I am not a nurse yet, but I'm an EMT, have worked in and around the hospital, and I am currently finishing my last two prerequisite courses before applying for ABSN programs. It seems like 90% of my current classmates in nursing prerequisite courses, along with other prospective nurses I've worked with, are entering the nursing profession with the goal of become a Nurse Practitioner or CRNA.
Do you, especially those already working as nurses, feel a lot of new graduate nurses are entering nursing for the sole purpose of becoming an APRN? I feel like since APRN's are gaining more popularity, people are entering the nursing field to become an APRN and not a "nurse", in lieu of becoming an MD/DO or PA. I'm not saying more education is bad, but it seems like people want to be an NP, not a nurse, if that makes sense. Which leads me to believe (and I know it's been discussed before) a huge over saturation of APRN's is in the near future.
Thoughts? Again, I'm not a nurse yet, so I could be completely off base.
Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
I don't think any of us hate the bedside aspect of it, we just feel like it's not needed to become a successful provider. I've seen so much negativity though on bedside nurses that feel we're cheating by skipping a step for advancement. A lot of made up stories on their experiences but no hard evidence.
From what I have read on AN, there are numerous nurses here who dislike the bedside. Regarding your comment about becoming a provider, I am one of those who feels strongly that bedside experience is necessary before practicing in an Advanced Practice role. I think is fine to disagree, Rekt, but to say the stories are "made up"?
From what I have read on AN, there are numerous nurses here who dislike the bedside. Regarding your comment about becoming a provider, I am one of those who feels strongly that bedside experience is necessary before practicing in an Advanced Practice role. I think is fine to disagree, Rekt, but to say the stories are "made up"?
I respectfully agree we can disagree peacefully; there are lots of people selling wolf tickets here though.
"Don't take what people say in your pre-req courses too seriously. People talk big, but few follow through. At least in my pre-req courses, most couldn't even make it into nursing school."
Talk is cheap, isn't it? I remember years ago a tech who was in nursing school was on our ICU unit, talking about how he wasn't going to work "in a place like this" but he was going to work in "a real ICU, with traumas and all that, not in this nursing home ICU." I was like, what the heck is he talking about? It wasn't the sickest of the sick type place, but it definitely wasn't a low acuity ICU; it was a 16 bed general ICU that took medical, surgical, and a fair amount of CCU type patients, and the overwhelming majority were pretty complicated &/or very sick patients. Anyway, my coworker rolled her eyes and said "He'll be a clip board holder in 6 months." As it turned out, Mr. Trauma Nurse didn't even make it through nursing school. And we've all known at least one person in school who would tell anyone who'd listen that they were going to be a flight nurse, only to be found later working as an admissions coordinator at the rehab center, or something along those lines.
I am talking about the nurses that I personally work with on my floor that I have seen go through graduate school. I work with them and see the things that they miss and the gaps in their critical thinking. They are where I would expect 2-3 year experience RN's to be at, and I am not saying I was any further along at that point in my career. However, you do not even know what you do not know until around two years, and that's if you stay within the same specialty.
Are you saying that they are not ready to be bedside RNs or ready for advanced practice when you said that they are not ready to be "independent practitioners"? If you work with them on the floor, are you judging their competency in the APN role?
I think we all agree that you don't know what you don't know until you have some experience in the role.
With less years of experience, I'm willing to bet those BSN's probably haven't seen it all, or are not 100% proficient in their practice. Case in point: I had a patient whose port kept occluding. Flushed with Heparin, flushed with clot busters, still didn't have good blood return. Looked on the Xray...the damn needle was right up against the side of the port wall. And you know who inserted it? One of our nurses who's in an NP program.
Do you feel 100% proficient in your practice? In my experience it's the people that think they are 100% that are the most dangerous. It has also been my experiene that anyone, regardless of their experience and education, can make errors on technical skills at times. I really don't feel that one (relatively) small technical error as a bedside nurse negates the ability for that nurse to be a competent APN.
In my very limited opinion, I believe that RNs are being herded towards the advanced degrees mercilessly.
Don't get me wrong, bedside nursing gets losses from people who get in and realize, "Holy cow this is so NOT what I want!" and then move on to higher education as a means of escape, which used to include administration primarily.
I am a bedside nurse in an ICU that has 10-20% (depending on the year) turnover annually. We get a large number of newer (less than 2 years experience) nurses whose only goal (not mentioned in interviews for the most part) is to get the requisite ICU component of their CRNA or Acute Care NP experience. This stresses our unit out significantly. We are always in flux hiring new nurses and losing nurses that are just barely starting to "get it".
Certainly there must be a need for these APRNs, but the continuing need for RNs continues to suffer for it.
What bothers me though, is this question. "You're smart, why aren't you in school for....?"
This suggests that bedside nurses are either:
A. Not smart enough to go on to APRN or...
B. Not required to be smart as a bedside nurse.
This is almost as insulting as the comment, "You should have gone to Medical School."
Um, no thank you to both.
I enjoy being a bedside nurse in a really challenging MICU with remarkably complicated patients, but it's the hardest job I've ever had, and not glamorous in the least.
So for my two cents, I believe that the bedside suffers for it's intrinsic difficulty and is highly disrespected by many of the organizations that are supposed to represent nurses.
Specializes in Student Registered Nurse Anesthetist (SRNA).
Perhaps its the idea that "advancement" in nursing=away from the bedside. Interestingly, the policy for the clinical ladder program at my hospital specifically says that its purpose is to support RNs who seek advancement while at the same time remaining at the bedside.
Excuse my lack of knowledge, when you all are taking about away from the beside, are you referring to APRN's as a whole? Or only certain ones like those who work as FNPs in a primary are? For example, would am NP working in an ICU still be considered bedside, or no?
Perhaps its the idea that "advancement" in nursing=away from the bedside. Interestingly, the policy for the clinical ladder program at my hospital specifically says that its purpose is to support RNs who seek advancement while at the same time remaining at the bedside.
That's the way it is at my hospital, too. The clinical advancement program is only for those who remain in the "staff nurse" category and/or 1 step away from that (i.e. unit educators, permanent charge nurses, shift coordinators, etc. who still take a patient assignment at least part of the time.)
best and brightest are smart enough to realize quickly the dysfunction in nursing even if there main goal is to stay. We have to make the working conditions better for professionals and not keep it a dumping ground and abusive with low pay.
I don't totally disagree with you. We do need to improve conditions. But we also need to restructure our career paths so that nurses planning to go into APRN roles don't suck all the resources out of our hospitals by working as staff nurses for only a year or two.
The problem needs tackled from both ends.
Yes, improve working conditions for staff nurses. But also, get those people who have no intention of being a staff nurse for more than a year or two out of our expensive staff nurse orientation/residency programs. Allow those resources to be invested in the nurses who hope to be staff nurses for at least 2-3 years. The expenditure of resources on those nurses who have no interest in a hospital career is one of the reasons there are so few resources left to support the nurses who do want hospital careers.
So for my two cents, I believe that the bedside suffers for it's intrinsic difficulty and is highly disrespected by many of the organizations that are supposed to represent nurses.
That is my $.02 also. I think it would be proven if other factors we're discussing were elminated - and they should be, since they too, are part of the problem. This problem should be considered from multiple angles and all of these confounding issues should also be discussed and dissected so that real solutions can be found. But I think that if/when all of that happens, the remaining (and unchangeable) sticking point will be a staunch and determined refusal to treat excellent bedside RNs with a respect that is in line with standards that a professional could reasonably expect.
Some things that aren't congruent with the claim of valuing excellent professional BSNs at the bedside:
- Punching a clock (and especially the practice of being penalized for punching in more than X minutes before shift or for not punching out "on time")
- Dishonesty in making departmental changes; being disingenuous about reasons for policies (the "hydration station" situation being a perfect example)
- Asking nurses to interact disingenuously with patients ("scripting," and others...)
- Not holding other members of the team to a similar standard (Example: "this particular med hasn't scanned properly for weeks now".....Oh well. It is what it is. Pharmacy is aware. But meanwhile we are tracking your scan rate.)
- Any talk of the practice of reducing errors by removing professional critical thinking capacities; actively seeking to automate the nurse's role, even when doing so is unsafe (plenty of protocols come to mind...)
- Twisting and misusing statistics
- General disrespect in speech and communication (sending emails with all-caps or multiple exclamation points or poor grammar/spelling; publishing unredacted patient complaints or complaints without any context)
- Purposely exaggerating the breadth or depth of an issue in order to threaten staff (the drug diversion issue comes to mind)
- Mischaracterizing, misrepresenting laws and regulations (HIPAA, EMTALA, OSHA) for self-serving reasons
- Pretending to value nurses' input on problems (or having them waste their time honestly working on problems) when the solution has already been decided
- Subjecting staff to paradigms that are harmful to patients and nurses ("Lean thinking" comes to mind)
- Teaching/Education that is done by individuals who have no particular expertise on the subject and in fact don't even possess the level of knowledge of the nurses being "taught"
- Ever-enlarging "reams" of policies under which nurses are expected to operate, which are never organized in a useable manner whether in paper or electronic form
I don't know. I fear that there is a desire for professional RNs at the bedside, but no accompanying motivation to treat the professional the way such a person would rightfully expect.
I believe that "needing to be coddled" and intolerance of even constructive criticism is also part of the problem. I work with a number who are not this way so I don't have a good handle on how big the problem is, but yes, I agree.
Boomer MS, RN
511 Posts
From what I have read on AN, there are numerous nurses here who dislike the bedside. Regarding your comment about becoming a provider, I am one of those who feels strongly that bedside experience is necessary before practicing in an Advanced Practice role. I think is fine to disagree, Rekt, but to say the stories are "made up"?