Am I, as a nursing student, part of the problem?

[marie-francoise]

NOTE: Please read the replies on this thread before you post a reply to this thread. Thanks.

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OK, I might get "flamed" for this question, but...

As a nursing student in an ADN program, am I part of the problem in nursing today? (I have an MPH, and do not know if I will ever pursue a BSN, for a couple of reasons.)

Are there simply too many nursing students that are feeding the mill of poorly staffed/poorly operated hospital nursing units and temporarily (until they burn out and leave) providing a quick-fix to the high turnover that results on those units from poor working conditions?

Are we current students (and new grads) therefore keeping hospitals from facing the facts that RETENTION, esp of more experienced nurses, is key to addressing poor nursing working conditions today?

Maybe hospital leadership KNOW there is a ready batch of new grads to fill a vacancy left by a burnt-out nurse. (Although training a new hire is mighty expensive, and seems now to involve preceptors who are recent grads themselves, as well as decreasing preceptorship duration.)

I'm not saying we don't need new nurses - just that the system might need to be forced to prize their current nurses more, and not to be made so comfortable in the assurance that new nurses are being "churned out".

Maybe the caliber of new nurses needs to be raised. Maybe nursing programs actually need to be MORE selective. I don't know.

Maybe short programs to a nursing degree are not intensive OR selective enough and contain too many low-caliber students who will not help in gaining future respect for nurses? Maybe we are making it too easy for people to go through a program that will end with a job that makes pretty good money compared to other jobs with similar training intensity/duration?

Maybe we don't really have a "shortage" of nursing instructors - maybe programs need to be made both more selective AND intense. (I don't like when the "shortage of instructors" reason is furnished for the nursing shortage - it seems more like an excuse to avoid facing the reality that there is a nursing shortage because many nurses and potential nurses don't want to put up with crappy working conditions.)

Anyway, my basic question is, am I part of the problem, as a nursing stduent going through a relatively short, not very clinically intense (so far) program?

I keep wondering, though, if we should bring those old diploma programs back. Maybe make them competitive, intense diploma programs with an intense preliminary didactic component for learning diseases and rationales for nursing interventions, and then have the rest of the training be in the hospital, basically.

[RNperdiem, RN]

Nursing sits in a gray zone between a trade and a profession. We are a mixed bag of people too.

Are we a profession? Theory based education

Are we a trade? Apprenticeship of doing

Nursing started out as a trade. The diploma programs taught learning by doing. Of course the hospitals staffed almost entirely with student nurses before the 1940's, so they benefited financially from the arrangement.

[Valerie Salva, BSN, RN]

Marie- Francoise,

Your post is very insightful, and I think you've pretty much hit the nail on the head in a lot of ways.

[Valerie Salva, BSN, RN]

I have a very high veneration for nurses, and actually think the program I am in is a good one.

A lot of my fellow students, though, don't seem to have much insight into the greater issues surrounding nursing - such as the rampant understaffing and too many requirements for documentation - so I don't have much hope that they will go up against "the system" once they are nurses, and, if they do, they will likely get pushed out of the unit they're on since the hospital can replace them with a new grad anyway. My reference to caliber is not regarding the curriculum itself.

My concern is that as long there is always a new grad ready to go into bedside nursing, the hospitals will not prize the nurses they already have, or the nurses who have left the bedside because of understaffing and other workplace problems.

I guess what I am saying, in short, is that before nursing working conditions get better, the nursing shortage will have to get worse for the "system" to start really caring to change it.

So, anyway - nursing education is something that has always interested in me, I do admire the program I am in, and I do admire nurses.

You are saying the same kind of things I've said to colleages and fellow students a number of times over the years. They often have no idea what I'm saying and look at me like I'm from Mars when I express my thoughts on the hemorrhaging of seasoned nurses from the bedside, and the "transfusion only" approach our society is taking- crank out the new grads, bring in the foreign nurses- but to hell with improving working conditions in order to keep seasoned nurses at the bedside.

Many employers prefer new grads overseasoned nurses for a number of reasons: They are cheaper, they do not have back injuries, and when they are overwhelmed by the job, they think it's them- seasoned nurses know it's not them- it's the work load, the system, and just the way nursing is.

And yes- I agree that in many programs academic and clinical standards are being lowered in order to ensure a flood of new grads.

Also, many students have no clue about the bigger issues and problems in nursing.

[marie-francoise]

You are saying the same kind of things I've said to colleages and fellow students a number of times over the years. They often have no idea what I'm saying and look at me like I'm from Mars when I express my thoughts on the hemorrhaging of seasoned nurses from the bedside, and the "transfusion only" approach our society is taking- crank out the new grads, bring in the foreign nurses- but to hell with improving working conditions in order to keep seasoned nurses at the bedside.

Many employers prefer new grads overseasoned nurses for a number of reasons: They are cheaper, they do not have back injuries, and when they are overwhelmed by the job, they think it's them- seasoned nurses know it's not them- it's the work load, the system, and just the way nursing is.

And yes- I agree that in many programs academic and clinical standards are being lowered in order to ensure a flood of new grads.

Also, many students have no clue about the bigger issues and problems in nursing.

Well said! Maybe nursing programs should include a 1-credit course on "Advocacy and Problems in Nursing Today" - basically, a course that tells it like it is, instead of pretending that everything is hunky-dory in the land of nursing.

Maybe schools deliberately don't let students know about the realities of the nursing workplace because they fear we'd all get scared and run away.

Maybe schools' goals of getting as many students to pass the NCLEX and providing a supply of nurses to local hospitals (my ADN program doubled its number of students this year) overrides the broader goal of trying to educate nurses to improve nursing working conditions, since that latter goal may actually scare some students away, since it fesses up to the reality of the problems facing nursing today. But, if we really want to bring about change, we have to present the truth so that we can confront it and grapple with it. And that truth should be presented in nursing school.

[morte, LPN, LVN]

I don't necessarily think that every nurse having their BSN is an answer to our current nursing shortage problem. My RN-BSN program was practically junk. I learned very little that could be applied to "real life" nursing.

Why can't colleges advance themselves and make relevant RN-BSN programs that help nurses become stronger clinically? I know I would have loved a class that was focused specifically on surgery. We could have observed in the OR and learned all the new useful information about the OR. Same goes with pharmacology, pathophysiology, lab, radiology, medicine, psychiatry, legal matters, etc. Why not have classes that teach about the in depth specialties that some of us know almost nothing about? I would have loved to have taken a class on neonatology for my BSN.

My BSN was not relevant to my nursing practice because the classes were all "theory." They included research methods, statistics, healthcare finance, leadership and management, blah, blah, blah. These classes do not specifically benefit staff RNs. No wonder people don't want to get their BSN! It doesn't always benefit them in there work setting!

I wish that all nurses had their bachelor's degree so that we could perhaps be more respected by other healthcare professionals. But, in my experience the current BSN programs do not do much for teaching us what we would really like to know.

what you are speaking of is "training" as in nurses' "training"

a BSN is both a nursing degree and a basic college education. there is no time to cover both in the same time period(all the additional classes you mention and the req for the BS)...if you want that additional training/education persue it individually or get a MSN in your area of preference

[Laughs-a-lot, RN]

Trying not to be offended. I went through nursing school with 4 kids, and a 4.0 GPA going into clinicals. I made alot of sacrifices as did many of my fellow students. I feel that I am a very competent nurse, and the majority of the nurses that I work with, I would gladly have at my bedside.

[marie-francoise]

I wasn't referring to competence - I've no doubt the many, many nurses out there are competent.

I was more thinking about the awareness level of students regarding issues affecting nursing today, and their willingness to try to "fight the system" once they're in it. I was also thinking on more of a "systems" level:

1) How current nursing students are unaware of the greater issues & problems surrounding nursing.

If students aren't aware of the issues, how can they work to advocate for change?

As one poster said, newbies tend to think "it's them" when they are miserable in a workplace, when actually it's the systemic problems that all too familiar in so many nursing workplaces that are really plaguing them, not anything regarding their own, individual ability or "stress management" or "time management" skills.

2) How a constant supply of new grads might make hospitals less appreciative of their current staff, esp if that current staff voices real concerns about real workplace problems.

With more grads supplied from nursing schools, my fear is that hospitals might be less inclined to take seriously those concerns voiced by the more veteran nurses, since they know they can hire a newbie if the "disgruntled" employee leaves or causes "trouble" by voicing (those very valid) concerns, rather than working on ways to try to address their concerns and RETAIN those seasoned nurses.

Faced with that kind of scenario, current, more seasoned nurses might not think it worth it to speak up against a system that gives too many patients to a nurse; requires far too much documentation; does not give nurses enough respect yet gives them a huge, very stressful amount of responsibility; asks them to do extra tasks not within their scope of work; mandatory overtime; holidays/weekends/problematic work scheduling; not enough time for "biobreaks"; 12-hour shifts that become 14-hour shifts, etc., etc... And, so, they will leave. And voila - a new grad to fill his/her vacancy and take away the power of the statement of a seasoned nurse leaving.

Anyway, I'm not saying that this scenario really does exist - that hospitals aren't working hard enough on retaining nurses due to the availability of new grads - I'm just saying that, basically, it seems that there is far too much focus on recruitment over retention. And that new recruits aren't sufficiently aware of, nor understand, systemic problems in health care that will inevitably affect their daily worklife as a nurse.

[Kim O'Therapy, BSN, RN]

I appreciate the fact that our instructors do cover the issues you have mentioned. Ironically, it is the students that ask for it. Many of the students in my class witness some of this short-staffing, burn-out, and patient overload (and the errors they cause) during clinicals. The next day we address and discuss these problems and possible ways they can be remedied. Also, I do not believe that the majority of turn-overs are due to disillusionment and frustration. Baby boomers are retiring now. Our population of 65 and older patients is growing yearly and demands more health care workers. The 85 and older population is now the fasted growing population = even MORE nurses needed. Finally, I feel the bedside shortage has to do with nurses moving on and/or being promoted to higher-level positions; thus, leaving bedside vacancies. About 50% of my class of 120 students plan to continue their educations and become CRNAs. All of THOSE bedside vacancies will be open once that happens. The hospital across the street from my school is adding ten more floors and will need alot of my graduating class to cover them. However, I do feel some of the shortage is also d/t hospitals not wanting to let loose of money, so they do not staff enough (I notice this on weekends the most). I never, ever thought of my getting an education as part of the problem; however, I did enjoy the points of discussion you came up with. Thanks. :cheers:

[BeachBayNurse]

I hate to say this cliche but: when you become a nurse, you will understand. There is NO real nursing shortage, NO shortage of good nurses. There is a shortage of good nurses that are willing to work in current conditions. There are plenty of nurses I know personally that will only work in certain areas, or will only work in education. If all of theses nurses didn't think med/surg was a forecast of h*ll, there would be a nursing surplus.

[Daytonite, BSN, RN]

i think that being a high caliber nursing student or nurse is a totally personal decision and action. you either are or you are not. to blame it on the system is simply passing the buck and refusing to take responsibility for one's own actions.

when i became a supervisor i was shocked at the number of mediocre nurses i ran into who were willing to just do mediocre caliber work. where does that come from? the self and no where else. how sad. i also saw nurses who would get stumped by things they did not know and just sweep it under the carpet hoping they wouldn't have to deal with it. what kind of professionalism is that? however, it happens more than you would know. you can't start a fire under these kinds of people if they aren't going to respond to it in the first place. i think a lot of it is based in the old feeling that nursing is a blue collar profession and much of the mediocrity is blue collar mentality. you can't stimulate activism in people who only go to work to collect a paycheck.

[DutchgirlRN, ASN, RN]

To be a good nurse takes time, time working the floor. Who would be better qualified to teach nurses than those who have actually put in the hard work and time? I think ASN's should be allowed to teach, at least clinicals, from what I have observed of the Clinical Instructors they know how to tell someone how to do somethig but cannot actually do it theirselves.

Watching the clinical instructor trying to talk a student through starting an IV was a real joke. I had to leave the room to keep from laughing out loud. Poor patient.

[Valerie Salva, BSN, RN]

I wasn't referring to competence - I've no doubt the many, many nurses out there are competent.

I was more thinking about the awareness level of students regarding issues affecting nursing today, and their willingness to try to "fight the system" once they're in it. I was also thinking on more of a "systems" level:

1) How current nursing students are unaware of the greater issues & problems surrounding nursing.

If students aren't aware of the issues, how can they work to advocate for change?

As one poster said, newbies tend to think "it's them" when they are miserable in a workplace, when actually it's the systemic problems that all too familiar in so many nursing workplaces that are really plaguing them, not anything regarding their own, individual ability or "stress management" or "time management" skills.

2) How a constant supply of new grads might make hospitals less appreciative of their current staff, esp if that current staff voices real concerns about real workplace problems.

With more grads supplied from nursing schools, my fear is that hospitals might be less inclined to take seriously those concerns voiced by the more veteran nurses, since they know they can hire a newbie if the "disgruntled" employee leaves or causes "trouble" by voicing (those very valid) concerns, rather than working on ways to try to address their concerns and RETAIN those seasoned nurses.

Faced with that kind of scenario, current, more seasoned nurses might not think it worth it to speak up against a system that gives too many patients to a nurse; requires far too much documentation; does not give nurses enough respect yet gives them a huge, very stressful amount of responsibility; asks them to do extra tasks not within their scope of work; mandatory overtime; holidays/weekends/problematic work scheduling; not enough time for "biobreaks"; 12-hour shifts that become 14-hour shifts, etc., etc... And, so, they will leave. And voila - a new grad to fill his/her vacancy and take away the power of the statement of a seasoned nurse leaving.

Anyway, I'm not saying that this scenario really does exist - that hospitals aren't working hard enough on retaining nurses due to the availability of new grads - I'm just saying that, basically, it seems that there is far too much focus on recruitment over retention. And that new recruits aren't sufficiently aware of, nor understand, systemic problems in health care that will inevitably affect their daily worklife as a nurse.

Yes, the scenario you describe does exist.

I agree with your posts wholeheartedly.