Boy did you ever hit a tender spot! It has taken me years and a lot of experiences and observations to even begin to have any real thoughts about your concerns. Nursing, unfortunately, is NOT the angel of health care who's worth is universally recognized and who's value is a given. To many organizations, nursing is a COST CENTER to be carefully controlled, defined and managed.
On top of this is the reality that nursing is populated with many dedicated, committed, educated, caring, compassionate individuals who are sincerely professional and usually possess high personal and professional standards. How do you meet the needs of this group AND control them at the same time? For many other professions and organizations, that was a quandry. Unfortunately, with the best of intentions, this was assisted by many well meaning changes. JCAHO has continually placed more and more requirements on institutions which have translated into more and more documentation and review requirements placed on the staff RN. At the same time, managed care and the need for financial profits pressured organizations to squeeze more and more out of less and less staff. Coupled with this is the reality that the primary "customer" for many health care organizations is NOT the patient, but the physician. To further complicate matters, the presence of and the role of the registered nurse is required in acute care facilities by law. ( I have heard CEO's and CFO's even discuss this necessary evil!) The reality is that nursing and staff nurses in many facilities are powerless in the big picture. Now back to control: we can't let them know that. So hold them accountable for everything. Promote empowerment opportunities, teamsmanship and excellence guidelines. Few nurses will realize that whoever allows empowerment...can also take it away. Why do you think that the CNO position is viewed as short term? The CNO tries daily to balance the needs of the PATIENTS, with the staffing requirements to meet these needs, considering the needs of the staff, the physician culture, the regulatory guidelines and the financial realities of the organization.
And, in my opinion, Nursing is not very good about promoting the profession or its value (diploma vs BSN vs AD: still raging). We are still having articles and research attempting to PROVE that we are a profession. Add to this confusion the fact that nursing students are graduating with less and less clinical preparation (which is forcing the organizations to provide preceptorships, to demand that existing staff orient/train new grads, or accept the "eat their young" mentality) and you have the recipe for stress.
I love this profession and refuse to give up on the right of patients for quality professional nursing care-even when the "bottom line" is the profit margin, the need for meeting JCAHO and other institutional standards, and the need to stay current in a rapidly changing field.
[This message has been edited by jtfreel (edited January 24, 2000).]