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

BSN-to-MSN, ADN, BSN, RN · Feb 20, 2020

7 hours ago, DeeAngel said:
Nothing will change in nursing until chronic institutional understaffing is no longer the norm.

Yes, I agree. Understaffed and floating to staff other units when mine is short. Management expects the same level of care and to answer call lights right away.

Closed Account 12345 · Feb 20, 2020

-Improved undergraduate education with a standardized entry to practice, including more focus on pathophysiology, pharmacology, nursing assessment, achieving competence in nursing skills beyond a single check off, better coverage of legal concepts like scope and standards of practice, MANY more real world clinical hours worked with nurse preceptors, introductions to improving clinical documentation and case management concepts, and stronger critical thinking skills, i.e. Your patient has X medical history, physical assessment, vitals, labs, and is in X cardiac rhythm. What assessment findings would concern you during your shift? What nursing actions do you anticipate implementing, and why? If X complication arises, how will you respond? Are all of the existing orders safe and appropriate for this patient?

-Longer on the job orientation/residencies across the board for all new graduates with supportive preceptors who are compensated accordingly

-Readily available specialty training/residency programs for experienced nurses who'd like to work in a new field, which requires acknowledgement that nurses are not interchangeable and that working in new roles requires new education, still paying these nurses for the knowledge and experience they bring to the table from their previous work instead of requiring big pay cuts

-Requirement for 2+ years in specific role/specialty before acting as charge nurse, better leadership training for charge nurses, no patient loads for charge nurses, better compensation when acting as charge

-Immensely more professionalism- less cliques, less cattiness, less drama, less for-show martyrdom, more support for peers, better attitudes at work, improved written and verbal communication skills

-And yes... lower nurse to patient ratios, more unlicensed assistive personnel available in all units so nurses can focus on true nursing

Wuzzie · Feb 20, 2020

Recognize nurses as actual providers and bill for service by acuity. I am not a chair or a bed and I shouldn’t be billed as part of the room cost.

And everything FacultyRN said ^^^

vintagemother, BSN, CNA, LVN, RN · Feb 21, 2020

On 2/17/2020 at 4:18 PM, labordude said:
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.

Nurses need to be kind to other nurses. If there is a problem, there should be a way to address the issue without It being punitive. Seriously, just a way to offer feedback to help the other person.

guest974915 · Feb 21, 2020

On 2/17/2020 at 6:45 PM, labordude said:
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"

^^^^Completely agree! I have long thought that academia is entirely out of step with nursing practice. At the curricular level, I remember the hours and hours spent in the classroom learning NANDA nursing diagnoses. In the real world, no one give two whits about care planning (other than to check off the mandatory boxes in their documentation). Then, as touched on above, nursing theory-I'm sorry but some of these theories are so arcane and just wacky-really? No practical application whatsoever! Lastly, APA ad nauseum; When what you say (write) means little but the complete preoccupation with capitalization, commas, and citations-give me a break!

TheDudeWithTheBigDog, ADN, RN · Feb 21, 2020

On 2/19/2020 at 9:45 PM, HomeBound said:
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.

As a student, I'm OK with this in the classroom. That's supposed to be teaching me to pass the exam. Where I personally think my school is completely failing me is that I'm graduating soon, and clinical is still 99% being a glorified unpaid CNA. I'm barely learning to apply anything to the real world. I'm so tied up doing bed baths and feeding, and vitals, and literally everything else that the aide is supposed to do, that I'm missing the entire side of nursing beyond "skills." I'm sure I'll pass the exam, and I can put a foley in just as good as literally everyone else who's ever been trained to put a foley in, but for actually being a nurse... The only way I feel safe towards my patients right now is to just drop out, stay a CNA, and start over at a better school.

I think schools need to get rid of the idea that we're there to kiss the hospital's ***. We should help out when we can, and the basics should be taught, but when we graduate, that hospital wants a nurse, not an aide. My clinical now, in our last semester, isn't even preparing us for the level of understanding that I use at work as an aide, and this is the education from a long-time ACEN accredited college that I'm relying on to move up to something harder. Luckily, the hospitals around me are on top of recruiting for residencies since they've also noticed that after graduation, we should not be on the floor as a nurse, and they're going to fix that.

While we're at it, let's kick ACEN and CCNE out of the schools. All they're accomplishing is making millions off of these schools getting hyperfocused on keeping or gaining their accreditation, that quality of educuation gets replaced with better statistics, and the only people who suffer when a school can't get accredited are the students that go to that school, while the school still fills every spot in the program. It has nothing to do with the quality of education.

And nursing needs some changes in how it works with other people. It's like the only opinion from a doctor that matters is one that has an MD after his name. When someone is having serious dehydration problems, you'd think a dentist would be on the list of who they need an appointment with when they're discharged... But nope! Just follow up with your regular doctor who has absolutely no training in dentistry. Ophthalmologists and optometrists are literally never consulted with there's any issues going on with the eye, it's like we completely forget that they're even doctors. But they have diarrhea after they drank too much milk, we better call their doctor and get a specialist in there and get some labs done.

DTWriter · Feb 21, 2020

Get some stakes, a matchbox, some matches, and a bunch of patients' survey forms together...

On a serious note:

It would be nice for all nursing programs to make it a point to prep students for the NCLEX and make sure that the students have their techniques down cold (i.e. starting an IV, maintaining an IV, starting a feeding tube, reassessing, etc.). It is no longer acceptable or fair to get students in the mindset that the employer will give them training in whatever procedure they did not get to do on clinical rotations; more and more employers expect the students now RNs to hit the ground running on day one.

Guest856929 · Feb 21, 2020

On 2/17/2020 at 3:18 PM, labordude said:
"Nursing as a profession is in definite need of improvement as we go forward into the future."
Some people rightfully question whether nursing is even a profession, or more of a vocation. Excluding graduate degree gigs, most of nursing is vocational, especially bedside nursing, including but not limited to ER and ICU. In the 21st century, it is still more of an art than a science. Quite unfortunate.
This might be controversial, but I think more men are needed in the "profession" for a variety of reasons. We also need to devaluate the emphasis on nursing theories in the spheres of academia past the baccalaureate level (which should be the minimum entrance level).
Graduate prepared advance practice nurses focusing on clinical practice should all be at the doctoral level. Scrap away LPNs, ASNs and clinical MSNs. We can start there and move forward. As such, nursing will be more competitive, salaries will be higher, and respect will rightfully be earned in the profession.

QuestionableTimes · Feb 22, 2020

22 hours ago, tonyl1234 said:
As a student, I'm OK with this in the classroom. That's supposed to be teaching me to pass the exam. Where I personally think my school is completely failing me is that I'm graduating soon, and clinical is still 99% being a glorified unpaid CNA. I'm barely learning to apply anything to the real world. I'm so tied up doing bed baths and feeding, and vitals, and literally everything else that the aide is supposed to do, that I'm missing the entire side of nursing beyond "skills." I'm sure I'll pass the exam, and I can put a foley in just as good as literally everyone else who's ever been trained to put a foley in, but for actually being a nurse... The only way I feel safe towards my patients right now is to just drop out, stay a CNA, and start over at a better school.
I think schools need to get rid of the idea that we're there to kiss the hospital's ***. We should help out when we can, and the basics should be taught, but when we graduate, that hospital wants a nurse, not an aide. My clinical now, in our last semester, isn't even preparing us for the level of understanding that I use at work as an aide, and this is the education from a long-time ACEN accredited college that I'm relying on to move up to something harder. Luckily, the hospitals around me are on top of recruiting for residencies since they've also noticed that after graduation, we should not be on the floor as a nurse, and they're going to fix that.
While we're at it, let's kick ACEN and CCNE out of the schools. All they're accomplishing is making millions off of these schools getting hyperfocused on keeping or gaining their accreditation, that quality of educuation gets replaced with better statistics, and the only people who suffer when a school can't get accredited are the students that go to that school, while the school still fills every spot in the program. It has nothing to do with the quality of education.
And nursing needs some changes in how it works with other people. It's like the only opinion from a doctor that matters is one that has an MD after his name. When someone is having serious dehydration problems, you'd think a dentist would be on the list of who they need an appointment with when they're discharged... But nope! Just follow up with your regular doctor who has absolutely no training in dentistry. Ophthalmologists and optometrists are literally never consulted with there's any issues going on with the eye, it's like we completely forget that they're even doctors. But they have diarrhea after they drank too much milk, we better call their doctor and get a specialist in there and get some labs done.

Just FYI ophthalmology is a medical specialty... I don’t think it’s a doctor of ophthalmology, but a doctor of medicine that is board certified in ophthalmology.

CKPM2RN, ASN, EMT-P · Feb 22, 2020

On 2/19/2020 at 10:34 PM, perc71 said:
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.

I find it quite humorous that you spelled profession incorrectly.

MJJFan1, BSN, RN · Feb 22, 2020

I think it starts with nursing schools. There seems to be such a difference from when I came through. I believe we should also invest more in our preceptors. That’s what makes or breaks new nurses.

TriciaJ, RN · Feb 22, 2020

57 minutes ago, CKPM2RN said:
I find it quite humorous that you spelled profession incorrectly.

I didn't even notice that. I got stuck on "bachelorette" degree.