Change in consciousness for nursing

nurseprnRN, BSN, RN · Mar 4, 2012

as a former staff educator i feel your pain. when i did a needs assessment, i found data to support my conclusion that the staff had enough required-attendance things already, did not want to come in on a day off (or for the night shift, in the middle of their sleep period), and didn't see the benefit to it. i would bet these are pretty universal findings.

i asked them what they were interested in knowing more about, and got a less useful response.

so i started by getting recognition for the few who had gotten certification in their field, including a plaque at the entrance the unit and new name tags with the certification on them.

i put up articles on the bulletin board in the middle of the unit. people would stop for a sec to read them. peers would see that.

i made self-learning packets and stocked them on the unit in big manila envelopes. whoever checked them out put his/her name on the envelope...another subtle demonstration and bit of peer pressure.

i brought in speakers from equipment vendors, drug sales, and such, including off-shifts; many of them can give ceu certificates, so i got those and thumbtacked them on the board for pick-up-- more peer pressure.

if your management are apathetic about all this, it may be because they are overwhelmed with everything they have to do to. if your staff are apathetic, they may be feeling overwhelmed too. take the initiative to get a speaker or put up some articles-- your manager will have one less thing to do. have the company or drug rep bring snack and ceus -- rewards for people who don't think they're not getting enough.

and alas, if your staff aren't charting, that's a management problem. speak to your manager about it, without naming names. if nothing happens, drop a line to the facility risk manager, who will be interested in knowing.

RNperdiem, RN · Mar 5, 2012

I would be curious to know the demographics of your unit.

A very experienced, cohesive group of nurses who work in a very positive and supportive environment might be more receptive to the higher level professional duties.

I have floated to units/floats with a patched togeter staff of float nurses, agency nurses, new grads and a few overwhelmed senior nurses. Places like these can barely finish the passing pills, assessments and basic nursing responsibilities. Asking more of an already drowing staff is not met with a positive response, and nurses tend to become defensive if they are required to do even more. Morale is low.

I have experience with both places.

Computer charting is more than just clicking boxes when there are 6 patients or if there are not enough computers to go around.

Inservices can be tricky. During certain times of they day nurses often do not have 15 minutes uninterrupted to learn about the new equipment. If they are scheduled during time off, management better pay for the time.

kcmylorn · Mar 5, 2012

I also find a lack of interest in the current nursing environment/workforce.

Maybe because our generation has seen such radical changes in practice: paper charts to computer charting, the evolution of the nurses role from handmaiden to independent thinker. Task oriented practice to critical thinking skills that require the assimilation of all the health sciences. Where we have seen this transformation, we can appreciate it, those who came into the profession with these things already in place, take it for granted. I find the newer nurses attitude, most but not all, very sad- they will never challenge themself and with out that, will not find the satisfaction in what they do, will not progress to the level of expert nurse.

What are they going to do when the realize that nursing is an ongoing learning process. Just because one graduated from a program, doesn't mean that the learning stops. How sad for their patient's.

And yes, the Nursing and administrative management is no inspiration either- they have the same attitude.This is one of the things I find very appauling- it's like widespread apathy, a sesspool of lack of knowledge and anyone with more widespread knowledge be damned, look out, your dead. Advances in nursing "science" and decision making is not just about the technology- the cellphone, computer apps, PYXIS, scanners for med braclets- one actually has to plug some info into them for them to work, that infor has tocome from the brain, if there's nothing in the brain,. thoses things don't mean much.

I have be told on occassion by my nursing managmenemt to "not tell others what I know", I now work in a clinic setting after spending 18yr in med/surg/oncology- including administration chem, knew SE and dosages like the back of my hand(inaddition to 7 yrs in cardiac telementry/cardiac surg stepdown, 2 yrs endoscopy/sameday surg, 1 yr neuro/neuro surg unit, 6 month Public health disease outbreak investigations) The situation was a patient walked into the clinic with a "rash" with observation and interview- the patient was having a chemo reation- I was told" don't tell other's what you know" and by a nurse manager!! The same nurse manager allows the appointment clerk to give patients their lab results without first having the provider review them. This is not a short cut this is blatant malpractice, this is violation of ethics and HIPPA laws and a total lack of professionalism. It's persons like this that will drag down all that nursing has accomplished. I might add this manager has much less experience that I and only in 1 speciality- maybe 10 yrs at that and the ED, she is a second career nurse. That to me says that she may have graduated the nursing program on paper but her mind is locked into that first career- what ever it was. Nursing was probably an ago trip for her or seen as status. Something in her is totally lacking. Her choice of words to me and the patients are quite offensive. For example: instead of saying to someone: "from your perspective"....: she says: "well maybe in your reality" And can not figure out why some one would want to go for her throat. Not Nursing material at all. She like a colostomy bag explosion in an enclosed space!! I might add- she is always talking about her grandmother- makes me wonder if she keeps her in a dark closet with her total lack of respect for those older than herself. Or maybe she thinks the grandma subject is trendy also.

Creamsoda, ASN, RN · Mar 5, 2012

"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?"

Maybe they feel insecure in their knowledge? I don't understand your units attitudes. There needs to be a culture change, but how you go about that I don't know. are you an educator on your unit or staff RN. Having a great education system for a unit takes enthusiasm. Its unfortunate your not seeing that. And also having strong management and educators having a high expectation. Not the minimum standard but high expectations.

Maybe to "encourage" more attendance, there needs to be a minimum number of in services that everyone needs to attend a year, you know they can pick and choose what they want to attend, but have there be a bare minimum. Food usually helps.

Knowledge is confidence. I guess I'm a nerd. I love going to in services, conferences, learning whats new and cool. I don't retain everything, but I just feel so much more empowered in my practice when I feel like I'm better educated. I know what to expect from the MDS, I can anticipate their next move, next thought process ect. Its make for better patient care. And I know they appreciate it too. I know the docs trust my intuition and opinions on patient situations. Otherwise I wouldn't be calling them! Whats your doc/nurse relationship like? Is it poor? that may play a role too.

You could approach your manager about having a staff run education commitee. Theres gotta be SOME people who would be willing to put in the effort....make sure you are paid for the time you put in, to try to bring more educational topics to the table in a more creative and fun way. (ahem...food):hrnsmlys:

alwayslookingnp · Mar 5, 2012

Thanks creamsoda. I am an educator but am now rethinking it. I think its as you say- some managers don't know how they will fit into the new system.Maybe they see empowering the staff could become a threat for them.

Knowledge is power and confidence. I agree.

alwayslookingnp · Mar 5, 2012

kcmylorn thank you. It helps to know I'm not all alone out here.

P_RN, ADN, RN · Mar 5, 2012

Twice a year every typical machine, procedure, code box etx was set up in a huge room/audiorium. You had to drop by on duty or come in if off duty. There was a CNS or NM by each station who checked you off. No show, no paycheck til you did show. It took approximately 30-45 minutes in a steady stream-no waiting. It worked great. Have you tried that?

GitanoRN, BSN, MSN, RN · Mar 5, 2012

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.
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?!)

unquestionably, you hit the nail right on the head with this post. furthermore, you made me lol when you stated and i quote "i graduated just before the ice age. they chipped out my diploma on a stone tablet. " however, i agree with you 100% regarding the assume attitude of some managers and nurses. consequently, i have taken drastic measures in order to resolve the situation, after countless meetings trying to resolve the issue without anyone coming to an agreement. in addition, i have tried the strategy of bringing snacks to these in-services without avail. therefore, now i make the in services mandatory and they have to sign in or they will adhere to the consequences. needless to say, i'm aware that some nurses are resistant to new methods and others are fearful or overwhelmed. however, if we are going to move forward with the times, we need to place aside our complacent attitudes and become 21st. century nurses

nursefrances, BSN, RN · Mar 5, 2012

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?
quote]
i love this thread.
before starting nursing school i thought a nurse gave pills and cleaned patients and said "yes..doctor..whatever you say doctor..." little did i know.
i am 39 years old and i have only been an rn for 3 years, yes...still a baby.
i vent, grumble and whine...i mean have "discussions" with my fellow "young" nurses and this is why i think all of the push back occurs:
i have been wanting to start a thread to ask more experienced nurses if you have noticed a change in nursing with all of the computer charting, etc. with all of the healthcare and medicare regulations it seems like they (hospital) continuously add more and more to our daily tasks; audits, surveys, new computer screens, which to me are redundant and we end up double charting. i know the hospital needs to cover it's butt, but all the extra stuff seems to overwhelm us at times. i remember when they started adding all of the new screens, management said it was to get away from narrative notes. then the doctors complained because they didn't have a note to read and they didn't want to navigate through the many screens, so we ended up doing narative notes again but kept all of the extra screens.
i see the morale down on our unit. i am on a tele unit and we are transitioning to a stroke unit (the hospital is trying to become a stroke center). we have had a lot of education and i am loving it. my problem is the balance of trying to care for the patients and their families and keep up on the computer work and daily huddles (where the manager reminds us of all that we need to do becaues cms or medicare is coming and jahco is coming and the office head honchos are coming and don't forget to do this..or that.. or you will be written up). i consider myself a nerd and a rule follower so i try my best to do all i need to do while still caring for my patients.
i don't know how nurses used to care for so many before they started ratios. i have heard stories of one nurses caring for many patients during a shift and we (newer nurses) whine when we have 4 patients. but believe me, i am running the whole 12 hour shift with my 4 patients. my documentation gets done and i try to attend the huddles and education, but usually i am in the patients' rooms feeling like i am trying to catch up. our floor can be very heavy and we receive a lot of sitter patients so we don't have cnas at times. sometimes we will not have cnas for a few weeks and this is when i feel truly burned out (and when morale is low). some have told me (friends who work at neighboring hospitals) that our hospital is notorious for having the most charting needed, in our area.
i feel bad for my nurse manager because she has a very hard job trying to keep the head honchos happy and trying to keep 60 fickle nurses happy. i gotta give her props because she has a hard job.
anyways, there's my two cents (or one and a half)
p.s. i truly admire all you nurses out there that "graduated just before the ice age" and "have your diploma on a stone tablet" ( i loved that!) you have seen so much change over the years. thanks for being there for us newbies.

xoemmylouox, ASN, RN · Mar 5, 2012

I am one of those younger nurses who would LOVE to have such inservices. I am pushing for more education in our dept. I am really trying to get people comfortable with codes. I think that managment is the biggest hold back. I don't know if it is a lack of funds, time, etc.

dudette10, MSN, RN · Mar 5, 2012

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.

Your description of the way nursing used to be taught.

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.

This is how I was taught. I'm not sure if it is just my school or every school.

Why then, am I seeing so much push back in this new consciousness particularly from the younger nurses?

So why make the comment that younger nurses are the ones that don't get it?

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?!)

Getting consent is a task. This is not "critical thinking." In my experience with inservices, they are all task-based. "Here's our policy; here are the forms to fill out." "Here is our new IV pump; this is how you work with it."

At any rate, according to standards of practice, RNs only witness consents, but we can educate on the procedure itself and what to expect. Any discussion about risks, benefits, and other options is indeed "the MDs" job.

Compounding the problem are managers who do not seem to value education.

All over this site, you hear about managers/facilities pushing people to get their BSNs, and the responders don't want to do it. They've been practicing since the stone age, and they don't want to go back to school. Is it really the managers?