What's Wrong With 21st Century Nursing

Nurses General Nursing

Published

I love being a nurse and all that this profession was, is, and will be, but there is still something that deeply troubles me about this profession as a whole.

Working in a fast paced environment and a haven of knowledge I often find myself wondering what we could do better as a profession to keep up with the cutting edge.

My issue: nurses don't know enough.

From nursing school up to staff nurse, nurses just aren't taught enough.

I often find myself admiring just how much effort goes into a physician's education.

I love how doctors respect one anothers expertise and how their is a culture of teaching and learning in medicine. The chief teaches the resident or medical student, wealth is shared and the medical profession as a whole in turn reaps the benefits of shared knowledge.

Don't get me wrong we nurses can learn so much from each other, but are we? Do we share?

Sometimes I wish nursing school was longer and was less about the fluff and more about real time situations. Too much goes into learning how to pass meds and cleaning patients. Too little goes into how to monitor your patients, what signs to look for and basic bedside skills.

I was miffed when in my first semester of clinical we were sent to a nursing home to basically learn how to give bed baths and pass medications, as if that was all a nurse did. The next semesters were not much different at all, again learning how to pass meds, and look in charts.

I was also irritated on how little we actually learned about certain diseases, what to look for and tying that into the clinical aspect! (in regards to how lab data, patient presentation, medications, all rope together to help you think critically)

Sure nothing prepares you for the real world, but shouldn't you atleast be as prepared as you can be?

I'd love to be able to read CT scans/x-rays. I hate answering questions of worried patients/family member without knowing the entire picture. I hate saying ''oh the doctor has to tell you more about that'' because I lack the basic foundation doctors are drilled to have. Why should I be a bedside nurse for 10 years to know the things that a second year resident knows?

What bothers me also is how much more valued physicians are! Even physicians in training! Any given hospital has no issue paying a resident up to $70k/yr, a resident or intern who most likely won't stay at that hospital he or she trained in after they become an attending. But to train a new grad nurse or pay for continuing education for nursing staff is always a budget issue.

I love hospitals that value nurses enough to have something called a ''clinical ladder'' were a nurse is trained and prepared for a role of greater responsibility.

I love when a hospital puts time and money into training new hires, especially new graduates. I cannot tell you how enraged I was when I found out a prospective employer would only give a new grad nurse 2 weeks of bedside training for the ER of all places? With a crappy 4 weeks of classroom training to learn about paperwork!

I find myself wanting more. No, med school is no longer my dream. There is something special and unique about nursing, but I'm tired of nursing schools training students just to pass NCLEX, train us on how to be NURSES! I envision a nursing where nurses receive high quality education and training and in turn have a greater say in each and every single patients' care.

But until we value each other, our own profession, and our own value as professionals, nothing will change.

Learn what you want to know. We're not stopppin' ya. But 'something being wrong with 21st century nursing' doesn't follow. Nursing in the late 20th century into the present is all I'm personally familiar with, and it has its pros and cons; it's probably waaaay better than nursing in the 19th century. I do not feel there's any such thing as "the good old days", in nursing or any other area of life. I think overall, the world is better now. And hey, there's room for it to be better still. Same with nursing.

You haven't been doing this for very long. I'm going to take your post in the tone I hope it was intended, that of an idealist who wants to do as much good as possible. But your words could also be taken another way, and one could rush to the conclusion that you see yourself as God's Gift To Nursing, and that you have to straighten the rest of us out. I don't think you really feel that way, but I do think you're trying to draw Really Big Conclusions based on a really small data set. Sometimes people who are new to a field might rush to sweeping conclusions that others in the field do not share, and maybe do not even see evidence for.

My previous post might have come off a bit harsh in the second paragraph. I really think what you're chafing at is your present scope of practice. The thing is, if, as a bedside nurse, you develop the knowledge base to read the diagnostic tests and apply that information to the particular patient and arrive at a conclusion, you still may not inform the patient of that conclusion. It's not within your scope of practice. That is why they don't teach things like x-ray interpretation in nursing school (at least, not in mine). Nursing school teaches the basics you need to know to get into nursing, and to act within the given scope of practice.

However, if a proactive nurse notes his patient is hypertensive and somewhat wheezy, and his o2 sats are dropping, his call to the doctor to request appropriate orders will be more fruitful if he can report "Today's chest film is hazier than the last". But that nurse would be ill advised to tell the patient "You've got CHF".

As for respect, well, treat others with respect, and respect yourself, of course, but not getting it from others is sometimes just part of life. Learn all you can, because it will help you take ever better care of your patients. But nursing is some things, and it is not other things, and that doesn't necessarily mean there's "something wrong" with it. It's not a failure of nursing that it does not require the same education as medicine. It's a DIFFERENT education. I do not know any MD's who can competently start a peripheral IV, let alone provide bedside care for a patient through a twelve-hour shift, but I don't think that's a failure of medical education. The fields are collaborative and different. If you need to do something that is different - maybe to you, "more", than what you're currently licensed to do - go for it.

Specializes in Medsurg.

ALL4NURSINGRN

I agree with you completely.

I think a lot of time we were taught a whole bunch of stuff that was not really what we faced in the real world.

One good example is we were always taught too much on "nursing interventions," but that never included knowing what are the stable/unstable conditions and lab values, vitals. It was mostly tasks, tasks, tasks, and not alot on diagnoses and critical thinking on diagnoses and what to do, what to expect...yaddi yadda. In nursing school we were always taught that the normal blood pressure is 120/80. Well, it was a wake-up call to learn that most people in the hospital did not have that perfect blood pressure, and I did not have to panic if they didn't. We were taught what is the "norm" but not taught what was too low, too high, urgent, critical, and need to call the doctor. What we got in nursing school was text book stuff, and totally not what we encountered in the real world.

I understand that nursing has completely advanced, and nurses have so much more knowledge and autonomy now. But where does the line stop? Sometimes I feel like nursing is getting to be almost like being a doctor. Most of the time we find ourselves having to make the same judgments like doctors. EVEN though we don't act upon it as a doctor would...we would call the doctor so that he/she could order something. We are expected to know the acceptable, and not acceptable. We don't have all the medical training that doctors do, but we are expected to know so much as to make an initiation to call the doctor and anticipate what labs, or orders are needed. And if something is missed, or ordered in error, we are expected to catch it. And why? Since we are not "medically" trained as doctors, why are we expected to catch such orders that only a doctor has the knowledge to make????

Doctors have extensive medical knowledge and training in these parts, and we don't. But we are expected to alert them at the right time, and for the right reasons. Maybe we lack all the education needed for that.

RNs are taking up more responsibilities. I think the standards and roles of nursing should either be decreased, or increase the training and level of medical knowledge in nursing school. I go for the latter. RNs need to be better prepared.

By the way, I looked in a career book the other day and tried to find nursing under "medical" careers. I found it under "social."

And then I went to the nursing section to look for a book that will help nurses in certain situations, testing skills, and knowledge of lab values and tests combined with nursing practice....and found very little. Most of the books are on How to pass the NCLEX... ay ya yay! Some of those continuing education class books needs to be out there.

I am an old nurse. I went to nursing school before HIV/ AIDS was known, graduated when AIDS was treated by suiting up in a martian like outfit and approaching the patient. We, as medical professionals have come a long way. I recall my aunt, a RN now in her late 80's saying that they used to spend night shifts sharpening needles and autoclaving them for use the next day. WOW..can I say it again?...medical profession in general has come a LONG way!!. And along that way, we are responsible as professionals to keep up with the times. I see patients now in the home health setting that would have been in the ICU or DEAD when I went to nursing school. Now I get the privilege of teaching these patients to become independent care givers or patients, and manage their own disease and medications at home SAFELY. It is your responsibility as a professional to learn and keep learning, keep current and knowledgable. My education started with nursing school, but it has not and won't end there.

To the OP, I don't know how much experience you have, but with years of experience you do learn to listen to patients, look at lab results, ex-rays, etc and tell the patient what you see...not what you "diagnose", but what is interpreted, and then refer to the MD about appropriate treatment. It takes time, lots of continuing education, and most of all a lot of bed side care in order to feel comfortable in your own shoes and learn these things. Your nursing school was just to prepare you to "enter" the nursing field. NOT to be a "master" at your career, otherwise you wouldn't have to spend so much time with a preceptor at your first nursing job, or at a new job after years of experience and change your field of practice. You should have learned enough to be able to enter the nursing field and be safe at your practice, not everything there is to know about nursing/medicine/disease management or medications. These things evolve every day, new treatments/diseases/medicines etc are being developed every day. The learning comes when you start delivering care to your patients. You have to know how to crawl before you walk, and to walk before you run. If you feel you are not learning fast enough, then seek it out on your own, don't just sit around and whine that you can't do it. If you love nursing, then stick with it. If you feel you made the wrong choice in your career decision making, then use your nursing education to afford you to continue your studies and go to Medical school (or aerospace engineering...or underwater basket weaving). Do not expect it to be handed to you on a silver platter, or that you can absorb it by osmosis, it does not work that way. If you want it...SEEK it out. And if you thought you should have learned it all in nursing school....well you'd have to constantly stay in school because it changes every day!

Good Luck!

Specializes in none.
I love being a nurse and all that this profession was, is, and will be, but there is still something that deeply troubles me about this profession as a whole.

Working in a fast paced environment and a haven of knowledge I often find myself wondering what we could do better as a profession to keep up with the cutting edge.

My issue: nurses don't know enough.

From nursing school up to staff nurse, nurses just aren't taught enough.

I often find myself admiring just how much effort goes into a physician's education.

I love how doctors respect one anothers expertise and how their is a culture of teaching and learning in medicine. The chief teaches the resident or medical student, wealth is shared and the medical profession as a whole in turn reaps the benefits of shared knowledge.

Don't get me wrong we nurses can learn so much from each other, but are we? Do we share?

Sometimes I wish nursing school was longer and was less about the fluff and more about real time situations. Too much goes into learning how to pass meds and cleaning patients. Too little goes into how to monitor your patients, what signs to look for and basic bedside skills.

I was miffed when in my first semester of clinical we were sent to a nursing home to basically learn how to give bed baths and pass medications, as if that was all a nurse did. The next semesters were not much different at all, again learning how to pass meds, and look in charts.

I was also irritated on how little we actually learned about certain diseases, what to look for and tying that into the clinical aspect! (in regards to how lab data, patient presentation, medications, all rope together to help you think critically)

Sure nothing prepares you for the real world, but shouldn't you atleast be as prepared as you can be?

I'd love to be able to read CT scans/x-rays. I hate answering questions of worried patients/family member without knowing the entire picture. I hate saying ''oh the doctor has to tell you more about that'' because I lack the basic foundation doctors are drilled to have. Why should I be a bedside nurse for 10 years to know the things that a second year resident knows?

What bothers me also is how much more valued physicians are! Even physicians in training! Any given hospital has no issue paying a resident up to $70k/yr, a resident or intern who most likely won't stay at that hospital he or she trained in after they become an attending. But to train a new grad nurse or pay for continuing education for nursing staff is always a budget issue.

I love hospitals that value nurses enough to have something called a ''clinical ladder'' were a nurse is trained and prepared for a role of greater responsibility.

I love when a hospital puts time and money into training new hires, especially new graduates. I cannot tell you how enraged I was when I found out a prospective employer would only give a new grad nurse 2 weeks of bedside training for the ER of all places? With a crappy 4 weeks of classroom training to learn about paperwork!

I find myself wanting more. No, med school is no longer my dream. There is something special and unique about nursing, but I'm tired of nursing schools training students just to pass NCLEX, train us on how to be NURSES! I envision a nursing where nurses receive high quality education and training and in turn have a greater say in each and every single patients' care.

But until we value each other, our own profession, and our own value as professionals, nothing will change.

You or anyone doctors included don't know everything. That's why there are specialist. new Information is coming out constantly. New meds new procedures. you can't keep up with it all. The best investment would be a smart phone connected to the web. even that would not be enough. BSN from the time of the first course to the time of graduation. the information the she learned in the first course is out of date.

Specializes in none.
I love being a nurse and all that this profession was, is, and will be, but there is still something that deeply troubles me about this profession as a whole.

Working in a fast paced environment and a haven of knowledge I often find myself wondering what we could do better as a profession to keep up with the cutting edge.

My issue: nurses don't know enough.

From nursing school up to staff nurse, nurses just aren't taught enough.

I often find myself admiring just how much effort goes into a physician's education.

I love how doctors respect one anothers expertise and how their is a culture of teaching and learning in medicine. The chief teaches the resident or medical student, wealth is shared and the medical profession as a whole in turn reaps the benefits of shared knowledge.

Don't get me wrong we nurses can learn so much from each other, but are we? Do we share?

Sometimes I wish nursing school was longer and was less about the fluff and more about real time situations. Too much goes into learning how to pass meds and cleaning patients. Too little goes into how to monitor your patients, what signs to look for and basic bedside skills.

I was miffed when in my first semester of clinical we were sent to a nursing home to basically learn how to give bed baths and pass medications, as if that was all a nurse did. The next semesters were not much different at all, again learning how to pass meds, and look in charts.

I was also irritated on how little we actually learned about certain diseases, what to look for and tying that into the clinical aspect! (in regards to how lab data, patient presentation, medications, all rope together to help you think critically)

Sure nothing prepares you for the real world, but shouldn't you atleast be as prepared as you can be?

I'd love to be able to read CT scans/x-rays. I hate answering questions of worried patients/family member without knowing the entire picture. I hate saying ''oh the doctor has to tell you more about that'' because I lack the basic foundation doctors are drilled to have. Why should I be a bedside nurse for 10 years to know the things that a second year resident knows?

What bothers me also is how much more valued physicians are! Even physicians in training! Any given hospital has no issue paying a resident up to $70k/yr, a resident or intern who most likely won't stay at that hospital he or she trained in after they become an attending. But to train a new grad nurse or pay for continuing education for nursing staff is always a budget issue.

I love hospitals that value nurses enough to have something called a ''clinical ladder'' were a nurse is trained and prepared for a role of greater responsibility.

I love when a hospital puts time and money into training new hires, especially new graduates. I cannot tell you how enraged I was when I found out a prospective employer would only give a new grad nurse 2 weeks of bedside training for the ER of all places? With a crappy 4 weeks of classroom training to learn about paperwork!

I find myself wanting more. No, med school is no longer my dream. There is something special and unique about nursing, but I'm tired of nursing schools training students just to pass NCLEX, train us on how to be NURSES! I envision a nursing where nurses receive high quality education and training and in turn have a greater say in each and every single patients' care.

But until we value each other, our own profession, and our own value as professionals, nothing will change.

You or anyone doctors included don't know everything. That's why there are specialist. new Information is coming out constantly. New meds new procedures. you can't keep up with it all. The best investment would be a smart phone connected to the web. even that would not be enough. BSN from the time of the first course to the time of graduation. the information the she learned in the first course is out of date.

hi i am fairly a new nurse since sep of 2011 but didn't get my first job until dec in long term care worked there for about 2 months it didn't work out. now i work in homecare for peds with trachs my orientation for trachs was putting a trach in a dummy. since then i have had only one opportunity to put a trach in and that was with help from the lady i work for. she is a great person willing to teach her nurses that care for her child the things they should know how to do to do a good job. well i also work for another lady and she is just the opposite so quick to get on the phone and call the agency for anything and everything. well to make a long story short i have never had to put a trach in by myself i know its easy to do but have never had the opportunity to do so . well last night at this homecare job the childs trach came out and i had not notiiced it because the stem was under the gauze and he had a trach mask on an it looked fine to me. well the mom noticed it and i was honest and told her i had never had to put a trach in so she called the agency and told them her childs trach came out and i never put a trach. the agency called me and said why did i tell her that that it made me look incompentent. again its not like i put trach in everyday and i know i could do it just never had opportunity to do so, and that they had other cases coming in that they thought about putting me on but now they are not even sure. i am so sick it makes me so mad that they are treating me this way. i was honest but i am feeling like i should know everything no questions asked. I am so sick of nurses scared not to ask questions because then they will look like they are incompetent and when something does arise they get shafted because the employer will say you should of asked, its a no win situation. what do you think about this situation. oh by the way i work 3rd shift and the one case i work at the mother changes out the trach and other place i work at the first shift nurse changes out the trach and i am sure she was trained because she too is brandnew like me and the women we work for well the first shift nurse went to school with her so i am sure the mom helped her change her first trach. I think i need to get out of that home. And it makes me mad that the care coordinator of that agency was once a homecare nurse and i am sure she must have known everything and never made mistakes (yea right) I feel just like calling them up and say I quit give my two weeks and find something else. I don't know who you are but i read your post.

any suggestions or opinions or am i just a incompent nurse.

thanks

I am wondering why you would have accepted taking care of these patients when you knew the responsibility involved trach changes and you did not, nor have you sought to get that skill. I am also concerned that the agency would want you to represent them without the proper skills.

I read that you had quit another job because you feared being fired for mistakes. If you continue to run when things get hot eventually you will unhireable. No one wants to spend the time, energy and money to acquire a new employee when she has a history of jumping ship when there are problems.

You need to take responsibility to learn what your job is and get the skills to do that job. Why blame the care coorinator for her growth when you seem to be reluctant to do the same growing.

I am sure this sounds harsh. I am just floored that you would accept an assignment when you were incapable of performing the work.

I am wondering why you would have accepted taking care of these patients when you knew the responsibility involved trach changes and you did not, nor have you sought to get that skill. I am also concerned that the agency would want you to represent them without the proper skills.

I read that you had quit another job because you feared being fired for mistakes. If you continue to run when things get hot eventually you will unhireable. No one wants to spend the time, energy and money to acquire a new employee when she has a history of jumping ship when there are problems.

You need to take responsibility to learn what your job is and get the skills to do that job. Why blame the care coorinator for her growth when you seem to be reluctant to do the same growing.

I am sure this sounds harsh. I am just floored that you would accept an assignment when you were incapable of performing the work.

I don't want to sound harsh either, but I agree with this post. If I'm looking after a patient with a tracheostomy, I need to know how to manage it. If I don't know, or don't feel confident, it's my responsibility to make sure I do find out, become confident with the changing procedure, and make certain I can handle any complications that may occur, especially in a situation like this where there is no back-up. If that's not possible for some reason (not enough time, no-one to teach me, whatever), it's up to me to turn down the assignment until I do have the skills.

Specializes in Oncology; medical specialty website.

i echo the sentiments of the above two posters. there is no shame in admitting you don't know how to do something. i have lots of experience in different areas, but there is a lot i don't know how to do. the professional thing is to admit it up front, not after you've already gotten the assignment. in home care, you can't rely on family members to show you how to do a procedure or even do it themselves. they may be using inappropriate technique, and above that, they are paying the nurse to come to provide care. consider it a lesson learned. ask the agency if they will let you shadow a nurse who has a trach case so you can be shown how to do it per the agency's protocol.

one of the unfortunate consequences of hospitals not hiring new grads is that new nurses wind up getting jobs in areas where there is little to no support. while a few new nurses here or there do well in a private duty or home care situation, the fact is a lot don't. as a new nurse, you need a place where someone else can help you with a new procedure, someone you can bounce a question off or help bail you out until you are ready to stand on your own two feet. our new grads are really being done a disservice with today's hiring/staffing practices.

Specializes in none.

To radgey never be first relax. Second you're new you don't when to be honest and when to keep quite. I too wonder why you took a case if you felt uncomfortable putting in trachs. What I did on my one case that I had where the guy had a trach I would time some time out every few days and go over the steps for changing a trach. Then when I had to do it, i remember saying the steps out loud. The other thing is the reality that someone's life is in you hands. There are no teachers that will help you. You are on your own. People that you meet in this profession aren't always nice. You made a mistake in tell the mother you never did a trach before by yourself. But all is not lost. You have to do the best you can with the patient you get. Go over the procedures until you can recite the steps in your sleep. There is an old trick I use when I'm giving out meds. If a patient asked me about a new medicine that he's taken and I don't know what it is i say," oh, that medicine has a lot of uses let me see what the doctor is giving you it to you." Then I hurry to the med cart and look the thing up. When you go on a case always have a trach book and med book around so you can look up the procedure. Even if the family is there you can always say you're going to refresh your memory.

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