Most Pressing Issues in Nursing Today

ExpNurse_RN_MA · Mar 7, 2018

Really??? There are very few posts that drive me to actually take the time to respond, but this one struck such a chord that I just cannot shake it off. It's clear from the number and types of responses, starting at the very beginning and continuing on through 5 pages worth, that the single "most pressing issue in nursing today" is exactly the same as it has been for the last 45+ years that I have been a Registered Nurse: the inability for nurses to get along with each other, as evidenced by the ongoing competition amongst nurses to always be "right", the continued lack of compassion and consideration for colleagues, the persistent bullying of younger and/or weaker colleagues, and the rampant defensiveness and dishonesty should anyone dare to challenge motives that are clearly self serving and intended to fit a personal agenda, regardless of whether it's a need for a graduate level research topic or just a plain old desire to stir up trouble. The original post asked a question, for whatever reason, the asker obviously doesn't want to hear an honest answer, but rather wants to continue to bait the audience. The audience takes the bait, as I acknowledge I myself did, and the bickering continues. And in the end, it's all just like arguing with a teenager: you both get dirty and the teenager loves it.

NsugaBuga · Mar 7, 2018

The patients.

TriciaJ, RN · Mar 7, 2018

I was going to ask about this. Just graduated; not yet employed. During my clinical rotations, there was a huge emphasis on keeping the patient "happy." This was the case even when safety was compromised (in my opinion.) I had a patient who was a hoarder and his room became an obstacle course. I asked how we would get the crash cart in if he coded and was given a blank stare. I also suspect that patient satisfaction ratings are behind the whole "pain is subjective" movement. So if a patient is relaxed, watching TV, drinking a soda and talking on the phone and rates his/her pain as a 10, it's a 10. No questions asked. Is this a departure from past protocol or has it always been this way?

It's a big departure and now we have an opioid crisis. There was a tendency to under treat pain because we were all worried about causing addiction. The "studies" showed that people tended to be undermedicated and we now know that untreated pain does slow down healing. So there was a push to make sure pain was adequately treated. Unfortunately, this coincided with the "make the patient happy at all costs" corporate movement. So yes, you can be laughing on your phone and still get a pill for your 10/10 pain, just like you can get a turkey sandwich and a coke for your abdominal pain and nausea.

JBMmom, MSN, NP · Mar 7, 2018

The pressing issues of nursing today are staffing, or lack thereof, and educational preparation.
Get rid of the nursing theory at all levels and give us some meat.

I think this is a huge issue! I just started an NP program and my first class has literally been a joke. Wrote a five page paper, got 100% less than 8 hours later, not a single comment. 15/16 students did the assignment, average grade 187.5/200, so all 15 got 200 and 1 got zero. I have a 100% in the class, as do most, with some fellow students that can barely follow directions (group work has been a nightmare). The professor has never posted a single individualized comment, I believe he has a list of questions he asks for the weekly discussions, but never follows up. This is what I paid $2000+ for? I ripped the course on the evaluation, but the fact is they took my money for absolutely nothing of value. In the end, I will have a degree and I hope I will be judged upon the quality of my work and character, but I thought that this school was decent and based on this first class I'm almost regretting my decision to enroll if they think this is how they prepare NPs. And it just adds to the stigma that on-line degrees are a joke, and when some of us are geographically limited to on-line programs, it hurts the profession as a whole.

pmcgrady · Mar 8, 2018

Really??? There are very few posts that drive me to actually take the time to respond, but this one struck such a chord that I just cannot shake it off. It's clear from the number and types of responses, starting at the very beginning and continuing on through 5 pages worth, that the single "most pressing issue in nursing today" is exactly the same as it has been for the last 45+ years that I have been a Registered Nurse: the inability for nurses to get along with each other, as evidenced by the ongoing competition amongst nurses to always be "right", the continued lack of compassion and consideration for colleagues, the persistent bullying of younger and/or weaker colleagues, and the rampant defensiveness and dishonesty should anyone dare to challenge motives that are clearly self serving and intended to fit a personal agenda, regardless of whether it's a need for a graduate level research topic or just a plain old desire to stir up trouble. The original post asked a question, for whatever reason, the asker obviously doesn't want to hear an honest answer, but rather wants to continue to bait the audience. The audience takes the bait, as I acknowledge I myself did, and the bickering continues. And in the end, it's all just like arguing with a teenager: you both get dirty and the teenager loves it.

omg you guys got me. Im baiting you guys into a debate and I stole my graduate research topic on something I didn't know...my topic, which isn't broad at all and totally deserving of a graduate level paper, is that nursing is understaffed because of corporate America. Nobel peace prize material.

OldDude · Mar 8, 2018

omg you guys got me. Im baiting you guys into a debate and I stole my graduate research topic on something I didn't know...my topic, which isn't broad at all and totally deserving of a graduate level paper, is that nursing is understaffed because of corporate America. Nobel peace prize material.

So now that the cat is out of the bag I submit there isn't anything else to talk about so how about we let this thread reach it's omega. However, recognizing you are a "last word" individual I invite your last word so we can put this thread out of its misery. Amen

Been there,done that, ASN, RN · Mar 8, 2018

So now that the cat is out of the bag I submit there isn't anything else to talk about so how about we let this thread reach it's omega. However, recognizing you are a "last word" individual I invite your last word so we can put this thread out of its misery. Amen

No last words.. we were played.

My suggestion was ...best not to feed it. Should be interesting to see what the mods do, up to them to shut it down, and let us save some pride.

pmcgrady · Mar 8, 2018

No last words.. we were played.
My suggestion was ...best not to feed it. Should be interesting to see what the mods do, up to them to shut it down, and let us save some pride.

I believe the mods will understand sarcasm...

nursemike, ASN, RN · Mar 8, 2018

omg you guys got me. Im baiting you guys into a debate and I stole my graduate research topic on something I didn't know...my topic, which isn't broad at all and totally deserving of a graduate level paper, is that nursing is understaffed because of corporate America. Nobel peace prize material.

I don't spend as much time on these boards as I once did--part of an ongoing fight against internet addiction--but when I come here, I try to make it a rule not to waste a lot of time guessing a poster's motives, or what they really mean. I can very easily see why some people thought (and some probably still do) that this was "research" for a class. And it's clear from some of your subsequent posts that you had some ideas on the topic when you began. Then again, I have a Y chromosome and subtle nuances confuse me, so I find life a lot simpler if I just take most things at face value.

That said, the original question of this thread is one that gets discussed a lot--even offline. I think there is almost a universal consensus that there is something(s) wrong with our profession. I have to confess, in my present context, I don't find matters as dire as I once did. I feel there are real problems worth addressing, but I also suspect that would be true doing QC in a pie factory.

Still, I think I have an answer to the question posed, though I'm much less confident of a solution. The biggest problem in nursing today--indeed, in all of healthcare--is: THE OPIOID CRISIS!!! And, by that, I mean very damned little to do with the actual opioid crisis, but rather the knee jerk stupidity that has been both a cause of and response to said crisis, and by that I mean a long and pitiful history of healthcare regulation by people who know next to nothing about healthcare. Pain is not and never was a fifth vital sign, and a Pyxis buffet is not and never was the answer, and you could probably count one one hand the healthcare professionals who ever thought so, but the very last thing the media or the suits could ever believe is that doctors and nurses usually have a pretty good idea how much pain you are in, or what to do about it. And it's the same story with pretty much everything we do.

When I admit a patient with a stroke at 0340, one of the questions I must ask is: what can you tell us about yourself that will make your care more individualized? And with whatever cognition that patient has, he or she is thinking, "Oh, my God, I'm in the hospital! Am I going to die?" And so I chart, "Likes chocolate pudding." Because, you know, actually getting to know someone and learning what they need takes more time than the suits can afford.

I started this post as a reply to ExpNurse_RN, then abandoned it because I needed more time to mull it over, but I think she (?) touched on the best solution I can see with the why can't we all just get along idea. I have some ideas why we sometimes don't: we are all often under a lot of stress; most of us really believe what we do is important; we're inclined to take it personally even more than we probably ought to. A fellow nurse who appears indifferent is an affront to our core beliefs--and perhaps rightly so, although maybe we shouldn't be too quick to assume indifference. A fellow nurse makes a stupid mistake--we all know the potential for disaster, there. Still...

Another thread I've recently seen asked something along the lines of what do you love about nursing, and I can't help thinking that's a critical part of addressing what's wrong with nursing. Has a lot to do with my own experiences in the past couple of years. To make a long story short (yeah, I know, that shipped sailed awhile ago) I love nurses. The ones who took care of me while I was sick, and the ones I work with, and certainly not least the ones who've taken care of me at work, from my beginnings as a hapless newbie to more recently as a dead man walking.

I once observed, only half in jest, that there is nothing in heaven or earth that three nurses working together can't accomplish. The hard part is getting three nurses to work together. I think this applies to standing up for our profession in the face of the powers that be, but even more so during the course of a routine shift. This is hard work, and it can be very lonely, at times. We see things a lot of people don't. We make choices that seem impossible. We put our asses and sometimes our souls on the line. And I am going to make every effort I can to realize as often as I can that the people I work with are doing the same thing. Which shouldn't be too difficult, since quite a few have done the same for me.

nursemike, ASN, RN · Mar 8, 2018

BTW: I believe the multiple paths to entry into nursing are one of its greatest strengths. In a field comprised almost exclusively of white women, we are a lot more diverse than most people think, because we come from such varied backgrounds.

CrunchRN, ADN, RN · Mar 8, 2018

I love what you said Nursemike. You are so right in my opinion.

Leader25, ASN, BSN, RN · Mar 10, 2018

The patient , because if you go the Planetree route they will be telling you what to do.