A Paradigm Shift in Nursing Practice - page 3

by mamain 12,974 Views | 28 Comments

CONGRATULATIONS, YOUíRE JUST A NURSE JUST a nurse. I am JUST a nurse. No big deal, had I been more adventurous maybe I would have gone to medical school. These thoughts are the thoughts of many, including myself, which I... Read More


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    Are you grading papers here or trying to get to the content. Please.
    SHGR likes this.
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    Quote from RoxyDi
    Sorry, but the grammatical errors made it difficult to follow this post. If you want to elevate the nursing profession, please be sure your thoughts are well expressed.
    The thoughts were expressed well enough for others to reply to this thread... If you want to elevate the nursing profession please clarify statements and/or questions that you don't understand instead of giving smart *!# irritable remarks that may interfere with the positive flow of this thread.
    cdsga likes this.
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    Actually, trying to understand how to read the intent of the post. Just being honest here. Really.
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    The intent is pretty clear. A PM offering to edit for grammar/spelling/clarification is sometimes appreciated and much more tactful. The author did ask for comments and state that the ideas are in development- as all nursing theories seem to be.

    It's a worthwhile discussion. Money keeps the doors open and the lights on, no matter how idealistic a nurse may be.
    lindarn likes this.
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    You know, readers decide in the first few sentences whether or not they will continue to read a post. This is what I was trying to say - I did not go further due to the errors in the beginning. The "hook" was not there for me. Professionals need to keep this in mind when publishing something for all to read. I have no intention of offering to edit a post for someone who is trying to convince me of an idea or concept. I'm sure the discussion is a valid one - that was not the point of my post.
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    Quote from joyouter
    Socialised medicine has it own problems, obviously, higher taxes being one aspect. My question is how does your nursing management recognise the impact of the fee systems upon nursing staff and are there supportive approaches for the nurses employed there
    As a nurse in a non- socialized medicine socieity/country I can only speak to how that system is run. One of the primary components facing nursing here (USA) is lack of recognition so to speak for nursing care and nurses. Nursing care is "built in" to other charges on the facility bill. That is part of the reason that Tylenol is $40 a pill, or other medications/services are greatly inflated. Most systems now do not take acuity into account period when making decisions regarding staffing/ productivity. It is all about the numbers. And yes census should be a part of the algorithm, but not the entire algorithm. As an ED nurse we are instructed to "down-staff" periodically throughout a 24 hr period according to census or number of patients seen. The C-suite has determined that productivity should remain above 90% at all times and preferably more than 95%. The problem with this rationale is it doesn't take into account the acuity or severity of the patients being cared for. If a minimal number of patients are seen but are critical care in nature ( i.e. STEMI, trauma, sepsis, post- cardiac arrest, multiple critical care drips, etc, etc.) we are still expected to meet the same productivity guidelines. In addition, experience levels of staff are not factored into the algorithm either. It is much easier to care for those patients with less staff if most nurses are experienced. This is rarely the case. Many times you may find yourself as the only experienced nurse on shift.

    So, it is a multi-faceted problem and a worthwhile discussion. While I am not sure how I think/stand regarding a strictly pay for services program for nursing there does need to be a change somewhere. The patients should see a charge for nursing care reflected in their bill. Nursing provides 90% or more of all care given to patients and yet is the only profession not represented in the billing. Every year our profession is voted "the most trusted profession" by the public, shouldn't they then know exactly how much of their care is attributed to that profession? Hospitals and other facilities have to acknowledge what nurses do, as well as consider that not all patients are created equal. Physicians do bill extra for critical care and that should be considered for nursing as well, in billing and other determinants.
    We have many discussions and decisions that HAVE to be made for our profession but it is time WE THE NURSES started making them instead of others and then trying to change the decisions or undo them.. Be proactive not reactive.
    lindarn and cdsga like this.
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    ya, we need less documentation, not more...that's where I stopped reading and had to disagree with the post.
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    Quote from FLmomof5
    I disagree with one point made by the PP. Chronic care is not devalued. In fact, from my own job offers, those LTC/LTAC/SNF jobs I have had or was offered paid MORE than the hospital job!I would rather have my care based on CPT code than patient surveys!!Fact is that too many Americans have been taught that outcome is the goal...not equal opportunity but equal outcome....translated medically that it isn't equal opportunity for good nursing care but better outcomes for the patient. Doctors are not Gods and they cannot always predict who will or will not survive. They cannot predict one head injury outcome over another...it is 'wait and see'. How many stories have we heard where a patient wasn't expected to survive but did or vice versa.How do we as nurses begin to get the world to realize our true value? It will never come from becoming medical waitresses. As a career transitioner, I had NO concept of all the knowledge that a nurse needs to pass the NCLEX and then to provide care. Somehow, some way we need to get the general public to know that we are not just the doctor's handmaidens. Honestly, the silliest, but most effective way would be proper nurse based drama shows. As long as the public sees nurses behind the desk as the station gossiping about nothing....then see the doctor do all the procedures that are the nurses area of practice, they will NEVER see our value.
    Exactly what I have been saying all along. We should be friends.
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    Simply love this idea !! Will never happen but your point is well stated. I would add one more radical idea. Since false allegations against nurses for drug diversion is pandemic ,Hospitals should be required to have only designated Nurses pass out Narcotics on each floor each shift. Those Nurses should be randomly drug tested per a prescribed schedule. This would give less opportunity for retaliation against nurses the Manager simply does not like and deframation of character.


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