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.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
On 2/17/2020 at 10:56 PM, NurseBlaq said:
But I might want to use bad grammar. You know, not all of us used huktd own foneks! ?
Well, there's that. I was lucky to have been taught phonics in primary school. I know a lot of people didn't get that and it has to have made things harder. But dang - doesn't higher education have a rudimentary language proficiency requirement?
Well, there's that. I was lucky to have been taught phonics in primary school. I know a lot of people didn't get that and it has to have made things harder. But dang - doesn't higher education have a rudimentary language proficiency requirement?
I wonder how some people got through the basic English Comp classes.
First dart acting like professionals. One way is to stop taking on all tasked assigned because it’s for the patient. Do you see any other professions take on room cleaning etc? As long as we allow us to be treated as servants instead of professionals we will not be looked on as one. Also, we need to act as professionals and stop with the silly says on shirts like nurse call the shots etc. You do not see other professions that sound like they are in middle school.
Specializes in ER, ICU, Infusion, peds, informatics.
I've always believed that one of the primary responsibility of a nurse is to monitor the patient. Nurse monitor for changes, for responses to medications, responses to treatments. That's how problems are caught early.
Years ago, some efficiency expert (non-medical) posted here about a family member's hospitalization and how the nurses didn't have enough to do. That poster didn't realize how much nursing can/should be a thinking job, not just an active job.
Those parts of nursing are really important to the overall care of our patients, but tend to be skipped when you have too much running around to do. I guess it is part of good staffing ratios, but part of the reason why good staffing ratios are important is so that the monitoring aspects of our job can be done.
Specializes in MICU/CCU, SD, home health, neo, travel.
19 hours ago, 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.
Especially when they're your manager. This has actually happened to me!
Aside from that, and preparation, let's please get AWAY from the "business model" of nursing. In fact, let's get away from it in the whole healthcare profession, please. We are supposed to be about taking care of PEOPLE, not the bottom line. Let's get back to that. And let's go back to proper preparation. More clinicals. Less theory. The old diploma model had a lot to be said for it, and there's a lot from that which needs to be incorporated into modern nursing education. Please don't come at me with the "anyone can learn to blah blah blah in the year after they graduate but they need to learn all this theory first". No they don't. They can learn it concurrently. And you don't need to know calculus to be a good nurse when simple algebra will do, but you do need to know how to make a patient comfortable and how to treat that patient like a human being, not a piece of a profit and loss statement.
Have nurses work together and not form cliques and bully people. I’ve seen it a lot and it makes for a tense environment. It also doesn’t promote teamwork... who would want to go ask a bully for help? I also believe that nurses are expected to do too much, the remote is broken, garbage needs to be changed, calling family members, clerical work, etc... the nurse is expected to take care of it. I’ve worked places that won’t staff properly and on top of it we won’t have a CNA or a secretary, phlebotomists, EKG techs, etc. I wish the burn out wasn’t a real thing, unfortunately it is though.
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.
There is one thing which would do the job. It is making nurses and care they provide FINANCIALLY visible.
That was, essentially, what Florence Nightingale did to justify the necessity of existence of nursing as a separate profession. Initially, it all had nothing to do with education or anything else except for the fact: solgiers in Scutari stopped dying like flies and money stopped to flow into bottomless hole because there were nurses. Just showing exactly how much, in dollar equivalents, nursing actions contribute (or may be not) to the outcomes in healthcare would make nurses $-winners for the industry, not pure spenders which they are at the present time. And once there will be hard number of $$$ nurses contribute, they get attention and care they deserve.
The problem is how to do it. To answer just one rather simple question: which NURSING interventions are the most effective in inpatient pain management, under which conditions, and how much performing these interventions can potentially decrease the length of admission or risk of complications from opioid analgetics - will take multiple studies and years of time, with close to 100% guarantee to create a lot of very unhappy "customers", in the hospital rooms and beyond them. There are tons of people who for their lives won't allow bedside nurses to practice to the full extent of their knowledge and abilities instead of just obediently picking up a phone "to let doctor know" for yet another order for something for something. Some of these people hold the ties of really Big Money Bags. And some of others, sadly, belong to nursing profession on its every level.
Well, better incorporate those programs into current nursing education programs. We need to start from the bottom up. Better preparing students will hopefully lead to better prepared nurses.
Stop monetizing every aspect of nursing, thereby incentivizing the hyper-competitiveness.
Stop bonuses for Nurse Managers and Directors that incentivize stripping nursing staffing to the bone. (this is NOT about safe staffing. this is about an almost criminal enterprise to maximize profit over people)
Knock off the "divide and conquer" techniques--you know the ones---pitting nurse against nurse by allowing favoritisim, nepotism and cronyism. Fairness documented with actions and consequences for all. "The law applies to thee, and not me."
Cut the cord between the schools and the hospitals---cut off the pipeline. Instructors that inculcate the nursing students to the politics of "the only way to be a 'good nurse' is to spend thousands you don't have on an education you don't need".
Bring in unbiased public scrutiny to the "residency" programs and the hiring processes ---as in, a public member board that oversees the fairness of hiring qualified nurses. Nursing has become one big club---and if you aren't in it, or you pi$$ someone off for any reason, you can literally lose everything you have.
End the Boards of Nursing as "public protectionists"---make them independent of the state legislatures---where there would be an equal number of public, professional and legal members to oversee the profession in each state---answering to a centralized, standardized body that is fair, free of political money, and as unbiased as possible.
Knock off the constant, unrelenting push to do nothing but learn how to pass the NCLEX on the first try with nursing schools. Cutting good people who would most likely make excellent nurses---because they aren't predicted to pass the NCLEX on the first try. NURSING SCHOOL IS NOT ABOUT NURSING. Which begets the problem that NEW GRAD NURSES ARE BURNING OUT AND FEELING WORTHLESS when they become nurses----because they were never taught to BE nurses in school! Get this garbage OUT of the schools.
I stringently object to the question and the caveat---I want to improve nursing but don't ask me to do the obvious---treat the nurses with respect and pay them a fair wage.
What the blahblahblah ever. How about deal with THOSE basic human rights FIRST and we can talk about "how to improve nursing".
The fact that nurses are treated like cattle is the problem that begets all of the other problems like rampant bullying, favoritism, soaking the students of every penny out of fear.
Which goes back to monetizing the entire field of nursing. You must have the CEN. and then the AACN. and then be a member of the ANA. and then do another certification. and another. and buy another book to be a better nurse to pass another test.
Knock that garbage off---and deal with the basic things you want to ignore---SAFE STAFFING and ADEQUATE PAY---and you'll improve nursing.
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.
There are some valid arguments that suggest the nursing is not truly a proffesion since there are many pathways a student can go to be NCLEX ready, ADN, ADN-Bridge, BSN, Diploma post bachelorette degree in another field, etc. IOM is recommending that the entry level should be BSN which I advocate. BSN provides a broader training.
Standardized education thru BSN route and simply have a grandfather's clause in those Nurses who are ADN or diploma.
TriciaJ, RN
4,328 Posts
Well, there's that. I was lucky to have been taught phonics in primary school. I know a lot of people didn't get that and it has to have made things harder. But dang - doesn't higher education have a rudimentary language proficiency requirement?