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

[labordude]

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.

[Subee2, BSN, MSN, CRNA]

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

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.

I you want to see the BON become independent from the state government, then who would pay for this independent entity that governs nursing? I don't think nurses are willing to pay higher licensing fees.

[Nurse Beth, MSN]

On 2/25/2020 at 1:37 PM, tonyl1234 said:

Do you really not see a problem that so many schools have almost no patient interaction at the level of a nursing student?

Good point, yes it's a problem. Hospitals are de facto nursing schools to new grads.

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.

The BON/BRN approves nursing programs but does not accredit.

It's possible for a program to be BON/BRN approved but not ACEN/CCNE accredited. Doesn't necessarily mean it's not a good program, but there can be challenges transferring credits and obtaining federal loans..

[Serhilda, ADN, RN]

On 2/25/2020 at 4:37 PM, tonyl1234 said:

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.

I wholeheartedly agree with you about nursing school, even though this wasn't my experience. Some of it depends on the hospital's attitude toward students. The culture on allnurses probably won't mix well with what you've said though because it draws a clear distinction between a CNA and an RN. Yes, we do more. Yes, we know more. Therefore, we need to do more while in school. We need to be teaching our nursing students to start MANY IVs, insert NG tubes, and how and why to titrate drips. Emphasizing the importance of these skills is not the equivalent to degrading what CNAs do. We need new nurses to hit the ground running but that'll never happen if we're sending nursing students off to do every bed bath because we're short staffed.

[caliotter3]

On 2/17/2020 at 7:42 PM, Emergent said:

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

Yes. Add a mandatory pass English usage test to the usually required math calculation test. If you don’t want to take up classroom time, then place it as part of the nursing school application process (and make the test meaty, not an excuse that everyone passes without a thought).

[labordude, BSN, RN]

9 hours ago, Serhilda said:

I wholeheartedly agree with you about nursing school, even though this wasn't my experience. Some of it depends on the hospital's attitude toward students. The culture on allnurses probably won't mix well with what you've said though because it draws a clear distinction between a CNA and an RN. Yes, we do more. Yes, we know more. Therefore, we need to do more while in school. We need to be teaching our nursing students to start MANY IVs, insert NG tubes, and how and why to titrate drips. Emphasizing the importance of these skills is not the equivalent to degrading what CNAs do. We need new nurses to hit the ground running but that'll never happen if we're sending nursing students off to do every bed bath because we're short staffed.

There is a distinct difference between the skills necessary to place an IV or an NG tube and the assessment/knowledge/etc needed to titrate drips. It is this difference that forms the major gap between CNAs and RNs. Give me a new grad with a strong physiologic and a pharmacologic knowledge base any and every day and I can teach them physical skills like IVs, NGs, and Foleys. The opposite situation is much more difficult.

[TheDudeWithTheBigDog, ADN, RN]

On 2/27/2020 at 10:30 AM, labordude said:

There is a distinct difference between the skills necessary to place an IV or an NG tube and the assessment/knowledge/etc needed to titrate drips. It is this difference that forms the major gap between CNAs and RNs. Give me a new grad with a strong physiologic and a pharmacologic knowledge base any and every day and I can teach them physical skills like IVs, NGs, and Foleys. The opposite situation is much more difficult.

Yeah. I know nurses who have been doing it for 30+ years who always have someone else start an IV because they just know they're bad at it. But they're still better nurses than everyone else on that floor. But that's because they're good at knowing how to react to changes, knowing what they need to do to take care of the patient's actual diagnosis. This is the stuff that giving a bed bath isn't teaching me. This is stuff that the only way I'm going to learn is by actually being there with the nurse when it happens.

To whoever it was that pointed it out, I completely understand that in the real world, RNs have to give bed baths. But I'm not an RN. I'm not an aide at that hospital. I'm a student. I'm there to learn, not work. And this is a concept that it seems like people forget.

My average day working as a CNA is on a higher level than my time in clinical as a nursing student. Something is seriously wrong with that. I'm not in clinical to become an RN, I'm in clinical to become a CNA.

[Orion81RN]

On 2/27/2020 at 9:30 AM, labordude said:

There is a distinct difference between the skills necessary to place an IV or an NG tube and the assessment/knowledge/etc needed to titrate drips. It is this difference that forms the major gap between CNAs and RNs. Give me a new grad with a strong physiologic and a pharmacologic knowledge base any and every day and I can teach them physical skills like IVs, NGs, and Foleys. The opposite situation is much more difficult.

True, but....I'm STILL not being taught. When do you have time for that being short staffed? I had strong physiologic and pharmacologic knowledge upon graduating but was one of the students who did practically nothing in clinical, skill wise. Then big surprise when I'm stuck in this scenario...

I'm working at a post acute rehab center and admit a pt to diurese r/t CHF. I can go on and on about her diagnosis, the pathophysiology behind it...I can tell you the tx required...BUT I CAN'T START THE DANG IV! I can't even find all the supplies necessary to do so. So I ask for help from the whopping 2 other nurses working, but guess what? They are extremely busy with their own patients...you know, the whole staffing issue we're not supposed to talk about. The ENTIRE shift I'm constantly asking my coworker if she is ready to help me. It took her til 10pm. The pt's son is understandably pissed. He puts in a complaint about me. Management writes me up and tells me I should have asked for help. ?‍♀️ By the time that other nurse came to help me do you think she was in a teaching mood? No, it was a hurry up and get this done quickly before the family absolutely snaps scenario.

I'm the first to say nursing students need to make the best out of their clinical experience. Giving a bed bath is great for assessment. If you are asked to give someone a bed bath, even if you weren't assigned to that pt, you should still be listening to their lungs, heart etc. BUT by the time you are in your second year that should NOT be the only thing you are doing. Students should be allowed to look for skills opportunities throughout the floor, regardless of if its "your patient" or not.

What was I doing my second year? I recall one time my clinical instructor forcing me to be the aide on the floor bc they were short staffed. I got an entire assignment of patients. My instructor did not assign me patients that day for "nursing." No med pass, nothing. So I didn't even have time to play nursing student and learn with those patients. I was part of the hustle. That is absolutely bogus and not what I paid for. Here I am, 8 years out, and incredibly unconfident in skills. I've started maaaybe 3 IVs and inserted 2 foleys.

[NurseBlaq]

33 minutes ago, Orion81RN said:

What was I doing my second year? I recall one time my clinical instructor forcing me to be the aide on the floor bc they were short staffed. I got an entire assignment of patients. My instructor did not assign me patients that day for "nursing." No med pass, nothing. So I didn't even have time to play nursing student and learn with those patients. I was part of the hustle. That is absolutely bogus and not what I paid for. Here I am, 8 years out, and incredibly unconfident in skills. I've started maaaybe 3 IVs and inserted 2 foleys.

Say what now? No way in hell would I have been the free help with a full assignment as though I were staff. You basically paid to do free labor. I would have filed a long, documented complaint to the Dean of Nursing. There are many violations I can think of off top. What were your classmates doing in clinicals? Did they have assignments too? That's bunk!

[Orion81RN]

On 2/24/2020 at 6:17 AM, Kitiger said:

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 didn't so much as change an IV dressing in nursing school let alone a "complex" dressing change. Our school only had us take on a 3rd patient (2 patients) the last week of clinical. And for some reason, I still only had one patient assigned to me. Ridiculous.

[Orion81RN]

12 minutes ago, NurseBlaq said:

Say what now? No way in hell would I have been the free help with a full assignment as though I were staff. You basically paid to do free labor. I would have filed a long, documented complaint to the Dean of Nursing. There are many violations I can think of off top. What were your classmates doing in clinicals? Did they have assignments too? That's bunk!

My classmates were learning with their assigned patients. I was completely left out of clinical that day. I worked as a CNA/sitter, so my instructor offered me up. She DID ask me. But it wasn't really a question if you know what I mean. I was walking on thin ice with a false accusation as it was. So my instructors hated me.

[NurseBlaq]

3 hours ago, Orion81RN said:

My classmates were learning with their assigned patients. I was completely left out of clinical that day. I worked as a CNA/sitter, so my instructor offered me up. She DID ask me. But it wasn't really a question if you know what I mean. I was walking on thin ice with a false accusation as it was. So my instructors hated me.

Understood but it's still no way to treat a student. You had crummy instructors. She sort of abused the situation and took advantage of your prior work experience to rescue the staff, again for free. You didn't sign up for that. I hope she's not still teaching. And yeah, I get the ask part, but in reality it was more like an order. I've been there before but at work, not in school in that situation.

[kbrn2002, ADN, RN]

I'm sure it's already been said but here's my $.02 for what it's worth. Nurses are not maids nor are we waitresses, plumbers, electricians, cable or computer repair etc. Patients are not customers.

I blame the powers that be who came up with the brilliant idea to tie repayment of medical services to a customer satisfaction survey. I'd love to try that concept with my bills. There wasn't anything good on cable TV this month, I'll give them a bad survey so I don't have to pay as much. Now doesn't that sound ridiculous? Yet that is exactly what health care has become.