Overhaul of health care system needed to address nursing understaffing? - page 2

It seems as though the nursing profession, esp hospital nursing, has reached some dire straits in the past 15 years - getting worse, in particular, over this past decade. Would you agree? The... Read More

  1. by   marie-francoise
    Quote from Retired R.N.
    Once upon a time, when most nurses graduated from hospital diploma schools, they had all the clinical experience they needed to hit the ground running.
    I had a nurse tell me this same thing during clinical - she was so adamant about it, and it was the first thing out of her mouth (I had just met her - she had just stepped into the OR to take over for a CRNA), that I believed her. Maybe a climb down from the ivory tower and into reality is what nursing schools need...

    I will let experienced nurses respond to your questions about recruitment from other countries. I did see a documentary, though, where people - including a doctor - actually became nurses just so they could get into the U.S. And I've heard foreign nurses say nursing is a good job since it gives stability and also a chance to be in the US.

    Laudable cause, since I love my country & I'd also want to come here if I weren't here already! (Thanks, ancestors! You picked a great place! :spin But I'm just saying maybe it's not so much we're sucking nurses away from other countries, but actually incentivizing people to become nurses so they can get into the US, since we have such a well-known shortage of bedside nurses here. But that is just my theory - I have no idea what the real data are, admittedly...

    Anyway, the lack of respect of nurses is, yes, something I wish nurses would address. In school everything is ivory-tower, with no mention of self-advocacy & and the realities of the unit. And some of the energy spent on nursing theory and different types of language like nursing diagnoses may have been better spent on combatting the stereotypes of the ill-educated, submissive, and replaceable nurse.
    Last edit by marie-francoise on Dec 20, '07 : Reason: grammar
  2. by   marie-francoise
    Quote from spacenurse
    We ARE doing much better in California.
    No hospital CEOs don't respect nurses. They view us as costly but take us away and you just have a building.

    The public trusts and respects us more than any other occupation. We need to continue and expand our advocacy to earn that trust.

    Just calling in a union is useless. BUT together continued working together won safe staffing ratios with the obligation that the hospital increase staffing by acuity.
    WE together can work to improve patient care and nurses working conditions.

    http://www.calnurses.org/nnoc/

    http://www.calnurses.org/assets/pdf/nnoc_101.pdf
    I'm wondeirng - Did the ratio improvements in CA occur without sacrifice of ancillary staff or other services, or of supplies?

    I hear about nurses striking in the Bay Area, so that has me a bit worried that the ratio rule may have been technically implemented, but with other cuts made, so with still shoddy results for nurses.

    I don't want to sound skeptical - I'm just trying to learn how such things get done successfully.

    I think the nation looks to the CA nurses with great thanks, that they got that change pushed through! We need examples to follow like that. (And I'm personally grateful about the California decision, since that is the state I want to get my license in, for familiy reasons.)
  3. by   Retired R.N.
    Quote from RN1989
    Preach on Retired RN!!! Have you considered running for governor? I'll work on your campaign for free!
    Thank you for your support, but I don't think I really want to get into politics at this time. The nicest thing about being retired is that I can say whatever I think is true without having to worry about getting fired. I fully realize that not everyone agrees with my criticisms of the present system of nursing education, but I do think that a more realistic education would have a significant effect on conditions for nurses and lead to better care for patients.
  4. by   Retired R.N.
    Quote from RN1989
    Ok, so now my thought is....Is there a nursing shortage in those countries caused by recruiters in the US stealing the nurses?

    I swear that there are hospitals units in the DFW area where none of the nurses speak American English as a first language. All of the nurses on those floors are from other countries.

    I understand that the Phillipines is probably the only place where there are too many nurses for one area and nurses are the biggest export. But what about other countries?

    Are U.S. employers purposely keeping things in bad shape to force US nurses to quit nursing so that the employers can recruit nurses from other countries who are less likely to be vocal about the conditions? And what are the ramifications of these business tactics in those other countries?
    How can you accuse U.S. employers of such dastardly motives? I had one administrator defend this process of raiding foreign countries for nurses by claiming that the U.S. paychecks those nurses earned were good for their countries because they helped to support the families they left behind.

    Do you know that the visas and work permits for these nurses often state that they must work for the same employer for a stated length of time or they will be deported? Should we call this slavery or is merely a case of being an indentured servant?
  5. by   MayisontheWay
    Quote from Retired R.N.
    I fully realize that not everyone agrees with my criticisms of the present system of nursing education, but I do think that a more realistic education would have a significant effect on conditions for nurses and lead to better care for patients.
    I'm not making the connection...maybe I'm a bit dull at 4am. How does less education make nurses better?
  6. by   Martinette
    It is not LESS education. It is a different kind of education. My 3 year diploma program was a lot tougher than your average Bachelors degree in other fields.

    I was attending nursing school while my twin was doing a degree in education. I was at a 3 year diploma hospital nursing program that was affiliated with a top university for all of our sciences etc. My twin was at a 4 year school doing a degree in education at the same time. Guess who spent more time in class.... had more material to study that was much more complex...etc etc? I did more work and covered more material in 3 years than she did in 4.

    It is a different kind of education.
  7. by   Retired R.N.
    Quote from MayisontheWay
    I'm not making the connection...maybe I'm a bit dull at 4am. How does less education make nurses better?
    A hospital diploma program for RNs is not less education because the students must learn all the same nursing principles in order to be able to pass the NCLEX. It is however, much more intensive in the clinical experience area, as the students put in many more hours under the supervision of their clinical instructors and they have many more opportunities to observe experienced nurses in their work. By the time they graduate they are able to cope with a full load of patients, and have been able to learn the duties of a charge nurse while under supervision.
  8. by   MayisontheWay
    Quote from Retired R.N.
    A hospital diploma program for RNs is not less education because the students must learn all the same nursing principles in order to be able to pass the NCLEX. It is however, much more intensive in the clinical experience area, as the students put in many more hours under the supervision of their clinical instructors and they have many more opportunities to observe experienced nurses in their work. By the time they graduate they are able to cope with a full load of patients, and have been able to learn the duties of a charge nurse while under supervision.
    So, it's your position that BSN prepared nurses aren't as capable because diploma nurses have more clinical experience? That's probably true for a minute, and then the BSN prepared nurse gets a few months experience. Now they're equal clinically, and the BSN nurse still has more education.
  9. by   Retired R.N.
    Quote from MayisontheWay
    So, it's your position that BSN prepared nurses aren't as capable because diploma nurses have more clinical experience? That's probably true for a minute, and then the BSN prepared nurse gets a few months experience. Now they're equal clinically, and the BSN nurse still has more education.
    So, while the BSN prepared nurse is getting that experience (s)he cannot carry a full patient load, and the unit remains inadequately staffed. The problem we were originally discussing was that the BSN education was not appropriate for the duties the student would face on the job immediately after graduation.

    Do the BSN prepared nurses use that extra education to do anything concrete about improving the working conditions for nurses or the nurse/patient ratio, or do they escape the world of hospital nursing as soon as they possibly can?
  10. by   MayisontheWay
    Actually, that hasn't been my experience....as a BSN graduate, I was hired directly into an ICU in May, took the NCLEX in June, and took a "full load" of patients on July 4th weekend for the first time. No one had to pick up after me, or subsidize my work, especially not the non-BSN new graduate nurse that remained in orientation trying to get through the ECCO course.
  11. by   marie-francoise
    Quote from Retired R.N.
    So, while the BSN prepared nurse is getting that experience (s)he cannot carry a full patient load, and the unit remains inadequately staffed. The problem we were originally discussing was that the BSN education was not appropriate for the duties the student would face on the job immediately after graduation.

    Do the BSN prepared nurses use that extra education to do anything concrete about improving the working conditions for nurses or the nurse/patient ratio, or do they escape the world of hospital nursing as soon as they possibly can?
    You make a good point, Retired R.N.. A consistent theme in the threads on these and other nursing blogs is that people are getting their BSN, MSN, etc., to essentially get away from the bedside (I can't blame them, given today's case loads). One higher education guru has said that nurses have all the incentive to get a higher degree to get away from the bedside, and not enough to stay at bedside.

    So, I went to public health school, got my master's, and afterwards attended an accelerated 1-year BSN program for a while. Let me tell you, the theory in both programs bordered on academic blarney. Maybe it was just the program I was in - but I've now opted for a 2-year ADN nursing program, which is vastly superior to the BSN program I was in.

    I'm not saying "BSN bad, lesser degree good" - esp since programs will vary inevitably. I'm just saying that, with the health care system in the crisis that it's in - wiith so many demands, too few staff, more complex treatment protocols - that we have to get practical about things and really train people in a practical way.

    And I'm not saying, to heck with learning theory and scientific rationale. But I do wish those diploma programs would return. Or, at least perhaps nursing programs that are more modeled after med school programs, in that they would have a relatively brief, intense upfront didactic period (as in, reading up on diseases, their treatment, and nursing interventions w/rationales), followed by an intensely clinical one, where students are actually doing what they'd do as nurses in the real world, albeit under supervision.

    Maybe there's not enough clinical site space to go around for such programs anymore, or maybe we place too much emphasis on ivory-tower theory (this latter problem is more easily solvable) - but those diploma programs perhaps should be revisited.

    Martinette, hey, I have a twin, too - identical! She went the doctor route, though. She also told me it's tough to do patient care, and she's just talking about the relatively few times she had to do so! (She went into pathology.)

    Anyway, sorry to stray from the subject. But, better preparation of nurses, as in, intense instruction in an actual clinical setting, sounds like a good idea, if doable these days. As far as making nurses into advocates - maybe nursing schools could intensely instill that, too.

    Although I don't want to get into an ADN vs. diploma vs. BSN debate - I guess it's such a universal topic that it inevitably gets brought up. And it does have relevance esp since BSN and higher degrees are essentially a "ticket out" of the bedside setting. (Again, I don't blame a soul for opting for that ticket.)

    As for the BSN empowering bedside nurses - I can't tell that BSN equips nurses more for "standing up to the system". Wouldn't having a degree that allows one to "escape the bedside" actually reduce the incentive to stand up to & protest the system, since one could just leave the system instead?

    Anyway, sorry for the long post. I'm not even a nurse, just a nursing student. But I wanted to give you my perspective on the nursing program I left, and the nursing program I opted for.
  12. by   MayisontheWay
    Quote from Retired R.N.

    Do the BSN prepared nurses use that extra education to do anything concrete about improving the working conditions for nurses or the nurse/patient ratio, or do they escape the world of hospital nursing as soon as they possibly can?
    I'm smart enough to recognize danger and stay away from it. I have no interest in putting my license at risk. Fortunately, staffing and ratios haven't been an issue for me either in the ICU or the CVICU.

    And by the way, aren't BSN nurses still the vast minority? Just wondering how such a small number of "ivory tower" nurses can be responsible for so many problems.
  13. by   lindarn
    Quote from Retired R.N.
    So, while the BSN prepared nurse is getting that experience (s)he cannot carry a full patient load, and the unit remains inadequately staffed. The problem we were originally discussing was that the BSN education was not appropriate for the duties the student would face on the job immediately after graduation.

    Do the BSN prepared nurses use that extra education to do anything concrete about improving the working conditions for nurses or the nurse/patient ratio, or do they escape the world of hospital nursing as soon as they possibly can?
    The BSN prepared nurses would love to do concrete things like improving working conditins, improving nurse-patient ratios, but unfortunately, we get not support from Diploma prepared and ADN nurses who did not receive anything but but nursing care education in their programs. We beat our heads against the wall trying to get these individuals to see what needs to change, but we are beating a dead horse. We cannot do it alone. We ALL HAVE TO WORK TOGETHER TO MAKE THE NECESSARY CHANGES TO MAKE A DIFFERANCE. They do not have the desire to change, and wish to maintain the status quo. They can then spend their career spinning there wheels, going nowhere, and watching the hospitals and nursing homes whittle and dumb down our professional practice. Nurses are ignorant on how to fight back.

    BSN grads, on the other hand, are able to take classes in management, alternative careers for nurses, discuss workplace issues, such how unionization of the nursing profession can improve the above issues, legal issues, public speaking, leadership, assertive training, etc. We leave bedside nursing because when get no from other nurses who can't see the forest for the trees. They are too busy trying to care for there 10+ patients to be able to effectively put forth the effort to affect change in the workplace. Which of course, is exactly what the hospitals want. "Idle hands are the work of the devil", and nurses who are not overwhelmed in the workplace would have time to sit (idle) and discuss how unhappy they are, and what steps that they can take to change it and make things better.

    I consider these to be "quality of life" classes. They teach the nurse how to navigate the muddy waters of nursing employment. I would add classes like "Employment Law", Administrative Law", and "Insurance Law". Nurses are quite naive when it comes to knowing what their rights are in the workplace, and what measures they can take to protect themselves. They have no idea how to utilize our legal system, and therefore are self made victims of employer abuse. Ignorance is not bliss when you are a nurse.

    Being able to "hit the ground running" the day after graduation, is more a quality of needing to validate your self worth and self importance to make up for the lack of at least a four year college degree, that would make us professional equals of other health care professionals, rather than starting ones career as a professional underdog.

    That is more important than being able to function at 100% the day after graduation, which only benefits the hospital.

    Lindarn, RN, BSN, CCRN
    Spokane, Washington
    Last edit by lindarn on Dec 21, '07 : Reason: spelling

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