We don't need your kind here
Every unit has them. The nurses who, at any level of licensure, have been with the facility for a number of years. Depending on how small your Town is, those nurses who know patients and their histories well. Who know the family dynamics, know when the patient is not "themselves", how to convince a patient to do what they want them to do for the patient's benefit. It is a level of compassion and caring that only can come from years of experience. A day in which if you can keep a patient warm and dry and happy that their nurse "gets" them, and all will be ok.
Then in comes the Management team. They tear apart the way that is better for the patient's peace of mind, instead, to have a nurse become more efficient. Everything based on a number, a graph.
A de-personalization to the point of monotone scripting of basic communication. Because at the end of the day, they could care less is Mrs. G doesn't take her lasix because she doesn't want to be up all night peeing (where one could assume that the prudent nurse would speak with the MD about changing the time of the med to see if that works), they would like you to diurese the patient, and get them the heck outta the unit.
Patients as numbers or little dots on graphs are a new concept to a number of nurses who have been in this field for any length of time. Managers that don't want any direct patient care and will let the nurses struggle as opposed to lending a hand is a new concept.
There was a day that every code, every rapid response, the manager and sometimes even the DON would be right there. Because the mindset was on good patient care. Nurses who had a sterling nursing practice. That when a patient was admitted to the unit, they were understood, the communication was careful and individual, the the nurse was really working towards a common patient oriented goal, as opposed to a unit or facility goal.
Some facilities are working so hard to become "better" than the next facility by hiring BSN's only, phasing out those who don't fit that mold, and making them into everyone says the same thing to the same patient day after day. Don't care if you understand it, but gosh darn it, I am leaving you in capable hands!!
More education is not a bad thing. A BSN is a worthy goal. But just because someone has a BSN doesn't make them a better or worse nurse than another lower licensed nurse with years of experience. And it is sad to see nurses who are hired purely due to their degree, who are then taught that nursing is all about graphs and numbers.
Stick to the script, check off the boxes, stop elaborating, we don't care. We want the patient to assume you are kind and helpful, but you don't really need to be that way, just act as if you are. But you have 8 patients. Go in, report at the bed, don't forget to play up the oncoming nurse, don't really care if you believe that person to be a good nurse or not, but you must convince the patient that they are, smile, act interested, but don't show any individualized compassion. That doesn't get us paid. You don't need to connect to patients. They are not really people, they are numbers. And the goal is to act as if they are VIP's so that they will check off the appropriate boxes on the survey.
It is sad that facilities have come to this. That a nurse, regardless of degree or experience in other realms of nursing, can find themselves in a facility that employs this type of practice. That nurses who have a history with a facility are not valued for their knowledge, but corrected and sometimes fired for and individualized approach to patient care. It is such a direct conflict to how and what the nurse is in practice, that most move on to an alternate position. But the saddest part of that is, that's not their loss. Move on, who cares, there's 10 more applicants who will take your place tomorrow. Too bad, so sad. And I believe it IS too bad. And very, very sad.Last edit by Joe V on Jan 9, '15
Aug 15, '13I firmly believe that most of the things you mention ultimately have their roots in the US government. It is the truth that Medicare/Medicaid are the largest money pockets for any given hospital, and now that reimbursement is being tied to patient satisfaction scores, hospitals have to keep those scores high to stay afloat. Who cares if you are late giving Mrs. Smith her BP medication - if your patient Mr. Jones across the hall is complaining, he is the priority because his scores might drop if you don't go in there right then.
Tying reimbursement to patient satisfaction scores is a horrible, horrible idea. The people that are the most aware of their surroundings and who will be able to say the most about their care are the LEAST SICK patients. A patient going downhill that's half in and half out is not going to remember if you talked up your oncoming nurse, but the patient who you put off because of the patient going downhill will remember you never being in the room... because you're saving someone else's life. Do they know that? No. Does HCAHPS care if you were saving a life instead of waiting on your stable patients hand and foot? No. It really makes me angry thinking about it!Aug 16, '13Excellent writing. Very true, very on target. You hit the nail on the head as to the state of nursing today.Aug 16, '13Very well said. Only a nurse sees the reality of the insanity of HCAHPS scores.Last edit by cubby777 on Aug 16, '13 : Reason: addAug 16, '13You bring up a good point. As a longtime patient, I have seen it all and done it all. The thing that sticks out most for me is the fakeness of everything. Nurses (and doctors) seem fake. Like, I hear the same tired out words all the time. In fact, I could tell you EXACTLY what they say. "Kmmurphy? Hello, yes, come this way. We are ready for you." And if they were running behind, they throw in a standardized apology. If I am lucky. Mostly, it goes like this. "We're running behind today." That is all. Sad but true. Thank you for this wonderful story. Now I know that I'm not the only one who thinks this.Aug 16, '13I see nothing wrong with how you are greeted or what they say if they are behind. What exactly is it you're expecting?Aug 16, '13Patient satisfaction scores are a way for Medicare to get out of paying. First off- the score needs to be a 100 percent positive. Not 90 or even 99 percent- it must be 100. Last I heard 90 Percent was a pretty good grade in school. The method has unrealistic expectations but so doesn't all of nursing. The demands on nurses and Drs are unrealistic also so this should come as no surprise. This makes me so upset because Medicare knows it is a ridiculous standard. I don't know how they got this implemented in the first place. Oh right- probably from some one who does not work in health care and has no idea of what they are talking about.Aug 19, '13I think the system could really benefit from a severe nursing shortage. Do we have a glut right now?Aug 26, '13Agree with you on most points, but please remember: BSN-prepared nurses are not "higher-licensed" and ADN and diploma-prepared nurses are not "lower-licensed". And RN is an RN and a would-be magnet hospital may prefer the BSN candidate but that RN license is the same no matter how you got there. Same test, same scope of practice.Aug 26, '13I agree, Emmy. And I don't think that it is right in the least that there's a same NCLEX for all, however, more and more facilities are pushing for BSN's--and each of the other degrees/diplomas have taken and passed the same exact test.Aug 27, '13I continually hear hospital executives use the phrase "quality care", while doing things behind the scenes to ensure that it is almost impossible for the staff to deliver it. The "more is better" mentality is behind a lot of what is going on in health care. Hire only BSNs because they have more education - never mind that the ADN you laid off to hire one has years of experience, is at least equally smart and can work rings around most of them. As long as you can say in your ads that all your RNs are bachelors-prepared, the public will believe that they are better. Perception, not reality. And you can't just be XX Hospital anymore. You have to be XX Hospital Medical Center. You have to be both, not one or the other. The more words in your name, the better the facility is. It's about image, not results.Aug 27, '13Alas for your theory, those BSN nurses will have the time-in-grade and gain the attendant experience eventually-- and they aren't all new grads, anyway-- but the ones without the BSN will not gain the education as the years roll by.Aug 28, '13Quote from GrnTeaAnd choices made are choices made. There is no more investment in a BSN prepared nurse than an ADN or . All about numbers and graphs.Alas for your theory, those BSN nurses will have the time-in-grade and gain the attendant experience eventually-- and they aren't all new grads, anyway-- but the ones without the BSN will not gain the education as the years roll by.
Effective nurses come with various degress. But to hire BSN just for the sake of a star on the chart of facility-dom is not the answer. If the facility wants the nurses that are under their employment to be of a higher degree, then they need to make that a feasible option. In this day and age, with other obligations and money stressors, this is not always do-able otherwise.
I don't have $30,000 for a bridge program. I enjoy being an LPN. I am old. I have a kid in college already that I am assisting in tuition payments. Does that make me any less effective in what I do? Not by a long shot. But myself and some ADN/diploma nurses are being made to feel non-effective and moved about due to "needing BSN's to hit those numbers". Indeed. HCAPS in the toilet, blind leading the blind, no one knows what is going on---new grads, new to the unit nurses, and managers that went directly to MSN's without any floor experience. That's ok though, as long as you stick to a script, humor the patient, and get them the heck outta the unit. Pronto.
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