Am I assessing today's nursing situation accurately?

[marie-francoise]

Maybe this is more for the career advice forum, but I have two questions for working or recently working nurses - who have been working as a clinical nurse sometime in the past 7 years or so.

My two specific questions are at the end of my post.

So, I'm a student in an ADN program, have a MPH degree and some years' work experience. I'm doing very well in nursing school - straight A's so far, don't find the material difficult, get along great with my peers and teachers, etc., etc.

But... I've found that I don't like patient care, and I hate clinicals. I like talking with patients well enough, but I just don't like performing constant procedures on strangers.

When I'm at a nurses' station during clinical, I look around me and just don't feel I would be happy as a nurse. And I certainly can't imagine being a nurse with a 5-12 patient load! Not to mention the constant charting. Seems like we have to chart every passing flatus, just to be prepared for that ever-possible courtroom case sometime years down the road.

And I'm also trying to honestly assess, with open eyes, the "real world" of nursing that lies in wait for me, should I graduate. And I find that... I dread that world. It seems full of stresses that only a super-human could manage and come home anywhere remotely "happy" or in a healthy state of mind.

I try to assess what I'm feeling during clinical, and then mentally extrapolate that to a real-world situation of 5-12 patients, and I really think I'd be downright miserable in that situation. The likelihood of committing an error just seems unacceptably high, too - even for the most well-organized, cheerful, and well-adjusted person (which I'm not saying I am).

So, in short, I love the nursing knowledge I'm gaining, I truly respect the profession of nursing and those who practice it, and think nurses need more respect for the knowledge and capabilities they have. But I'm not sure I like nursing, based on my experiences in school; and know I'd likely hate it 10x more after graduation, when I experience today's real-world working conditions.

My theory is that the nursing shortage largely resulted because the health care system cut nursing staffing a decade or so ago, started overly focusing on $$$$ due to managed care and spiraling health care costs - which, additionally, also ensured that only the most high-acuity patients were admitted - and thus made working conditions unworkable for nurses, and now.... so few people are willing to put up with the resulting nursing working conditions, that... voila! a nursing shortage.

And it seems as though "the system" is addressing the nursing shortage, esp in hospitals, by churning out new nurses every year or two who'll work for a year or two, then burn out, then get replaced by a new crop of just-graduated nurses who'll tolerate the job for a year or two, until they themselves also get burned out and themselves are replaced by yet another new crop. Etc., etc.

Thus... a constant cycling of new nurses into and out of the hospital since few people can tolerate the job very long... unless they really have to - because of money and making ends meet, because they desperately want to be in America - a very undsterstandable goal - this is a great country! - or because of other life situations.

Maybe I'm assuming things; but this is my theory of why there is a nursing "shortage". (Likely not a shortage at all - just a shortage of people willing anymore to use their RN in such self-punishment.)

I've tried talking to my nursing schoolmates about my worries, and it's like they haven't a clue about the nursing problems today.

And my teachers won't say anything substantive about the real world of nursing, except hinting at how we'll need to really optimize our "time management skills". I questioned one teacher who presented an example of a 4-to-1 patient-nurse ratio, and I asked, isn't it true that patient loads are really a lot higher than that now? And she said, "Well, yes, as a nurse, you'll all have to learn to hussle." And that was it. Other teachers make it seem as though we'll have oodles of time for patient education. Maybe they can't talk about it because we'll all run away.

Ten or twenty years ago, maybe nursing wasn't so bad. But it now seems, since somewhere in the 1990s, that nursing working conditions have deteriorated. Am I correct? It seems as though a typical hospital nurse's day (or night) would strain anyone's repertoire of "stress management techniques".

Maybe some nurses can take that glowy feeling they get when a patient says "thank you" or when they've positively impacted someone's health or medical condition, and use that to buoy up their spirits to face the next day, or to keep them from quitting. I sincerely applaud them for it, and for their stamina & good-heartedness.

But I don't know if I myself could take that as consolation for constant stress & worry over possible errors I may have committed when absolutely time-strapped.

I'm just trying to be honest with myself. I've had the intention to become a nurse for 15 or so years, and I'm exceling in my classes, but... I really think I'm ready to squash that dream, the more I see and learn about the profession and the pressures placed on it.

Anyway, all that said, would you:

1) Say that nursing is likely not for me, after hearing this (admittedly rather bellyaching...) description of my views?

2) Say that my assessment of the nursing situation as it exists today is accurate? (esp for hospital nursing)

Thanks for the ear...

[CITCAT]

It sounds like maybe your barking up the wrong tree, consider research,or maybe political advocate governent with nih? Nursing has changed no doubt Maybe you need to reeval, your goal long term

[showbizrn]

WARNING: GET OUT OF NURSING!

IF STRESS AND BURNOUT CATCH-UP WITH YOU, YOU'RE THROUGH!

:uhoh21:

I'm not sure of your "stats" and history on the Nursing Shortage. I've been tooo busy enjoying my juggle with Nursing and Showbiz to pay any attention.

Much Success to You!

[NoWhereNear]

I'll be starting my pre-nursing classes next fall, but have been talking to a lot of people and doing a lot of research. I've been told in no uncertain terms by one nurse I know (she has been in the profession for about 40 years now) to learn what I need to learn, do bedside nursing for a little while, but in the meantime, pursue further education in order to get a nice admin job somewhere. I don't know that it's good advice for me, as I'm completely fascinated by all things medical and am looking forward to the challenge and a job that makes me run my a** off (not that I might not change my mind completely when it's time for clinicals, I suppose). But maybe that's something you could look into? I'm under the impression from everything I've read on these boards that there's a LOT you can do with a nursing education. If you do a search of these forums for "leaving nursing" you'll see a LOT of post with suggestions for jobs that don't involve direct patient care. (Try not to read the original posts though, they get to be kind of a downer.)

[hope3456, ASN, RN]

Judging from your post -my perception is that you might be happier in a management type of position where you actually get to influence decision making. I would say you are a very talented writer and very intelligent. Wouldn't your MPH provide you with a successful career and (just curious) what type of employment did you have previous to going to nsg school?

You might feel overqualified as a RN - your opinion doesn't always count for much and sometimes it is best just not to ask - which bothers me sometimes.

For example, my manager is complaining about being over budget - I had to sit thru a 1hr staff meeting listening to her complain about it, but then she recently hired an RN who has no experience into an LPN position and I know a very experienced and qualified LPN had also applied for the position and the LPN's get paid about $7 less per hour....I have no idea why but find it is best just not to even ask and that is just the most recent example. And I actually consider myself in a good job, don't even ask about my previous position. And this position is not even close to being an RN specific job.

The way I see it at least I have a job but if I had a degree or job opportunities in another field I would be fine with that and wouldn't be in nursing.

[Tweety, BSN, RN]

The nursing shortage started long ago, not just in the 90's. ADN programs sprung up many years ago to help alleviate the problem. So it's nothing new.

The "real world" and the nursing school world are indeed different. Your teachers are teaching you the ideal and that is probably how it should be, but it does leave a "reality shock" when you hit the real world. But there really isn't a good way to teach that.

I think it's great you're talking an honest look at yourself, but don't forget to focus on some positives. Instead of "performing constant procedures on strangers" how about "helping sick and weakened people get well, that need help" or something like that. Also why look at the nursing future with such fear? Fear of making an error, fear of not handling 5-12 patient assignments, etc. It's a challenge that most of us rise up to and conquer, albiet not without a lot of stress.

There are many non-bedside nursing positions but they are hard for new grads to get, unless you want to work in Long Term Care. It sounds to me like you're in for a miserable first few years if you stick with nursing. No shame in moving in another direction.

[S.T.A.C.E.Y, LPN]

I totally understand where you are coming from because that was similar to how I felt in nursing school. But, I have to ask, have you only been looking around you, and making broad-based judgements from the few floors you may have seen? What I mean is, have you looked into other specialties perhaps? I work in the ER, and usually have 4-5 patients. By the time I finished school, and started my first job I could juggle three patients comfortably, slowly that became four, now five some days. Ya, some days are busy, but you do your best, and don't take it home with you. Night shifts I often do have time for more patient education, and to actually talk with people. I do chart alot, but its not all that bad. If you worked in ICU, you may only have 1-2 patients....not balancing a load of 5-12 on medsurg. In an ICU environment, where the same patients often stay for days-weeks-months, the nursing staff sometimes get to know them very well. Maybe an environment like this would work better for you? Have you thought about pediatrics or NICU maybe? Sometimes its even the type of patients you deal with. I know geriatrics just burns me out. I don't have the kind of personality to work with old people day after day like I saw on the medsurg floors I did clinical on. Maybe you're the same? Think about what it might be like to work with kids for a whole shift...maybe that would relieve some of the stress you feel now. I know if I were to stay in medsurg I would have been very unhappy. Balancing that 5-6 on days, then however many more on nights, plus med-passes, diaper changes, bed baths, ambulation, feedings, teaching, and all the rest of it would have drained the hell out of me. But for where I'm at right now, I feel like I'm constantly learning something new. I never know what I'm going to be doing next, some days its quiet and I can sit at the desk for 30-40 minutes at a stretch and relax, while other days I am run off my feet.

I agree with your point about the nursing shortage, and how nurses burn out super-quickly and the next wave just replaces them. But, I noticed in nursing school that alot of people go into this profession because they wanted a job they could do lots of things with. Many girls wanted to be stay-at-home mom's and went to nursing school so they could just work part time post-baby. Others because they weren't sure what do with their lives and hey at least a degree in nursing means a guaranteed well paying job after graduation.....unlike that liberal arts degree. Personally, for me, I see it as a stepping stone. Ya, I want to get my experience, but I don't plan on wiping butts till I retire. In a couple of years, I'll be able to go back to school, specialize in something different, move on to a different area of health care and do something else thats new and different. Nursing is a great job some days, but I will agree it is a crappy job other days.

I don't know how far you are in school, but I would guess you've busted your butt to get in, to get this far, and you might as well finish the program. Start looking around for specialties that would interest you, and maybe try heading in that direction after graduation. Then, see where you can go next. Maybe a year or two in a specialty as you study for your masters...then into research, pharmaceuticals, medical equipment sales, etc.

[siggie13]

Speaking from lots of experience (40 years), I would say that you have a firm and realistic grasp of the nursing situation. I love caring for patients; hate the politics!! My advice to you would be to think long and hard and find something else! Nursing is what it is and I see no changes in sight. One really has to want to do this profession to last and you sound like you are off the fence and on the "no way " side. If I knew what I know now back when I considered nursing, I would have become a vet.

[hisblueskies]

I think your assessment is right on target. Working as a nurse in a hospital is frequently chaotic, highly stressfull and frustrating. There is too little support, the patients are very sick and you have too many to properly care for. I think you have to be very successful at multi-tasking, time management and being able to flow when everything is working against you. Unfortunately the nursing schools will not address any of these issues so when you actually start working as a nurse you are in for a rude awakening. The trick is to find the right area for you as a nurse. You may be successful in a branch of nursing that others couldn't do if their life depended on it. Don't let your early nursing experiences tarnish you. You are wise to realize during your clinicals that you are in the wrong area but I'm willing to bet you will find the right area for you. It may take time and trial and error but I'm confident you will find it. Go easy on yourself and don't give up on nursing.

[celle507]

I guess you need to ask yourself what you want to do. Do you want to be involved in policy, research, program planning, etc. (more macro-level type jobs) in the health industry? If so, with an MPH and an RN, you have an edge over others who only have an MPH. When you plan programs and think about budgets, you understand what it's like to be "in the trenches" and the people who are directly affected by the decisions you make will be grateful.

BUT, if you don't see yourself in the health industry at all, I wouldn't continue with the RN. If you've always wanted to be working with unions or teaching or whatever, then this degree will just take you farther from what you really want to do.

[BBFRN, BSN, PhD]

have you considered going into infection control? You'd be a great candidate with a MPH & RN.

[Shantas]

You may call me a negative person but the points you brought up are absolutely correct. Not just me, every one of us in our floor are overwhelmed. Everyday I go to work hoping things will get better, we will have a less stressfull day but it never changes....bedside nursing is very very hard.

Perhaps you should aim for higher education and try out PA, education or case management.

Good luck:)