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How would you improve the nursing profession? (beyond better staffing, higher pay, etc)

Nurses   (3,304 Views | 64 Replies)

labordude has 14 years experience as a BSN, RN and specializes in L&D, OBED, NICU, Lactation.

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TL;Dr: Nursing needs some help. What do you think will help improve the profession?

Nursing as a profession is in definite need of improvement as we go forward into the future. Many additional tasks are thrown at us, sicker patients are assigned to us, and we’re always asked to do more with less and do it faster. There has been a palpable push toward tasks over people, a decidedly different path than historically and from what is taught as nursing in schools.

Based on your experience, what would you change or do to improve the profession?

I’m going to preempt some answers here and say go beyond better staffing/ratios, higher pay, ancillary staff, unionizing, etc. Think about the profession itself and how you think nursing fits within healthcare as a whole now and five years from now.

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Jedrnurse has 25 years experience as a BSN, RN and specializes in school nurse.

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You post about "many additional tasks, sicker patients" etc. then preclude the solution of better staffing/ancillary staff etc...

That's like saying "how do I get in better shape?" but please don't mention exercise.

Edited by Jedrnurse
typo

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Rose_Queen has 15 years experience as a BSN, MSN, RN and specializes in OR, education.

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2 hours ago, labordude said:

Many additional tasks are thrown at us, sicker patients are assigned to us, and we’re always asked to do more with less and do it faster.

Truly, the only way to fix this is to add staff, get ratios, and get ancillary staff. Just like Jedrnurse said, it's like trying to get something without doing the required parts.

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labordude has 14 years experience as a BSN, RN and specializes in L&D, OBED, NICU, Lactation.

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1 hour ago, Jedrnurse said:

You post about "many additional tasks, sicker patients" etc. then preclude the solution of better staffing/ancillary staff etc...

That's like saying "how do I get in better shape?" but please don't mention exercise.

Those things don't fix the profession, they fix the job. I'll admit my wording could have been better.

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Kitiger has 40 years experience as a RN and specializes in Private Duty Pediatrics.

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11 minutes ago, labordude said:

Those things don't fix the profession, they fix the job. I'll admit my wording could have been better.

Can you be more specific in what you mean by, "Fix the profession"? Are you referring to our relationships with other caregivers? Or are you talking about the way the healthcare system is set up? Something else?

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Jedrnurse has 25 years experience as a BSN, RN and specializes in school nurse.

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10 minutes ago, labordude said:

Those things don't fix the profession, they fix the job. I'll admit my wording could have been better.

I don't think you can separate the two. You would go a long way to "fix" the profession by making it more doable. That would be done by improving working conditions.

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labordude has 14 years experience as a BSN, RN and specializes in L&D, OBED, NICU, Lactation.

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2 hours ago, Kitiger said:

Can you be more specific in what you mean by, "Fix the profession"? Are you referring to our relationships with other caregivers? Or are you talking about the way the healthcare system is set up? Something else?

Well let's start

Education: The nursing education system needs a revamp. We need a single defined educational entry that allows one to sit for licensure. More focus needs to be placed on pathophysiology and other science-based curriculum topics and not as much on theories (sorry Jean Watson) at the entry to practice level. Since clinical experiences with live patients can continue to be limited, maximize simulation while finding alternative experiences that practice application of knowledge. Interdisciplinary training/classes are incredibly important and the earlier in the educational program for every discipline the better off for future collaboration. The NCLEX needs to add a hard lifetime limit. Other professions have this. Standardization of curriculum across states will also help. Residency/preceptorship programs need to be improved and also standardized. There exists best practice for many of these programs, but they aren't always used.

Nurses need to be more visible as community, organizational, and political leaders. Nursing is always considered one of the most trusted professions, but it's only recently we've started climbing up the list of most respected. When it comes to the future of care in the community and education to keep it that way, nursing must be on the forefront. Having representation at higher and higher levels of the government is necessary to have the voice heard. Very few members of Congress are nurses and as far as I can find, a nurse has never become a U.S. Senator (one from TN tried but she didn't win back in 2006). Also, did you know that in some states, in court a physician can be an expert witness on nursing standards of care?

I won't argue that resources aren't an issue, but having seen this from the top down in several organizations, it has often come down to poor planning, budgeting, and forecasting. The organizations that handled this better were ones where nurses had voices higher up that were listened to. I have seen plenty of organizations where nurses are in visible positions of title that either have absolutely no business being there or are simply great "yes men/women" (although this happens in all industries).

There is an experience/complexity gap with staff today. The "shortage" is because we have a glut of inexperience not a number deficit. Healthcare itself needs a gut check and must work on increased collaboration across disciplines which includes less improvement in silos and more truly impactful projects. This silo issue is a reason why many initiatives (in healthcare and outside) fail due to lack of actual stakeholder input.

Since we know we are going toward a more electronic system and the ones we have now had nursing input...mainly after the fact, it's time to fix that for the next generation. Regulatory requirements put a huge damper on things, though if we stuck to one it would still be easier (e.g. something like using CMS rules for documentation and other insurers accept those). A lot of this is driven outside and away from the bedside BECAUSE there are no nurses there.

I've worked for some amazing organizations who did so many things well and also for others where the left and right hand actively hid things from one another. I've worked in positions from bedside staff nurse to right-hand of the COO & CFO and many things in-between. I'm not trying to say all of this should/would/could/can be done, it's just things that I believe would help.

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TriciaJ has 39 years experience as a RN and specializes in Psych, Corrections, Med-Surg, Ambulatory.

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Nurses need to be prepared to nurse, first and foremost.

There was a time when nursing was an entry-level job.  Young girls came in off the farm, were put to work scrubbing hospital floors, then worked their way up.  Somewhere along the way it was decided that a little formal education would come in handy.  Hospitals developed schools of nursing.

Then someone decided that you couldn't be a true professional without a university degree.  That wasn't a bad idea either.  Then advanced degrees got added.  No problem there.

Except our education is taking us farther and farther from the actual bedside.  If this forum is anything to go by, so many people study nursing for the express purpose of doing anything but nursing.  Even the nurses who choose to be at the bedside are dragged away by the multiple peripheral demands.  Who is providing the actual  hands-on care while we're tied up  with computers and other paraphernalia?  CNAs, that's who.  People with very limited education are providing the bulk of nursing care.

I guess it all comes back to staffing.  If facilities were appropriately staffed, then patients would be receiving their care from the people who have been extensively educated to provide that care.  This is not a slam on CNAs or ancillary staff.  It's just that we've come full circle by educating ourselves away from our patients.

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Emergent has 25 years experience.

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I'd like all nurses to have good grammar and present themselves as educated professionals. 

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TriciaJ has 39 years experience as a RN and specializes in Psych, Corrections, Med-Surg, Ambulatory.

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5 minutes ago, Emergent said:

I'd like all nurses to have good grammar and present themselves as educated professionals. 

Amen to that.  We all make occasional typos, but nothing is more cringe-worthy than seeing someone with alphabet soup after their name demonstrate the writing skills of a third-grader.

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I don't think nursing as a profession will improve until nurses band together and get on the same page.... as a profession. We are one of the only professions where there is infighting about the most minute things, including titles and specialties.

For example, teachers band together to demand higher pay and lately there has been a nationwide push to pay teachers more. Meanwhile, nursing wages have been stagnant while duties continue to increase. Our pay does equate what we're expected to do. They have basically pushed nurses to do the job of many while only being paid for one. Patients suffer, nurses suffer, our families suffer, etc.

Second example, police unions support their officers, even when they're dead *** wrong. We lack nursing unions yet we're one of the only professions where someone can beat the hell out of you and you'll lose your license for defending yourself. There have been numerous stories lately where nurses are murdered or assaulted on the job. Yes, some of them are domestic issues but many are not.

These are just a couple of examples. I have many more. The gist is until we stand together, no one will take us serious.

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On 2/17/2020 at 10:42 PM, Emergent said:

I'd like all nurses to have good grammar and present themselves as educated professionals. 

On 2/17/2020 at 10:49 PM, TriciaJ said:

Amen to that.  We all make occasional typos, but nothing is more cringe-worthy than seeing someone with alphabet soup after their name demonstrate the writing skills of a third-grader.

But I might want to use bad grammar. You know, not all of us used huktd own foneks! 🤪

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