This "us" vs "them" mentality.... - page 7
I've been reading through the posts from the last few days, and I'm completely astonished by the "us" vs "them" mentality that is showing up between the nursing students and the staff nurses. ... Read More
Oct 1, '11 by VICEDRN, BSN, RNQuote from xtxrnThe skills you refer to are absolutely suitable to a CNA/tech and I have seen a tech do every ONE of the skills you just mentioned. IV starts, foleys, even drop an NG (was a nursing student but unlicensed all the same). In homes and schools everywhere, people are receiving all kinds of meds and feedings through all kinds of accesses and they are being administered by NON RNs and the patients are surviving.But getting out of nursing school does imply that someone is competent to sink an NG, put an IV in, a Foley, check NG placement for meds, do accucheks when conditions change on a diabetic, etc.....the SKILLS are very basic- and not CNA-level. Yes- they also need the critical thinking- but if they can't get past cramming food into a lethargic, diaphoretic diabetic, how can they be trusted with anything else?
Nursing involves skills and thinking/planning. How many students "drop off" their homework here ,and don't even participate in the discussion? No thought involved at all- just the ability to make two fingers flutter around a keyboard (gotta give credit to the ones who at least don't "text" message- LOL
Yes- in a code situation an IV could save a life....and NO not all places have someone else to do that job (that is a HUGE myth). Why have the attitude that someone else can do it? They have the same RN license- why is someone else picking up the slack for someone else's ineptitude??? Why is that even remotely ok?
Now, there are units in hospitals to deal with that- which should not be the hospital's problem. They are the clean-up team for lousy nursing schools. It's pathetic. AND unfair- to the students, and the nurses who do not want to teach. I enjoyed it. But my patients were my first priority- NOT the student who has a clinical instructor who isn't doing her (his?) job. THAT instructor probably scraped by with a whole lot of "mediocre" and was accepted into the teaching end of things because of not being able to do the job herself (not ALL--- I know there are some good ones being identified- but the MIAs can't be considered as competent when they're nowhere to be seen.
JMO..... And it's not likely to change - but I do feel badly for both sides of the issue. The staff nurses are out of school...this is not their battle to fight. The students need to demand decent education- by not going to schools that don't emphasize clinical skills; theory can be learned later (even us "trailer park" ADNs can think with the "gated community" BSNs- and have the clinical chops to earn our keep-- the housing issue is just a metaphor- don't anybody go getting all twisted up over that- the battles don't stop with student vs staff nurse....the distaste and condescension continues w/some major superiority attitudes towards more than that).
The logic that you need to have basic manual skills to grasp concepts of patient assessment is flawed at best. You do not need to "earn" the respect of other nurses by "proving" you can start an IV before being exposed to actual patient care. In fact, its bullying and its very common in nursing and its one of the ugly unprofessional sides of nursing that make me often embarrassed to be counted among us.
Imagine the pressure. You are weak at a skill or just never got exposed to it in nursing school and now, some undereducated bully is judging your entire ability to provide safe effective care because you just never dropped an NG before. So sad for the little newbies.
Unless you plan to code the patient yourself, there will always be another person in the room besides an RN. For example, an MD will likely attend and while I have no idea how many codes you have attended for patients that have no access but its a common issue and even the best sticks in the house may still not get it. Don't know how many times I have had to stick another nurse's patient because she just wasn't getting it and I don't make some big stink about it like its a reflection of her skills and neither does the MD when they drill the IO or start the central line.
I have no idea why anyone would call that a "myth" and I certainly can not entertain justifying that starting an IV is more important than identifying a coding patient but hey, that's just me. Don't know how many times I see nurses minimize or undervalue a tanking patient. I would trade any of their "skills" in to rewind back a few hours and have them identify and intervene when it would be more effective.
As for the educational units described in this thread, I am not remotely impressed by the argument that hospitals now have to "make up" for nursing schools' failure and that this is somehow costly to the hospital. Most of us came out of school to expensive, time consuming contracts that ensure the hospital gets all of its training money back (though I have to see a single RN get all of the training as promised) AND most of what they "teach" you when you start in a hospital is a requirement of regulatory bodies that require hospitals to show that each member of the team has received appropriate training in their field.
For example, every hospital will require you to check off on the accucheck machine and while you can sit here and fuss about how nursing students just "SHOULD ABSOLUTELY KNOW" that, they will soon be wearing their fancy RN scrubs with a fresh RN name badge....aaaaand...wait for it...sitting through some two hour class and check off on the glucometer. And the next job you take or I take? Yup, we are gonna be checking off on it too. JCAHO requirement after all.
The real issue here is a philosophical one. Which direct is nursing moving? Will it be a skills based job? (Gosh, I hope not! We are overpaid and overtrained for it if so) Or will it be assessment based? (Hope so!) The tension you describe in your last paragraph is real and palpable to me too but I suspect we sit on different sides of the aisle.
The ED is not the same as the floor....whatever- we're both firm in our positions.
We still have lousy new grads out there with no skills. All the theory in the world will not get the job done without the ability to actually DO something.
Have a ball in your padded-staff situation...pray you never hit the floors as a staff nurse there.
Techs aren't allowed to do all of that in every state...you want those patients sent to your lovely little Nirvana of so many unlicensed staff???
If you did bedside nursing, you'd probably get it- aside from just wanting to let someone else do the job....?????
And skills being required for assessment skills wasn't my issue- of course they're different. They need BOTH.Last edit by xtxrn on Oct 1, '11
Oct 1, '11 by Esme12, ASN, BSN, RN Senior ModeratorQuote from VICEDRNI beg to differ....without IV access the patient wil die while everyone else is discussing the clinical picture to advocate for the patient for someone to start that IV. I have been asked on many occasions....How good are you at IV's as the resource person. Without that IV access.....the patient will die. If not the nurse then who starts them where you work? Not all hospitals have IV teams (which by the way are RN', in my experience). And not all ED's have resident/fellows and Medics.I guess that's what it comes down to. I don't think they missed anything. I think they missed out on something that they have defined as nursing: namely, skills. I certainly knew a lot of people who felt like that when I went to school too. Its too easy to call nursing a collection of skills and its too easy to point to it as being what they missed out on. Thank god nursing professors do not spend their time worrying about what a bunch of nursing students think they should be doing. IMHO, its almost narcissistic: this desire to "do" something to the patient. How about PAY attention to the clinical picture instead?
Let me just say to those folks: you won't save a life because you know how to start an IV. There will be plenty of people in the room who can do it instead. You save a life by advocating for a patient that you observed to have a serious situation. (critical thinking and advocacy, not skill sets.)
PS: Your future employer won't care to ask you about how many ivs you started or foley's you did. They will ask, "Now, what would you do in this situation?" to judge your ability to make decisions, act under pressure and think.
For me I believe that the lack of the skill set is what is damaging bedside nursing which is just as important as any other speciality in nursing itself and without us at the bedside....who cares for the patient while we are analyzing the clinical picture. When I went to school I got the best of both worlds.....diploma Is placed on the college campus and professors for the academics. I had the clinical of the diploma grads and had to fit college in between.
I have no narcissistic desire to help but I do enjoy "nursing" and being a nurse.Isn't it and example of the "us versus them" in the post? I believe that we have swung to an extreme away from being nurses and will educate ourselves away from the bedside. I have always been very proud to be a bedside nurse, just a bedside grunt, taking satisfaction from a job well done. I have always wondered at the look of disdain when I've been asked about furthering my education and saying I'm very happy
being the best bedside nurse I can be.....just a bedside grunt that has no ambition for any higher education.
I hope the pendulum swings back the other way and being a bedside nurse is OK and having a good set of skill sets is an asset and not a lack of education looking at the clinical picture long enough to hold someone's hand.
It's just my opinion and you know wha tthey say about opinions....they're like.....umm....noses..... and everybody has one that's different. :redpinkhe
Oct 1, '11 by Esme12, ASN, BSN, RN Senior ModeratorQuote from xtxrnYes it would...Without beside grunts, that ED would get pretty backed up, eh?
Oct 1, '11 by OCNRN63, RNQuote from linearthinkerThe reason I won't teach nursing students (besides the obvious facts that I am not nursing faculty, am not adequately educated in pedagogy and am not being paid to teach) is that I get all of the responsibility and no power. IMNSHO, the bar is set way too low for today's NS. I'd throw half of them out for being a) lazy and b) stupid. My cousin is in a RN program, and that girl is dumber than a sack of hair. I read posts here all the time from people that I desperately hope are not really nurses, b/c they sound dumb as he//. Half the nurses I know are an embarrassment to the profession and given the opportunity there is no way I'd ever have let them pass. So if you wont give me pass/fail authority, don't ask me to teach them anything more than where the bathroom is. I hope they already know how to flush the toilet and wash their own hands, but I know better than to count on it.
I know what you mean. I just read a post on another thread that left me wondering if the writer was stroking out/heavily medicated/just plain illiterate. I certainly hope she communicates IRL better than she does on a MB.
The post from "nurse educate" referring to clinical sign-offs made me think of that little procedure book we had to carry around on clinical. It had all of the required procedures you had to do to progress to the next level. If people think "Survivor" gets dirty, they should have seen how it got when you had a bunch of people vying for the chance to do the more uncommon procedures.
I get impatient with myself; I really don't have the temperament to take on a student. Students require more nurturing than I can provide while trying to get my job done.
Oct 1, '11 by linearthinkerI think nursing needs to do a better job of weeding people out. Let's start with requiring some SAT scores comparable to the other professional schools, which means no more of this community college for RNs stuff. It's nonsense. Professionals have college degrees (don't bother with the "I know a BSN who is a terrible nurse" crap- you will not convince me). The NCLEX needs to be much harder, and much more expensive. CEU requirements need to be more stringent, as in more rigorous, and more of them. In addition, RNs should have to reboard every 5 years, just like physicians.
I honestly think if you weed out the lowest common denominator you will attract a higher caliber of professional, and then the money and respect will follow. I have said it before, and it isn't popular. The reason nursing isn't respected is because it is populated by people who simply aren't going to gain respect from other professionals. We need to get rid of them. Raise the bar, weed them out. I don't want girls who look and act like they belong on the pole representing nursing. I don't want Gomer Pyle representing nursing. I don't want idiots representing nursing. I don't want Jerry Springer guest material representing nursing. Raise the bar. Let's get rid of them.
You want nursing to be elite, start only accepting elite into the ranks.
Argue too strenuously with this, and I'm going to assume you fall into one of the Gomer Pyle or Springer categories.
Oct 1, '11 by woahmellyQuote from Flo.I think the problem is that staff nurses are being over worked. When I went to nursing school we had a clinical instructor on the floor. We asked the CI all of our questions and disturbed the RN as little as possible. Now there is no CI on the floor and students are assigned to work with the RNs. We don't get a lighter assignment or extra money. I don't think this is fair to any party involved.
But to answer you question yes you are being idealistic. But I like it, I was idealistic once and according to older RNs I still am.
No clinical instructor? Wow. I'd be lost without mine, and I know the nurses would probably kick us out on our bums without her there for us to ask questions.
Oct 1, '11 by All4SeasonsLinear Thinker says," the reason nursing isn't respected is" ; my question for him/ her is, isn't respected by whom? That is a massive generalization.
Oct 1, '11 by No Stars In My EyesI'm not an RN, I am an LPN, and though I was trained FOREVER ago, they key word in my training was PRACTCAL. We had clinicals in which we repeatedly practiced what we learned in theory. When I was sprung from nursing school I was ready, willing and able to DO all the skills that were required of me AND was able to back them up with the practice of making assessments because clinicals weren't just a matter of knowing how, but knowing why. Even if I wasn't signing off on my assessments, I had to damn well have the substance to back them up. I knew my scope of practice peripheries, but I also knew my "stuff". And I have been told by many that I needed to 'get' my RN. NO WAY! I like being a grunt! That used to be the only little corner of nursing where being a good bedside nurse was at the fore. Of course, now things have changed, and pfft...who needs the LPN anymore, huh?It didn't used to be the "us" vs. "them" mentality. And staff nurses were not expected to hold our hands. WE were expected to hold our own, because we were trained THOROUGHLY before we graduated.....by our clinical instructors. There was also the opportunity to learn new skills, but that was at the discretion of the facility at which you worked and was undertaken by that facility. But, you were no longer a student, you were a colleague.
Quote from No Stars In My Eyes:rckn:I'm not an RN, I am an LPN, and though I was trained FOREVER ago, they key word in my training was PRACTCAL. We had clinicals in which we repeatedly practiced what we learned in theory. When I was sprung from nursing school I was ready, willing and able to DO all the skills that were required of me AND was able to back them up with the practice of making assessments because clinicals weren't just a matter of knowing how, but knowing why. Even if I wasn't signing off on my assessments, I had to damn well have the substance to back them up. I knew my scope of practice peripheries, but I also knew my "stuff". And I have been told by many that I needed to 'get' my RN. NO WAY! I like being a grunt! That used to be the only little corner of nursing where being a good bedside nurse was at the fore. Of course, now things have changed, and pfft...who needs the LPN anymore, huh?It didn't used to be the "us" vs. "them" mentality. And staff nurses were not expected to hold our hands. WE were expected to hold our own, because we were trained THOROUGHLY before we graduated.....by our clinical instructors. There was also the opportunity to learn new skills, but that was at the discretion of the facility at which you worked and was undertaken by that facility. But, you were no longer a student, you were a colleague.
Oct 1, '11 by RN in trainingI'm a student. I'm a relatively new student, so my experiences are limited, but I have no problems with staff nurses in clinical. I do the very best I can to figure things out on my own when I can, and when I can't I try to ask my clinical instructor before troubling a staff nurse with it. When I can't find my CI or if my question is too unit-specific for my CI, I ask a staff nurse. Also, I generally give pt care and helping my nurse as much weight as completing my clinical assignments- aside from wanting to make a good impression on the staff in case I ever end up applying for a job there, I just can't stand to sit around and watch someone else do work that I know how to do and is within my scope as an SN/CNA.
Maybe its just my clinical location...I could have just gotten really lucky...but the staff nurses are patient with me and seem to really hope for my success and getting the best education I can get...One even took a few minutes aside the other day to break down an ekg and showed me how to find a first degree AV block!
I agree that there are a lot of students who have IQs of a box of teddybears...and the work ethic of a wet noodle...they make me look bad in clinical, and make all of us look bad to the public. I think they should make nursing school admission standards more stringent. There were 30 alternates for my program when I was admitted who didn't get in because they didn't have points to be competitive with those who did get in...however, enough people had to forfeit their spot in the program for various reasons (financial, scheduling, etc) that every single alternate got into the program. Some alternates had fewer points simply because they had not yet completed all their prereqs, but there were some who had scraped by on their prereqs, gotten mostly Cs in classes like A&P, pathophysiology and the other basics...Please tell me why they are in the same class as me? I am not meaning to sound arrogant at all and I do not think that I am better than the classmates I'm referring to. Either they were smart enough to get the grades but too lazy to try, or they did not have the aptitude to understand basic health concepts...would you want somebody that's too lazy to make an effort in very important career-foundational courses caring for you or a loved one? Or someone who has no aptitude in the basic field cornerstone courses?
I realize that nurses do not requires as much schooling as doctors, but nurses are on the frontlines of pt care and have the power and opportunites to save just as many lives as doctors if not more. So why should nurses not have equally high expectations for schooling??
okay getting off soap box now. I think we as nurses (and NS) determine to a great degree how the general public views our profession- so it's time to get more selective about who gets to determine how our profession is viewed!