What I Wish Would Change/Be Different

Some of my thoughts and reflections on nursing that I wish would happen. They would make nursing a more perfect career for me. I think it can happen. I think as nurses we are a lot more powerful than we think we are and if we joined together, we could make drastic change. This is sort of an informal list with some paragraphs. Feel free to add your own thoughts in the comments section. Nurses Announcements Archive Article

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What I Wish Would Change/Be Different

Cartoon and "cutesy" patterned scrubs. (Disclaimer: I do wear patterned scrubs.) Nurses and CNAs are the only healthcare workers I see who wear patterned scrubs. I have never seen a MD or PA wear patterned or cartoon scrubs. They will wear solid color scrubs. I think we look more professional when we wear solid scrubs or nice patterns versus mickey mouse. I think the "cutesey" scrubs should be reserved for pediatrics. I am in no way saying that nurses who wear such scrubs are less intelligent or less competent, but I think we look less professional when we dress this way.

Stop the Diploma vs. Associates vs. Bachelors infighting. There are great nurses with diplomas, Associate degrees, and Bachelor degrees. A degree does not equal competence. I'm not saying one is smarter than the other or less smart than the other. I do think, however, that we have to set a standard and in the eye of the public a Bachelor's degree means more than an Associate's degree or a Diploma. If we want to be respected as a profession, there have to be set standards, not three ways to become an RN. There aren't three different degree paths to become an MD. That being said...In my opinion, there should be a plan to phase in the Bachelor's degree as an entry level degree with current Diploma and Associate degree RNs being grandfathered in, and incentivized, but not forced to return to school. I don't think an Associate's degree RN who has worked for 30 years should be forced to spend hard earned retirement money get a Bachelor's degree. I do not think LPNs should be phased out. In fact I think they are underutilized. We could utilize a "med pass LPN" on the floors who can pass meds on a handful of patients who don't have IV push medications. They can share an assignment with an RN. I know this used to be done.

Speaking of infighting...The specialty wars that exist in some places is getting very tiring. Enough said.

Nursing schools must cut some of the fluff and focus more on the practical.

Titles/degrees. There has to be a standard that everyone follows for listing degrees and certifications. The standard is first name last name, highest degree, lowest degree (if highest degree is not a nursing degree), and then certifications. There should be standard for NP titles as well. Maybe just CRNP, followed by specialty or just plain CRNP.

The ratios. Nursing home ratios are insane. There are some med-surg units where the nurse patient ratio is 7-8 or more to one RN and there may or may not be a CNA. Patients are getting sicker and sicker. I don't know what we can do about this, but if we continue to put up with it and not speak up more it will continue. Part of the reason the ratios are being harder to deal with is because there is an increased focus on customer satisfaction.

The focus on customer satisfaction is killing nursing and killing patients too. I think it's only a matter of time before the data comes out that we are doing more harm than good. This is another thing that we should not have to put up with.

Speaking of data...nurse researchers should focus on publishing studies using randomized controlled trials with measurable data that offers practical conclusions. While there is a place for nursing theory, I feel there is too much emphasis on this in nursing education and research.

The documentation. Some places are better than others. I wish there was a standard way to document that could be used across the board which wouldn't be so time consuming.

Boards of nursing. I know that nursing is state regulated, but if you take the NCLEX, which is a national exam, your license should be valid in all states which means that all schools of nursing should be accredited by the two recognized national certifying agencies CCNE and ANCC. Nursing schools should be required to have accreditation. If there was a national board of nursing, the unaccredited schools would not get away with what they do.

Interactions with patients and colleagues. We should not have to put up with rude patients and family members yelling, hitting, throwing objects, stealing supplies/food, being disrespectful, spitting, cussing etc. Of course the exception is made if there is a clinical reason for their behavior. If this happened outside of the hospital would you put up with it? Or would you press charges potentially? The same can be said related to our colleagues, including physician colleagues. We should call people out on their inappropriate behavior and report it to management and then to HR if the behavior continues after intervention(s).

You are only encouraging drug seeking behaviors by pushing Dilaudid in 15 seconds. Dilute your Dilaudid in 10cc NSS and push over 2 minutes. FYI morphine should be pushed more slowly to avoid respiratory depression. At one place I worked, the doctors started ordering 1-2 mg Dilaudid diluted in 50 cc of NSS that ran over 1 hour. The ER I currently work in is "Dilaudid free." So changes are being made and there is increased awareness. Have you noticed this in your workplaces? Effective pain management means keeping up with pain not catching up with pain and utilizing your non-narcotic analgesics in conjunction with narcotics. Post op patients should have scheduled pain meds. Many times, providers give in to the requests of "frequent flyers" who request medications that are not indicated, such as Benadryl, Zofran, and Dilaudid cocktails. These patients often deny itching or nausea, but rate their pain upwards of 10/10. I feel that it is a violation of the five rights of medication administration to give a medication that is not indicated.

It's not my patient, it's OUR patient. If you get report from the day shift nurse and a dressing change wasn't done, labs weren't drawn, and/or the patient needs a new IV, don't make her stay to complete those tasks. Is this about YOU or the patient? Of course if there is a trend, laziness shouldn't be tolerated, but for your typical hard working RN, some days are just terrible, and the last thing you need is the next shift RN making you stay when all you want to do is go home. The better thing to say is "Hey Lisa, can we do that dressing change now together?" And I work both days and nights and nights are really busy too.

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Lev

About Lev, MSN, RN, NP

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Specializes in Med-Surg, Emergency, CEN.

:) Yes, yes, yes!

I hate the patterned tops too, but I will tell you that the providers I work with do wear cutesy scrubs under their lab coats. One in particular wears a rainbow tye-dye lab coat if his patients are not acutely ill.

For example:

tye_dye_lab_coat.jpg

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Very interesting read. I plan to keep all of this, and more, in mind as I go through my schooling. Good job constructing a 'rant' that just might not step on anyone's toes. Especially considering the subject content covered! I'm interested to see how my opinion on these matters change as I go through my program and enter the nursing field. I get the feeling that if I act as best a 'good' person I can, I will have a better time in this profession.

I have always disliked politics, I should have known it was in nursing too!

Good luck to everyone tackling these matters! I'll join you once I get some experience in.

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You have basically summed up all of Allnurses.com except for the homework threads. ;-) There are some important changes that nurses are driving to happen through their collective voices, such as safer nurse- patient ratios. It's happening, very very slowly.

I work peds and I do have cheerful scrubs. However they are not extremely cutesy or cheerful. For one, most of our patients on my unit are on isolation precautions, infants, severely neuro affected, or sedated, so the only ones who can enjoy the patterns are our fellow co-workers. Secondly, sometimes I work PICU (cross-trained) and I never know what kind of patient I'll get. It would be a bit inappropriate to wear cheerful dancing Dora scrubs if I get a 15 year old male in a life-threatening condition and am trying to reassure his parents that he's in professional hands. I try to keep it cute but toned down and generic to all patients. Also if I'm having to hold down a toddler to deep suction her nose and happen to be wearing a Hello Kitty top, she'll probably hate Hello Kitty for the rest of her life.

Here's what I wish. I wish doctors who call back about a patient when I page them will introduce themselves clearly, first and last name (or at least last name if they are well-known) so I don't have to ask them to say it again. They should be aware that I have to chart who I talk to, and "Jenny" or "Mike" will not work on a chart.

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Specializes in Med/Surg/ICU/Stepdown.

I don't know that I can find any other aspect of nursing that I'd change that you hadn't already addressed. Bravo. I think, however, if I had to choose an additional topic, I'd definitely change doctor-nurse interactions. I'm aware that this is often a facility issue and even more a personality issue, but the way physicians address nurses is often overkill. Nurses are educated professionals with a keen eye for patient changes that should be respected. If a nurse approaches an MD with a concern, it is both unprofessional and inappropriate for a snarky comment, eye-roll, or dismissal to follow.

I've been on the receiving end of this many times and had to tactfully (and sometimes not tactfully) tell a physician to calm down.

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The ER I currently work in is Dilaudid free.” So changes are being made and there is increased awareness. Have you noticed this in your workplaces?"

NO, good grief, I WISH. But there's a pain management nurse who runs around making sure everyone is getting their fix, and they keep coming back over and over again until we're giving them dilaudid and methadone in the same day and abusive behaviors get worse and worse. I had a patient threaten to physically harm me this weekend over not getting pain meds he felt he was due (that his doctor would not prescribe) and nursing administration/security did nothing but ensure he got more medication. Plain insane.

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Right on, but I'm not sure I'm 100% with you on the pain medication. The idea that nurses may be contributing or causing drug seeking behaviors in the ED shouldn't be that great of a concern. Are you really going to be the cause of someone being an addict in 4 hours or less? Pain, as you know, is very subjective and I personally would not hold back on analgesics in an emergent situation. I've worked in the ED and know that there are a lot of drug seekers coming through the door. The frequent fliers were obvious and known to pretty much everyone in the department and I had no problem being more conservative if they did not have any obvious signs of pain.

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Specializes in Family Nurse Practitioner.

@pitt2philly I used to work on a surgical unit. We got a lot of the "abdominal pain" patients. Dilaudid left and right. (That's the place that started with the diluted dilaudid run over 1 hour). I'm not saying to not give pain medication, but how many times have you had a patient asked you to "push it fast"? No I'm not saying we cause addictions, especially not just for 4 hours in the ED.

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Specializes in Family Nurse Practitioner.
NO, good grief, I WISH. But there's a pain management nurse who runs around making sure everyone is getting their fix, and they keep coming back over and over again until we're giving them dilaudid and methadone in the same day and abusive behaviors get worse and worse. I had a patient threaten to physically harm me this weekend over not getting pain meds he felt he was due (that his doctor would not prescribe) and nursing administration/security did nothing but ensure he got more medication. Plain insane.

Agreed!

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Specializes in LTC Rehab Med/Surg.

The ability to tell an able bodied patient "you can do that yourself", without fear of retaliation by management.

The expectation by the patient that no request is out of bounds.

Promoting health instead of helplessness.

Discharging patients who are noncompliant with their care, when they are perfectly capable of making informed decisions.

The return of "visiting hours".

Return the hospital to a hospital, instead of a hotel.

Screaming, yelling, and throwing things, is not rewarded with drugs the patient wanted in the first place.

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Specializes in Registered Nurse.

It's a long road ahead to solve many of these issues....and I am afraid, "Not in my lifetime", is the way I feel about it....at least for a lot of what you mentioned. But what I would want to see is even more of a dream! I'd like to see truly bad nurses somehow attached to a reject button. I'd even give them 2 or so chances...and then 3 strikes your out. In all seriousness, as a patient last year, I actually had a nurse finger my medication. Not good, IMO. Afterward, I realized I was *more susceptible to infection...and remembered her fingering my med. :(

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I think another issue that needs to be addressed (hear me out, nurses!) is the nurse-doctor wars largely propagated by nurses. I haven't actually seen a lot of it here on allnurses, but at my hospital I feel as though there are too many nurses eager to jump on every mistake a MD makes, telling everyone they know about it again and again. I know nurses who still talk about MD mistakes from years ago! There is also so much talk about what idiots new residents are, etc. etc. I mean, of course new residents are idiots, in exactly the same way new nurses are! They (we -- I'm still new) don't know anything. So why the hate?

Why do I care? Because I think that it can make nurses sound insecure. It sometimes feels as though nurses want to point out MD mistakes as a way of saying, "Look, everyone thinks they are so awesome but they don't know this! They did this wrong! See? See?! They're not that much more awesome than nurses after all!"

Unfortunately, I understand where the desire to do this comes from, because nursing often is not respected as an 'intellectual' profession. I personally think that it is one, and that all nurses should be incredibly proud of the knowledge and skill they need to do their job. However, I grant that society tends to be blind to said knowledge and skill, and I think we have all heard, "I want to speak to the MD!" from a patient who won't listen to your opinion just because you don't have a white coat. However, I think that we nurses shoot ourselves in the foot when we try to elevate perceptions of our profession by tearing down MDs. Let's just be secure in how amazing we are, know that we are smart, and acknowledge that MDs make terrible mistakes (just like nurses), while remembering that at the end of the day we are all doing jobs with immense amounts of responsibility and stress. Nursing is an amazing profession and I am grateful everyday that I was somehow wise enough to choose to live my life as a nurse; let's help more of society to realize what a great profession it is by showing them that we feel no need to compare ourselves to doctors. We are nurses. We are different. And we are proud to be.

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