh, a mother of an 18-month-old daughter as well as her 4-year-old son, has arranged her 36-hour work week into 12-hour shifts.
When both she and her husband are at work, the kids stay with her cousin, a stay-at-home mom whose children are in college. "She kept me when I was little," Waugh said, adding that she pays her $25 a day, though her cousin almost refused to accept any compensation for what she considers a familial duty.
"I wouldn't be able to work like I work, or pick up an extra shift," without her, she said.
Because of the way Waugh loads her schedule, she can go days without seeing her daughter. One Saturday evening, she hadn't seen her since Thursday because her parents, who live just a few miles away, had kept the child on Friday and Saturday while she worked.
"It's best for her," she said, because it doesn't disrupt her daughter's sleeping schedule. While the separations can be difficult, Waugh prizes her extended support system. "That gives me time to kind of be alone, or sit down and read a book, or just sit down and do nothing. And a lot of people don't get that."
Waugh plans to eventually go into nurse education or a different type of nursing. "I just don't want to do direct patient care forever," she said.
She struggles to say whether she would still choose nursing, if she had to do it over. "I go back and forth. I love my job, and then at the same time I hate my job. But would I like being a teacher? Probably not."
The combination of a tough job market and the growing demand for nurses by an aging population drove up the number of nurses between 2007 and 2008 by over 240,000.
Now, however, a shortage scenario is shaping up.
Just over 100,000 of that big jump in nurses between 2007 and 2008 were people over 50, said Peter Buerhaus, a professor of nursing at Vanderbilt University in Nashville, Tenn.
An improving economy with better retirement prospects could encourage many older nurses to retire, according to an analysis by Buerhaus and others published in the New England Journal of Medicine on April 18. And that could mean a shortage if there are not enough newcomers to replace the old guard.
The Affordable Care Act, which broadens insurance coverage, will also boost demand for nurses. But it also increases the need for nurses to take leadership in developing teams and coordinating team care, Buerhaus said, offering them greater autonomy and responsibility. That could mean more stress on nurses, but also more control over their work.
Buerhaus, himself a certified RN, said that the system has decided to move in a direction that nurses have often called for. "Now nurses must show, 'Yes, we can do it.'"