General questions from a student

Trauma Columnist · Oct 5, 2006

Hi and welcome...I'll take a stab at this one tonight - I'm getting ready to go out the door to work.

UM Review RN, ASN, RN · Oct 5, 2006

Now that I have my coffee, I'll try a few.

1. I can only describe her as intelligent, educated, and clinically expert. She is ethical and moral, but not self-righteous. She is nonjudgmental and compassionate, but able to discern dysfunctional health habits and teach based on her observations using hard data and intuitive observation.

2. Nursing is the art and science of helping a human being to be the best they can be, physically, mentally, emotionally, spiritually. All the nursing activities, in all the areas of nursing that we work, function to carry out and promote this ideal.

3. Three main issues facing nursing: 1. lack of proactive leadership within the profession; 2. a profession defined by autonomy without the majority of members actually having autonomy in their workplace; 3. inability to improve poor working conditions and retirement benefits.

4. Yes, I care. You'd have to read "From Silence to Voice," by Suzanne Gordon and Bernice Buresh to really understand why it's so critical that all nurses should care. Yes, it does affect the way we practice.

5. I would not change the current educational process for RNs. How you get to the NCLEX and how you pass it is already quite rigorous, no matter the length of the program or number of adjunct courses you take.

6. I loved my NPs. They're all very good. In fact, I went to one doctor because of his NP. I counted on never being able to actually see him, and I didn't. The drawback--she wanted to admit me, he didn't. So I wasn't admitted. In hindsight, I should've been admitted. But oh well, I'm still here.

7. That depends on what they're allowed to do. Regardless of that caveat, the nurse is always responsible for directing the UAPs, and legally can be held responsible. Sometimes it's cost-effective to do so, but more often, employers take advantage, and the nurse is completely overwhelmed and unable to even supervise the UAPs effectively. Of course, both nurses and UAPs are undervalued and underpaid, so when looking to get a better bargain for health care, they already have a sweet deal going with the nurses and UAPs, because both have very little power in the workplace. Unlike the pharmaceutical companies, which I'll bet eat away a lot more of your health care dollar than nursing care.

8. How would I feel? Depends. If it was my mistake alone, I'd probably feel worse than awful. I'd probably go find another job, or at least change to a job without patient contact. More often, a facility is sued and any nurse who cared for that patient, whether they made a mistake or not, is also sued. Two of the LTC facilities I worked for were sued on behalf of patients after they passed away. Neither of these cases had any merit whatsoever. I felt genuinely angry that these patients got the best care possible, and I truly believe that their relatives just don't want to pay the bills.

9. The best leader I ever knew was FAIR. She had one standard for everyone. So if SuzyMae got written up for something, it wasn't because SuzyMae had an unpopular opinion or led a different lifestyle or was fooling around away from work. It was because that was the standard for everyone, period.

10. The worst leader I've ever known played favorites, didn't do her own job and expected you to do yours and hers, and then she'd take the credit for it. She did not keep her clinical skills or her knowledge base updated. She yelled at people and treated her employees like dirt.

11. A bad delegator gives the easy assignments to all the people she likes. A good delegator matches the nurse's abilities and interests to the patient's acuity and needs.

12. A good union is a very good thing. A bad union is worse than having a bad employer. Therefore, an open shop is best.

13. We do not, but we're heading toward it. I just hope the programs are better than the old DOS dinosaur programs we're using now. It's embarrassing that nursing has to limp along with this stuff when you see what the admins, managers, and docs get to play with.

Maybe someday some Florence Nightengale will convince facilities that they're only as good as their nursing staff, and that it behooves all to treat us with respect. Maybe that student is you.

For the sake of our profession, for the sake of our patients and our healthcare system, I truly hope so.

Daytonite, BSN, RN · Oct 5, 2006

hi, gemini901d!

1. have you ever met the ideal nurse? what characteristics do they have?

very early in my career i ran into a nurse who i felt was the best role model. she was always energetic and smiling. she seldom sat down. there was always something she would do for her patient's first, and always with a smile, no matter how nasty or belligerent a patient might get. i was always amazed at how she was able to pull this off. she oozed positive thoughts. some people didn't like her because of this and her enthusiasm. a call light would go off and someone would groan, "not again, (s)he just rang 20 minutes ago," and this nurse would jump up and say, "i'll go for you and see what (s)he wants." when i was a patient myself and in radiation isolation i was so surprised to see her answer my light one night when i was freezing to death and rang the light to ask someone to bring me an extra blanket. most of the staff didn't want to even come near a room with radioactive elements in it. but, there she was, not a look of care or concern for herself on her face. i've never forgotten her and i often wonder if she is still practicing, where she is and what she is doing these days. i doubt that she knows what an impact she made on me.

5. how would you change the current educational process for rn's?

i think that nurses need to come up through the ranks. i don't think that 2 years of school is enough to become an rn. i think rn education needs to start at a cna level and the person work their way up. more focus needs to be taken in the clinical levels at first. this way educators can see just who is cut out for the role and who isn't. turning rns out into the working world with no clinical experience is horrid. new grads are basically thrown in the pool and they either sink or swim. that's pretty savage. even the doctor's don't get treated that way in their education. however, how many people would want to go into a nursing program that lasted 5 or 6 years and included a working apprenticeship?

7. should unlicensed nursing staff be used to reduce health care costs?

yes, if they are well-trained. the fact is that medicare, medicaid and insurance companies are the driving forces behind all the cost cutting going on. as medicare continues to collect computer data and show that certain standard care things can be delegated to unlicensed staff, it is going to be done more and more to save money. i believe that part of the resistance by licensed staff to this, is a reluctance on their part to perform the professional nursing that we were taught in the first place. it's so much easier to regress and go back to those simpler things we know how to do, the things we delegate to unlicensed staff, than it is for some rns to manage and supervise patient care which is what they should be doing. if they keep doing that, however, they are going to put themselves right out of their jobs.

8. how would you feel if a lawsuit was brought against you?

probably a little upset at first. however, i've taken a lot of classes on documentation and protecting myself against being sued, so i would be very surprised if this happens. also, i know that when someone brings a lawsuit, they name everyone who took care of them. that is a basic strategy since they cannot add names to the list later. usually if the case goes to court the only people left on the complaint are the ones with money or those they want to hurt because they were mean to the plaintiff.

9. what traits did the best leader that you've known have?

they were fair, fair, fair. they listened to what i had to say, tactfully told me when i was full of beans so as not to hurt my feelings, were personable and i felt comfortable going to them. they maintained confidentiality and didn't feel like they had to "be" one of the staff just to be accepted by them. a good leader stands back and lets subordinates be creative and have some of the power. they only use their power and influence when people are getting out of line or need direction.

10. what traits did the worst leader that you've known have?

gossiped with the staff. played favorites with the staff. didn't act on questions or complaints. tried to change the way people did things personally when this really was her own ego trip. couldn't even define the word fair. lied and then made excuses when confronted about it. ran and hid from staff in order to avoid questions and dealing with problems.

11. what qualities do good/bad delegators have?

the biggest problem i've seen with people who have problems with delegating is that they are not assertive enough. they are afraid to speak up and do the actual delegation because they are afraid the other person won't like them. to avoid that, they'll just go ahead and take on the task themselves in addition to all the other things they have to do--not a good decision. the other problem is that when they do get up the backbone to tell someone to do something they don't make their request clear, concise and specific enough and follow up and get feedback. for example, they don't tell the delgatee to report back to them when they have completed a task so they can get that feedback. then, they wonder at the end of their shift if the task ever got done.

12. how do you perceive unions?

i worked for two unionized nursing staffs. they both needed them at the time the unions came in because the hospitals had been walking all over the nurses--hardly any vacation time, no medical insurance coverage, forced overtime, the list goes on. awful situations. the unions made the nurses benefits better. however, when you work where there's a union, there is a contract between the union and the hospital and probably some old bad blood there as well. both sides are going to go right to that written contract and follow it to the letter when a rule has been broken. there will be no leeway when it comes to enforcing the rules on both sides. when you are in a non-union facility, there is a lot of compromising with the rules that goes on. not in unionized places. union reps, i found, were often not nurses, so they didn't think like nurses. they, as i said, would advise us in terms of what the written contract said.

13. do you use computerized records? how do you like them?

yes. i am taking another degree in health information management and that is all we are studying is the computerized record. this is big stuff and more is to come. i think it's great. computerizing data has already helped to streamline a lot of the medical treatments that are being done for patients. i do believe that in the years to come (much farther down the road) a great deal of the medical services provided today will be very routine and done by trained technicians. if you think nurses are upset with unlicensed people taking over some of their tasks, wait until you hear the doctors start up about some of their things that will be able to be delegated out! the day is going to come when you can walk into any medical facility on the planet and your medical record will be instantly accessed. it sure will save all the time and energy of having to keep your own files of your medical history! it will also make continuity of care a reality for everyone.

please join the other students on the nursing student forums at these links:

https://allnurses.com/forums/f205/ - nursing student assistance forums

https://allnurses.com/forums/f50/ - the general nursing student discussion forum

welcome to allnurses! :welcome:

jenni82104 · Oct 5, 2006

Just wanted to say these are really good questions, and I am enjoying reading the responses!:)

gemini901d · Oct 5, 2006

Thanx once again for all input in helping me with this assignment. I really do appreciate you're taking the time from your busy schedule to help me. I really do promise to do the same when I can contribute.

fd5151 · Oct 11, 2006

hi, gemini901d!
very early in my career i ran into a nurse who i felt was the best role model. she was always energetic and smiling. she seldom sat down. there was always something she would do for her patient's first, and always with a smile, no matter how nasty or belligerent a patient might get. i was always amazed at how she was able to pull this off. she oozed positive thoughts. some people didn't like her because of this and her enthusiasm. a call light would go off and someone would groan, "not again, (s)he just rang 20 minutes ago," and this nurse would jump up and say, "i'll go for you and see what (s)he wants." when i was a patient myself and in radiation isolation i was so surprised to see her answer my light one night when i was freezing to death and rang the light to ask someone to bring me an extra blanket. most of the staff didn't want to even come near a room with radioactive elements in it. but, there she was, not a look of care or concern for herself on her face. i've never forgotten her and i often wonder if she is still practicing, where she is and what she is doing these days. i doubt that she knows what an impact she made on me.
i think that nurses need to come up through the ranks. i don't think that 2 years of school is enough to become an rn. i think rn education needs to start at a cna level and the person work their way up. more focus needs to be taken in the clinical levels at first. this way educators can see just who is cut out for the role and who isn't. turning rns out into the working world with no clinical experience is horrid. new grads are basically thrown in the pool and they either sink or swim. that's pretty savage. even the doctor's don't get treated that way in their education. however, how many people would want to go into a nursing program that lasted 5 or 6 years and included a working apprenticeship?
yes, if they are well-trained. the fact is that medicare, medicaid and insurance companies are the driving forces behind all the cost cutting going on. as medicare continues to collect computer data and show that certain standard care things can be delegated to unlicensed staff, it is going to be done more and more to save money. i believe that part of the resistance by licensed staff to this, is a reluctance on their part to perform the professional nursing that we were taught in the first place. it's so much easier to regress and go back to those simpler things we know how to do, the things we delegate to unlicensed staff, than it is for some rns to manage and supervise patient care which is what they should be doing. if they keep doing that, however, they are going to put themselves right out of their jobs.
probably a little upset at first. however, i've taken a lot of classes on documentation and protecting myself against being sued, so i would be very surprised if this happens. also, i know that when someone brings a lawsuit, they name everyone who took care of them. that is a basic strategy since they cannot add names to the list later. usually if the case goes to court the only people left on the complaint are the ones with money or those they want to hurt because they were mean to the plaintiff.
they were fair, fair, fair. they listened to what i had to say, tactfully told me when i was full of beans so as not to hurt my feelings, were personable and i felt comfortable going to them. they maintained confidentiality and didn't feel like they had to "be" one of the staff just to be accepted by them. a good leader stands back and lets subordinates be creative and have some of the power. they only use their power and influence when people are getting out of line or need direction.
gossiped with the staff. played favorites with the staff. didn't act on questions or complaints. tried to change the way people did things personally when this really was her own ego trip. couldn't even define the word fair. lied and then made excuses when confronted about it. ran and hid from staff in order to avoid questions and dealing with problems.
the biggest problem i've seen with people who have problems with delegating is that they are not assertive enough. they are afraid to speak up and do the actual delegation because they are afraid the other person won't like them. to avoid that, they'll just go ahead and take on the task themselves in addition to all the other things they have to do--not a good decision. the other problem is that when they do get up the backbone to tell someone to do something they don't make their request clear, concise and specific enough and follow up and get feedback. for example, they don't tell the delgatee to report back to them when they have completed a task so they can get that feedback. then, they wonder at the end of their shift if the task ever got done.
i worked for two unionized nursing staffs. they both needed them at the time the unions came in because the hospitals had been walking all over the nurses--hardly any vacation time, no medical insurance coverage, forced overtime, the list goes on. awful situations. the unions made the nurses benefits better. however, when you work where there's a union, there is a contract between the union and the hospital and probably some old bad blood there as well. both sides are going to go right to that written contract and follow it to the letter when a rule has been broken. there will be no leeway when it comes to enforcing the rules on both sides. when you are in a non-union facility, there is a lot of compromising with the rules that goes on. not in unionized places. union reps, i found, were often not nurses, so they didn't think like nurses. they, as i said, would advise us in terms of what the written contract said.
yes. i am taking another degree in health information management and that is all we are studying is the computerized record. this is big stuff and more is to come. i think it's great. computerizing data has already helped to streamline a lot of the medical treatments that are being done for patients. i do believe that in the years to come (much farther down the road) a great deal of the medical services provided today will be very routine and done by trained technicians. if you think nurses are upset with unlicensed people taking over some of their tasks, wait until you hear the doctors start up about some of their things that will be able to be delegated out! the day is going to come when you can walk into any medical facility on the planet and your medical record will be instantly accessed. it sure will save all the time and energy of having to keep your own files of your medical history! it will also make continuity of care a reality for everyone.
please join the other students on the nursing student forums at these links:
https://allnurses.com/forums/f205/ - nursing student assistance forums
https://allnurses.com/forums/f50/ - the general nursing student discussion forum
welcome to allnurses! :welcome:

hi daytonite,

i am in a group project in a research class in my nursing program and we have been told to find a topic in nursing practice that has changed over the years. computer informatics is the topic we have chosen and i would like to know if you can recommend any good sites to visit on the net. we are encouraged to use scholarly references, although if this is not possible, i would still welcome any references you have that would introduce to this topic as it isn't something any of the group memebers are all too experienced with.

thanks in advance,

i appreciate your help!

Antikigirl, ASN, RN · Oct 11, 2006

1. Have you ever met the ideal nurse? What characteristics do they have? I have met many ideal nurses, just as I have met many ideal Doctors, Patients, Lawyers, Teachers, Paramedics and the list goes on! What makes someone the ideal nurse is the one that helps each individual patient with skill, compassion, and a dose of old fashioned common sense! That truely means that many nurses are ideal nurses dependant on their strengths and weaknesses. I may not be the Ideal nurse for children, but I sure am for elderly and older adults.

2. How do you define nursing? Nursing to me is a profession that instills quality, compassion, integrity, confidentialty, and individually care to patients in the healthcare setting. What activities are important for you to carry out? Direct care, communication, and follow through to ensure a patient has resources outside the hospital to tend to their changing healthcare needs.

3. What are the 3 main issues facing nursing? Public perceptions of nurses and healthcare in general. Medical mistakes. Understaffing of nurses and higher demands on nurses regardless of safety for patients.

4. Do you care if nursing is a profession? Will it affect the way you practice? I wouldn't have become a nurse if it wasn't a stable professional career!

5. How would you change the current educational process for RN's? Easier transition, lower costs for ADN's obtaining their BSN (which is happening slowly actually!).

6. Have you ever been to an N.P. for care? How would you rate your experience? If not, would you consider going to one? Yes I have, and my son has. I appreciate the NP for their knowledge of how nursing is directly and indirectly related to my individual healthcare issues and communicates with them for a broader spectrum of healthcare facilities/services to fit my needs. My MD's would refer me to another MD, where my NP could help me with other services she knew about that may not involve just MD's! My NP seemed to know far more about services, classes, and community support for issues than my MD's have...and that makes me feel I am being treated as a total person!

7. Should unlicensed nursing staff be used to reduce health care costs? Depends on the tasks an unlicensed staff member would be doing!

8. How would you feel if a lawsuit was brought against you? Depends on circumstance of the lawsuit.

9. What traits did the best leader that you've known have? Knew my strengths and weaknesses and helped me to strengthen my weaknesses and qualify my strengths!

10. What traits did the worst leader that you've known have? No appreciation, barked orders, would not listen, and treated everyone like they were idiots that they had to endure...

11. What qualities do good/bad delegators have? A good delegator listens and can be flexible and just on an individual basis. A bad delegator may listen, but isn't flexible and just on an individual basis and tends to strictly quote or go by 'the book'.

12. How do you perceive unions? A helpful tool for nurses to get fair recognitition and compensation for their work if one so chooses.

13. Do you use computerized records? How do you like them? Don't have them yet, but will in 2-3 years. I am eager to use them, and feel that it will be better than charting by hand for communication, you can read it (vs handwriting), don't have to flip through a chart hoping you find something (or missed something!), and a continuity of communication and care.

Daytonite, BSN, RN · Oct 12, 2006

i am in a group project in a research class in my nursing program and we have been told to find a topic in nursing practice that has changed over the years. computer informatics is the topic we have chosen and i would like to know if you can recommend any good sites to visit on the net. we are encouraged to use scholarly references, although if this is not possible, i would still welcome any references you have that would introduce to this topic as it isn't something any of the group members are all too experienced with.

i am studying health information management (him) which is about medical records. i don't know much about informatics. i believe it involves more to do with programming and the creation of software. him is about generating reports and compiling information with software that already exists. i also know that if you go online and search for information on nursing informatics you will find information about it.

you should check out the threads on the informatics forum here and/or contact the moderator of that forum for information:

https://allnurses.com/forums/f28/ - nursing informatics

llg, PhD, RN · Oct 12, 2006

1. Ideal nurse: No, I've never met anyone who was ideal. Nobody's perfect. The ideal nurse would be knowledgable, able to problem-solve, committed to providing wonderful care, compassionate, kind, technically skilled. ... and probably 100 other wonderful qualities.

2. I like Kristen Swanson Kauffmann's definition best. "Nursing is informed caring for the well-being of others." I like Virginia Henderson's statement that nurses do for the patient what he would do for himself (or herself) if he had the ability (knowledge, skill, etc.) to do it himself. That's not the exact quote, of course, but it's that idea.

3. Issues

(1) Clarifying and standardizing educational standards, educational programs, degree titles, certification systems, etc. We need a clear, easy-to-understand system of education and credentialing that everyone (nures and the public) can understand.

(2) Nurses need to become more politically powerful within society and within health care organizations. Doing a good job with the education issue above would help that a lot.

(3) Creation of satisfying, long-term career opportunities. If #1 and #2 were taken care of, this issue would get resolved.

4. Care if profession? Yes. It wouldn't change how I practice, but it might help get nurse more power.

5. Change education First, I would keep the ADN programs, but insist that they take only 4 semesters of full time study post high school to complete. I would also insist that the difference between ADN and BSN program be made clear by requiring that the differences in their foci be evident. In other words, I would insist that the ADN programs stop adding more content into their programs trying to make their graduates equal to a BSN. That defeats the purpose of having the 2 levels to begin with and only sets the profession up for fights and competition between those who have ADN's and those who have BSN's.

Second, I would insist that the hospital-based diploma programs choose to either form partnerships with ADN programs or with BSN programs. Go one way or the other. Inserting a 3rd type and 3rd level of education in there only makes it worse. The programs can remain based within the hospital: no school would have to close. But I would force them to form a partnership with a community college or university to help the students get their coursework accepted by other colleges later in life ... and I would insist that their graduates be clearly prepared at either the ADN or BSN level. 3 levels is simply too confusing for the public.

I don't think the Master's level needs a lot of major change, but I'm sure I could find some tweaking to do in order to promote consistency in degree titles, etc. I would leave NP programs, CNS programs, teacher prep programs, etc. at the master's level. I would design the programs with a core group of classes such as theory, research, issue, etc. and then let the students choose among various clinical specialization and specific role preparation paths. For example, someone might choose the FNP path and then add the teacher prep courses as electives or as an extra certification later.

At the doctoral level, I would only allow 2 degrees. One would be the traditional PhD, focusing on knowledge development (philosophy, theory, research, etc.). The second degree would be a practice degree that would include some core courses on knowledge development, but focus more on practice. The student would choose a practice path at the doctoral level similar to how they did at the Master's level. That path could be a clinical specialty or administration, informatics, teaching, etc. Regardless of the "practice path," the title of the degree would be the same -- perhaps something like DNP. I would eliminate the confusion caused by so many degree titles.

As for people entering nursing from other careers, under my system, the flexibility to enter at the MSN level could still exist through what would probably be a 3-year program. Entry at the BSN level would also be very possible by simply taking the nursing courses within a BSN program and maybe a few pre-req's (but I don't think there should be a million pre-req's).

6. NP care Yes, with mixed results. Some were good. Some were not -- the same as with physicians.

7. Unlicensed staff Yes, but only with strict guidelines as to their role and not allowing them to perform tasks for which they are not adequately educated. There should be educational standards for such roles and preferably, state certification. Adequate supervision is also necessary.

8. Lawsuit Terrified

9. Best leader traits Humor, compassion, understanding, forgiveness, tolerance, vision, intelligence

10. Worst leader traits Stupidity, vindictiveness, closed-mindedness

11. delegators Same as leader traits

12. Unions Not very well as they frequently become too self-serving and pre-occupied with power issues, losing sight of the big picture. They frequently hurt themselves and their membership by working too hard to maintain power for the individuals within the union at the expense of more important, long-term issues. The presence of a union tends to encourage an unhealthy "we vs them" culture within the organization. I prefer to work in a non-union environment with an enlightened management. However, sometimes they are necessary.

13. Computerized records I have worked in several hospitals in which most or part have been computerized. In general, I do not like them for certain parts of the record, but do like them for other parts of the record. I like them for recording meds, labwork, etc. Hate them for nursing notes and the notes of other team members because they stifle free communication.

fd5151 · Oct 12, 2006

i am studying health information management (him) which is about medical records. i don't know much about informatics. i believe it involves more to do with programming and the creation of software. him is about generating reports and compiling information with software that already exists. i also know that if you go online and search for information on nursing informatics you will find information about it.
you should check out the threads on the informatics forum here and/or contact the moderator of that forum for information:
https://allnurses.com/forums/f28/ - nursing informatics

oops, guess i used the wrong terminology, it is health information management that we are looking into doing a project on. do you have any recommendations that you can offer me for searching the web?

thanks again

MIA-RN1, RN · Oct 12, 2006

1. Have you ever met the ideal nurse? What characteristics do they have? Not sure if anyone can ever be the idea (perfect) nurse. But (s)he would be caring and compassionate.

2. How do you define nursing? What activities are important for you to carry out? To me, nursing is caring for the whole individual along with or in spite of the medical procedures/illness etc.

3. What are the 3 main issues facing nursing?

Hotel vs Hospital and that whole disney thing.

Shifts that are too long

The continual controversy/threat of doing away with ADN nurses, and requiring them to get BSN.

4. Do you care if nursing is a profession? Will it affect the way you practice?

Not sure I understand. Nursing IS a profession and I am a professional.

5. How would you change the current educational process for RN's?

Not sure I would change it.

6. Have you ever been to an N.P. for care? How would you rate your experience? If not, would you consider going to one?

yes, I have seen an NP and one of my friends is an NP and I would choose an NP over a doctor any day.

7. Should unlicensed nursing staff be used to reduce health care costs?

Only within their scope of practice. And not at the expense of good nurses.

8. How would you feel if a lawsuit was brought against you?

Scared, worried but confident that justice prevails.

9. What traits did the best leader that you've known have?

Willingness to listen and take into account all sides.

10. What traits did the worst leader that you've known have?

"Do as I say no questions asked"

11. What qualities do good/bad delegators have?

Good: say please, understand what the delegatee has to do aside from whats being asked, reasonable.

Bad: Just do it mentality. Not caring what else is going on.

12. How do you perceive unions?

I am not sure.

13. Do you use computerized records? How do you like them?

No and no.