A Nurse's Viewpoint
- 1Jun 16, '01 by Chellyse66This article was interesting and provided for a me a perspective or position that some over here might want to add thier own viewpoints too. So I thought I would place it up here.I plan on responding to this writer myself and suggest that those willing do the same.
A Nurse's Viewpoint
Questions and answers about nursing
By Roberta B. Abrams, RNC, MA, LCCE, for HealthLeaders.com, June 11, 2001
It started, as such things often do, with a question: "Why are you a nurse?" I don't remember the answer I gave. Considering that the question came from a child, I probably gave one appropriate to her age. Since then, I've been giving some thought to the topic - that I'm going to share with you - from A Nurse's Viewpoint.
My reasons for becoming a nurse and my reasons for staying in nursing were not the same. I became a nurse - all those many years ago - because I considered what I believed to be the alternatives, and nursing was the only one that appealed to me. I knew several nurses - including my mother - and, for the most part, their discussions about their field seemed interesting. (Of course, there was Hilda, who considered herself as the physician's "handmaiden." I knew that I wasn't going there.)
I was fortunate in my choice of schools of nursing. The program was long and difficult, both physically and intellectually. We spent five years earning that coveted degree in nursing - five calendar years. The faculty's aggregate mission was to foster in us the knowledge and values that would enable us to be thinking, caring professionals. (It occurred to me that the hospital's mission was to find a source of free labor.)
The relationship between the nurses and the physicians was, generally, one of mutual respect and positive regard. (Of course, there were exceptions on both sides - this was the real world.) We even had collaborative rounds where several disciplines (including physicians) provided input into the patient care regimen.
It was a good beginning. There were mentors who I hope always to remember, and there were those who I'd love to forget but can't. Above all, there were my classmates, most of whom have remained lifelong friends and, collectively, major support sources through my life.
I still believe that nursing was the right choice for my career. I reaffirm that feeling when I go to the supermarket and run into a patient who stops to tell me about the difference that I made in her childbirth experience. I reaffirm that feeling when, at holiday time, I receive a letter from a patient whose baby's birth I attended more than 25 years ago. She writes to share current events in her life, and to inquire about mine. The unspoken message is that she remembers - and values - the time we shared together.
Earlier this year, I received a letter from a former student. She is now a masters' prepared clinical specialist. She has long since realized the promise that she showed almost 30 years ago when, as a student, she helped a patient deal with cancer of the uterus. I hope that she still has the letter that the patient sent to me, and that I gave to her with an award at her graduation. I know that she hasn't forgotten, and neither have I.
I also heard from the alumni association of a school of nursing where I taught when my children were young. The writer invited me to be a guest at the reunion that they were planning. It's truly gratifying to realize that, through nursing, I have made a difference in the lives of many different people. I presume that chief among reasons for staying in nursing is just that - the ability to make a difference.
I am still, tangentially at least, an active nurse. I no longer make daily rounds on patient care units, nor do I carry a bag and make home visits. However, my colleagues continue to call requesting input on clinical or administrative matters. Others invite me to present at conferences or to do in-service education sessions on matters related to healthcare. Friends, neighbors, and family call me with questions related to their health and/or that of those close to them.
As a nurse, I have benefited greatly from the different career opportunities that were, and are, available to me within that broad expanse called nursing. My career in nursing has included episodes in clinical practice, in education, and in administration. While most of my experiences have been in acute care hospitals, I spent about five years learning the intricacies of home care.
The vistas open to nurses are limited only by their imaginations. During my career, we have experienced an incredible growth of opportunities available to the advanced practice nurse. Nurse practitioners carry their own patient loads and are frequently found in clinical sites promoting wellness care and education. Nurse midwives are sought after by an ever-growing clientele who enjoy the attention, knowledge, and comfort that they provide. Nurse anesthetists are found in offices, in outpatient surgery centers, and in hospitals. I stand amazed by the growth of nurse attorneys - who not only perform invaluable services as either plaintiff or defense team members, but serve also as risk managers, as guides in quality improvement activities, and in diverse roles on ethics teams.
Nurses are also found in industry, in schools, in community care programs, and in specialized practices including palliative care, pain management, and wellness settings.
I like nurses. Nurses share a group of characteristics that makes them wonderful friends. Nurses care. We care about others. Why else would we go into such a demanding profession? We care about one another - most of the time, and we're getting better about it as the demands on the individual nurse increase. I don't believe that any of us could have completed the demanding course of study that was ours without the support and encouragement of our classmates. We are resourceful. Given two Kelly clamps and a role of tape, we can perform miracles.
Nurses are creative. We keep finding new and better ways to provide for those in our care. Nursing research has progressed from the laboratory to the patient care arena. Our researchers work with the clinical staff to study the outcomes of even our most basic interventions. Do we consistently produce the outcomes that we seek? How can we do it better?
These are hard times in healthcare - and especially in nursing. We deal on a daily basis with staffing issues, short supplies, sicker patients, the plethora of ills that have beset healthcare.
In that environment, it is all too easy to get lost in a morass of, "Oh, ain't it awful!" We need to regroup and refocus. We need to find leaders who understand that it's cost effective to improve salaries and working conditions so that the nurses and others who are not working, or working only part time will return. Recruiting travelers or nurses from other lands is, at best, a temporizing measure. We need to sponsor "refresher" courses to enable some of those who have not been in the acute care setting to return with confidence in their skills and knowledge. We need to so improve the healthcare environment - and those in it - that health professions, including nursing, are once again attractive to those still making choices in careers.
That's a tall order. We need real leaders in our healthcare environments. Nurses want reimbursement commensurate with their knowledge and abilities. They want a place at the table where decisions are made. And they want it now.
We need to refocus. We need to remember why we became nurses. We need to tell and retell our success stories. Who wants to join a group whose conversation is fixated on problems? We all have wonderful stories to tell.
I'd like those of you who read this column to share with me the stories of your successes. I'd like to share them with others. Let's talk about the power of nursing, about nurses and patients that we remember with joy. Maybe we can make of that a tapestry that we can display, say, and mean: "I'm glad that I'm a nurse. Come and join me."
(E-mail stories about your success as a nurse to RBAbrams@aol.com.)
Roberta B. Abrams, a regular columnist for HealthLeaders.com, uses her education and experience to help further the evolution of healthcare delivery systems through her consulting group, RBA Consults, in Farmington Hills, Mich. She also is on the adjunct nursing faculty at Madonna University.
Abrams' career has included a variety of positions in women's and children's health, including roles in nursing education (diploma, associate degree, and bachelor's degree programs), nursing service (as a clinical specialist), and nursing administration, as director and associate administrator for nursing in two major teaching hospitals. She has participated in the development of a women's health center, two school-based teen health clinics, and two women's and children's home care programs. Abrams is a member of the Wayne County Medical Society Task Forces on Violence Reduction, Teen Health and Adolescent Pregnancy. She also served on the Oakland County Health Department Task Force on Perinatal - Neonatal Care.
Abrams holds master of arts degree in administration/supervision from Fairfield University in Fairfield, Conn., and a bachelor of science in nursing from the University of Rochester in Rochester, N.Y. Contact Roberta by e-mail at RBAbrams@aol.com.
- 0Jun 16, '01 by fiestynurseThis is a very well written article. However, she does not give any suggestions on how we improve working conditions, salaries, and patient care. She talks about finding leadership and a "place at the table". Isn't that what we are fighting for? We are not going to demand change by telling people about our "wonderful stories" Now is the time for the public to hear the truth! Yes, it's ugly, and we are walking a fine line. How do we attract people to the profession, while at the same time telling people how awful it has gotten.
- 0Jun 17, '01 by NRSKarenRN, BSN, RN AdminRoberta Adams writes bi-weekly column for healthleaders.com. Here is another column offering solutions.
Problem solving: The Nursing Process
By Roberta B. Abrams, RNC, MA, LCCE, for HealthLeaders.com, May 29, 2001 http://www.healthleaders.com/news/fe...ontentid=20068
The daily newspapers, weekly news magazines, and professional journals all regularly provide testimony to the shortages of healthcare providers. Nurses, pharmacists, physicians, rehabilitation therapists - the ranks of providers are dwindling.
At the same time, the population, here and around the world, is aging. The ability to maintain life, for all parts of the age spectrum, continues to increase. In the coming decade, the number and percent of people aged 65 or older is projected to surge, with a concomitant decrease in the caregiver population, ages 18 to 64. A recent study published by the University of Illinois College of Nursing tells us that: "the ratio of potential caregivers to the people most likely to need care decreases by approximately 40% between 2010 and 2030."
We have a current crisis in healthcare. That crisis will not spontaneously disappear. Portents for the future of healthcare are grave. The good news is that there are a growing number of people who are aware of the problem and sense the burgeoning need for action. Let's look at some of those proffered solutions from A Nurse's Viewpoint.
It is interesting to me to explore the responses our state and federal legislatures have made to the problem. They're into the timeworn - and not very effective - actions of the past: Throw money at it. There are bills in many states, and in Congress, to increase enrollment in schools of nursing by providing scholarships and other financial aids. Interesting but not in and of itself effective. The ranks of applicants to schools of nursing have dropped precipitously. Women, who comprise 92% of the nursing workforce, have experienced a vast increase in their career options. Today's high school graduates pursue degrees in medicine, engineering, business, electronics and a host of other professions that they perceive to be more rewarding, more stimulating, and less demanding than nursing.
Further complicating the situation is the realization that, just as there are severe shortages in all other aspects of nursing, there is a growing shortage of nursing faculty. Nursing education is a stimulating occupation. Its rewards are many - none of them financial. Today's nursing faculty, as with all other nurses, is aging. Many of them will have retired before the full impact of the shortage hits in 2010. Recruitment and retention of qualified, experienced faculty is another part of the solution to the nursing crisis.
Another legislative initiative deals with facilitating the importation of nurses from other countries. Again, an interesting reaction, with some short-term benefits, but not usually considered a long-term solution. There are language barriers, custom barriers, and disparities in practice to overcome. If we bring in a significant number of nurses from other lands, what happens to their families? What happens to care in their countries? Is this reasonable? Is it ethical? Is it practical? We have done this for years on a limited scale. We know the problems. The solutions are not as well detailed. Our assessment of the current nursing crisis has many facets. They can be summarized as follows:
*Technology has improved our abilities to treat patients and prolong life.
*Our population is aging; in 2010 the baby boomers will have achieved their seniority.
The elderly have increased needs for healthcare.
*The population available to become healthcare providers is shrinking.
The part of the population that usually becomes nurses has other choices, which they currently perceive to be more attractive.
*There is a direct corollary between professional nurse staffing and patient outcomes.
*There is, therefore, a need to change nursing's image, professional attributes, and working conditions to attract and retain a population of nurses sufficient for the healthcare of the nation.
Plans to ameliorate the current and projected crisis in nursing cannot depend on nursing alone. The current crisis in nursing was produced by disparate elements of the society in which we live. The solution must also be vested in that society. Solving the crisis in nursing requires a multi-faceted, multi-disciplined approach. It will be a risk-taking venture which requires the support of educators, policy makers, providers, insurers, and technological experts. The system of providing healthcare must change.
The solution begins with the youth of society. We need to create a bond between elementary and middle school teachers and experienced nurses. We need to help those teachers develop a real understanding of, and appreciation for, nursing. As a high school student, I remember several of my teachers who indicated, beyond any possibility of misunderstanding, that they believed my interest in nursing would not make full use of either my intellect or my abilities. That was, and is, not an isolated occurrence. If educators deprecate nursing, how can we attract the caliber of candidate that we so desperately need?
We need to interest young students in healthcare careers. We need to revive (and revise) the Future Nurses Clubs - transform them into health career clubs, and involve our youth in the many forms of careers that healthcare offers. We need to teach the three "C's" - communication, collaboration, cooperation - before they begin their formal healthcare education. We need to expose them to mentors who will encourage and nourish their career aspirations so they enter that part of their education with a clear idea of where they are going and a realistic appreciation of what they will do.
We need to revisit nursing curricula to ensure that we include all that is necessary to begin clinical practice. The focus needs to be on the biopsychosocial mode of provision of healthcare, including care throughout the spectrum from wellness to death. We probably each can find things in the existing curricula that are not really cogent (I'm thinking about the course in physics that I was compelled to take). We need to ensure that the faculty who teach these courses are fully prepared for what they do and are not only skilled in the subject matter, but also in the principles and practices of nursing education.
We need to improve working conditions in healthcare facilities. We need to create a more professional and appropriate work environment not just for the nurses, but for all providers of patient care. We must increase salaries and benefits to recruit and retain the highest possible caliber of providers. We must so structure the governance of the healthcare facility that we empower the providers to do those things that are in the best interests of patient care.
We must also seek to attract a more diverse work force into nursing. Our predecessors thought of nursing as "women's work." It is - and it is also the work of men, of first careers, second careers, and so forth. We need to open our doors to all who have the intellect, the will, the commitment, and the compassion to provide care for those who are in need of care.
We should regularly review practice patterns to ensure their cogency and focus on optimal possible outcomes for care. We should consistently research technological phenomena to ensure that we are practicing in a cost effective and quality dedicated environment.
What about the cost?
Somewhere out there, one or two administrative managers are shaking their heads. "What is she talking about? Does she know the costs involved in these endeavors?" I think I do. I also am aware of the current costs of nursing turnover, of unplanned patient readmissions, of litigation, of closing beds because of staff shortages, of hiring "travelers" or agency nurses to fill holes, and of mandatory overtime. Those items not only have a fiscal load, but an emotional burden as well. If we are to retain nurses and other caregivers, if we are to entice new individuals to careers in healthcare, we must change the practice environment. It needs to become health promoting - both for patient and caregiver.
While we are recreating the care environment, let us focus on relationships involving the caregivers. Collaborative practice was just emerging from its infancy in the last decade when it was offered up on the alter of expediency. There was no time for the involved meetings. There were no funds to support the efforts involved. Collaborative practice, clinical ladders, continuing professional education, and shared governance were allowed to deteriorate into meaningless phrases. They need to be made whole, need to be made real - need to support the new environment for healthcare.
So, we have the beginnings of a plan. The elements must be carefully thought through, and put forth with due diligence. Education, practice, research: the pyramid for patient care must be rebuilt - and it needs to begin now.
- 0Jun 17, '01 by MijourneyHi. Ms. Abrams in my opinion is well-informed about what's going on in nursing and health care. It's good to see well written essays about the situation. But real action needs to be taken, and it needs to be taken right away, because very few people from within and without the health and medical industrial complex had the foresight to properly manage and monitor the long term impact of advanced technology and a growing, now slowed economy.
Ms. Abrams mentions the fact that legislators frequently throw money at problems. I don't have a problem with money being thrown at the problems in nursing, because I believe in a real sense that greed of different types and stripes is the reason we're in the fix we're in. What I would like to see is money thrown in the RIGHT direction, with a purpose, and MANAGED appropriately. We have had too much milking, scheming, and skimming going on in health and medical services, and it's ridiculous.
It does not make sense for patients and the direct care providers of health and medical services to suffer the way we do. Yes, I knew that I would have pain when I chose nursing. That's not the issue. The problem is the totally unnecessary complications that I have to go through to help take care of my patients from within and without nursing.
One way for nurses to help in improving our stature within the market is to educate others when we have a chance. I agree with many of the posters of this bb who feel we need to give our responses to staff shortages and patient care through the mainstream media. We don't need to stay encapsulated in nursing oriented journals.
We do need to be sitting at the same table as the boards of directors, CEOs and other administrative staff when decisions are being made that can have a favorable or adverse impact of patient focused care.
We do need the support of other disciplines and the public to strengthen our profession and patient care. So establishing coalitions is important.
We do need to stay in constant contact with our legislators and let them know what we are facing and possible solutions to the problems at hand.
We do need to be in schools establishing rapport with students, educators, and administrators alike. PTA meetings is one avenue. School mentoring programs is another.
We do need to establish ourselves as upstanding members in our individual communities as well as on our jobs so that we can get the respect we deserve from the public, our patients, and other staff and disciplines.
So, Ms. Abrams, thanks for being upbeat about nursing, and I will try one way or another to follow the suggestions in my post which were summarized from other nurses including yourself.
[ June 17, 2001: Message edited by: Mijourney ]