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SunnyVet14 1,901 Views

Joined Sep 7, '12. Posts: 15 (27% Liked) Likes: 5

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  • Jan 29 '14

    Quote from AnnMarie52471
    I am taking classes towards my BSN because like other nurses with a diploma or ADN I am being "forced" to return to school for my BSN. I have had my ADN for 9 years. My question is HOW is statistics, critical inquiry, and the other classes going to make me a better nurse? Isn't hands on training the best way to learn? I feel like they are requiring BSN now and in 10 years want MSN so that we wont need doctors working on the floors, because nurses will do their own orders!!

    I am 42 y/o and rally don't want to do this, but I have a minimum of 23 years left of working and had to be forced to stay where I am due to not having a BSN. Sure they say we may be "grandfathered" in, but that limits us to stay put.

    Anyone have any input on this, as to what am I going to learn getting my BSN and why the requirement now?
    Why now? Because the academics have been trying to push it FOREVER. Why now? because everyone and their brother has gone to nursing school and there is a surplus of nurses. Why now? simply because they can. Anytime this has been attempted legally...they have to grandfather already licensed nurses in or pay out of their pocket to re-educate...they can't take away your license. They can however refuse to hire you.

    However, with the current climate and bad behavior of the powers that be...I wouldn't out it past them to try. So they do the next best thing....they will not hire without a BSN.

    and the argument continues.

    Will the classes you take after your ADN really ADD to your practice at the bedside? No...they won't....other than the ability to find work.

  • Jan 28 '14

    Some states have laws that prohibit this... including mine. In Tx, mandatory overtime is only permitted in cases of true emergency or natural disaster. Also, if a nurse refuses mandatory overtime, it cannot be considered patient abandonment. Here's the reference Mandatory Overtime/Consecutive Shifts

    I have taught management skills for a while.. one of the most basic staffing precepts is "overtime is not an acceptable staffing strategy". If this occurs on a regular basis, there is definitely something wrong with the way the organization is being managed.

  • Jan 24 '14

    Last year, or perhaps the year before that, I attended an all-staff meeting that was being facilitated by the hospital administrator, chief nursing officer, and a couple of other members of the site leadership team. I will never forget a statement the administrator made.

    "We are now hiring nurses for personalities. We no longer hire nurses for their skills," he said.

    I raised my hand and kindly asked him to elaborate on this statement. He explained that almost any newly hired nurse can learn the skills necessary for bedside nursing. But what management desires in a nurse, and what they cannot teach every individual, are certain work-related social skills such as basic courtesy, getting along with others, caring for patients as part of a team, maintaining camaraderie, and being a good coworker and the type of caregiver that patients and colleagues will like.

    He went on to say, "Now that Medicare reimbursement rates will be determined by patient satisfaction scores, it is important that we hire and retain nurses and techs who have good attitudes."

    I clarified, "So you will now hire people based on their soft skills and hope they are able to grasp the hard skills?"

    The administrator and chief nursing officer simultaneously confirmed that, yes, they would hire staff based on the personality conveyed during the interview process. The old way of hiring prospective employees would be gone forever.

    In the nursing profession and in other occupations, there are two types of skill sets: hard skills and soft skills. The hard skills are the hands-on, technical, procedural skills that a typical bedside nurse needs in order to perform the job effectively. Examples of hard skills include starting peripheral IV lines, performing dressing changes, inserting urinary catheters, administering injections and checking vital signs. On the other hand, soft skills are the intangible social skills that an employee needs in order to facilitate communication and navigate the workplace successfully. Soft skills are comprised of the personality traits, positivity, cordiality, work ethic, dependability, workplace etiquette, behavioral competence, emotional intelligence, reliability, communication style, personal habits, optimistic attitude, interaction, and unspoken social graces that come together to render someone a desirable employee.

    A person who does not possess soft skills is often viewed as an undesirable employee, even if he / she has a wealth of hard skills.

    It has been said that employees can be trained to perform the hard skills, but the soft skills come from within. For instance, an organization can easily teach someone to apply a wound vac machine, but they cannot train this same nurse to have empathy for others, communicate effectively, or change the selfish personality that she has displayed since middle childhood.

    Soft skills are important enough to make or break a person's career because, although a pleasant person can thrive in the workplace without a high intelligence level, a very intelligent individual with hard skills will struggle in his or her professional life without polished soft skills. In fact, the Center for Public Resources did a national survey and found that 90% of the time people are fired for poor attitudes, inappropriate behavior and poor interpersonal skills rather than deficient job skills (McNamara, 2003). A lack of soft skills will impede the ability to foster interpersonal relationships in all aspects of life.

    McNamara, P. (June 19, 2003). What Does A Positive Attitude Do For You? Soho Day. Retrieved November 5, 2012 from

  • Jan 24 '14

    Nurses who have the misfortune of working at healthcare facilities that utilize Press Ganey patient satisfaction surveys are probably subjected to the practice of scripting.

    For those who are unfamiliar with scripting, here's a brief rundown. Every nurse is supposed to recite the same pre-written scripted phrases to all of their patients with every interaction. The point is to reinforce the phrase 'very good care' in every patient's consciousness so that, upon each discharge, the facility will generate favorable patient satisfaction survey results. 'Very good care' translates into a score of five on the Press Ganey patient satisfaction survey.

    A score of five is the highest rating each patient can bestow upon the facility on this particular survey. Likewise, 'very poor care' is the lowest rating any patient can give and would translate into a score of one on the survey.

    Here are a few striking examples of the canned, scripted phrases some members of nursing staff are expected to recite to their patients. Be sure to take notice of the prominence of the key words 'very good':

    1. "Is there anything I can do to make you more comfortable? I have the time!"
    2. "We know you have many choices, so I'd like to thank you for choosing ABC Hospital, which is a very good facility."
    3. "Your doctor is very good!"
    4. "My goal is to exceed expectations and provide very good care!"
    5. "Thank you for choosing ABC Hospital and I wish you well!"
    6. "I want to assure you that we will do everything possible to exceed your expectations."
    7. "Our goal is to provide you with very good care!"
    8. "In 7 to 10 days, you will receive a survey from the hospital regarding your stay."
    9. "Please let me know the moment we can do something better!"
    10. "Staff recognizes this must be an inconvenience for you, but we strive to provide very good care!"
    11. "You are making very good progress!"
    12. "I am pulling the curtain to ensure your privacy."
    13. "Our team wants to make your stay very good!"
    14. "What? You asked for graham crackers 15 minutes ago and haven't received them? I'm sorry! That is far short of the very good service we aim to provide!"
    15. "I sure want to ease your pain! I am going to get your pain medication!"

    When dealing with scripting, I call shenanigans. I do not use scripting because the canned phrases sound phony and insult the intelligence of the patients. Moreover, repeated use of scripting insults the intelligence of nursing staff because management no longer believes in our human ability to establish connections with patients and families. Does administration truly believe that patients will automatically return surveys with ratings of 'very good care' if staff continually repeats the phrase?

    I am wearily cognizant of all the new pressures surrounding the linking of Medicare reimbursement rates to scores received on patient satisfaction surveys, but uttering canned scripts over and over seems robotic and is devoid of any critical thought. Our encounters with patients should be honest and warm, not derived from phony scripts where the primary goal is reinforcement of a particular phrase.


  • Jan 3 '14

    It seems almost unreal: in six days, I will don my scrubs, put my name badge on, and go to work at the nursing home like I have almost every weekend since last July. I will pass meds, listen to hearts and lungs, change a dressing or two, greet visitors, answer questions, and do admission assessments in much the same manner as I have for the past sixteen-and-a-half years.

    Only this time, it will be for the last time.

    After many months of having one foot firmly planted in nursing and the other foot testing the waters outside of it, my career as an active, working nurse will be over as of next Sunday. It's actually been over for some time; I simply wasn't quite ready to acknowledge the fact until a month ago, when I looked at my December schedule and saw that I'd been scheduled for only four shifts all month. The reasons for it are many and have no place in this discussion; suffice it to say that the reduction in hours told me everything I needed to know about where I stand in clinical nursing.

    They say everything happens for a reason. Just as I was surrendering to the inevitability of going back to Vocational Rehab and begging to be retrained for something that didn't require me to ask customers if they wanted ketchup or fry sauce, I got the call offering me the position that had literally been my dream job for years.

    First reaction: That call did NOT just happen.....did it? Second reaction: Omigosh, what do I do now that I'm not the loser I thought I was? You see, when I lost my assisted-living management job last spring, I'd become convinced that I was branded and would never again hold any position of consequence, in nursing or anywhere else. And when I tried to recreate the magic I'd made the first time I worked at this LTC, I crashed and burned, disappointing not only my superiors and co-workers, but myself. That's when I knew it was the end of the line for me as a nurse, and I could almost feel my entire life beginning to unravel.

    No one starts out in nursing with the idea of being satisfied with mediocrity. We don't throw ourselves against a wall every day for decades just because we want a paycheck. It's when years of physical and psychological stress wear us down to the point where we can no longer perform to our own standards that we lose what made us good nurses in the first place, and burnout occurs. I'd been through it before; it had always been temporary, though, and I'd always been able to recover and come back stronger than before.

    Not this time. I will be 55 in a few weeks; I'm tired, and I've run my course, though that has less to do with aging than with mileage. Some nurses can maintain the required level of intensity in their 70s, while others should've gotten out in their 50s or even their 40s. When I put my bandage scissors and hemostats away next Sunday, when I turn in my badge and collect my final paycheck, the sigh of relief will probably be audible in every corner of the nation. This career has been good to me in many ways, but it's nearly destroyed me in other respects and I am ready to be done.

    I'm just thankful that there's a second act for this "semi-retired" nurse. I'll keep my license active because I'm a specialist in this position and need the credentials, but there will be no more shifts, no more running the floor with my hair on fire, no more 24/7 responsibility for too many residents with too many care needs. I can't work like that anymore. I can't LIVE like that anymore.

    Even if something were to go haywire with this new job, my days as an RN in any vital capacity are over. And as with every other decision I've made at gut level, I'll never regret this one. I may wish I could still nurse the way I used to, but I can't, and walking away is the best gift I could have given myself---and my patients---this Christmas.