I graduated just before the ice age. They chipped out my diploma on a stone tablet. Back then nursing was pretty task oriented. (Was anyone taught to answer a patient who asks what medication you are giving to answer "it is something ordered by your Dr?"haha) The idea of a "good nurse" was one who could pass all of her meds, get all the Drs orders taken off and leave all her patients clean for the next shift. She knew the number to central supply without even looking it up. Nurses were not really expected to know much pathophysiology or pharmacology and in many cases were discouraged from doing so.
Nowadays "critical thinking" and "failure to rescue" are buzz words. Although caring is still a large part of what nurses do, nurses now have a practice and they are responsible for it. They no longer depend on the MD to write appropriate orders. Their practice dictates the responsibility of a nurse to know what a nurse should know. This means the nurse recognizes an inappropriate intervention because they know pathophysiology and they know the pharmacology of the medications they are given.
I love it! Finally nursing is being recognized for what they should have been all along.They are competent eduacted professionals who possess a large body of knowledge and expertise and their skill set has unlimited growth potential. Why then, am I seeing so much push back in this new consciousness particularly from the younger nurses?
My unit hardly has inservices anymore because no one attends. Some of the education here is excellent and definitely beyond the scope of what is offered in nursing school.My unit has begun trying to teach new concepts by email but the majority don't even open them. Needs assessments and my understanding is that none were returned.
The ease of computer charting is nice because you can click boxes. Still, a narrative note is very important to really tell the story and individualize it for the patient. The MDs all do that.More than not, a narrative note is not present and some times there are no notes at all the whole shift (not even clicked boxes!) Most nurses are defensive when this is brought to their attention.
A speaker recently spoke at a staff meeting about the importance of getting a consent signed before starting a moderate sedation procedure.It turned into an unpleasant discussion the tone being "now we have to be responsible for the MDs job, too?"(Seriously?!)
Compounding the problem are managers who do not seem to value education. Perhaps it is because they have been very successful in the old way of nursing and are not sure where they will fit in to the new road nursing is taking. How do you change things without the support of management?
