bring back diploma they can function on graduation

labordude, BSN, RN · Nov 15, 2019

10 minutes ago, JKL33 said:
Serious question: How might that relate to your preference for moving around?
I ask because I do think nursing might not be as overall difficult if there were never any external pressure to stay anywhere very long and become significantly involved in a facility or community--but, regardless of profession, that is not probably the most common way that people go through life long-term.
I can't speak for Wuzzie, but my view is that nurses seem to experience frequent demands that are out of proportion to resources and they are declared to have multiple far-reaching duties and responsibilities without the autonomy and decision-making authority that makes these duties/responsibilities legit. As a group we are regarded quite poorly by corporate employers despite the services that we strive to provide and the nature of those services. I think that's kind of the gist of it.
I will give you the benefit of the doubt, but it's becoming very difficult to take people seriously when they imply what you are implying. For instance, where shall people "get a new job" when large corporations are in control of this work sector across very large regions? It sounds like you're saying that if people don't want to live a rather nomadic lifestyle, well, that's their problem.

Actually the moving around was travel nursing based and the past 4.5 and 7 year periods respectively have been in two total places so it doesn't relate other than to give a different perspective from various locations. There is no nomadic lifestyle involved.

I really need to choose my words more directly, so here goes. My point is that people have a choice to continue working in their current position, that's it. No reading into it, no thinking about where to work if someone controls much of the work sector, that is irrelevant in the notion of whether or not continuing to work in the current position in and of itself is a choice. or not. Just because someone may not like a choice or feel like they don't have one, doesn't mean that they don't actually have the ability to make a choice while obviously accepting any and all consequences that go along with it.

You bring up two different points: first that we have demands out of proportion to resources and this I have definitely seen come across. I'm curious about your second point and us having duties and responsibilities without authority, autonomy, etc to bring them about. Can you elaborate?

For example, right now I'm totally making the choice to procrastinate studying for my exam that is at 3pm today ?

Wuzzie · Nov 15, 2019

15 minutes ago, labordude said:
I'm curious about your second point and us having duties and responsibilities without authority, autonomy, etc to bring them about.

Ooooo! Me! Me! Earlier this week I was in charge and had to figure out how to get 157 patients through an Oncology clinic (read really sick patients) with only 18 rooms. That's the lack of resource part. One of the physicians called and wanted to add on 10 patients and I was not allowed to tell him "no, we can't handle the extra patients" so I had to figure out how to make it work and when it didn't, because it wasn't possible, I had to also take the heat from both the patients, the staff and the patients that were forced to wait over 2 hours past their appointment times. Add an RRT and a Sepsis code to that mix. WE are often told "make it work" but not given the authority for that to happen.

JKL33 · Nov 15, 2019

54 minutes ago, labordude said:
No reading into it, no thinking about where to work if someone controls much of the work sector, that is irrelevant in the notion of whether or not continuing to work in the current position in and of itself is a choice. or not. Just because someone may not like a choice or feel like they don't have one, doesn't mean that they don't actually have the ability to make a choice while obviously accepting any and all consequences that go along with it.

I understand what you're saying, I just think it's too reductive an idea to be of practical use.

54 minutes ago, labordude said:
I'm curious about your second point and us having duties and responsibilities without authority, autonomy, etc to bring them about. Can you elaborate?

Sure! Not to be repetitive, a simple example I have posted before would be delegation to UAPs. These days they work fairly independently, but every one of their activities is de facto delegated by the patient's RN as far as the law is concerned. I have no fantasies of micro-managing, but I do expect that what is done to (or with) my patient by a UAP will actually get done, will be the proper thing and will be done correctly. The last time legitimate care concerns arose in relation to this, the entire group of staff RNs were told to stay in their lane and that the activities of UAPs were not our lane. ?

In my area (as well as many others) there are numerous and ever-increasing mandates (especially in the realm of documentation) that compete with necessary hands-on care and patient interaction. In some facilities/corporations, the mandates are notoriously above and beyond what is required by law/regulation -- these are simply senior-level management choices and initiatives, not regulatory imperatives. Well, any time these compete in priority with non-negotiable patient needs, there is a problem and the nurse's choice is to do what is best for the patient at the expense of following random willy-nilly policy. This is simply not uncommon at all, it's just that many people don't process it for what it is. The every-day nursing autonomy does not exist to change these things, and "autonomy" is reduced to the "ability to freely choose" between two high-priority competing interests, knowing that either choice can be roundly criticized and result in legal, ethical or personal economic threat.

Now-am I disabled/incapacitated by these very real issues? No. But they are not right and I cannot change them even though I bear a great deal of responsibility within them. I can do my best and try to do what is least harmful, most ethical, and most defensible. That's fine...but it wears on people after awhile, and the more that nurses' all-encompassing "ethical duties" are relied upon as as the backbone of a business model, the more toxic it becomes.

Nurse Carol · Nov 15, 2019

I did not mean to insinuate that nurses other than BSN don't have some good preparation. There are great schools, great instructors, great students at many different levels. Only that since I have taught at ALL levels of nursing including MSN. There are some levels that do a deeper dive into some of the pathophysiology, pharmacology etc. That combined with a residency/preceptorship might be the ideal situation. Education has to change with the complexity of the healthcare arena and patient acuity.

mmc51264, BSN, MSN, RN · Nov 16, 2019

Watts school @ Duke was one of the last diploma programs I know of. They have officially paired with a brick and mortar university so that the students can do the diploma program and their BSN studies concurrently. Kind of sad. The diploma nurses, which we have a lot of, are great nurses. It has been difficult for the older nurses to get their BSN as required by Magnet. Some are grandfathered in.

angel337, MSN, RN · Nov 20, 2019

On 10/17/2019 at 3:26 PM, winniewoman9060 said:
Best of both worlds, would be a 5 year degree. Clinical experience with the class time. One nurse I worked years ago graduated from a university with such a program.

I teach BSN clinicals and I always tell students an additional year of clinical would be paramount to their overall success.

The curriculum is too much for the expectation. More clinical time would change the quality of RN education.

Subee2, BSN, MSN, CRNA · Nov 26, 2019

I wish we could return to the 5 year program that Columbia and Cornell had in the 70's. Two years if pre-nursing anywhere and then 3 years on the floor being charged with diploma rates since the students are providing labor. Students could graduate without debt with an ivy league degree on Friday and ready to run on Monday. People who couldnt afford the expensive 4 year degree had a chance for a great education. But what happened that made hospitals so student unfriendly and I dont understand why regs can't be changed to allow students to "work" again.

FurBabyMom, MSN, RN · Nov 29, 2019

Some states DO publish clinical hour data. I completed my BSN and was originally licensed in Ohio. I haven't looked lately but at the time I was attending college this was all published.

I think this conversation needs to address a more complex issue which I didn't see while skimming the discussion. Nursing schools can WANT to increase clinical hours or change the format of what clinicals have evolved to become. However, nursing schools do not OWN this. There are extremely specific and complex contracts and requirements from hospitals and other clinical site locations that have helped to make clinicals what they are not as opposed to what they used to be in the "good old days". I would argue that there are more restrictions on students of all varieties and disciplines due to organizational desires to limit liability and mitigate risk.

This is of course, compounded by the fact that even if a school has a contract with a hospital, that does not mean the staff is open and accepting of having students. While I was in my MSN program, I was a BSN tutor and TA for several BSN classes. You cannot imagine how many times, from the number of students myself and other class faculty heard that (insert unit name / insert facility name / insert info about primary preceptor) is not open to having students, it's a second thought, nobody is willing to teach during clinical time.

We are not helping this problem any. Clinical nurses, management and leadership own a part of this. Nursing schools own part too. But the students also own part. Another part is that even when I was in school (~10 years ago now) the quality and competence of our clinical instructors varied greatly. That's on us - those of us practicing clinically - to be willing to help change things. We can be part of the solution or part of the problem...but we shouldn't be complaining if we're the ones unwilling to teach students.

Not to mention, the regulation of clinical facilities is vastly different than it was many years ago. All of these comments referencing the 1970s, 1980s, 1990s - have we forgotten that all of those situations predate this focus on patient safety, morbidity and mortality? Just because most students and many patients survived doesn't mean it was actually better.

As for the comment about working doubles regularly as a student (or otherwise): there is a TON of data and literature that shows that the potential for making an error vastly increases after 10 hours of work. I have worked my share of 16's, been on call for a week straight in addition to working my regular hours, have worked easily 80 hours in one week regularly... Just because we accept it does not make it right or best, and it actually tends to hurt our argument for "better".

I greatly benefited from being a nursing assistant during nursing school. I was in the float pool at a large university hospital - I learned time management, to advocate for myself and to trust nobody. I had to unlearn that last part - about trust - to a healthy level of concern in my current job. I love the team I'm part of now, but wouldn't value it without what I experienced as a float nursing assistant. I had to learn time management - the float was ALWAYS given the worst assignment (save for a few select units who treated us well) and my assignment often changed q4 hours. Having learned time management and some other key skills, I was in a better place as an RN.

As an OR nurse who frequently precepts our new hire OR nurses and surg techs - I have to endorse the comment shared earlier that the task skills can be taught and refined. The bigger picture issues take much more work.

Horseshoe, BSN, RN · Dec 10, 2019

On 9/22/2019 at 1:12 AM, Susan Boff said:
I graduated from 3yr diploma school 2weeks off in 3years We did everything charge nurse nights supervisor You name it double shifts no weekends off We didnt have an instructor with us At times we had the whole ward. Gave meds did dr orders called drs wrote notes gave report After graduation worked in ICU very confident..I had major experience.But the Rns with associates & BSN had no clue all book work & charting never did IV Foley hung blood or ran a code...big difference letters after RN mean nothing...experience.Wow Nurses in ER professionalism is gone...bring back diploma they can function on graduation

Bold by me. I don't think that's anything to brag about. I get that you don't want to have to depend on an instructor for every little thing, but a student just thrown onto the floor with no instructor???? Sorry, that could be downright dangerous. I don't want a nursing student working with my loved one without having access to her instructor.