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.
Educated guess? 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.
I see your point about less experience = having less opportunity for proficiency. However, to be fair, do you think that accessing ports is a large portion of a nurse practitioners job? Do you think lack of expertise at that (or even having
Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
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.
Hmmm...I agree with every point articulated here. It was painful to read because I find it to be spot on. I'll say again I think nursing can be its own worst enemy. The big positive change in nursing is that nurses are paid better now. Other than that, the problems are still there, many different but no less disturbing. I loved what I did but got frustrated with what the above OP stated. When business got involved in healthcare, it changed things for the worst. I predict things may improve if there is another shortage of RNs at the bedside. It's part of life to see change, but I got quite disheartened with some of what I saw before I retired. My passion is with the bedside nurse, and to see so many, at least on AN, inquire about the quickest, cheapest and easiest way to become an Advanced Practice Nurse is alarming to me. If so many schools are pushing this, then shame on them. Who is going to take of us at the bedside? How can we nurture the bedside nurse and help him/her advance his/her knowledge to stay at the bedside?
There are 3 million active RNs in this country, the fact these problems exist is evidence that nurses are doing a crappy job advocating for themselves.
Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
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?
I can see why you are confused with all the chat here about "bedside." Traditionally the bedside nurse is in a staff nurse role. An Advanced Practice Nurse practices under a different model, that of a provider. If an Acute Care NP practices in a hospital and cares for floor or ICU patients, he/she will actually go to the bedside to see the patient, just as an MD goes to the bedside. (Except for tele medicine, but that's another story.) So an NP seeing patients in an ICU would not be considered a "bedside nurse" because the role and practice are not the same as the primary nurse. There are many different specialties in which NPs can practice with specialized training. Hope this helps.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
No. I am not suggesting BSN nurses have superior anything. I am suggesting the world has changed. BSN is quickly becoming the minimum nursing degree. Just a fact. And you're right nursing is not rocket science. That is a fact also. But when I hear that comment, it's usually in a dismissive way... even when it's said by other nurses. I guess we can all have different sensitivities.
When I was in my BSN program 40-some years ago, we were told that the BSN was quickly becoming the minimum nursing degree. Turns out, not so quickly.
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.
Employers are in the driver's seat. There is an oversupply of nurses in general and nurses are quite easily replaceable, and that is what employers want. Also, employers use agency nurses, and for specialty areas, travel nurses. They can hire experienced specialty travel nurses when they need experienced specialty nurses. Employers want a flexible labor force with a small core of "permanent" employees. As soon as the large corporate employers start making noises to the state governor that there is a shortage of nurses (read: the commodity known as nurse labor is not available at the desired price) then we see more funding for nursing schools and even more nurses being produced.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Wow. Poor Susie. I wonder if she has any idea how much of a disservice her father is doing to her.
Same for these young adults. Whether they asked their parents to help them or not, their parents need to let/make them figure out how to be adults.
I remember when I graduated college and moved out of state to start my first job as a nurse. (A job that I had found and interviewed for all by myself). It SUCKED for the first six months and my mom knew I was miserable when I would cry on the phone. She said I could just come home. What?? I told her, "No! I'm not running back home! This is my job and my life, and I'm not moving back!" I think I might have actually hurt her feelings a little - oops
Susie was 100% behind her father's call to the manager and was INCENSED that it did not have the desired result.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Actually I just noticed this. I worked on CCU and everyone there had plans of going somewhere else. It is fine and all, but I remember one new grad that was terrible with foleys at first and always needed (me, the tech) to help or take over. Within months she is being accepted to CNA school. I had no clue they could get in that quickly... But she did, and suddenly she was the holy queen God, correcting everyone as if she was so exceptional and talented... You can manage to handle putting a tube in a bladder how you gonna manage putting one in lungs?
When I was in my BSN program 40-some years ago, we were told that the BSN was quickly becoming the minimum nursing degree. Turns out, not so quickly.
Not that long ago, but we too were told the same. I believe that those who have tried or wanted to bring that standard into existence over the years were largely coming from a genuine angle of believing that the profession of Nursing (and the state of Nursing in general) would be improved by such a move. I think intentions were good - that it was believed that general respect and autonomy and professionalism, and even direct patient care would be improved by having professional nurses at the bedside.
I think it never happened on any reasonable timeline because of the things I'm saying: Those controlling the pursestrings never wanted to afford professional nurses at the bedside, they just want to have professional nurses at the bedside.
They finally came up with a proper scheme, right? I'd say Magnet status is accomplishing it. Nurses have said "NO."
When I was in my BSN program 40-some years ago, we were told that the BSN was quickly becoming the minimum nursing degree. Turns out, not so quickly.
I'm not as far in as you -- just a little over 20 years for me. But I can attest with certainty that in my city you will not work (as a new nurse) in any one of the major hospital systems without your BSN by 2018. I know it's not like that everywhere, but as one who thinks highly of the nursing profession and encourages kids who are healthcare minded to consider it as a career, I always advise looking at the BSN as the minimal, entry-level requirement. I work with (cream of the crop) nurses who have been nurses forever who are finishing up their BSNs just for this reason.
My advocating for nurses to have their BSNs isn't out of some elitist mindset. It's simply a reflection of the changes I'm seeing in healthcare. My hope is that it will help us, as a profession, to tackle some of the issues we're talking about in this thread as well.
I should clarify: I don't think they're saying "NO" to BSN, at all. I think they're saying, "If I'm going to do that, and you're going to treat me like this, then no thanks. I'll look for some other way to use my BSN."
Julius Seizure
1 Article; 2,282 Posts
I see your point about less experience = having less opportunity for proficiency. However, to be fair, do you think that accessing ports is a large portion of a nurse practitioners job? Do you think lack of expertise at that (or even having