I went into nursing because I love science and medicine, and thought working with like-minded people to deliver high-quality care sounded like a great job. Since entering the profession, however, I've discovered that there is widespread mistrust and criticism of education and research in nursing. Nurses who are curious and love to ask questions are sneered at, and nurses who pursue further education are labeled "book smart" and lacking the prized "street smarts", which seems to equate to knowing how to start an IV. I've never heard of any other profession where furthering one's education is seen as a bad thing. I'm feeling so disappointed about this attitude, and really disenchanted with nursing. I loved school, I love learning, and I think more education is always, always, always a good thing. Will I always be an outcast in nursing because of this? If we want to be taken seriously as professionals, shouldn't we be embracing theory and knowledge and intellectual curiosity?
Again, I might be wrong, but it is my opinion, that outside of critical care, nurses for the most part are performing tasks. That's not to say that M/S nurses do not critically think, but that the level of critical thought necessary is not the same as in the ED or ICU.
Med-surg nurses have to care for a wide variety of acutely ill, often unstable patients, and require a great deal of medical and nursing knowledge, and the ability to think critically to a high degree in order to safely care for patients. They do much more than just perform tasks, as do other nurses in specialties outside of critical care. Have you cared for patients in med-surg? Do you know how sick the patients can be? Are you doing student clinicals in med-surg? You are right that some nurses do not think critically as they perform nursing care, and not all nurses receive good nursing education, but these problems are not endemic to the profession. There are plenty of good nurses, who are knowledgeable, competent, ethical, caring professionals. Becoming a good practitioner takes time; one is not experienced and knowledgeable when one starts, but with a good foundation in a quality nursing program that provides good clinical opportunities for hands-on, direct care, with practice, and with further study (on one's own time), through on-the-job training, and through taking CEU courses, one can greatly increase one's knowledge, competence, and ability to think critically.
Yes, ED and ICU specialties require specific knowledge and training, but med-surg nurses (who care for 5 or more patients at a time) need to have excellent assessment skills, be able to recognize subtle changes in patient condition and intervene appropriately, understand lab values in order to understand what is happening medically with the patient and to act accordingly, whether that is calling the doctor or holding a medication. They must administer medications and treatments safely and evaluate the outcomes, provide care for and monitor patients who have very recently had surgery, admit and discharge patients, deal with families, doctors, and more. When you have some med-surg experience, post back and tell us what you found out.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I don't think people splinter their thoughts regarding nurses the way those of us who study our role up close and personal and view it through the prism of gender politics. The concepts of holistic care and associated ideas articulated by Jean Watson and others applies to the way the public views nurses as it does to the way nurses view the patient.
I will continue to embrace the whole, embrace curiosity and lifelong learning despite the stereotypes some learned professionals have internalized due to unfortunate experiences in their past or value judgements and disparaging comments about English expression that has nothing to do with effective nursing and often mirrors the diversity of the patient population, making it a good thing as long as the ideas expressed are the same.
If it's possible to light the fire of intellectual curiosity in adults who may not have seen it modeled in their homes I'd love to see it bottled and given away for free. I may get the flame-thrower treatment myself here, but this thread smacks of elitism as much as it attempts to trumpet the value of education. The IOM Report specifically stated that the ADN route to a nursing career brought diversity to the field of nursing. I hope their acknowledgement of that figures into how they proceed without losing such an important quality.
@ladyfree I think perhaps you misunderstood me. I am not saying that nursing hasn't historically been respected or rigorous. I thought I had made that clear in my first post. I do, however, get the distinct impression that many people are starting to see it as the less difficult alternative to med school, because while some programs may have retained that vigor, I think it's becoming very common for schools to make easier core classes for nursing students. When I say I want more for nurses, I mean that I hope we can recover from the trend that I believe we are currently slipping into with nursing education - not that I think the veteran nurses need to 'do better'... You seem to think this issue is not as common as I believe it is. It's true that I may be new to this, but I have done quite a bit of heavy digging in the process of picking a program. I am concerned that by the time I have the letters RN behind my name, nurses will be a dime a dozen, because everyone and their mom will have been able to complete their nursing education, which may or may not be a program of any worth.
The program I'm choosing to attend (hopefully) will be as fantastic as I have heard it is (from students and nurses alike). I'm not saying that nursing hasn't come from an excellent place- more that I'm worried the educational trend is an unfortunate one. That is the reason I believe some people keep pushing for higher degrees. It's not that anyone is looking at nurses who have been doing this for 30 years and thinking they are underqualified. It's that people are looking at what passes for a college education in a lot of places these days and finding it laughable. So they think "maybe if we require everyone to get the next higher degree, that will fix it." The reality is that many schools will make those programs more accessible as well, and pretty soon the value of the BSN will also be in the toilet. It's like educational inflation. I don't mean to imply that all schools do this, but truthfully, I believe many do.
soldiernurse seems to have attended an excellent program..but I would posit that when some public state universities offer watered down classes for the BSNs while offering different courses for their BS/BA students..it's becoming more and more common. It's hard for me to believe it is a rare occurence anymore.
BusyBee91, the unless we have actual concrete evidence that there are "watered down education" in state universities-I disagree BTW-the Standards and Practices of our scope as nurses transcends education; the BON sets what is REQUIRED to graduate and sit for a national standardized test; if one goes to such a "watered down" program (which are programs that may be in danger of closing anyway or "commercial" schools) there will be enough credence to shut down the program altogether.
Again, nursing education is not, I repeat is NOT like the typical college education; so you can compare apples to oranges here.
I had the unusual circumstance of attending an ADN program (did not pass), a diploma program (for my PN) and a BSN program; nursing, regardless of base, is rigorous, requires work, thinking, and a GOOD- to stellar program will do so; the icing in the cake for these schools are NCLEX pass rates-even though pass the NCLEX the ability of the nurse will be solely up to the nurse; very empowering btw-as well as a reputation of producing excellent students; I don't think there are a plethora of programs that have "water-down" pre req's; again, to suggest that is off the mark.
The only way to "flush down the toilet" ones education is to cease attempting to hone their practice and career knowledge; at least in this business.
Med-surg nurses have to care for a wide variety of acutely ill, often unstable patients, and require a great deal of medical and nursing knowledge, and the ability to think critically to a high degree in order to safely care for patients. They do much more than just perform tasks, as do other nurses in specialties outside of critical care. Have you cared for patients in med-surg? Do you know how sick the patients can be? Are you doing student clinicals in med-surg? You are right that some nurses do not think critically as they perform nursing care, and not all nurses receive good nursing education, but these problems are not endemic to the profession. There are plenty of good nurses, who are knowledgeable, competent, ethical, caring professionals. Becoming a good practitioner takes time; one is not experienced and knowledgeable when one starts, but with a good foundation in a quality nursing program that provides good clinical opportunities for hands-on, direct care, with practice, and with further study (on one's own time), through on-the-job training, and through taking CEU courses, one can greatly increase one's knowledge, competence, and ability to think critically.
Yes, ED and ICU specialties require specific knowledge and training, but med-surg nurses (who care for 5 or more patients at a time) need to have excellent assessment skills, be able to recognize subtle changes in patient condition and intervene appropriately, understand lab values in order to understand what is happening medically with the patient and to act accordingly, whether that is calling the doctor or holding a medication. They must administer medications and treatments safely and evaluate the outcomes, provide care for and monitor patients who have very recently had surgery, admit and discharge patients, deal with families, doctors, and more. When you have some med-surg experience, post back and tell us what you found out.
I said MS nurses perform more tasky type things, not that they do not need critical thinking skills.
I also said that in MY LIMITED EXPERIENCE, I have come across a lot of nurses who are not great critical thinkers (whatever the heck that means), I'm saying they are good at IV starts, NG drops, those types of skills, and they are great nurses, but they may not know when to titrate vaso up vs when to titrate dobu up, and TO ME, that requires critical thinking skills, and I FEEL, that cannot always be taught.
In any case, I have readily admitted that my experience is limited, and I'm willing to change my opinions.
I said MS nurses perform more tasky type things, not that they do not need critical thinking skills.
I also said that in MY LIMITED EXPERIENCE, I have come across a lot of nurses who are not great critical thinkers (whatever the heck that means), I'm saying they are good at IV starts, NG drops, those types of skills, and they are great nurses, but they may not know when to titrate vaso up vs when to titrate dobu up, and TO ME, that requires critical thinking skills, and I FEEL, that cannot always be taught.
In any case, I have readily admitted that my experience is limited, and I'm willing to change my opinions.
I respect and understand that your experience is limited. It's absolutely fine to have limited experience. But since you are posting on this thread, I am understanding that you are open to information. I am not clear what nursing actions in med-surg you consider to be "more tasky", versus other specialties. Could you give some examples? Nurses in other specialties, including the ER and ICU, also perform bed-baths, change diapers, and clean up diarrhea. Performing these actions also gives one an opportunity to assess the patient, i.e., for skin breakdown, amongst other things.
In nursing, the critical thinking process is known as the Nursing Process. It is a series of steps: assessment (subjective and objective), formulation of a nursing diagnosis, planning, implementation, and evaluation. It is often referred to as ADPIE or SOAPIE. If you are starting nursing school, you will be taught about this. You are correct that titrating drips requires critical thinking, but so does starting IV's and inserting NG tubes. For instance, when starting an IV it is a good idea to know about the patient's condition, i.e., are they on blood thinners, or do they have severe sepsis with a systolic blood pressure of 80? It is good to know what medications and fluids you will be infusing, and the reason they are indicated. It is good to know if the patient has a dialysis shunt, and on which arm. These things will influence the decisions you make in starting the IV, such as where you will place the IV, what gauge needle/catheter you will select, and what problems with insertion you will prepare for. All of this is critical thinking.
Critical thinking in nursing can be taught. It is a matter of training ourselves to ask questions while following the nursing process. Of course, the critical thinking is based on our knowledge of nursing practice, which we can increase if we wish to. In nursing we are always asking ourselves questions, i.e., "What does this change in our patient's blood pressure and pulse mean?", "What is contributing to it?", "Is this a change from the patient's baseline?" "What is the patient's normal blood pressure and pulse?" "Are these changes something we should expect, or are these changes of concern?" "What should we do about it?".
Not all nurses have developed their critical thinking abilities. But we can choose to develop this ability or not. Some nurses see starting an IV as a task. In my RN ADN program I was taught to see it as a clinical procedure, where one went through the steps I illustrated above. The Nursing Process is the framework for the care we provide, and for which we are held accountable for. Our practice is further defined legally by the Nurse Practice Act for our state, the Nurse's Code of Ethics, and applicable standards of care.
I respect and understand that your experience is limited. It's absolutely fine to have limited experience. But since you are posting on this thread, I am understanding that you are open to information. I am not clear what nursing actions in med-surg you consider to be "more tasky", versus other specialties. Could you give some examples? Nurses in other specialties, including the ER and ICU, also perform bed-baths, change diapers, and clean up diarrhea. Performing these actions also gives one an opportunity to assess the patient, i.e., for skin breakdown, amongst other things.
In nursing, the critical thinking process is known as the Nursing Process. It is a series of steps: assessment (subjective and objective), formulation of a nursing diagnosis, planning, implementation, and evaluation. It is often referred to as ADPIE or SOAPIE. If you are starting nursing school, you will be taught about this. You are correct that titrating drips requires critical thinking, but so does starting IV's and inserting NG tubes. For instance, when starting an IV it is a good idea to know about the patient's condition, i.e., are they on blood thinners, or do they have severe sepsis with a systolic blood pressure of 80? It is good to know what medications and fluids you will be infusing, and the reason they are indicated. It is good to know if the patient has a dialysis shunt, and on which arm. These things will influence the decisions you make in starting the IV, such as where you will place the IV, what gauge needle/catheter you will select, and what problems with insertion you will prepare for. All of this is critical thinking.
Critical thinking in nursing can be taught. It is a matter of training ourselves to ask questions while following the nursing process. Of course, the critical thinking is based on our knowledge of nursing practice, which we can increase if we wish to. In nursing we are always asking ourselves questions, i.e., "What does this change in our patient's blood pressure and pulse mean?", "What is contributing to it?", "Is this a change from the patient's baseline?" "What is the patient's normal blood pressure and pulse?" "Are these changes something we should expect, or are these changes of concern?" "What should we do about it?".
Not all nurses have developed their critical thinking abilities. But we can choose to develop this ability or not. Some nurses see starting an IV as a task. In my RN ADN program I was taught to see it as a clinical procedure, where one went through the steps I illustrated above. The Nursing Process is the framework for the care we provide, and for which we are held accountable for. Our practice is further defined legally by the Nurse Practice Act for our state, the Nurse's Code of Ethics, and applicable standards of care.
I hope this is helpful.
Thanks for taking the time to reply to me.
As far as the examples you asked for, I will admit that I had thought of IV insertion as a series of steps following a doctor's order, but I am starting to think differently.
As far as the examples you asked for, I will admit that I had thought of IV insertion as a series of steps following a doctor's order, but I am starting to think differently.
You are welcome. If you are interested, there are some very good current nursing procedure books that incorporate using the nursing process along with the procedural steps.
Just slightly off topic.......I get a little irritated when I hear people, especially other nurses, imply (or directly talk about) the superiority of critical care nursing over med/surg. Granted, fact of the matter is that there are easier areas to work on than others, and easier facilities as well. For example, when I am sometimes floated to the rehab floor in my hospital, I find working there to be a walk in the park compared to my home GI surgical floor. Often boring, in fact. But to say med/surg nursing in general, and the nurses therein, are inferior to critical care nurses is ridiculous. You possess and hone different sets of skills depending on where you are, and each of these skills play an instrumental role in patient care. I've seen nurses that had worked in the ICU for years come to my floor and comment on how much more busy and challenging it was.
I'm not saying nurses from either area are better or worse, quite the opposite, I'm saying both areas can be challenging and require the same degree of knowledge and critical thinking.
Just slightly off topic.......I get a little irritated when I hear people, especially other nurses, imply (or directly talk about) the superiority of critical care nursing over med/surg. Granted, fact of the matter is that there are easier areas to work on than others, and easier facilities as well. For example, when I am sometimes floated to the rehab floor in my hospital, I find working there to be a walk in the park compared to my home GI surgical floor. Often boring, in fact. But to say med/surg nursing in general, and the nurses therein, are inferior to critical care nurses is ridiculous. You possess and hone different sets of skills depending on where you are, and each of these skills play an instrumental role in patient care. I've seen nurses that had worked in the ICU for years come to my floor and comment on how much more busy and challenging it was.
I'm not saying nurses from either area are better or worse, quite the opposite, I'm saying both areas can be challenging and require the same degree of knowledge and critical thinking.
Ok, I'm going to address this because I feel like you may have been talking about me.
I, in no way, believe that CC nursing is superior to MS. I feel that they each require a different skill set.
Which is why different areas of nursing offer specific and specialized certification.
Ok, I'm going to address this because I feel like you may have been talking about me.
I, in no way, believe that CC nursing is superior to MS. I feel that they each require a different skill set.
Which is why different areas of nursing offer specific and specialized certification.
Sorry, no I actually wasn't directing that towards you , or anyone in particular. Just something I've thought about for a while and have seen on this site a few times here and there. I see it at work sometimes too, there are a couple of ICU nurses that I hate interacting with because they have this unspoken condescension towards med/surg nurses. Was just kind of venting, more than anything. :)
Susie2310
2,121 Posts
Med-surg nurses have to care for a wide variety of acutely ill, often unstable patients, and require a great deal of medical and nursing knowledge, and the ability to think critically to a high degree in order to safely care for patients. They do much more than just perform tasks, as do other nurses in specialties outside of critical care. Have you cared for patients in med-surg? Do you know how sick the patients can be? Are you doing student clinicals in med-surg? You are right that some nurses do not think critically as they perform nursing care, and not all nurses receive good nursing education, but these problems are not endemic to the profession. There are plenty of good nurses, who are knowledgeable, competent, ethical, caring professionals. Becoming a good practitioner takes time; one is not experienced and knowledgeable when one starts, but with a good foundation in a quality nursing program that provides good clinical opportunities for hands-on, direct care, with practice, and with further study (on one's own time), through on-the-job training, and through taking CEU courses, one can greatly increase one's knowledge, competence, and ability to think critically.
Yes, ED and ICU specialties require specific knowledge and training, but med-surg nurses (who care for 5 or more patients at a time) need to have excellent assessment skills, be able to recognize subtle changes in patient condition and intervene appropriately, understand lab values in order to understand what is happening medically with the patient and to act accordingly, whether that is calling the doctor or holding a medication. They must administer medications and treatments safely and evaluate the outcomes, provide care for and monitor patients who have very recently had surgery, admit and discharge patients, deal with families, doctors, and more. When you have some med-surg experience, post back and tell us what you found out.