What's Wrong With 21st Century Nursing

  1. 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.
    Last edit by brian on Jan 12, '12 : Reason: formatting
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  2. 58 Comments

  3. by   Oppon262
    No offense, but if you feel this way, why didn't you just go to medical school.
  4. by   All4NursingRN
    because i love the profession I have chosen, so just because I think it could do with some improvements doesn't mean I dislike what I do. Why do I have to be a doctor just to be more knowledgeable?
  5. by   GHGoonette
    All4, I'm sorry to have to disillusion you, but the bulk of nursing care is, in fact, basic care. Certainly you utilize more of your scientific skills in critical care areas, and judging by your post, I would say that further study in Advanced Practice (whichever direction you want to study in) might be the best option for you, but performing those basic care tasks is where you learn to interact with your patient, not when you're being the scientific whizz-kid.
  6. by   rita359
    Have no experience with current day nursing schools but if passing meds and bedside care are not what you want to do because passing meds is a huge part of our day then sounds like np is the route to go. No passing meds, you would have know exactly what you are talking about to be competent in that role, independence would be greater and pay would be higher. Whats not to like?
  7. by   WhichWayIsUp?
    Just finished my second masters, a masters in nursing (MSN). I think the conflict here is something that we covered in class. Today's basic nurse has to master a body of knowledge that is huge. Have you seen the latest version of Brunner's Medical Surgical Textbook? It is two massive books! When I went to nursing school it was only one large book. And we didn't even cover every chapter. Today's nursing student doesn't stand a chance. Studies have proven that to gain enough knowledge to truly function in nursing today a nursing student needs to be in a 5 year program. Wow! And we are still arguing if we should eliminate the LPN status? Ridiculous. If you work on the floor you know that passing drugs and doing basic care is 2 of the least of tasks you need to do and ranks very low. Today's nurse is responsible for being the safety net for the patient. You are expected to know everything about the patient and everything that is being done to and for the patient. You need to know that the patient was admitted with a possible PE but the Doc did not order a venous doppler study to rule out other possible DVTs. You need to know which acute rehab facilities will accept which patients with a host of co-morbidities but not others. PCTs have taken on the role of caregiver, bathing, feeding, tolieting and comforting. The days of RNs doing that gone. It is no longer economically feasible in the USA to maintain that thought process. Nursing has grown past that. The LPN, and ADN need to be eliminated. The minimal entry point needs to be a BSN with many more seeking MSN and DSCN. This is the direction of nursing and it will not change. Change or perish, there is no going back.
  8. by   RNperdiem
    Nurses do keep learning.
    Most of our learning is informal and continues long after nursing school.
    A lot of the old timers know a whole lot more than they let on.
    My brother just finished his residency. To gain the knowledge he has to be a doctor required working 80 hour weeks at the hospital. Break down that $70K (most hospitals pay far less) into money per hour and it isn't much.
  9. by   gettingbsn2msn
    Totally agree with the less fluff!
  10. by   Esme12
    The amount of knowledge you have is totally up to you. As an "old timer" I am proud of what I know. I knew my nursing education did not stop at school, but continued at the bedside to better care for my patients. In the days before Fax's and tele imaging, intensivists, and hospitalist......we the bedside nurses were the one's that told the cardiologist what the 12 lead ekg showed. We dealt with the open hearts and "numbers" without the benefit of having anyone but ourselves to depend on (an standing orders) I suggested treatments and collaboratively was allowed to follow my instincts and change a patients outcome. The MDs that taught me to care for their patients were generous giving men who treated us as a part of the team....as an equal team member.

    I have seen this easy collaboration slowly slip away. That is what I find most disappointing.

    While I believe that BSN is the next natural step for nursing education and minimal education requirement. I have never felt the need to, I believe the phrase was "eliminate", any of my peers. I also believe you can't learn to be a nurse online. I also believe that you shouldn't be able to take the NCLEX until you pass.....no matter how many times it takes.

    We shared in our knowledge and supported each other and shared our knowledge. Somewhere along the line we have decided to degrade the value of our fellow nurses and have therefore become hoarders of "individual" knowledge terrified if we share what we know we are no longer worthy somehow. Somewhere along the line we have engaged in school age banter "my ball is better than your ball" playground bullying......and that makes me sad. NO member of any team is more or less worthy that the other as well all contributions that are valuable. We took pride at being good at what we did, always eager to learn more.

    Knowing that a patient was admitted with DVT and needs a ultrasound done does not depend on how many degrees you process. It depends on having bedside experience to know what to suggest to the MD when he may have forgotten to.....he's only human (or new) too. Knowing to check the PTT before giving coumadin is a nursing responsibility and has nothing what so ever to do with how many degrees one possess. It has to do with caring for your patients and wanting to to your very best.....all the time every time.

    I don't feel nurses should be removed from the bedside. We save patients lives very day by what we do, or don't so....or prevent others from doing. We are the 24/7 eyes and ears for patient treatment and care and the more we put each other down the more we will be held down.....unable to evolve and grow.

    To the OP. You talk of burnout in other threads/posts and have only been a Registered Nurse for a year and a half. If you feel so frustrated by lack of learning my question to you is why have you stopped trying to gain knowledge. How many inservices/seminars have you attended. How many professional organizations are you involved in.....do you belong to the ENA? Are you going to New Orleans for the conference? Do you have your CEN, ENPC, ATLS? If you don't then your education, or lack of education, and learning is in your hands.

    When I became a nurse....all wanted to be was a nurse. You don't have to be a doctor to be knowledgeable you just have to have a thirst for knowledge and the iniciative to go and get it.

    Peace.
    Last edit by Esme12 on Jan 12, '12
  11. by   neverbethesame
    To the OP,

    These desires and feelings are good signs for you, where your passions are and where your gifts and talents can be best utilized. There is so much in nursing where you can find what you are looking for. It will take more schooling as others mentioned such to be an NP or whatever else will be coming up in nursing. I know you said no med school but I know girl who was an RN and wanted more and she become a PA who loves her job and is very good at it.

    Good Luck!!!!
  12. by   OCNRN63
    Quote from Oppon262
    No offense, but if you feel this way, why didn't you just go to medical school.
    What he/she said.

    Based on some of the accounts that I've read, people still don't spend enough time learning how to pass meds. Med. administration is pretty doggone important.
  13. by   Morainey
    There are definitely things I feel like my nursing school did a poor job covering, but I don't think learning stops with graduation. If I don't know the ins and outs of a condition my patient has, I dig out my med surg books or even fire up Google. My hospital offers lots of continuing education and seminars.

    What's wrong with learning to how to give a bed bath? That's part of nursing. So is passing meds. It's important. I would go so far to say that is a fundamental part of nursing.

    No one expects nurses to be like Dr. House. It's not our responsibility to provide a differential diagnosis, or to read CT scans or X-rays.

    I love being a nurse. I love my job. I value myself. What I don't love is when people complain about "bedside nursing" like it's some low-class, filthy job. What did you expect??
  14. by   nurseprnRN
    when i finished my mn i (and many other mns) were working bedside. if you want to compare medical education with nursing education (which is sorta silly, but for sake of argument), i had my six years. people who want more education can always get it.
    i see ny state has a bill before the legislature that would mandate every rn to have a bsn within 10 years (ten years!) of graduation from a lesser level. you think?

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