Nursing service reaches higher level with doctorate - page 9

by tokidoki7 11,369 Views | 84 Comments

nursing service reaches higher level with doctorate by debra erdley pittsburgh tribune-review monday, december 20, 2010 when lisa bratton-henry graduated from the shadyside hospital school of nursing in 1986 as a... Read More


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    I think nursing needs to do some serious soul searching with it's management first and foremost before it beats the drum for higher entry into practice mandates. It's 'leaders'- the nursing executives and administration need to first start/learn how to interact and manage their nurses in a professional, ethical and honest manner, and abandon their tawdry, destructive, character assinations, dinging peoples licenses for school girl reasons, raunchy business practices. This only slings dirt on the profession and knocks it down to a gutter level. This doesn't speak well for us as a profession. It's like nursing is governed by the insane lately. How long does the nursing leadership think they can keep this under wraps before it gets out to the public. If it has not already. Then how many patients are going to trust the nurse or the nursing profession with this crap going on. That is not done by diploma or ADN RN because we all know- us diploma and ADN RN's are not qualified to be nursing "leaders". This is done by those in higher education degrees. Specifically- nursing management degrees. It seems MSN's and MHA's were given to ones who were not a credit to the degree. I will not include the APN's or the NP's in this- I have never seen an APN or NP interact with any other staff member like I have seen nursing management. Maybe the distinction is that the APN's and NP's are clinically orientated. They are still connected with and very much an active part of their profession(excuse me: the contemporary business lingo is 'engaged'. Makes me want to barf- where's the diamond ring business world?) This has become a credibility issue and a liability on the entire profession. If these managers and administrator and exect.s don't change their ways and behavior- we are going to be digging our profession out of the gutter. Nursing vowed"to do no harm" I don't think it was only in reference to the patient. JMHO an old diploma RN + 3 years of college liberal arts courses.
    After the nursing leaders fix it self into mature functioning respectable professionals who will not continue to embarass the rest of us, then it needs to examine it's 'wolf cries' about the up an coming nursing shortage: what about all the older nurses they have offended and insulted, locked out and made unemployable, destroyed their resumes, self esteem, destroyed financially and all the new grads form 1-2 yrs past that have been refused experience that nursing leadership has thrown away and forgotton about but have paid their tuition, or taken out loans and passed their NCLEX. This devastation is as bad as any war- foreign or domestic. Stop admitting to the nursing programs, until all it's currently educated and licensed nurses are employed. Then see what kind of staffing is needed. Stop sitting in their offices dreaming the same old dellusions- put these weirdos on the medication they so desperately need. Stop ignoring the economic hardship that is in this country right now. If people don't have money for food, housing(forclosure/bankruptcy)health insurance(Maslow's Hierarchy of Needs- remember him??) where do they think money for education is coming from- any one with a tree in your backyard- stand up! The economy has to be better before people think of chucking money to tuition. That takes steady employment. not unemployment. A homeless person knows they need a home, but he also knows it take money from a job.
    Last edit by kcmylorn on Jan 17, '11
  2. 1
    Quote from kcmylorn
    I think nursing needs to do some serious soul searching with it's management first and foremost before it beats the drum for higher entry into practice mandates. It's 'leaders'- the nursing executives and administration need to first start/learn how to interact and manage their nurses in a professional, ethical and honest manner, and abandon their tawdry, destructive, character assinations, dinging peoples licenses for school girl reasons, raunchy business practices. This only slings dirt on the profession and knocks it down to a gutter level. This doesn't speak well for us as a profession. It's like nursing is governed by the insane lately. How long does the nursing leadership think they can keep this under wraps before it gets out to the public. If it has not already. Then how many patients are going to trust the nurse or the nursing profession with this crap going on. That is not done by diploma or ADN RN because we all know- us diploma and ADN RN's are not qualified to be nursing "leaders". This is done by those in higher education degrees. Specifically- nursing management degrees. It seems MSN's and MHA's were given to ones who were not a credit to the degree. I will not include the APN's or the NP's in this- I have never seen an APN or NP interact with any other staff member like I have seen nursing management. Maybe the distinction is that the APN's and NP's are clinically orientated. They are still connected with and very much an active part of their profession(excuse me: the contemporary business lingo is 'engaged'. Makes me want to barf- where's the diamond ring business world?) This has become a credibility issue and a liability on the entire profession. If these managers and administrator and exect.s don't change their ways and behavior- we are going to be digging our profession out of the gutter. Nursing vowed"to do no harm" I don't think it was only in reference to the patient. JMHO an old diploma RN + 3 years of college liberal arts courses.
    After the nursing leaders fix it self into mature functioning respectable professionals who will not continue to embarass the rest of us, then it needs to examine it's 'wolf cries' about the up an coming nursing shortage: what about all the older nurses they have offended and insulted, locked out and made unemployable, destroyed their resumes, self esteem, destroyed financially and all the new grads form 1-2 yrs past that have been refused experience that nursing leadership has thrown away and forgotton about but have paid their tuition, or taken out loans and passed their NCLEX. This devastation is as bad as any war- foreign or domestic. Stop admitting to the nursing programs, until all it's currently educated and licensed nurses are employed. Then see what kind of staffing is needed. Stop sitting in their offices dreaming the same old dellusions- put these weirdos on the medication they so desperately need. Stop ignoring the economic hardship that is in this country right now. If people don't have money for food, housing(forclosure/bankruptcy)health insurance(Maslow's Hierarchy of Needs- remember him??) where do they think money for education is coming from- any one with a tree in your backyard- stand up! The economy has to be better before people think of chucking money to tuition. That takes steady employment. not unemployment. A homeless person knows they need a home, but he also knows it take money from a job.
    Nursing leaders maintain their strangehold on the nursing profession by aligning itself with the powerful PTB, not the powerless nurses that they,"lead".

    They also, by way of their graduate education, have learned the nooks and crannies, ins and outs, of the business world, something that nurses are strangely ignorant of.

    Why are staff nurses so ignorant of the business principles that our "dear and glorious nursing leaders" hold so tightly? Because these very same business principles are what they derive their power from because they know the "lingo", to intimidate the staff nurses under them, and who they control .

    In my previous threads, I have suggested that one of the advantages of a BSN program, is that, for one, it is longer. By virtue of the fact that it is longer, there is more time in the program to include what I have called, "quality of life", classes. One of these classes that I have suggested is Business Principles, Employment Law, and Adminstrative Law. When one has the information, they will not be intimidated and pushed around by management and administration.

    I am fully aware of nurses who have been thrown under the bus, ruined professionally and financially by these people. Nurses have also been slow to use the law to help them. Most lawyers take these cases by contingency, and get paid when the case is settled. Nurses have been slow to use the legal system to get help and get back at the hospitals who try to ruin them.

    I have not suggested this because I believe that nurses should come out of school and form Fortune 500 companies, but because, by not knowing and understanding basic Business Principles, we are like lambs being led to slaughter. We have no idea what and how these Business principles affect us, but we are stuck having to work to adhere to these principles, and have no idea why or how to counter them.

    If we do not know how the Insurance Industry works, and we don't have a clue why certain things need to be done like this, we cannot effect change of something we know nothing about. And hospital administration milks our ignorance for all that they can get out of it and for all its worth, which is alot. I have said many times, that we are looked at as an expense, not an asset. That is what the PTb want to keep. As long as we contribute nothing to the hospital, we will continue to be cut.

    As long as our professional practice is rolled in to the room rate, housekeeping, and the complimentary roll of toilet paper, nothing will ever change.

    We also need to include certain elements of Employment Law and Administrative Law, for nurses. So we know when we are being lied to and manipulated, and then we can learn to manipulate right back, like management does to their advantage.

    Again, management counts on nurses not having a clue what their rights are in the workplace, how to use Administrative Law and Employment Law to our advantage. That is why we are discouraged from taking our breaks, encouraged to working off the books to finish our charting, blamed for having "poor time management skills", bullied by management, etc. We have the power to change this. But we need to have the same knowledge that they have to be able to sit at the table as equals.

    How many of us realized that when/if, we work off the books to finish our charting, work, that we are not covered under Workmans Comp if we get hurt? Or if we do something, give a last minute med, etc , and something unexpected happens, and the patient ends up suing. You are not covered for malpractice, negligence, if you were not clocked in. Just like you would not be covered if you were on your way home from work, and you stopped at the scene of an accident to help.

    There is alot tricks that management uses on the nursing staff, and the best way to counter this is to know your rights, and not be afraid to challenge them. It is amazing how quickly they back off when confronted by a staff nurse who knows when she/he is right. It is empowering as a staff nurse to be able to do this, lok them right in the eye, and hold your head up high!

    You can find some of this information on FindLaw. This is a free legal information service to the public. Just plug in your search term and see what you get. It has many different services, sections, and legal information. Give it a try. As I said, it is free.

    And don't forget- practice defensive charting, with management in mind, keep track of patient falls, and other things that happend when you are short staffed. Late meds, can't do patient teaching, increase in infection rates, especially when family members are encouraged to "camp out" in patient rooms and in the ICU. I have felt for a long time that the out-of-control visiting hours have contributed to an increase in infection rates in hospitals, and a spread of antbiotic resistance organisms in the community.

    You can take control to your advantage!

    As usual, JMHO and my NY $0.02.
    Lindarn, RN, BSN, CCRN
    Someplace in the PACNW
    Last edit by lindarn on Jan 17, '11
    joyouter likes this.
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    Quote from chuckster
    Not disputing that the situation in SE PA and NYC is not representative of the country as a whole but the recognition of and preference for the BSN as the minimum credential is hardly limited to those 2 areas or even just the east coast. There have been recent articles about AZ, CA and TN in which it was observed that the rates of employment for new ADNs were lagging considerably behind that of new BSNs. It is also the case that a very large national employer, the US Government, also requires the BSN as the minimum credential for most nursing positions.

    Again, this is not meant to in any way disparage ADN or diploma RNs and is only an observation of what seems to be a trend that is at least for the time being, increasing.
    As one who lives in California, I think I have a pretty good idea what hiring patterns look like, and I do not share the observation the unnamed article has, so please provide me with that source. Thanks!

    Quote from lindarn
    A " PT Assistatant", is not patient assistant, but a "Physical Therapy Assistant". Physical Therapy Assistanta have a Two year Associates Degree as entry into practice. A Physical Therapy Assistant's scope of practice does entail passing medications, doing treatments, etc, that endanger a patient the way a nurses scope of practice can.
    Again, please provide me with sources for these statements. How is a "nurse's scope of practice" going to endanger a patient? Not to be snarky, but I'm constantly reading from the pro-BSN only people that EBP is the gold standard and I simply am asking for you to provide that for me.

    I did not mean that LPN/LVNs endanger a patient. But too many hospitals and nursing homes use LPN/LVNs instead of RNs to save money, and these nurses are too often put in a situation that they do not have the education or scope of practice to be in.

    That is why LPN/LVNs do not work in ERs, ICUs, etc.
    I can't speak to the issue of nursing homes using LPN/LVNs, but I would dispute your claim that acute care facilities are hiring LPNs to save money. In California, the trend is to hire RNs far more than it is to hire LVNs nowadays. When I started it was not that way, which is why I have experience in the units you are saying LVNs don't work in.

    Nothing has changed about scope of practice that explains why LPNs don't work in ERs and ICUs. In some areas they still do.

    As for the ADN who is perfectly happy remaining an ADN nurse, and would rather spend their money on a vacation, shows the difference in the individuals who are drawn to nursing as opposed to the individuals who are drawn to PT, OT, Pharmacy, etc. Higher education has improved the image of these professions, and increased their pay. It can do the same for nursing. The needs of the many outweigh the needs of a few.
    In other words, nurses who hold associate's degrees are actually contributing to the poor professional image of nurses by not making a BSN their top priority in life? You've yet to explain the basis for your original statement that the reason for most of the negativity about nursing is the type of degree they earn before they take the NCLEX. I propose that most people don't know or care. They see a person with all the goods and bads, experiences in life, interests outside of work etc that make the well-rounded person you seem to be saying you need formal classes in school to become. I could not disagree more with that. And I speak as someone who is passionate about all types of learning.

    A single entry into practice will unify nursing. Three different entry into practice, splinters us, and does nothing but make hospitals happy- divide and conquer! It still works.
    If only you could convince the majority of people who don't hold that view. I submit there is more "divide and conquer" in your insistence that the BSN-entry point will eradicate all the problems you catalogued without providing any evidence to prove that point. I don't know about you, but I am sensing quite a bit of animosity in the rank and file, certainly it would be enough to indicate the people who do this job don't view it very much like the academic world does.

    An organizing entity will still not unify us, as we all have different practices, and therby, different needs, and issues. You don't see MDs including PAs into the AMA, now do you? Why? Because PAs are not MDs, and have different educations, and needs.
    That's because LVNs, ADNs and diploma nurses are all nurses. At least that's what it says on my license. A PA-C is not a doctor.

    edit: to add one more point - and it is that I've read many articles and blogs written by more doctors than I like to think about who think nurses becoming midlevel providers is a huge joke. They really aren't terribly impressed with a bachelor's degree. It's wrong, it may be sour grapes, who knows? But I honestly feel that those who believe BSN=respect from the MD will be disappointed.
    Last edit by nursel56 on Jan 18, '11
    elkpark likes this.
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    The idea of mandated BSN at entry level is laudable. The hard reality is that right now, in a climate of economic uncertainty, how many diploma RN's can afford university tuition, a reduction in salary and all of the accompanying economic challenges.
    I don't know if the career would actually be better respected, with mandatory undergrad and grad. degrees. The broader educational rewards are certainly excellent, but as has been said so often, do nursing programmes really produce excellence in practice?
    Upon reflection, the problem appears to how nursing as a professional body presents the profession, and I have said before, there is an overwhelming need to reorganize the practice, profession and rethink how it is represented at upper levels of power. There are 2 separate but important aspects being addressed. 1) Standardization of education and entry level nursing. 2) Being able to take our rightful place among leaders in health care, being a recognized and respected body of professionals who are able to dialogue and present a concerted effort in all health care discussions at national levels with influence for real workable change. That also requires a different approach from us as individuals and as a professional body
    lindarn likes this.
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    Just not seeing how all the dots are connected to accomplish those goals at present. It's sounding more and more vague.


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