A little venting, from a new nurse

[ladedah1, BSN, RN]

Preface: This is my personal opinion and is not meant to be offensive to anyone whose views may differ. I am a new nurse and my experience is limited – and therefore not meant to imply that all nursing experiences are identical to my own. I am simply hoping to share my feelings of frustration (because what good does venting do if you can't say it so someone who [hopefully] gets it, lol).

When I first chose nursing as a career path, I was naive. Having never actually known a real nurse,” I primarily derived my knowledge of the profession (AHEM – assumptions) from what little I'd been exposed to and the public illusion created by mainstream media. I may as well have presumed to put on a military uniform, stand upon the battlefield, and be catapulted with butterflies – what a moron I was! The first week of nursing school, after having been on a waiting list for YEARS, I felt that sudden churning in my stomach – you know the one I'm talking about – the one that says I've just made a monumental mistake.”

My creative, caring, and innovative nature was at complete odds with the rigid and aggressive nature of the nursing program. I'm a fast learner and hard worker, but I'm also an independent and philosophical thinker – traits which implore me to question and understand the reasoning behind every little detail (which becomes very time consuming with large volumes of information); likewise, despite the nursing profession's "official" praise of critical thinking and independent judgment, it would seem that it also has its "unspoken" rule about following the status quo (wherein certain lines of questioning have earned me my share of dirty looks and harsh responses). But despite my somewhat laid back and happy-go-lucky nature, I'm also a whirlwind of energy with a wicked ability to get things done… so keep this in mind as I speak of client loads. I am not opposed to working hard; I am merely dissatisfied with the unfortunate consequences (for both our clients and ourselves) which have resulted from the unrealistic expectations that are now today's norms.

If you ask any pre-nursing student (or just about any practicing nurse who can remember their initial rationale for entering the field), I'm fairly positive that not one of them would describe their goal as I would like rush from patient to patient – doling out meds, staring at a computers all day, filling out endless redundant forms, and wishing all the while that several lives and my license wouldn't be at stake every time I feel that a client needs additional teaching, assessing, therapeutic communication, or other specific attention!” Correct me if I'm wrong, but I recall general responses more along the lines of I want to help people… or save lives… or make a difference…” – with the occasional (and less likely) stable career field” or better income” thrown in here and there.

I suppose that my grudge toward the reality of our profession didn't fully develop until I recognized the hypocrisy which existed between theory and clinic. In theory, we were presented with a particular understanding of how clients should be cared for… ideas which certainly reaffirmed the notion that nursing might indeed be the caring profession portrayed by mainstream media outlets – albeit overly simplified and still somewhat inaccurate. Clinical rotations, on the other hand, were an entirely different experience… where time reigned supreme and nurses were lucky to just get through it all. How many prescription errors did I catch and point out to a preceptor because I was an attentive nursing student with only two or three patients? How many times did I stop an experienced and overburdened preceptor from implementing those same orders?

Even as I recently read through NCLEX prep books, I found that test takers are advised to answer questions as if you only have one client and all resources (including time) are at your disposal.” These books go on to further specify that answering questions based on clinical experience is highly discouraged” and that, although some things might be more common in real situations, questions are designed to be answered utilizing the CORRECT methods presented in educational materials. How strange, one might think, that it is a known fact to both professionals and higher authorities in nursing that current employment conditions are not conducive to situations in which nurses will be able to provide care at the standard to which they have been educated. Even worse, that a majority of nurses, regulatory bodies, and professional organizations remain silent in the wake of it all – instead, simply falling back on automatic responses related to existing societal norms as assumptions or excuses for the existing situation: There is a nursing shortage, so [insert facility] can't hire enough people – that's why we our patient load is so high” … or Cost effectiveness is a major concern and nurses have a duty to society to decrease the burden of healthcare expenses (or save [insert facility here] money)” ... and my personal favorite, every other facility has the same staffing ratios, process, procedure – that's just how it is and you have to get with the times.” Oh, for goodness sake!

Maybe it's just me, but I'm not a big fan of letting existing norms dictate what is possible or necessary – simply because it is how it is” – the logic behind this idea is very flawed. How, then, did it become the way it is”? Does the way it is” automatically mean that we are providing the best possible care for clients or that we must only work within the conditions that we are provided? No! Should it not then seem ironic that we, as educated professionals whose entire careers are based upon critical thinking and implementation of innovative changes, should be so reluctant to do so when the need has become abundantly clear? That our professional standards support client advocacy, yet we self impose limitations when a problem is too large”? Does that not make it even more of a priority?

We all know what the real problem is: the fear of standing up to obstinate minded people, large organizations, government policy, and the multi-billion dollar healthcare industry… the large proverbial hurdle which stands before us and causes us to think, nothing I do will make a difference… or I don't know where to start… or I don't have the time and energy.” Why is that, exactly? Do we not all hold the same belief about our profession – at least to some extent or another – that our nursing care could REALLY make the difference if we could actually provide it as truly intended? Our profession employs some of the most brilliant and dedicated people in the world… so how is it that we are simultaneously so ignorant to the idea that we have the power to change the way it is”?

Nursing today exists as two separate worlds… the public one and the real one. The public one? Well that's the one we read about in our education materials, the one shown on TV, and the one we had all hoped to become a part of. Then there is the second world of nursing – the world in which you have six (or more) patients (which, by the way, divides into ten minutes of contact time per hour – including charting – heaven forbid, you might have an admission or other time-consuming demand!). With the demands these client loads create, where is the time to assess, pass meds, start IVs, change bandages, write care plans, teach the client, evaluate progress, start a catheter, collect labs, evaluate results, review new orders, evaluate new orders, or any other combination of a million possibilities – and then chart it all – FOR 6 (OR MORE) PEOPLE AT A TIME, WITH TEN MINUTES PER PERSON, PROVIDED THAT NOTHING GOES HORRIBLY AWRY? Oh yes, and if you didn't chart it, you didn't do it… so the more you do, the more you must type… unless it just didn't happen.” And then there are extended care facilities… in which many nurses are given patient loads that virtually inhibit any nursing care beyond rapidly paced med delivery rounds and the occasional verification of a BP, AP, or BS. And somehow, we angels have time to really show compassion? To give the patient all the emotional or educational support they require? Hell, many of us don't even have to personalize care plans anymore – we just click buttons from a standard list of problems – and if that feels time consuming, how on earth could we ever find the time to develop a well thought and personalized care plan… for each of our six or more patients? There are many times that I just wonder if we've all been turned in to highly educated robots. What, then, was the purpose of all this education?

This is not what I signed up for; I doubt that it is what any of us signed up for. Yet we allow this false image to prevail in the public eye… this active sales pitch for our facilities, organizations, and regulatory bodies which favorably touts the progress and accomplishments of those who have created and perpetuated this inhuman, ineffective form of nursing care… while we silently eat the consequences of exponentially increasing demands and expectations of perfection. And if we fail to hold up the demands with which we are tasked, we are thrown out like yesterdays garbage; licenses revoked, failures of our profession. How many times have you seen the negative reviews of a facility linked in some way to nursing? The nurse didn't listen… the nurse missed something… the nurse seemed rushed… the nurse was rude and impersonal… the nurse sat on the computer all day doing nothing…” We are the scapegoats for the failed policies which are implemented not only in individual facilities, but in vast majority of large facilities across this nation. We spend a lifetime continually educating ourselves and do what we can to make a difference in the lives we touch. How is it that we've allowed our respected profession to be tainted in such a way? Whilst hospitals are allowed to make our positions nearly impossible to perform correctly, how is it that we are the ones held responsible?

Well, simply put, because we ARE responsible. We have allowed ourselves to be bullied by the system for far too long. Until we decide that this situation is not acceptable and begin working together to reestablish the amazing potential of our nursing profession, we will continue to be the pillar of blame for our ineffective healthcare system. Wake up, you smart and dedicated people! We've got work to do!

Ok, that concludes my rant… for now, lol.

[Oh'Ello, BSN, RN]

Wow! This was a lot of text. Admittedly I didn't read most of it. I did read the paragraph containing the time-breakdown per patient. We're always screaming at new nurses "TIME MANAGEMENT...MANAGE YOUR TIME". Seeing the breakdown "on paper" really puts into perspective how insane some of our ratios are.

[AnthonyD]

Thank you for venting! This was well thought out, extremely well written, and accurate. I actually did read the whole thing. Kudos to you for taking the time to write it.

[ArtClassRN, ADN, RN]

What does a lot of venting look like?

[ladedah1, BSN, RN]

What does a lot of venting look like?

Lol! I guess I should have given a bit more consideration to that title... though I do recall having turned in 16 pages on a 6 page report...

I guess I bring a whole new meaning to "detail oriented"

[NRSKarenRN, BSN, RN]

Moved to AN's First Year After Nursing Licensure for support.

[vanilla bean]

I think this topic is bigger than the "First Year After Nursing Licensure" forum. I don't think there was a diabolical rationale for moving it there, but it is almost the equivalent of burying it in the forums as this forum doesn't get anywhere near the traffic that the General Nursing forum does.

OP, I read your whole piece (before it was moved - I actually came looking for it again to see if it had generated any interesting discussion) and agree with a lot of it. I think you are speaking to experiences that many nurses are struggling with - be they newbies or seasoned. Thanks for taking the time to share your thoughts about issues you're struggling to reconcile in the "Ivory Tower" vs "real world" nursing dichotomy.

[HouTx, BSN, MSN, EdD]

BRAVO! Very nice rant!!!

I sincerely hope OP can hang on to that passion. Just want to add "the only way to dismantle the Master's house is with the Master's tools"........ We desperately need strong, well-informed nurse leaders to move into positions of power to effectively change that 'status quo' that OP decries. I hope OP's career follows this trajectory.

Passing the baton . . .

[middleagednurse]

From the perspective of a nurse with 44 years of experience, you are absolutely right. However, as with many activists, you can be right, or you can be employed.

[Graduatenurse14]

WOW!! You are an excellent writer!!! You need to write more about these topics in places where as many people as possible see it. There is a huge disconnect in what the schools teach and what really happens. Clinicals don't even do it justice. You are 100% correct about the way NCLEX is prepped and what is needed to pass since it too isn't real world nursing and crazily creates faux environments that don't match any nursing setting and that is just wrong. Everyone but the public knows the sad state of affairs of nursing which leads to poor care but no one does anything! So frustrating!!!

As a former teacher, the two most crucial aspects of a good test are is it valid and reliable of which the NCLEX is neither especially the validity aspect. This site http://www.proftesting.com/test_topics/pdfs/test_quality.pdf has good explanations of the terms that fit with NCLEX as opposed say the SAT/ACT.

[Hoosier_RN, MSN]

BRAVO! Very nice rant!!!

I sincerely hope OP can hang on to that passion. Just want to add "the only way to dismantle the Master's house is with the Master's tools"........ We desperately need strong, well-informed nurse leaders to move into positions of power to effectively change that 'status quo' that OP decries. I hope OP's career follows this trajectory.

Passing the baton . . .

I agree with you, except that many times the bean counters are making staffing decisions, not nurse managers. If nurse managers did, I think we wouldn't see rants like this or similar, be it from newbies or more experienced nurses. Persons who have no clue or are so far removed from the bedside have very unreal expectations

[NurseMikki]

I can't claim to be a newbie anymore with nearly 20 years under my belt but you hit the nail on the head in the reality vs what you envision pre nursing.