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 2/21/2020 at 9:15 AM, tonyl1234 said:
...clinical is still 99% being a glorified unpaid CNA.
Many of us do not see a distinction between "nurse work" and "CNA work". "CNA work" is just the aspect of our jobs that we can safely and legally delegate.
I think schools need to get rid of the idea that we're there to kiss the hospital's ***.
Unfortunately, schools do need to kiss the hospital's *** in order to be allowed to place students there. Schools are dependent on hospitals to provide clinical opportunities.
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...
Without any accrediting process, schools would be freer to take your money and provide little in the way of education. There's a reason licensing boards and employers shy away from graduates of unaccredited schools.
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...
Not sure what this is about. Are you thinking there needs to be a more comprehensive referral process? I think it may well be within the scope of a nurse to suggest a patient with dehydration seek regular dental care. If you think we're falling short of making important referrals, you may be right. I think this is likely just another function of staffing, time constraints and having to discharge patients on the fly.
Specializes in Former NP now Internal medicine PGY-3.
What do you want out of it?
its one of the highest paying 2 year degrees out there. Only thing I could see fixing issues is staffing ratios and protecting nurses from abusive patients.
if you want my opinion they need to ditch most of the psychological and sociological theories put into nursing and care plans. I feel these aspects and “nursing” diagnoses are just an illegitimate attempt to legitimize the profession but don’t really add much to patient care. More science less sociology
We should also try to reduce all the psychosocial jargon and APA paper pumping done in nursing curriculum. Seriously. Just stop! I know the nursing profession wants to DESPERATELY be taken seriously but making students pump out papers about holistic care and patient centered theories BLAH BLAH BLAH, is not going to help. Too much touchy feely stuff. Let’s incorporate more science, especially biology/biochemistry. This will also raise the standards for WHO gets in to nursing.
Let’s add more pharmacology classes. Let’s add more pathophysiology classes. Let’s cut back on the humanity/psychosocial theories.
Increase the clinical requirements. Make them REAL clinical rotations. Students should be receiving quality clinical rotations.
Sadly most schools only care about making money. Tons of degree mills out there. Pumping out nurses and even NPs left and right. These NPs never even touched a patient (direct entry) in their life, beyond their “clinical” in nursing school. Then they go out and prance around and act like they can just treat anyone.
Specializes in Former NP now Internal medicine PGY-3.
1 minute ago, QuestionableTimes said:
We should also try to reduce all the psychosocial jargon and APA paper pumping done in nursing curriculum. Seriously. Just stop! I know the nursing profession wants to DESPERATELY be taken seriously but making students pump out papers about holistic care and patient centered theories BLAH BLAH BLAH, is not going to help. Too much touchy feely stuff. Let’s incorporate more science, especially biology/biochemistry. This will also raise the standards for WHO gets in to nursing.
Let’s add more pharmacology classes. Let’s add more pathophysiology classes. Let’s cut back on the humanity/psychosocial theories.
Increase the clinical requirements. Make them REAL clinical rotations. Students should be receiving quality clinical rotations.
Sadly most schools only care about making money. Tons of degree mills out there. Pumping out nurses and even NPs left and right. These NPs never even touched a patient (direct entry) in their life, beyond their “clinical” in nursing school. Then they go out and prance around and act like they can just treat anyone.
I'm a diploma grad. I think most of us would agree that diploma grads were ready to hit the floor running, back in the day. But that was 40 years ago. We know so much more now, especially concerning physiology and pharmacology.
So, we've lengthened the programs from 3 years to a 4 year BSN. That was a start. The problem - in my opinion - is that we did away with too much of the diploma program. Instead, we should have added our increased knowledge to the basic program.
Even 40 years ago, I remember new BSN grads who had never started an IV or done a complex dressing change. They had never had more than 3 patients at a time. They made good nurses, if they survived the first year.
Why? Why send out nurses who are not prepared to work as an RN?
Why do the nursing schools expect the hospitals to finish teaching new grads how to be nurses?
I get that bed baths are a part of nursing. But is focusing on doing bed baths help build my judgement skills on the level of an RN? How does feeding a patient help me with understanding the reasoning behind why certain medications are being given? Why am I focused on BELOW my current job? WOW!! am I learning by continuing to do the exact job that the aide does? Clinical is supposed to be where you put all of your learning together, the focus should be way higher level than making sure linens are changed when you're about to graduate. Do you really not see a problem that so many schools have almost no patient interaction at the level of a nursing student?
EVERY nursing school is accredited. Both by the state BON, and the regional accreditation that's required to be a college. ACEN and CCNE do not mean that any school is better than the other. These two boards make MILLIONS every year to create this illusion. I know nurses who graduated from schools without these accreditations who run circles on people who do. Employers stay away from these graduates because as a country, we're easily manipulated by marketing. That's how apple so easily sells old technology for more than it cost new. Because it was marketed as better and people bought into it. There's already an accreditation that determines whether or not the school is up to safe standards and that it's putting out qualified and competent new graduate RNs, it's called the state board of nursing.
As for kissing their asses: Until I'm getting paid, I AM NOT a replacement for their aide. I'm there to learn, not to work. And that's a difference I think a lot of you are missing and just going along with it because that's how it was when you went to school. I'm not an employee at the hospital where I do my clinicals. If I'm "working" and a patient gets hurt, it's not just risking my future license, it's risking losing my home and everything I have in lawsuits.
I get that bed baths are a part of nursing. But is focusing on doing bed baths help build my judgement skills on the level of an RN? How does feeding a patient help me with understanding the reasoning behind why certain medications are being given? Why am I focused on BELOW my current job? WOW!! am I learning by continuing to do the exact job that the aide does? Clinical is supposed to be where you put all of your learning together, the focus should be way higher level than making sure linens are changed when you're about to graduate. Do you really not see a problem that so many schools have almost no patient interaction at the level of a nursing student?
. . .
As for kissing their asses: Until I'm getting paid, I AM NOT a replacement for their aide. I'm there to learn, not to work. And that's a difference I think a lot of you are missing and just going along with it because that's how it was when you went to school. I'm not an employee at the hospital where I do my clinicals. If I'm "working" and a patient gets hurt, it's not just risking my future license, it's risking losing my home and everything I have in lawsuits.
Nursing school is a joke.
As students, we did primary care on our patients. Bed baths helped us observe the work of breathing, and how they completed their ADLs. We did a complete skin assessment, looking for edema and for signs of poor circulation, among other things. We did informal teaching as we helped them with their ADLs. We had to be able to tell our instructor why our patient was on a certain diet, we had to know every med our patient was taking (class, side effects, interactions, etc.). We had to understand why the med was ordered, and whether it was likely to be long-term or not. We assessed out patient's knowledge and did more formal teaching.
We never worked simply as aides unless it was a weekend shift as a part time worker who earned a wage.
We started out with one or two patients the first year. Even then, we read the charts, looked up the labs, did dressing changes, monitored IVs, and called the doctors with our concerns. By the third year, we were team leading with a full load. By team leading, I mean we no longer did mostly hands-on care. We took one or two patients and had others that the aides working under us (and our preceptor) did. We were overseeing the care. We still did all the dressing changes, preps, handled the IVs, etc..
When we graduated, we worked as GNs (Graduate Nurses) until we took the boards, then we became RNs. But even as GNs we took a full load. Orientation usually meant learning the unit's routine, and where to find supplies. We didn't have long internships to teach us how to work as floor nurses. We knew how to do that.
If you don't have the time management skills to do the bed baths, dressing changes, etc., while also doing the rest, then you are not ready to work in the hospital. And that's why so many new grads are so stressed.
I get that bed baths are a part of nursing. But is focusing on doing bed baths help build my judgement skills on the level of an RN? How does feeding a patient help me with understanding the reasoning behind why certain medications are being given? Why am I focused on BELOW my current job? WOW!! am I learning by continuing to do the exact job that the aide does? Clinical is supposed to be where you put all of your learning together, the focus should be way higher level than making sure linens are changed when you're about to graduate. Do you really not see a problem that so many schools have almost no patient interaction at the level of a nursing student?
EVERY nursing school is accredited. Both by the state BON, and the regional accreditation that's required to be a college. ACEN and CCNE do not mean that any school is better than the other. These two boards make MILLIONS every year to create this illusion. I know nurses who graduated from schools without these accreditations who run circles on people who do. Employers stay away from these graduates because as a country, we're easily manipulated by marketing. That's how apple so easily sells old technology for more than it cost new. Because it was marketed as better and people bought into it. There's already an accreditation that determines whether or not the school is up to safe standards and that it's putting out qualified and competent new graduate RNs, it's called the state board of nursing.
As for kissing their asses: Until I'm getting paid, I AM NOT a replacement for their aide. I'm there to learn, not to work. And that's a difference I think a lot of you are missing and just going along with it because that's how it was when you went to school. I'm not an employee at the hospital where I do my clinicals. If I'm "working" and a patient gets hurt, it's not just risking my future license, it's risking losing my home and everything I have in lawsuits.
Nursing school is a joke.
Not sure what school you went to but doing the basics is part of being a RN. Not all units have enough aides to do all the baths etc. It is hard be a leader if you are not willing to do the basic yourself. Sometimes the basic is all the patient needs beside some IV meds. The basics are not below you. You are right nursing school is to help you but it all together and one of these is time management and learning how to juggle different patients needs at the same time.
TriciaJ, RN
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