Most Pressing Issues in Nursing Today

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Was listening to a podcast that said "Within your area of expertise, find a problem and begin to solve it. When you begin doing that, you will begin to find happiness and purpose."

In Post Modern America, what is the most pressing issue we face as nurses? After deciding on an issue, can you come up with a solution or at least a foundation to begin tackling the issue? Excited to hear your responses!

There's your project. Define the specific types of behaviours identified as "bullying" "lateral violence" and "nurses eating their young". How much of this can be attributed to thin-skinned people who take umbrage at every little nuance, real or imagined? (Previous AN threads should give you plenty of fodder.)

To what extent do managers pit nurses against one another to keep us all divided and conquered? It's pretty hard to present a united front when people are rewarded for tattling on one another and constantly nursing their hurt feelings. And we know working conditions will not change until we do stand up together.

I think you are giving managers FAR too much credit for being intelligent enough to plot out keeping us divided and conquered.

One of the main problems I've seen is that facilities hire "In-house" and some nurse that has just clung on long enough will be promoted to 'Manager' when he/she has absolutely no management skills.

Lack of management and BAD management are the death knells of any unit. I have found that the whole management title just goes straight to their head.

Once managers understand that they are actually there to facilitate and support the nursing staff, things will change. I don't see that happening any time soon.

The truth is, we often seem to think that the main of these issues is exclusive to nursing and it is not. A whole lot of this is just human behavior on the job. We have a large manufacturer close to us with a huge sales and marketing department that is comprised mostly of women. A great percentage of people I know work there and they routinely quit because of the in-house fighting.

This makes me wonder how much of the bad parts in nursing are nursing or just another day at the office?

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Specializes in Geriatrics, Dialysis.

Unfortunately in the management vs nurses scenario management almost always wins. As another poster mentioned a lot of this is because nurses as individuals usually need their job. They may be the primary breadwinner in the family. Even if they aren't losing the income generated as a nurse is a huge financial hit for most families. It's been seen over and over that the one or few who make waves don't usually stayed employed. In our current era of huge corporate conglomerates owning just about everything that means if you are fired at your job you can't just go down the road and get another job since that place is probably owned by the same company that just fired you.

Even when standing together concessions that are made are not very often meaningful. We have two major medical systems that own everything in our region. One of these had recent contract negotiations that were all over the local news. They were asking primarily for better nurse/pt ratios. Lower cost insurance and higher pay was of course also on the table but they weren't the primary want. There were threats to strike and multiple trips to the negotiating table. The union ended up accepting a contract that included a raise of a whopping 2% this year and a guaranteed 1% the next 3 years. Be still my heart! The employers promised to "look into viable competitors" for insurance coverage, which of course means absolutely nothing. Most important, the main thing nurses asked for was safe nurse/pt ratios and that wasn't even on the table when the contract was finalized. Why the union caved so completely I guess I'll never know. I'm just glad I don't work for that healthcare group since I'm pretty sure I would be beyond ticked off to be paying so much in union dues to get so little in return.

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Specializes in Pediatrics Retired.
Apology gladly accepted and welcome to AN. I actually really like your question and the discussion that has ensued. Right now I'm sitting back and mulling over the excellent points that have been made but I did want to address the last part of the quoted post. Is nursing "no-win"? I hope not but it's not an easy thing to change. One thing you have to understand is that, historically, any time women rise up and take a stand for something (right to vote comes to mind) they are often painted in unsavory terms. Men that rise up are heroes, women that do are witches (can't use the term that is most accurate). Because nursing is an overwhelmingly female occupation it affects us even more. Think of striking nurses. The vast majority of strikes occur because nurses are standing up for better care for their patients yet they are vilified by management, by the press and by the public as selfish women who are letting patients die to get more money. Furthermore management looks at nurses as disposable. Get rid of one and there are 10 more available to fill that spot. In nursing the squeaky wheel doesn't get the grease, the squeaky wheel gets fired. In my three+ decades I have seen more than my share of "noisy" nurses lose their jobs. And the world of nursing is very, very small. Whats more the percentage of women as primary breadwinners is growing exponentially so this is a big deal. They simply cannot risk their jobs so they put their heads down and take what's handed to them. Frankly, nurses are the modern day version of the turn-of-the-century sweatshop employees in that we don't like what's happening but we have to eat. I don't think it's defeatist I think it's survival.

Case in point from another post where the "nursing shortage" was the subject...hospitals have never had a nursing shortage - nurses had to shoulder a staffing shortage and still have to - but I've never been aware of a patient being turned away from a hospital because of a "nursing shortage." Throw in all the new brilliant cost cutting ideas, patient satisfaction surveys, and salary market analysis, and there you have it...Nursing 2018 - love it or leave.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
haha I genuinely dont have a project. But I am hoping that discussion may facilitate change. And this is a fairly large platform for a discussion. I believe there is an entire generation of new nurses that are entitled and have been told they are special and that they deserve respect without earning it. Snowflakes.

I really don't think it's the "entire generation of new nurses". In the past several years I've worked with many new nurses who are fantastic and certainly open to feedback. But negative experiences always "stick" better than positive ones, and one huffy snowflake (at work or on this forum) can really be a PIA.

But I don't think they're the burning issue. The real issue is how we're pitted against one another. Like "BSNs vs ADNs" and "Newbies vs Seasoned Nurses" "Lateral Violence" and "Incivility in the Workplace". There are "nurses" who sit behind desks and think this stuff up, do "studies" and publish papers because they still get to call themselves nurses without having to actually nurse.

Hospital management has latched onto a corporate business model where it's always better to keep people divided and conquered, even when they're herding you to Service Excellence Rah! Rah! Yay Team sessions. Then they tell you to "manage up" (which means loudly sing the praises of your coworkers) even while they encourage petty tattling.

We need to all stop being sucked in by this peripheral nonsense and learn to present a united front. I think unions that are nurses-only are a good way to go. I've belonged to them and gotten excellent representation. The large unions that represent a number of occupations are less effective for a variety of reasons. Having no union makes us all individual sitting ducks, with the more vocal among us having targets on our backs.

I really think there should be a class in nursing school that addresses workplace and labour issues for nurses. The good, the bad and the ugly; no propoganda. I think we'd have more newbies ready to function like professional adults instead of being thrown to the wolves like they are now.

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Feeling like there is very little time to be an actual nurse or give NURSING care.

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Specializes in OB, Medical-Legal, Public Health.

pncgrady, MSN, You are saying creating a uniform baseline education is a problem, but you believe all nurses should have a BSN?

You think turnover is a problem because we need performance based incentives and bonus structures?

We are from different worlds. I was poor. My single mom could not afford to send her children to school. The eldest paid his own way. The middle child had a football scholarship. I was in a co-op program in high school, working 1/2 days. I was engaged and married straight out of high school. I soon divorced. The reason why would make excellent lyrics for a Country and Western song.

I started as a night student business major. I debated the military or nursing school and started in LVN school. It was a good school and a good match. Upon graduation I thought, "I'm doing the same work as the RN, their pay is better." I worked full-time nights and obtained my ADN. It was available, practical and affordable.

My BSN I got around age 40, my MSN around 50. We've lived in rural areas. There were no incentives or career ladders. My husband is a CRNA. We were never dependent on my income. The salary cut I took when we moved to the mountains of North Carolina from Texas would curl your hair.

We were living in a beautiful part of the world, but high school graduates had a tough job finding work. The furniture factories and textile industries were closed down. There was some tourism, but jobs were scarce unless you worked in fast food, at the prison or for a local feldspar plant.

What would you have the young, less privileged, high school students do? What about the ones like me who weren't ready to travel and may not have been university material? What is your level of respect for community colleges?

I have mixed emotions about requiring a BSN for nurses. You are going to exclude the working poor. I can't address your 4-year degree vs. my hybrid one. It was fairly new and some of it was fluff. One friend said, "If is as if they consider us backward and are trying to civilize us." It was a moneymaker for the college.

Nursing is a respected profession. I applaud our increased autonomy and recognition as more than the the doctor's handmaiden, but if your opinion is based on nurses needing to study nursing theorists, I will have to disagree.

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Specializes in Case Manager/Administrator.

Most pressing nursing issue to me is "documentation not standard".

I think we waste valuable time with point and click and with the old fashioned pen and pencil documenting what we do.

I think there needs to be an electronic medical record that is standard based on an individual and body systems i.e. Neurology, Skin, ...then what ever the issue we go to that body system and chart. It should be universal and what I charted in Washington state you should be able to obtain that chart electronically in Maryland when the patient is there visiting and hurts themselves. The security should be one of those codes that change numbers every 60 seconds or less so you have to be fast typing in the numbers to get into the system, there are a lot of security measures one can take where you do not have to remember your password.

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I really don't think it's the "entire generation of new nurses". In the past several years I've worked with many new nurses who are fantastic and certainly open to feedback. But negative experiences always "stick" better than positive ones, and one huffy snowflake (at work or on this forum) can really be a PIA.

But I don't think they're the burning issue. The real issue is how we're pitted against one another. Like "BSNs vs ADNs" and "Newbies vs Seasoned Nurses" "Lateral Violence" and "Incivility in the Workplace". There are "nurses" who sit behind desks and think this stuff up, do "studies" and publish papers because they still get to call themselves nurses without having to actually nurse.

Hospital management has latched onto a corporate business model where it's always better to keep people divided and conquered, even when they're herding you to Service Excellence Rah! Rah! Yay Team sessions. Then they tell you to "manage up" (which means loudly sing the praises of your coworkers) even while they encourage petty tattling.

We need to all stop being sucked in by this peripheral nonsense and learn to present a united front.

x10.

I woke up this morning and wrote out a couple of posts related to this. Still deciding whether to share. I could not agree with you more. I think refusing to play this particular game is more than just common decency at this point, it's a powerful strategic maneuver whose time has come.

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Specializes in Pediatrics Retired.
x10.

I woke up this morning and wrote out a couple of posts related to this. Still deciding whether to share. I could not agree with you more. I think refusing to play this particular game is more than just common decency at this point, it's a powerful strategic maneuver whose time has come.

Speaking of a strategic maneuvers...I've often wondered how much false information has been documented and "fed" to management by the worker bees just to make them go away for a few days and let them think how successful their ideas are as they live on in their alter reality. HMMMMM

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Specializes in Critical Care.
I think lateral violence is a major issue.

I also think creating a uniform baseline education to be a nurse is a problem i.e. at baseline nurses should have a bachelors degree.

I also think that turnover is a problem in nursing because of a lack of solid performance based incentives and bonus structures

I think our poor understanding of the effects of BSN as entry to practice is one of the most pressing issues in nursing today. It's one thing if someone truly understands the entire range of pros and cons to making BSN the entry to practice, and based on that determines it is the better course, but pretty universally I find that those who promote the idea don't really understand the ramifications.

I do think we should find the single best curriculum and standards for teaching nurses and use that for all nurses, which we're already doing.

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The problems with nursing cost money to solve and most corporate leaders are simply unwilling to spend the money be it safe staffing, adequate resources, equipment, creating a no lift environment, employee retention. Most admin at the top are content with the way things are and willing to accept the high turnover rather than spend the money needed to create a better, safer high quality hospital system!

The healthcare system is not interested because they have already done the math, if they cut "x" number of nurses they will save "y" number of dollars, and "z" number of people will die. There will be lawsuits and they have figured out how much that will cost them. Nurses are cut accordingly to save the money, and lives be dam**d.

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Apology gladly accepted and welcome to AN. I actually really like your question and the discussion that has ensued. Right now I'm sitting back and mulling over the excellent points that have been made but I did want to address the last part of the quoted post. Is nursing "no-win"? I hope not but it's not an easy thing to change. One thing you have to understand is that, historically, any time women rise up and take a stand for something (right to vote comes to mind) they are often painted in unsavory terms. Men that rise up are heroes, women that do are witches (can't use the term that is most accurate). Because nursing is an overwhelmingly female occupation it affects us even more. Think of striking nurses. The vast majority of strikes occur because nurses are standing up for better care for their patients yet they are vilified by management, by the press and by the public as selfish women who are letting patients die to get more money. Furthermore management looks at nurses as disposable. Get rid of one and there are 10 more available to fill that spot. In nursing the squeaky wheel doesn't get the grease, the squeaky wheel gets fired. In my three+ decades I have seen more than my share of "noisy" nurses lose their jobs. And the world of nursing is very, very small. Whats more the percentage of women as primary breadwinners is growing exponentially so this is a big deal. They simply cannot risk their jobs so they put their heads down and take what's handed to them. Frankly, nurses are the modern day version of the turn-of-the-century sweatshop employees in that we don't like what's happening but we have to eat. I don't think it's defeatist I think it's survival.

I don't think nurses are quite the modern equivalent of sweatshop workers. In what other profession can you make almost 30 dollars an hour from an associates degree. Oh and also with upward mobility through tuition reimbursement programs. I think it is a pretty good gig. Could be better, which is why I started this post.

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