Just one persons opinion

Published

To all "experienced" nurses. Please help me with this issue. I need to know if I'm being overly sensitive or have I once again been slapped in the face by an organization that promotes itself as having my best interest at heart. When I got home yesterday I found the newest edition of The Maryland Nurse in my mailbox. In need of some light reading a bold statement on the front page caught my eye, "You can't take care of your patient if you don't take care of yourself and your profession." I had to read on only now I wish I hadn't. Tim Porter-OGrady, DM EdD, APRN, FAAN is further quoted as saying "experience is not sufficient for competence." "A nurse with years of experience is experienced in an age that we are now leaving behind." He goes on to profess the wonders of Evidence Based Practice. Now I have to tell you I was so mad at reading this seeing as I am a nurse with 27 years experience that my evening was just about ruined. This statement to me is another reason why I would be so disappointed is my daughter ever came to me and said she wanted to be nurse. Because this is such a blanket statement that those of us with experience have nothing new to offer. Anyway before I continue to vent I'd like to hear from others as to whether my anger was indeed out of place.

Specializes in Rehab, LTC, Peds, Hospice.

I can't imagine not keeping current. I want to protect my license! I don't understand people who don't frankly.

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Specializes in Community Health, Med-Surg, Home Health.

While it is true that there are people that do not keep up with current practice, I strongly believe that the 'old timers' are survivors, and you cannot discount that. With all of the changes taking place that can burn someone out, they preservered. They can show you how to prioritize, what are safer shortcuts to take when things get hairy and are phenomenal teachers! When I worked in step-down yesterday, they showed me more about team work than the newer med-surg nurses that are out for self. LPNs primarily administer medications in my hospital, and they told me that they will take care of the rest. I said to them "Don't you DARE! This is my chance to get experience in dressings, G-tube and peg feedings, and IV administration. Next time, you guys may not be around and I have to get all that I can." Once I said that, it was on and popping. Each thing they thought would benefit me, I jumped in and did. And, in exchange, I showed them how to obtain teaching material from the computer, gave them great suggestions continuing education courses and where they can get overtime in the clinics (and I will make sure that I can help them as much as they helped me!)

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Specializes in med surg, LTC, ER , OB, PSYCH.

i agree, this person has diarrhea of the mouth! another thing my old friends and i are experiencing is that it seems the more experience you have, the less eager a facility is to hire you. :banghead:guess its cheaper>to hire a less experienced nurse than to pay for all the tears of experience ?!:cry:

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I googled this former nurse. Apparently he has been preaching this for at least 4 years, ever since his dissertation. Then he opened his own business and wrote book and some articles. What I read seems to be rehash of his first interview. Interesting? Is he looking in the mirror?

I strongly believe that every nurse and other worker with patients must keep current. He did have a couple of good points in the article. He did acknowledge that hospital stays are shorter and that we discharge people before they have healed. (Give me news I don't know) I did not get any good answers to what nurses are to do about this, just that we had to be different.

He claims to be a wound care specialist and gerontologist. He is also a professor @ Emory so it may be 'publish or perish' time. I think he may be working on a new book.

We all know the pros and cons of older nurses. Please note I am one of those older nurses. I utilize the newer nurses to help keep me updated as much as I do my own cont. ed. I doubt that makes me a dinosaur and outdated. I believe it means I want all of us to work as a team. It is all give and take for successful outcomes for our patients.

I am happy to work with both experienced and recently graduated ones. We all can learn from each other.:wink2:

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Specializes in Geriatrics.

When I first graduated, I felt like " boy, I learned SO much!!" Almost immediately upon taking my first job, It changed to " Boy, I don't know ANYTHING!!" Thank God I worked with a wonderful lady who had been a nurse longer than I had been alive at that point. She ahd been a nurse 31 years and I was only 29. Another nurse (13 yrs) was also great.They and all of their YEARS of experience made me into such a better nurse. I learned enough to know that I will never know it all and to always ask questions when I don't know something. But I also learned enough that I have great confidence in my abilities as nurse and I am now education nurse at my facility. And I truly believe it is all because of those who knew so much and were wonderfully willing to share that knowlege with me. That said, I also think that new grad nurses have a lot to contribute, they simply need to know school did not teach them everything they will ever need to know and be open to others advice and assistance.

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Specializes in pedi, pedi psych,dd, school ,home health.
there's nothing wrong with evidence-based practice, although as someone else said there's good research and then there's not-so-good research.

i can also understand the concept that some of my experience may not be particularly relevant today- after all, there's not a lot of need to do clinitest and acetest urine testing for sliding scale insulin these days.

i think it's a bad idea to discount the value of experience in general, though. it counts a lot in some things, like the development of a good gut instinct, which i'd bet on against anybody's research evidence, any day. :yeah:

amen!! there are many times we see issues that are not "textbook" in appearance and you have to rely on past experience and your gut!!!!

i also really don't think most experienced nurses go stagnant. a few do, but not most.

while it is true that there are people that do not keep up with current practice, i strongly believe that the 'old timers' are survivors, and you cannot discount that. with all of the changes taking place that can burn someone out, they preservered. they can show you how to prioritize, what are safer shortcuts to take when things get hairy and are phenomenal teachers! when i worked in step-down yesterday, they showed me more about team work than the newer med-surg nurses that are out for self. lpns primarily administer medications in my hospital, and they told me that they will take care of the rest. i said to them "don't you dare! this is my chance to get experience in dressings, g-tube and peg feedings, and iv administration. next time, you guys may not be around and i have to get all that i can." once i said that, it was on and popping. each thing they thought would benefit me, i jumped in and did. and, in exchange, i showed them how to obtain teaching material from the computer, gave them great suggestions continuing education courses and where they can get overtime in the clinics (and i will make sure that i can help them as much as they helped me!)

good for you! see above statement!!

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Specializes in ER, ICU, Infusion, peds, informatics.

i can't comment on the contents of the article since i don't have access to it.

however, i'm going to agree with the quoted statement: experience isnot sufficient for competence.

maybe i'm dense, but i'm not understanding why so many seem to be taking offense to that.

i don't think that statement discounts the value of experience. you would be a fool to take the stand that experience is worthless. nursing school presents us with the absolute minimum of experience; yet you could memorize a med/surg or critical care text, and it wouldn't be worth much without the basic experience you gain during clinicals.

the knowledge a nurse gathers in multiple years of bedside nursing is invaluable. but it isn't enough.

as with any other lesson, what you do with that experience means more than the experience itself.

to me, that statement is more about the necessity of keeping up with current practices than it is about the value of experience. it is about learning from your mistakes and the mistakes others make. it is about accepting that learning does not stop when we graduate from nursing school ... or when you get done with orientation ... or once you've been a nurse for five years ... or fifty years.

a nurse with 20 yrs of experience who refuses to accept new policies, procedures, equipment, and techniques because "that's not how i was taught to do it" may not be competent.

a nurse with 30 yrs of experience who doesn't go to mandatory inservices on new equipment, or look up new drugs before she/he gives them may not be competent.

granted, "best practice" comes and goes. we work in a rapidly evolving field. part of being a competent nurse is accepting that things will change as research is done. we sign up for that when we decide to become nurses.

i freely admit that i don't like some of the changes i see. however, it is part of my obligation as an rn to be aware of the changes, and to work with them.

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Keeping current is not a major undertaking. Our employers do keep up on the latest evidenced based practice and change protocols as research comes in.

My hospital did a full inservice on the changes in skin care protocol, all nurses and aides attended, skin care products were all explained and made more easily available and our old practices updated.

As long as the experienced nurse is working, her practice is staying current whether she likes it or not.

Hmm, now see if I can remember my password for the latest computer program at work now. I have seven passwords now.

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Specializes in Critical care, tele, Medical-Surgical.

experience alone may not be sufficient for competence but a nurse cannot be competent without experience.

new technology and protocols are often implemented for the health of the budget rather than for the patient.

always they claim "evidenced based".

what does "evidence based" mean?

i have seen no scientific studies that scripting, rounding, computerized charting, pyxis, omnicell, nursing care plan software, wireless tracking devices, vocera, clinical restructuring, management consultant firms such as "six sigma), e-icu, telemedicine, "labor-saving" artificial intelligence, protocol, diagnostic and prognostic expert systems and such save lives or provide comfort for our patients.

nursing practice encompasses and requires the registered nurse to evaluate and make decisions for the patient's health care based on numerous variables including direct requests of the patient or the patient's family, physical signs or symptoms, the individual patient's particular personal context and diagnostic information that is obtained through various methods including the nurse's five senses.

there is scientific evidence that richer staffing saves lives.

and evidence that in countries with universal healthcare most people are healthier and live longer.

i recommend the book from novice to expert by patricia benner, r.n., ph.d.

  • novice:

that stage in the dreyfus model of skill acquisition where no background understanding of the situation exists, so that context free rules and attributes are required for safe entry and performance in the situation. it is unusual for a graduate nurse to be a novice, but it is possible. in most cases a newly graduated nurse will perform at the advanced-beginner level.

  • advanced beginner

one who can demonstrate marginally acceptable performance; one who has coped with enough real situations to note or to have pointed out by a mentor, recurring meaningful situational components. the advanced beginner has enough background to recognize aspects of a situation.

  • competent

the competent nurse is typified by considerable conscious, deliberate planning. the plan dictates which attributes and aspects of the current and contemplated future situation are to be considered most important and which can be ignored. the competent stage is evidenced by an increased level of efficiency.

  • proficient

the proficient performer perceives situations as wholes rather than in terms of aspects, and performance is guided by maxims. there is a qualitative leap or discontinuity in problem approaches between proficient performer and the competent level of performance.

the proficient performer recognizes a situation in terms of the overall picture. this person recognizes which aspects of the situation are most salient. the proficient performer has an intuitive grasp of the situation based upon a deep background understanding.

  • expert

the expert nurse, with an enormous background of experience now has an intuitive grasp of each situation and zeros in on the accurate region of the problem without wasteful consideration of a large range of unfruitful, alternative diagnoses and solutions.

the expert performer is no longer aware of features and rules, his or her performance is fluid and flexible and highly proficient.

the expert performer uses highly skilled analytic ability for those situations with which the nurse has had no previous experience.

expert clinicians make clinical judgments in a truly remarkable way. but while recognition from colleagues and patients is apparent, expert performance may not be captured by the usual criteria for performance evaluation.

expert nurses can provide consultation for other nurses.

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Specializes in Cardiac, ER.

hhmmm,.his statement doesn't really make much sense to me. "A nurse with years of experience is experienced in an age that we are now leaving behind."

Does he think a nurse that was licensed in 1985 has somehow missed everything that has happened since then? If I've been working since 1985,.I have "experience" from the 80's, 90's and now. Does he think I just slept through the last 28yrs and am stuck in the 80's?

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i agree, this person has diarrhea of the mouth! another thing my old friends and i are experiencing is that it seems the more experience you have, the less eager a facility is to hire you. :banghead:guess its cheaper>to hire a less experienced nurse than to pay for all the tears of experience ?!:cry:

when i hit near my 10 yr mark my asst. manager and i had an interesting discussion. she told me that many places, including our employer, had little use for nurses with 10+ yrs of experience and would find ways to downsize them and not hire them as new employees. they were too expensive not only in wages, but in their refusal to blindly follow orders no matter what. us "oldies" apparently dont' want to follow the status quo "because we've always done it this way". whereas newer nurses may think that bad situations are the norm and never say a word about them.

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Specializes in Government.

I have to admit, I'm always wary about the nursing newspapers/circulars etc. that flood my mailbox and the articles in them. One local one has a column written by a nurse I know. She always lists her # of years in nursing. You'd have to know her to know that she has never worked more than 1 shift a month in her career. To read what she has written, you'd think she invented the profession. Grain of salt!

Learning and keeping up are good things. Blowhards often make it seem like they have a secret "in" to best practice.

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