Is this the publics perception of nurses? - page 6
i am a charge RN in a cvicu. yesterday i took care of a man that was pod1 5 vessel cabg on a balloon pump and multiple drips. i had post op'd the pt the previous day so i had developed a repor with... Read More
Dec 28, '02Suzy, some would tell you that teaching pay went up because of their unions. Some would tell you it's because of the shortage of teachers. I would guess it's something between the two. Personally I think it has to do with teachers being able to make the public understand the importance of their role to society.
I think in many ways nursing can be equated to not only teaching but to law enforcement. I always have a tendency when looking at things to ask myself what came before? The past history. When the events of Sept.11 took place I wondered how many people across the country realized how many of the fireman and police that died were from Irish Catholic backgrounds. It was mentioned many times on the news, but how many people knew why there is such a tradition of Irish Catholic in those professions? When that group of people heavily immigrated to this country most went to Boston and New York, the major ports of entry, and when the got here they found that the "Nativists" didn't much care for them or their religion. Most New Englanders were from either a Protestant English background or a Scotch-Irish Protestant background, and the Irish Catholic were looked at as ignorant, dirty people who bred like rabbits. It was common for the Irish Catholic to find signs in stores that said NO IRISH NEED APPLY. But they could become policemen and they could become firemen because those were jobs that were considered "fit" for the Irish. Who cared if "those" people risked their lives in jobs were risking your life was the norm. The jobs paid very little, there was little respect for them and besides it was thought that most of the crime, particularly in New York, came from the Irish immigrants so each to their own kind. So what changed there? Police and fire fighters still don't make loads of money and likely never will. As we witnessed on Sept. 11, it is because the very thing that made the job fit for the Irish is what made these people heroes. The events of the 1920's and 1930's with gangsters and prohibition that changed the public's perception of police particularly. It became an honorable profession.
I believe that the public respects nurses greatly, from my own experiences anyway. What they don't understand is what we do regularly. I believe much of that is because of the media portrayl of nursing, but then nursing has changed a great deal since the 1970's and the media has not kept up most of the time. There are some shows that manage to give a decent look at nursing today, but most do not. I cringe every time I hear Jay Leno make a joke about porno and nurses. My kids have heard it and heard it about the times I or another nurse I work with push some physician to do something more appropriate for the patient, the daily little fights we have not only with the doc, but other disciplines. One day there was a commercial on that my son made sure and point out to me when he saw it a second time. It shows a man sitting there who says, I was diagnosed with cancer, my doctor said I had 6 months to live but my daughter A NURSE, told me about the cancer center and now two years later I'M ALIVE. My son, now 19, gets a huge kick out of that commerical, and I must confess so do I. To me it is a small way of letting the public know that nurses know a thing or two.
Many of my patients have made comments about how much nurses make and always their perception is that I make much more than I actually do. Most are quite shocked when I start citing how much nurses make across the country, especially the salary norms in the south. When they find out what nurses make the comment is invaribly that we should be making much more than that. And I always agree. But the truth of the matter is this, like police, like fire fighters, like teachers, our wages are paid by the public, and no matter how much the public respects and knows they need these specific professions they don't want to have to pay more of their taxes, more of the out of pocket cost to support these professions either. The way to change that is to become important enough to society that society is willing to pay for what it gets. I personally equate to rise in teachers pay when there was media who put out studies that showed that American children were far behind Japanese and European children in important fields of learning like math and science. How could America possibly continue to stay on top and compete economically with these areas of the world if we did not ensure our children's education? How can we possibly keep this country safe if we don't put resources into the police and fire depts of the country? And last but not least, how do we assure the health and being able to take advantage of the health technology if we don't put resources into nursing?
When society is willing to put resources into professions that serve the public it is usually because there is some percieved crisis that makes the public feel that if they don't do these things, aren't willing to put out the money than they are at risk personally. The massive nursing shortage that is looming worse in 5 years more than it is even now, may be the best thing that happened to nursing. It gives us a time to be able to educate the public because they are willing to listen now. Ah, the teachable moment.
And I just want to say this about floating. When you float somewhere the other nurses and the charge or manager of the floor don't know what your abilities are, nor do they know what you may or may not be able to do on your floor. Not only do policies differ from facility to facility, they are can be quite different floor to floor. Should you as a nurse be quite comfortable with passing meds or giving injections? Sure. But there is a flip side to that. I worked Neuro ICU and was quite comfortable with the meds we used routinely. But the first time they floated me to the Cardiac unit and I had a patient with IV nitro hanging I was not comfortable. I had never used the drug this way, it was a drug we used only rarely in Neuro and never as a drip. Nor was I used to patients who were vented and awake also. 99% of my patients were comatose, if not because of their injuries than because we gave them meds to put them in that state on purpose. I once floated to Peds ICU and was assigned to a three month old on a vent. I about stroked. This little guy had tubes and IV's, and the fluids going in were through a 60 cc syringe and measured in cc's, I felt like I had landed on an alien planet. Everyone acted like I should be comfortable and know what I was doing but I wasn't and I didn't. After two hours I called the house supervisor and told her so, and begged for her to send me anywhere in the house besides Peds ICU and send another nurse who did know what they were doing. I ended up switching places with an agency nurse who worked the Peds ICU regularly and I went to ER. I guess I would rather be asked if I can pass meds or do an injection than be put in a situation where I didn't know what I was doing at all.
Dec 28, '02Originally posted by SmilingBluEyes
...that lovely lady should be called "Nurse Judy" if they chose to do so. I think the harm done is insidious and quiet, but harm nonetheless when this is permitted.
Dec 28, '02I respectfully disagee when ANYone says it does not take a nurse to give injections or start IV's---wrong! It takes a nurse's background to understand the RATIONALE behind the "psychomotor tasks" we perform. HARM can and will be done by those performing psychomotor tasks in nursing w/o understanding the why's and if's and what to do when untoward reactions arise. It DOES take a nurse!
Dec 28, '02**knock me down with a feather, Suzy**. We agree ON SOMETHING.....miracles abound (lol)...ya know I am teasing ya.
Dec 28, '02Originally posted by LasVegasRN
Yeah, Shay. Quit teasin' and come on out!! :chuckle
Dec 28, '02hummm, could it be that the public's view isn't distorted (nurses do take care of the sick) but only preceived by their interactions with either their personal experiences, or indirect interaction through family members or friends of what and who a nurse is?
i remember years aqo [when i was much younger] when the "nurse" was the "lady in white", or the family friend who helped with the home delivery, or who told you old family remedies to take care of that toothache, they were viewed as "nurses". before the mid-1800's, nursing was without organization, education, or social status and basically did what a mom does for her family when they are ill or depressed (provide security, love, give the medicine the doctor prescribed to the loved one, etc).
i respectfully disaqree that an entry level [bsn] will help to rectify the concept of a nurse of the public if we still have those who are, like myself, an lpn (a nurse) or cna (who most think are nurses, especially the elderly, ltc).
even in 2002, there are a lot of people who do not know to enter this profession (some do not know if they should be an lpn or rn) or are suggested not to because it is not a good field....and "we" ourselves play it "down on the left hand and up on the right hand...
Dec 28, '02The nurse Judy thing makes me think of a patient family we had recently. The patient was colonized VRE, no infection. However we do contact precautions on both colonized and active VRE and MRSA. The family could not get it. They acted like the patient had the plague. Would sit in the room not touching her with gown, mask and gloves. All over the nursing staff about the appropriate way to do contact precautions, insisted on a private room instead of cohorting like the patient was in.
Ended up having a family meeting with myself as infection control, the charge nurse, the nurse manager(Clinical Coordinator) and our ID doc who heads the IC committee and various family members. The family member who was causing the most problems flat insisted on a private room stating she had been a nurse for 26 years and that she had called coworkers who also told her they had never seen a VRE patient that wasn't in a private room. Since I knew this family member had not been a nurse, but had been an aide, my big mouth popped out with "You do know that it is unethical if not illegal to identify yourself as a nurse when you are not don't you?" Lord, the total silence in that room made me quite sure that I would lose my job for being so blunt. Instead all of a sudden my manager backed me up and so did the doc. I then offered her a copy of the CDC guidelines which she declined.
I wish I could say the meeting helped with the family, but it didn't. But at least the family member didn't identify herself as a nurse again.
Dec 28, '02Way to go Helen! Why is it that people are so quick to identify themselves as a nurse, yet, we have so few people who honestly want to be one?
Dec 28, '02Ooooh, Helen. I think I love you. I would have paid good money to see an instant replay of that. You go, girl.
Dec 28, '02You know Suzy, that's a good question. A really good question. Could it be because nurses are quite respected by the general public and it is good for one's image to say I'm a nurse when in reality they are not? Could it be that they don't want to have to explain that they are an aide or a tech because their low man on the hierarchy of things? Both of these I think. And why don't they go into nursing instead of playing nurse? Just my opinion here, because they have a perception that what they do is nursing, how many time have you heard an aide say "I could do what a nurse does." because they only see the tasks, not the critical thinking that leads to what tasks we do. Not to mention that it takes an awful lot to be a nurse. For some people I think they want the image without the work to actually have it and as long as there are those out there that won't call them on what they are doing then it will continue to happen.
I truly believe that most of the public has a great deal of respect for nurses, but nurses do not give themselves much respect. If they did so then you would not have nurses who allow people to run all over them. Regardless of whether it is a doc, a manager or a patient/family member. I've never been molly milktoast, even as a teen. And as time has gone on that part of my personality has gotten stronger. Not aggressive, but I sure know I don't have any assertiveness problems. My one doc that never wants me to write wound care orders left an order on a chart day before yesterday that read "Helen is not to change wound care orders." Got the order and I was instantly pissed. So I called him. Told him I didn't change the order and I didn't feel the order that he had written was appropriate, that the order had been changed by the primary physician. He tells me that I called the primary, so I said you're right I did, after he changed the order on a weekend when I am not here. It was not an appropriate order so I called HIM, since it was his order not yours. AND since you had not seen the patient in a week and a half since YOU debrided the wound AND the last wound tx order was from the other physician it was my belief that he was now taking care of the wound, and the primary DID NOT disabuse me of this notion. I got oh, ah, oh ....then I told him that I felt it was essential for me to have a good, close working relationship with the physicians and that was something he and I had not achieved yet, and that he also needed to understand that I did not intend on being the ball between two physicians and perhaps he needed to speak to the primary about who was actually taking care of the wound. He agreed we had not worked out a good working relationship and perhaps we needed to. He also apologized for the order he wrote without understanding how the orders were changed then proceeded to tell me he was something of a perfectionist when it came to his wound orders. I told him I understood that because I was a perfectionist also and perhaps a some point in the future he and I could sit down and discuss things because I have been doing wound care on and off since 1994 and did have a knowledge base on which I was working off of. He agreed with that. So I'm hoping to not have a repeat the order he wrote, and to be able to start working with this man from a level of mutual respect instead of the current relationship that we have now. But that could never happen if I were not willing to call him on what happened. I figure these people put their pants on the same way I do, and I will not be treated like a moron. I also won't be treated without respect by anyone, be that as a nurse or not. I believe that people get what they demand, and if you have floor mat tattoed on your forehead than don't get upset when people wipe their feet on you. I have no qualms whatsoever with doing only what this doc writes, that is his practice and his patient as well, but I won't be treated the way he thinks is ok.
I sometimes think that people who want to play nurse but don't want to be a nurse also don't want the responsiblity. They only want the image.
Dec 28, '02Originally posted by SmilingBluEyes
I respectfully disagee when ANYone says it does not take a nurse to give injections or start IV's---wrong! It takes a nurse's background to understand the RATIONALE behind the "psychomotor tasks" we perform. HARM can and will be done by those performing psychomotor tasks in nursing w/o understanding the why's and if's and what to do when untoward reactions arise. It DOES take a nurse!
i remember the "nurse judy" thread very well. the reason, i got flamed my more than one NA/MA saying that they could do my job. my reaction was just because you know how, and it may or may not be with in your scope of practice does not meen i want you doing things with my pt. ie: in my facility, they are now talking about letting nurse techs in icu pull sheaths. NOT ON MY PT! i think just because you get some basic training on something, like this is how you do so and so, does not meen that you are educated on what will happen if something goes wrong. (we all know when you pull sheaths nothing goes wrong, right? lol) nurses, wether we are diploma/ADN/BSN are trained to do things that MA/NA just should not be doing.
i am lucky. in my facility i work with some very good techs. they all have no problem identifying themselves as techs. i have never heard any of them allowing a pt to believe that they are a nurse.
and i do have alot of respect for them.
Dec 28, '02yea, austin, frankly I am still SHOCKED when ANY licensed nurse expresses belief that " anyone can do IV's, catheters, injections" etc as if they are tasks we can teach monkeys. Yes, MONKEYS could DO these tasks, but not with the knowledge and accountability WE Have as LICENSED NURSES.....our title carries with it responsibilities as well as it's priveleges.
Dec 28, '02Originally posted by SmilingBluEyes
yea, austin, frankly I am still SHOCKED when ANY licensed nurse expresses belief that " anyone can do IV's, catheters, injections" etc as if they are tasks we can teach monkeys. Yes, MONKEYS could DO these tasks, but not with the knowledge and accountability WE Have as LICENSED NURSES.....our title carries with it responsibilities as well as it's priveleges.
When I say that anyone can do IV starts, injections - they can and do. Techs start the IVs for MRIs/CTs, MAs give injections, pharmacists administer flu shots. We are so quick as a profession to hold on to those psychomotor skills, thinking that those things are what makes us a nurse, not really realizing that what makes one a nurse is so much more than that - and not even the "why am I starting this IV" but "what does this patient need?" Sure the patient needs the IV, but if you had a tech come in and start your IV, you could still provide your "nursing care" to the patient which I guarantee you entails intangible things; things like knowing the subtle signs of distress/worsening conditions, things like when silence is appropriate or offering to hold a hand or listening or counseling, etc.
I believe until those things I listed above are seen as valuable and only delivered by a licensed nurse, will we be more respected. Hospitals don't care about what makes us a nurse; they care about our psychomotor skills, which, are easily replaced. Until we, as a profession, can market what it is we do, will we be seen as providing a distinct service that only a nurse can provide.