Need input for grad school presentation

MollyJ · Apr 21, 2001

*Bedside nursing staff to patient ratios

*?Over supply of APN's, particularly NP's??--I'm not sure on this one?

Workplace violence

*Legislative Issues ie prescriptive authority and the status of direct NP reimbursement in your state

How much longer can our health care system survive as it is? Are we ultimately headed toward national health insurance? The imbalance of the hospital, caregiver, insurance triangle TOWARD INSURORS.

Recruitment [of basic, entry level nurses] in a world where so many jobs exist and nursing has such a tattered image.

There are many others, but the starred ones represent my top choices.

**canoehead, BSN, RN** · Apr 21, 2001

1)Mandatory OT

2)Portrayal of nursing in media/how does it affect public perception

3)Accountability viewed by nurses/how does it change with short staffing

4)Illness/divorce/children's need for services R/T overtime, shift changes

5)12h vrs 8h shifts affect on health and family

6)Consumers expectations vrs the reality of hospital based nursing care

Happy to help-good luck with your course work.

**canoehead, BSN, RN** · Apr 21, 2001

1)Mandatory OT

2)Portrayal of nursing in media/how does it affect public perception

3)Accountability viewed by nurses/how does it change with short staffing

4)Illness/divorce/children's need for services R/T overtime, shift changes

5)12h vrs 8h shifts affect on health and family

6)Consumers expectations vrs the reality of hospital based nursing care

Happy to help-good luck with your course work.

Home Health Columnist / Guide · Apr 21, 2001

Check out web sites for ANA: http://www.nursingworld.org/

NYSNA: http://www.nysna.org/PGA/LEG/solutions.html

or check many of the posts here-- go to search at the top & type in nursing problems, you'll get ton of info.

Jason-ACNP · Apr 21, 2001

I completely agree with Canoehead. These are excellent topics, and I particularly support 1, 2, and 6.

I also like the responses from Molly J. While numerous factors play into the nursing crisis, in short, I feel that nursing school recruitment has significantly diminished due to a very poor image of nursing, (i.e. menial, laborious work for little pay and and a lack of respect, in addition to the possibility of mandatory overtime). Futhermore, as an acute care nurse practitioner, I too agree that that there are entirely too many NPs in the work force. Here are some thoughts.

1.) There are entirely too many NP schools in this country, and I strongly feel that most are grossly substandard. Two years ago, there were 288 (or close). Many of these schools are taught by nursing educators who were trained in nursing theory and don't have a clue about advanced practice. Some schools emphasize theory and research far more than pharmacology, physiology, and diagnostic reasoning because these schools lack the qualified educators to teach these courses.

2.) In addition to a substandard curriculum, MANY of these schools have very lax standards in choosing their students. PAs and CRNAs are subjected to a battery of interviews (with many schools) in addition to having an excellent GPA and GRE scores. Yet, many NP schools that are rated under the top 30 will take almost anyone who has a BSN, and with very little experience. My state alone has 3 NP programs, and 2 have been deemed GROSSLY substandard by many of its alumni.

3.) To add to the problem, NPs are under fire from the AMA on a monthly basis. In my state, the pharmacy board has also raised opposition. This alone supports the thinning of the number of NP programs and accepting only the "best and the brightest". The NP profession cannot afford to have poorly trained, inexperienced NPs in the workforce placing patients at risk. If an NP harms a patient, the fallout will reverberate throughout the entire state (in some cases). It projects a very poor image of NPs to physicians and the public who have never had the experience of working with an NP. The profession, in many areas of the country, is a time bomb waiting to explode. The NLN should take heed and thin the number of schools in this country. Very few states (such as Texas and CA) should have more than 3 schools, and many states should not have more than one school in my opinion. Unless I'm mistaken, there are only 50 to 55 PA programs in the entire country. I don't believe that the number of CRNA programs exceed this number.

4.) Here is a hot topic. RNs who have absolutely zero expereince with pediatrics and/or women's health entering an FNP program. It shouldn't be allowed. Many critical care nurses and/or med-surg nurses whose expereinces are strictly limited to an adult based population continually enter an FNP program. It shouldn't happen. A semester of pediatrics IS NOT SUFFICIENT to support FNPs who have no prior pediatric experience. While I'm sure that there are many excellent FNPs out there who provide excellent care to kids, a lack of experience in peds puts the kid at risk. Costly mistakes will happen. I read of two kids in recent months who DIED as a result of two newly graduated FNPs who misdiagnosed a child with influenza, (when each actually had bacterial meningitis). I feel that many people don't realize the implications of their role as an FNP (when entering the program), but instead see the FNP as being able to cover the life spectrum. Obviously, when mistakes of this magnitude are made, it is devastating to the family, and crippling to the profession. While there are probally thousands of incompetent doctors who make far more mistakes than most NPs, their status as an MD provides them with a much thicker blanket of protection.

Good luck with your presentation.

Originally posted by canoehead:
1)Mandatory OT
2)Portrayal of nursing in media/how does it affect public perception
3)Accountability viewed by nurses/how does it change with short staffing
4)Illness/divorce/children's need for services R/T overtime, shift changes
5)12h vrs 8h shifts affect on health and family
6)Consumers expectations vrs the reality of hospital based nursing care

Happy to help-good luck with your course work.

MollyJ · Apr 22, 2001

Originally posted by Jason-ACNP:
...Futhermore, as an acute care nurse practitioner, I too agree that that there are entirely too many NPs in the work force. Here are some thoughts.
1.) There are entirely too many NP schools in this country, and I strongly feel that most are grossly substandard. Two years ago, there were 288 (or close). Many of these schools are taught by nursing educators who were trained in nursing theory and don't have a clue about advanced practice. Some schools emphasize theory and research far more than pharmacology, physiology, and diagnostic reasoning because these schools lack the qualified educators to teach these courses.
2.) In addition to a substandard curriculum, MANY of these schools have very lax standards in choosing their students. PAs and CRNAs are subjected to a battery of interviews (with many schools) in addition to having an excellent GPA and GRE scores. Yet, many NP schools that are rated under the top 30 will take almost anyone who has a BSN, and with very little experience. My state alone has 3 NP programs, and 2 have been deemed GROSSLY substandard by many of its alumni.
3.) To add to the problem, NPs are under fire from the AMA on a monthly basis. In my state, the pharmacy board has also raised opposition. This alone supports the thinning of the number of NP programs and accepting only the "best and the brightest". The NP profession cannot afford to have poorly trained, inexperienced NPs in the workforce placing patients at risk. If an NP harms a patient, the fallout will reverberate throughout the entire state (in some cases). It projects a very poor image of NPs to physicians and the public who have never had the experience of working with an NP. The profession, in many areas of the country, is a time bomb waiting to explode. The NLN should take heed and thin the number of schools in this country. Very few states (such as Texas and CA) should have more than 3 schools, and many states should not have more than one school in my opinion. Unless I'm mistaken, there are only 50 to 55 PA programs in the entire country. I don't believe that the number of CRNA programs exceed this number.
4.) Here is a hot topic. RNs who have absolutely zero expereince with pediatrics and/or women's health entering an FNP program. It shouldn't be allowed. Many critical care nurses and/or med-surg nurses whose expereinces are strictly limited to an adult based population continually enter an FNP program. It shouldn't happen. A semester of pediatrics IS NOT SUFFICIENT to support FNPs who have no prior pediatric experience...

Amen, amen, amen. I am a MSN in Community Health and I claim no desire to do the physician extender role. My hubby is a FP and I have a great deal of respect for his body of knowledge. As I was finishing my MSN, my program was starting up a NP tract and ginning out NP's faster than you could say "Florence Nightengale".

Babes in the woods. Both the instructors and the students. One of my dear (and I do mean dear, she was sweet but...) colleagues went into the FNP tract. She was morally opposed to giving oral contraceptives to teens. Well, often, though not entirely this is a prime usage of FNP's--pelvics on teens. She objected to a prime function of her role. She's not working as an NP.

One of the NP's in my hubby's office has started the trek back to medical school because she felt that the NP prep just didn't do it.

I think it is silly that we generate so many NP's from population dense areas who have no more desire to relocate to population sporifice areas than the MD's themselves do.

Jason, re: your comments on too many [generic] nursing programs. That is my only point of major disagreement. I think that some of our problems in 2001 are very similar to the issues of the first third of the 20th century when the Brown Report (?) and other studies of the nursing profession were published. I agree that once again we have a proliferation of too many small programs but the motivation isn't so much as the provision of a work force like it was in the days when programs were largely the very old fashioned diploma programs. I think the motivation is to gin out a steady supply of entry level nurses to keep up with high level of those exiting the profession due to burn out.

But I think that many of these programs are small and based in very small community hospitals that have a limited ability to give students a broad based clinical experience on which to base learning. Plus, we've made entry into the profession so easy that people can accomplish an RN credential with observation clinicals alone if they have an LPN or similar credential to begin with. If you believe, as I do, that one task of a nursing program is enculturation into the Registered Nurse role, these nurses (from the latter setting) have scant opportunities to be with RN's much less be enculturated to be one.

But in my broad, stubby state where east to west travel is an 8 to 10 hour proposition, we would dramatically undersupply nurses to our low population density portions of our state if we kept only one or two programs. I personally feel one of the solutions is out reach programs based in Univerity settings that bring rare resources (MSN and PHD prepared nurses) to the remote rural regions via satellite uplink. Programs need to be a little more rigorous and I think the rigor of some programs is limited by their puny library resources. If you were affiliated with a major university, you could use an interlibrary loan system and hook into major university library computer systems. But 2 programs would not meet my state's needs.

Jason, I notice you are from Hot Springs. My sis in law is finishing a MSN through Jonesboro and she also talks about the emphasis on the NP role. She teaches in an ASN program. You live in a beautiful city (though humid).

Don't think our presenter better attack this issue; she'll either get attacked (eaten alive) or certainly not asked back.

Jason-ACNP · Apr 22, 2001

I couldn't agree with you more. Although I am a proponent of thinning the number of NP programs, I would never want to prevent qualified and highly motivated students from attending an NP progam just because they aren't able to make a lengthy commute. The school I attended, (UAMS) actually allowed for satelite classes in Texarkana, Jonesboro, Ft. Smith, and Fayetville. At the same time, there were a few students the NP program who readily admitted, "I look at lab values, but they mean absolutely nothing to me". Some of the brighest and the best live in various parts of each state, and can not pick up and move to attend school. Technology allows us to reach everyone (who is qualified). The persons I am speaking of did not make it through the program. However, with 288 programs across the country, I feel that there may be many people who are practicing by the seat of their pants. My drill instructor in the Marine Corps constantly reminded us, "It's the quality, not the quanity that saves lives", referring to the small population of Marines vs. other branches.

However, I don't think that we should thin the basic nursing schools of course. In contrast, we need more instructors to teach in these schools.

Ask you sis-in-law if she knows Dr. Mary Hartwig. She was once the director of the BSN program at Jonesboro, and taught pathophysiology at UAMS. She is without question the finest represenative of the APN role I've ever met. Incredibly intelligent.

Yes, it is very humid here, but I enjoy the lakes.

Originally posted by MollyJ:
Amen, amen, amen. I am a MSN in Community Health and I claim no desire to do the physician extender role. My hubby is a FP and I have a great deal of respect for his body of knowledge. As I was finishing my MSN, my program was starting up a NP tract and ginning out NP's faster than you could say "Florence Nightengale".

Babes in the woods. Both the instructors and the students. One of my dear (and I do mean dear, she was sweet but...) colleagues went into the FNP tract. She was morally opposed to giving oral contraceptives to teens. Well, often, though not entirely this is a prime usage of FNP's--pelvics on teens. She objected to a prime function of her role. She's not working as an NP.

One of the NP's in my hubby's office has started the trek back to medical school because she felt that the NP prep just didn't do it.

I think it is silly that we generate so many NP's from population dense areas who have no more desire to relocate to population sporifice areas than the MD's themselves do.

Jason, re: your comments on too many [generic] nursing programs. That is my only point of major disagreement. I think that some of our problems in 2001 are very similar to the issues of the first third of the 20th century when the Brown Report (?) and other studies of the nursing profession were published. I agree that once again we have a proliferation of too many small programs but the motivation isn't so much as the provision of a work force like it was in the days when programs were largely the very old fashioned diploma programs. I think the motivation is to gin out a steady supply of entry level nurses to keep up with high level of those exiting the profession due to burn out.
But I think that many of these programs are small and based in very small community hospitals that have a limited ability to give students a broad based clinical experience on which to base learning. Plus, we've made entry into the profession so easy that people can accomplish an RN credential with observation clinicals alone if they have an LPN or similar credential to begin with. If you believe, as I do, that one task of a nursing program is enculturation into the Registered Nurse role, these nurses (from the latter setting) have scant opportunities to be with RN's much less be enculturated to be one.

But in my broad, stubby state where east to west travel is an 8 to 10 hour proposition, we would dramatically undersupply nurses to our low population density portions of our state if we kept only one or two programs. I personally feel one of the solutions is out reach programs based in Univerity settings that bring rare resources (MSN and PHD prepared nurses) to the remote rural regions via satellite uplink. Programs need to be a little more rigorous and I think the rigor of some programs is limited by their puny library resources. If you were affiliated with a major university, you could use an interlibrary loan system and hook into major university library computer systems. But 2 programs would not meet my state's needs.

Jason, I notice you are from Hot Springs. My sis in law is finishing a MSN through Jonesboro and she also talks about the emphasis on the NP role. She teaches in an ASN program. You live in a beautiful city (though humid).

Don't think our presenter better attack this issue; she'll either get attacked (eaten alive) or certainly not asked back.

LoriUSAFRN · Apr 22, 2001

Thanks for your inputs-didn't think I'd get any comments re: NP's. I'm in the nurse admin track in my program. Have no desire to do the NP thing. I agree, I think the admission standards for NP programss aren't high enough. One MSN program I was in had nurses with 2 years experience doing the NP track. You barely know how to be a good nurse after two years, let alone be a pracitioner! Think a lot of people head this route tho to get out of bedside care. I DO NOT plan to address this issue in my presentation, as most of the class are FNP students, but I'm glad to know I'm not too off base in my philosphy. Think NP's are great and admire anyone in the job, but they need to be highly experienced in nursing before assuming the role.

Jason-ACNP · Apr 22, 2001

You've hit it right on the head. It may not be a good idea for you to address the issue, but you are absolutely right. Five years should be minimal requirment into an advanced NP program. However, I know that most schools require ONLY ONE YEAR of experience. I know of three schools that will allow new grad BSN students to enter the program immediately upon graduation (to take theoretical and research classes). I don't have a problem with them taking those types of classes, which should be abolished from the curriculum anyway. But happens when they finish those classes? They ARE NOT prepared to begin rotations, and their less than mediocre clinical performance

reflects poorly on NPs everywhere. Again, the NLN needs to have a reality check in accrediting schools, and the schools seriously need to revamp their admission policies.

Originally posted by LoriUSAFRN:
Thanks for your inputs-didn't think I'd get any comments re: NP's. I'm in the nurse admin track in my program. Have no desire to do the NP thing. I agree, I think the admission standards for NP programss aren't high enough. One MSN program I was in had nurses with 2 years experience doing the NP track. You barely know how to be a good nurse after two years, let alone be a pracitioner! Think a lot of people head this route tho to get out of bedside care. I DO NOT plan to address this issue in my presentation, as most of the class are FNP students, but I'm glad to know I'm not too off base in my philosphy. Think NP's are great and admire anyone in the job, but they need to be highly experienced in nursing before assuming the role.

Huganurse · Apr 23, 2001

I worry about becoming infected. All the universal precautions we take are great but we are just human! HIV, Hepatitis, TB, MRSA, C-diff, and other new strains of bacteria and viral infections just plain scare me! And what about when they become or already are airborne??? It takes 3 days for a culture result to come back and we don't always know what we are dealing with. Needleless systems are great but you can't access a port without a needle or draw blood and most places I've worked are to damn cheap to provide them! How many times an unsuspecting body fluid has hit my face? I hate to even think about it. I also worry about bringing something home to my family despite Universal Precautions, taking my shoes off before going in the house, and showering after work. I think nurses should get hazard pay for all the risk involved in caring for sick people.

Louie18 · Apr 25, 2001

The main issues in nursing are too much worry and resentment about who got what and who is doing what instead of keeping their own house up and helping those that need it instead of watching and gossiping about others as they struggle.

Louie