Ch, ch, ch, ch... changes. What are your long term goals?

gardengal1, ASN, RN · Feb 22, 2012

I DO believe change is in the air. I am within 3 years of retirement, working almost full-time in a busy ER and see all the staff stressed to the max with understaffing, sick call-offs, staff just not showing up for their shifts, a non-existent manager (we do have a manager, just rarely see her), Joint Commission making rules which are foolish - ie screening every patient who comes in our door for suicide risk - give me a break. We can barely get the facts as to why the person came to the ER without side tracking them with these kinds of questions! More and more is expected with less and less support. A new computer system which doesn't function well only adds to the fray. We have 23 nurses of which about half are counting the days until they can get out - either through retirement or, just quitting. The younger ones are going into other careers. The physical and verbal abuse, the weekends, the mental stress because patients are now sicker when they arrive in our ER, the bottlenecks in getting a patient admitted - all these stressors are piling up and many feel their ONLY choice now is to exit the nursing profession altogether and it is happening to both young and old. I have written my congressmen and women about many, many subjects but I don't see meaningful changes happening on our national front. Health care as we see it now is on that slippery slope towards rationing of care because it is becoming too expensive to heal the masses of people using ER's today. We are not seeing this at this time but our facility is trying to figure out ways to limit those who frequent our ER regularly, those who make no attempts at any payment and those who use the ER "because it is more convenient". Support the family practitioners financially (by increased payment system) and see if we can't get some of these people out of our ER's so that we can focus on those who truly need our services.

Sorry - got off on a side rant! I feel the changes that are currently occurring do not bode well for nursing in general or our current health care delivery system. I feel it - my colleagues feel it.

gypsyd8 · Feb 23, 2012

(thanks mr. bowie for the thread title).
those of us in the nursing field for twenty or more years have seen many changes to our profession, not in knowledge or scope of practice per se, but in the actual process of delivering care. we have rolled with it and adapted.
until now. somehow, this time it is different.
there is a distant whiff of change in the air, an ominous yet unseen brewing storm on the horizon that we can smell, and we instinctually know this is not just another policy revision; not just another economic dip.
there is a growing sense that nursing is being redefined as cheap, blue-collar labor, yes-men, and trained monkeydom. especially floor nurses on the front lines.
even my latest issue of "the american nurse" is greatly devoted to the future of nursing and nurses who have or are furthering their education in the (hinted- at undercurrent) context of health care reform, aco's and bundling.
is education advancement enough? i listened to a flustered and overwhelmed hospitalist vent to me a few days ago, that they'd taken away half of the pa's effectively doubling her workload.
i see msn's working the floor.
i see bsn's unable to find employment as a floor rn.
i see my own department ripped to pieces and sold to the highest bidder.
so, how many of you are rethinking your career path? if i was an appliance rn (rn married to a high-earner and only needs a little income to buy the latest cuisinart or a gym membership) i probably wouldn't bother.
but as it is...i'm about to bother.

i'm abbreviating a post to another thread so people don't have to jump around :

i have been a nurse for eight long years, after graduation, i worked the same low paying position as a staff nurse on a tele unit for five years. the only reason i stayed there that long was because of an incident that occurred when i took a second job. i thought a second job might rejuvenate me. instead, i realized just how evil and vindictive nurses could be. after that, i was afraid to look at any other opportunities until i gathered the courage to take yet another job. i kept my first job as per diem just in case.

the move renewed my passion briefly, but after awhile the working conditions just wore me down. i decided to go back to school for my bsn, found out how challenging full time school was with two jobs. i quit my "home" job (that i had worked since graduation) and stayed in the new place. although i could have begged my old manager for my full time job back, i chose not to because, quite frankly i couldn't stand dealing with her and my immediate supervisor at the new place was tolerable. in addition, the new place paid more and was closer to home.

keep in mind this place is the most bizarre, kafkaesque environment i have ever encountered. the hospital is old, but was purchased by a large for profit healthcare corporation some years back. every few years the higher ups in corporate get rid of everyone in middle management, and i mean everyone-they fire the ceo, cfo, cno, coo,directors, managers and anyone else they can get their hands on. they radically reorganize everything, have employees written up for anything, and generally cause chaos. when this happened i thought it so strange i asked old-timers *** was going on, they said, "oh this happens every couple of years." i did research and found out that this occurs in other facilities they own. i believe the poster said it was to "shake everyone up."

after this i started looking for work elsewhere. of course, that was just about the peak of the recession, and hiring stopped. i was trapped at this job, felt like i was working in the twilight zone. then he $#!% hit the fan, and i (thought) i figured out why they "shake things up" every few years. this place is a union shop, and contract negotiations were coincidentally due about the same time they fired everybody (my previous employer was non-profit and non union). after a year of tense negotiations, the union voted to go on strike, which i originally supported, until i found out what they were striking over. needless to say, it was total bs on both sides.

after graduation i transferred to the icu and have discovered that it's the same old $#!% (only worse). i got an offer to sell vad's went on an interview, but didn't get the job. i've been applying to the state prison system, gotten several offers i haven't really pursued because they are in bfe. i am sick of the bedside not because of the patients, whom i love caring for but because of the bs that prevents me from caring for them. i am only going to that hellhole so that i can pay my bills.

my plans? i'm going on another interview, might take the position. this new place is supposed to be "different," the job certainly is. after reading the op's post and others on this thread i am beginning to wonder if the poisonous environment where i work is the new normal. i am worried that i'm jumping out of the frying pan and into the fire. i intend on going back to school for my masters, and hope to transition into education, informatics, legal, anything that gets me away from the poisonous atmosphere that is acute care "hospital" nursing.

if "traditional" nursing is on its way out, i do not think the answer is to jump ship. i do not want to discourage the "new" nurses from embarking on this career, maybe they are the ones who can help us save it. if we can somehow band together to save our profession during this transition, maybe it will be better than it ever was.

gypsyd8 · Feb 23, 2012

Raising my hand as well ...
Did a complete 180 degree flip to nursing in my mid-30s ... and I'm glad I did so. No regrets here.

What did you do?

How can I do it?

workingharder · Feb 23, 2012

What will happen to the profession? Since I am relatively new to this business I have an almost outsider-looking-in perspective.

But, here goes. As most of us believe, the present situation is not tenable long term. Short staff, very limited and nebulous autonomy, too many responsibilities and liabilities, far too many new graduates and not outstanding pay. All this leads to overworked and stressed workers. Hospitals know this, but are short on funds (either by design or happenstance) to alleviate the situation. As the population ages it will also become more in need of medical and related services. I just don't know if the funding will be adequate to take care of the situation. I have no clue what the final healthcare bill will look like or if it will even address these concerns.

I offer this opinion for the future of Nursing. 1) Raise the bar for membership. Make nursing a Masters level degree and mandate 2500 hrs of clinical time for graduation. And I mean real down and dirty patient care. Not following around someone for six hours. 2) Follow the leads of the therapies and limit the number of schools who can teach nursing. 3) Have a clearly defined scope of practice for nurses that says only nurses can perform such and such duties. As is, our scope is fuzzy and when clearly defined it is incredibly small. 4) Stop trying to create something separate from medicine. We are part of medicine. And trying to deny it is further throwing the profession into uncertainty and ridicule. (I know, 3&4 seem like a dichotomy, but I believe it can be done) 5) Retool the boards. NCLEX is pathetic and just like "No Child Left Behind", the schools are teaching to the test. 6) Have a clearly defined and rigorous academic pathway on a national scale which drops the silly classes and concentrates on patient care, A&P, patho, pharm (HEAVY), and micro.

As is, I don't see floor nursing surviving long term. Technology, finances, overworked workforce, and the shifting of traditional nursing roles to techs are eating away at what nursing was (from what I've heard).

Of course, I could be wrong. I never thought bottled water would take off, either.

cdsga · Feb 23, 2012

I suppose we could enlist families/friends to take care of their loved ones while the docs staff the hospital like in 3rd world countries. Nurses would be used to record things that happen and send in reports of bad outcomes. Oops- We've come too far and the hospitals will not pay the amount of salary required for nurses to all have advanced degrees. They bank on the transience of nurses, interruptions of life events to prevent advanced degrees from being completed, or people just quitting. States need to bring back the student nurse designation where they can get REAL practical experience not being hired as nursing assistants. We need strong nursing skills at the bedside. We need supportive administration that gets roadblocks out of the way streamlining a plan for safe care and making practice much more efficient. When that happens nursing and patient care will be all the better for it all around.

Guttercat, ASN, RN · Feb 23, 2012

Amazing perspectives and responses in this thread.

Thanks all!

gypsyd8 · Feb 23, 2012

1) Raise the bar for membership. Make nursing a Masters level degree and mandate 2500 hrs of clinical time for graduation. And I mean real down and dirty patient care. Not following around someone for six hours. 2) Follow the leads of the therapies and limit the number of schools who can teach nursing. 3) Have a clearly defined scope of practice for nurses that says only nurses can perform such and such duties. As is, our scope is fuzzy and when clearly defined it is incredibly small. 4) Stop trying to create something separate from medicine. We are part of medicine. And trying to deny it is further throwing the profession into uncertainty and ridicule. (I know, 3&4 seem like a dichotomy, but I believe it can be done) 5) Retool the boards. NCLEX is pathetic and just like "No Child Left Behind", the schools are teaching to the test. 6) Have a clearly defined and rigorous academic pathway on a national scale which drops the silly classes and concentrates on patient care, A&P, patho, pharm (HEAVY), and micro.
.

While I appreciate your insights, there are a few quibbles I have:

#1) nobody is going to spend the time & money it takes to earn a Masters to go clean $#!% for a living. The system as it was envisioned in the 1960's would have worked just fine e.g. ADN prepared nurses at the bedside with a clinical ladder that broadens scope of practice and care. I know of no Masters prepared RN who wants to go back to the bedside. That is why we get our Masters after all.

#2) I agree wholeheartedly, but how? Admittedly I am not familiar with the "therapies" that you speak of. I should research that but honestly I don't know where to start. Would you use Government mandates? Shouldn't the free market decide? I think the problem is more with the chaotic mess that is the current accreditation system and the fact the the State BON's basically make their own rules as to who can take NCLEX. There is no national regulatory standard. Then again, that's not free market.

#3) agreed.

#4) agreed.

#5) Agreed. I passed NCLEX in half an hour with 75 questions. It was too easy.

#6) I worry about the term "silly classes." What classes are you referring to? I value my liberal arts education, the classes I had to take for my Associate and Bachelors degree requirements, e.g. the Arts & humanities (American Studies, Criminal Justice, critical thinking, Cultural Anthropology, English, history, psychology, sociology, speech) were the best classes I have taken in my academic career and greatly enhanced not only my learning at the time but my appreciation for learning in general. These classes are essential in a holistic field such as nursing. We are generalists by nature, we deal with the whole spectrum of human ills and responses to those ills, a well-rounded education is integral to our practice. I worry much more about the "diploma mills" and foreign schools that churn our newly minted nurses who have no idea who they are taking care of.

Case in point: we had a Coptic Christian on our unit recently. Most of my colleagues had no idea what a Coptic Christian was, just though it was some weird cult, and had no idea how to be culturally sensitive to this individual or his family. They had no idea that Coptic Christians had been slaughtered in religious wars in the recent past, and no idea that a Muslim nurse might not be the best caregiver for said patient. I have other examples of sheer cultural ignorance but I will leave them out for brevity.

In short, I have NEVER taken "silly classes," education is what the individual makes of it and a well educated person is a professional person. The lack of professionalism in our field might be indirectly related to ignorance that is a result of Nursing being treated like something one can learn in a trade school. We do not need Master's prepared nurses at the bedside, we need Nurses who graduate from Colleges that utilize a liberal arts paradigm. You can have an Associates program that covers the bredth and depth necessary to graduate a Professional Nurse. Unfortunately, you can also have a Masters program that covers nothing but the basics needed to pass NCLEX.

Guttercat, ASN, RN · Feb 23, 2012

While I appreciate your insights, there are a few quibbles I have:
#1) nobody is going to spend the time & money it takes to earn a Masters to go clean $#!% for a living. The system as it was envisioned in the 1960's would have worked just fine e.g. ADN prepared nurses at the bedside with a clinical ladder that broadens scope of practice and care. I know of no Masters prepared RN who wants to go back to the bedside. That is why we get our Masters after all.
#2) I agree wholeheartedly, but how? Admittedly I am not familiar with the "therapies" that you speak of. I should research that but honestly I don't know where to start. Would you use Government mandates? Shouldn't the free market decide? I think the problem is more with the chaotic mess that is the current accreditation system and the fact the the State BON's basically make their own rules as to who can take NCLEX. There is no national regulatory standard. Then again, that's not free market.
#3) agreed.
#4) agreed.
#5) Agreed. I passed NCLEX in half an hour with 75 questions. It was too easy.
#6) I worry about the term "silly classes." What classes are you referring to? I value my liberal arts education, the classes I had to take for my Associate and Bachelors degree requirements, e.g. the Arts & humanities (American Studies, Criminal Justice, critical thinking, Cultural Anthropology, English, history, psychology, sociology, speech) were the best classes I have taken in my academic career and greatly enhanced not only my learning at the time but my appreciation for learning in general. These classes are essential in a holistic field such as nursing. We are generalists by nature, we deal with the whole spectrum of human ills and responses to those ills, a well-rounded education is integral to our practice. I worry much more about the "diploma mills" and foreign schools that churn our newly minted nurses who have no idea who they are taking care of.
Case in point: we had a Coptic Christian on our unit recently. Most of my colleagues had no idea what a Coptic Christian was, just though it was some weird cult, and had no idea how to be culturally sensitive to this individual or his family. They had no idea that Coptic Christians had been slaughtered in religious wars in the recent past, and no idea that a Muslim nurse might not be the best caregiver for said patient. I have other examples of sheer cultural ignorance but I will leave them out for brevity.
In short, I have NEVER taken "silly classes," education is what the individual makes of it and a well educated person is a professional person. The lack of professionalism in our field might be indirectly related to ignorance that is a result of Nursing being treated like something one can learn in a trade school. We do not need Master's prepared nurses at the bedside, we need Nurses who graduate from Colleges that utilize a liberal arts paradigm. You can have an Associates program that covers the bredth and depth necessary to graduate a Professional Nurse. Unfortunately, you can also have a Masters program that covers nothing but the basics needed to pass NCLEX.

Very insightful post. Thank you.

A side thought: a problem with the nursing profession is the word "nurse." Even a Masters prepared RN still has the word "nurse" attached.

Within the medical community at large, and the lay public, there is a long and deeply rooted connotation of "weak" or "less skilled" or "bed pan toter" or "food tray fetcher" or "servitude", attached to that word.

annlewis · Feb 24, 2012

I have to stop reading all of you are depressing me

riw1 · Feb 25, 2012

I have been a nurse for thirty years. attitiudes have changed toward nursing and those practicing nursing and not for the better. I have to ask myself why anyone would submit to working a twelve hour shift with no breaks. most hospitals have a rule that there can be no food or drink at the nursing station. this means poor eating habits or worse no food or drink for 12 hours. WHY ARE WE PUTTING UP WITH ABUSE THAT IS UNACEPTABLE IN ANY OTHER PORFESSION?

there over whelming numbers of nurses. we could make a hugh difference if we banded together and had lobbists in DC like big business does. but everyone just wants to go home and ignore conditions as if they were a blue collar worker. is it any wonder that that is how our employers see us?

cdsga · Feb 25, 2012

Guilt trip is pulled-even among ourselves. How many times have you heard-What if it was your family? I've seen my family taken care of and I know unequivocally I take care of people just like I'd treat my family, and better than most nurses I have witnessed and experienced. Thank God I am a nurse because I know the difference between good care, poor care, and mediocre care. I also know that I wouldn't leave my family member in the hospital unattended in any circumstance. What does that say about us? I don't only stay to ensure safe and adequate care, I also stay because staffing issues make it difficult for nurses to see to the intricate needs of sick people. There I said it. With all the paperwork, checklists, second guessing of our treatment/medications, etc., it's a wonder anyone actually sees a nurse. I understand regulations and safeguards, but it has become such a burden and almost a conspiracy to keep the nurse away from the bedside. Where is the nurse who should be giving some helpful guidelines, insight to health and recuperation? Isn't one of the regulations now to allow the patient to be a part of their care? Isn't one of the regulations that we are to allow time for the patient to ask questions? Isn't it a federal law that states we must provide a legit. interpreter for our non-English speaking patients? How many times is it documented but not followed as it should be, but a box is checked to pass the regulations? Domestic violence questions, a consent for disposition of remains for retained placenta, when you have a live baby sitting with the Dad/family member/friend in the waiting room? Do we have to be told by the Joint that we have to do these things in order to get reimbursement for Medicare and Medicaid patients? When is someone in the ANA going to suggest streamlining of these processes and get the nurse subservient as it is back to the bedside? I don't mind working through a break just to get one if it means that there is a better continuity without that break, especially at a crucial time with a patient, but how many actually think about that? Nursing is not for the weak and passive. It's a complex job, requires some sacrifice, requires critical thinking, prioritization and current knowledge of clinical/pharmaceutical subjects. Since we are one of the most trusted and respected of professions shouldn't we own it? We've done enough talking about the profession, we've done enough surveys, we've done enough research on salaries and all lack substance. I'm just going to be the best nurse I can be, lead by example, take excellent care of the patients assigned to me, follow the policies and keep up with my education-since change is everpresent. Our national voice has sold out to the latest person in the Whitehouse, and they'll change again when someone else is elected or move us toward the regulatory, gov't mess that's already starting. Their lobbying voice is not my voice. So I guess I am going to have to live and roll with the changes as they come. I'll speak my piece when allowed and keep my ear to the ground. I love healing and helping people through sickness to some semblance of wellness. When I lose that love-I'll retire. Oh wait, nursing is 24-7.

cdsga · Feb 25, 2012

Oh and don't get me wrong, I don't mind asking all patients these questions, but it's hard to take when the treatment is only going to take 30 minutes. The admission process takes longer than the treatment. Amazing.