Too much emphasis on "caring"

  1. 45 I've gone back to school to get my BSN. I knew it would involve a lot of nursing theory and writing papers, but I figured I could handle it.

    After having to read and write about Watson and Ray and all this caring nonsense, I'm ready to pull my hair out. If I have to read the word "caring" one more time I might go off the deep end.

    After having been an RN for 5 years, I've seen enough to know that nursing is in trouble. Hospitals are trying to dumb us down, grind us down until we are nothing but broken bodies with broken spirits only to replace us with any one of the next 500 new grads ready to take our place. We are a necessary evil they must deal with to run the hospital. Nursing care is included with the cost of room and board for crying out loud!!

    Nursing does not need any more emphasis on caring! We have enough of that, in fact a little too much. What nursing needs is more emphasis on science, health care economics, and efforts to make nursing into a true profession. We need more autonomy. If we actually charged for nursing care and made money for the hospital instead of being included with the room rate, then we could start on the road to real autonomy. If we had autonomy, we wouldn't get "write ups" like we were children. We would have an active voice in the way the hospital runs. We wouldn't be short staffed and have no control over patient assignments. We need to recruit people who are not afraid to stand up for what's right, who want to learn the science of nursing, who are caring yet interested in furthering nursing as a whole. Right now we don't have that. Maybe it's too late and maybe we never will.

    I'm sorry for the rant, but I'm so frustrated right now. I care about nursing, I care about patients. This is making me re-think continuing my nursing career. Thank you for listening.
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  3. Visit  sweet~revenge profile page

    About sweet~revenge

    sweet~revenge has '5' year(s) of experience. From 'Southwest USA'; Joined May '11; Posts: 39; Likes: 142.

    51 Comments so far...

  4. Visit  wooh profile page
    6
    Brava!!
    DizzyLizzyNurse, Sisyphus, lindarn, and 3 others like this.
  5. Visit  opossum profile page
    3
    I agree...I just don't know how to approach this. It seems overwhelming. Strength in numbers, perhaps?

    Regarding the fact that "nursing care" is included in the charge of the room...I'm still floored by that. I remember a preceptor in nursing school telling me that was the case and just not wanting to believe it.
    lindarn, sweet~revenge, and anotherone like this.
  6. Visit  workingharder profile page
    18
    I started to write a short essay about what I thought needed to happen for the role of nursing to advance. Science, medicine, specialization, higher entry requirements, residencies,... Then I got to thinking (always a dangerous thing this late at night), I doubt that nursing will advance much further as time rolls on.
    Hospital nursing is going to become a victim of technology and budgets. UAPs are taking over many of the functions of nurses. Almost anyone can be taught to draw blood, hang an IV and punch in a few numbers(or the iv will be preprogrammed for the patient), take vitals and hand the TV remote to the patient. Med techs can pass medications. CNAs can fetch water or a blanket, clean a patient and distribute meals. Robots are becoming evermore common roaming the floors. In the (closer than you think) future, virtually all aspects of a patient will be monitored, with supreme accuracy, from a central site. I can easily see a time when any MedSurg floor can be staffed with one RN whose role will be to oversee the other personnel and equipment and take care of emergencies.
    Eventually, charting will be akin to the automatic log created by an automobiles' computer. Just punch in the patients ID# and everything that that patient has experienced from the moment they were admitted will be printed out. Doctors will not need a nurse to call them about a change of condition, the computer monitoring the patient will digest all the info being gathered and using incredibly complex algorithms will be able to text immediately the new condition of the patient.
    "Now, wait a minute", you may say. "Nurses have a scope of practice that only they can perform." Scope of practice can be changed legislatively. And when the hospitals start to realize the saving$, do you really think nurses can battle them in the legislature? Especially when it will be presented as a means to cut healthcare costs?
    Hospital nursing is going to be vastly reduced. The way this profession will survive will be in ICU, ER, home health, hospice, satellite clinics, industry, nursing homes, and advanced practice, (that as time goes by will be less and less like traditional nursing).
    I, undoubtedly, have some of these things wrong, but the general belief that technology and budgets will force a reorganization of the profession will still hold true.
    As mentioned, nursing is considered to be part of the room decor, and you know how easy it is to replace a flower pot.
    Maybe I should have stuck with the first essay, it might have been shorter and stayed with the original spirit of the thread.
    JRP1120, RN, kalevra, Ruby Vee, and 15 others like this.
  7. Visit  sweet~revenge profile page
    3
    Quote from opossum
    I agree...I just don't know how to approach this. It seems overwhelming. Strength in numbers, perhaps?

    Regarding the fact that "nursing care" is included in the charge of the room...I'm still floored by that. I remember a preceptor in nursing school telling me that was the case and just not wanting to believe it.
    I know, I don't know exactly what the solution is either. I think we need to start with billing for nursing care, but how do we do that? I read a paper about linking diagnosis related groups (DRGs) to an assigned nursing intensity weight (NIW). The more nursing care a patient required, the higher the NIW and the more it costs. But I'm not sure if we still use DRGs anymore, the paper I read on it was dated 2006. I'm still trying to research it.
    lindarn, opossum, and anotherone like this.
  8. Visit  sweet~revenge profile page
    3
    workingharder:

    You're right, I agree with you on both your original essay and what you actually wrote. Maybe it's just wishful thinking, but I can't help but think there must be a way to give nursing a chance. Maybe we just need to find a way to give nursing a strong foothold into a new better niche for ourselves in the future.
    lindarn, opossum, and anotherone like this.
  9. Visit  country mom profile page
    12
    Stay in nursing! Professionals like yourself who care to question the status quo, problem solve and critically devise solutions are exactly the kind of leadership needed. Yes, nursing will change. So will medicine, physical therapy, pharmacy and every other healthcare related practice. The question is, how can we lead the change to make health care better for our profession and our patients?
    Nurse Maru, Muffy5, elgin1962, and 9 others like this.
  10. Visit  BrandonLPN profile page
    25
    You don't need to really care (in a touchy-feely way) to be competent. Give me a cynical, world weary battle axe who knows her stuff over a Florence nightingale who's an airhead any day.
  11. Visit  SHGR profile page
    5
    Yes, there is a dichotomy between theory and practice, the real and the ideal...the ivory tower and real life.

    In reflective nursing practice, though-in the profession of nursing- theory underlies what we do.

    Also, caring supposedly can't be outsourced, so that idea gives me some hope.
  12. Visit  SHGR profile page
    18
    Quote from BrandonLPN
    You don't need to really care (in a touchy-feely way) to be competent. Give me a cynical, world weary battle axe who knows her stuff over a Florence nightingale who's an airhead any day.
    Brandon, Florence was the tough nurse who knew her stuff- she was the exact opposite of an airhead./end threadhijack
    OCNRN63, annlewis, DizzyLizzyNurse, and 15 others like this.
  13. Visit  BrandonLPN profile page
    12
    I should have said 'florence nightingale wannabe'. I meant no disrespect.
    annlewis, Muffy5, enchantmentdis, and 9 others like this.
  14. Visit  Fiona59 profile page
    6
    Don't worry Brandon, I knew the type you meant. They are all about "caring" but "forget/too busy" to do the patient washes or spend any actual time with anyone over the age of 80. We have two new grad RNs on my unit right now who fit the profile to a T. Their elderly patient's callbells are the last they will answer. They only go near the room when the UM is nearby.
  15. Visit  HouTx profile page
    21
    I applaud everyone's passion on this issue. But in the US, there is zero chance that nursing services will be billed separately because future reimbursements are moving into 'outcome' based mode - whereby everyone who participates in the care will have to share a lump sum - and that amount will be adjusted based upon how well the service was delivered, the quality of the outcome - and (ta da!) how well the patient liked everything. Rest assured that this state of affairs is not going down well with physicians either, who have been used to billing the patient whatever they choose. But our current situation has just too many fingers in the pie and our care delivery systems are struggling to survive under the increasing juggernaut of paperwork that is required to support our financial hairball. It has to be simplified.

    Keep in mind that Nursing care=hospital care. The only reason that patients are admitted to inpatient status is because they require continuous nursing care. "Room charges" are currently based upon all the 'stuff' that supports that stay, including nursing care. The problem is that nursing has never been viewed as a revenue center by the powers that be or accurately quantified in a meaningful way that can be confidently applied .... so they are at liberty to mess with us however they please - whether it is reducing the number of RNs or ratcheting up the workload. In actuality, nursing is the primary revenue center - because the need for our services is what drives admissions.

    I'm as old as mud, and have been a nurse for plenty-one years which gives me a bit of perspective. Every few years, the "charge for nursing care" issue bubbles up in popularity but dies down again due to lack of follow-through. Only in the last decade has there actually been any clear evidence of the role of nursing care in determining health care outcomes. Thanks to the work of nurse researchers/leaders like Linda Aiken and Tim Porter-O'Grady, we finally (!) are accumulating sufficient information to affect legislation and policy. But you know the drill - it takes ~ 17 years for research findings to actually be integrated into business practice. So - maybe next decade?? I hope all of you young ones will finally benefit. (fingers crossed)
    JRP1120, RN, Muffy5, DizzyLizzyNurse, and 18 others like this.


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