So I am taking a graduate level research class, and my textbook keeps talking about how there are all of these great care models shown to improve outcomes for patients that aren't being utilized in practice. I just keep thinking about how nurses NEVER have ANY time, and this is probably contributing greatly to the lack of research in practice. It seems like the problem is getting worse and in some cases practice is not only not evidence-based, it's not even safe. Then good nurses stop being nurses because expectations are impossible.
I guess I'm wondering if anyone has any ideas on how to improve staffing ratios? There is evidence out there that the role of the nurse as an educator is as important. How do nurses get the time they need to serve as effective clinicians?
I've read other posts with suggestions like, "cut the CEOs salary", which is a nice idea, but not likely to happen without some sort of catalyst. Does anyone know what the catalyst could be?
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Linda, in ANY specialty, skills used everyday are NOT taught in nursing school. I used MANY skills in OB that were not taught in school.
Nursing school is just a foundation. None of the specialities are covered well nor taught really, in school. That is why I tell new grads that the REAL learning is about to begin. Because it's true.
Skills are different, not more valuable. As a dialysis nurse, I had to attend months of classes just to learn to be a dialysis nurse. NONE of the skills I use (except taking BPs etc) were taught in school. We are not doctors, and our specialties don't compare. I would expect a doctor who spend 10 to 12 YEARS in residency to earn more than the family practice guy who spend 1/3 or 1/4 of that. But again,we are NOT physicians.
Don't backpeddle. You said ICU nurses deserve more pay, by virtue of their specialty. That has nothing to do with the original topic and besides, that is simply untrue.
Specializes in Critical care, tele, Medical-Surgical.
Working in critical care I've told the shift supervisor I need help assessing the amount of blood on a hip surgery. She relieved a nurse who came and gave me a quick in-service on post op hips as well as telling me not to worry about the amount of bleeding at that time.
Another time a chest pain patient with Heparin and NTG drips also had an order for chemotherapy. A chemo certified oncology nurse came to administer the medication and teach me and our charge nurse the side effects of that med, interventions to relieve them, and all precautions. For example we needed to know for example that no possibly pregnant person should care for that patient or even empty the Foley bag.
Med-surg nurses need to know the basics of most specialties. Those with years of experience can teach us a lot.
Having more patients to care for, is a matter of learning to prioritize your workload for the day. Learning to delegate to lesser trained personnel, etc. They are skills that are taught in a basic sense in nursing school. Titrating vasactive drips, while weaning someone off of the IAPB, is not taught in nursing school.
The above is an oversimplification.
Having more patients to care for is having more patients who are often extremely sick/unstable to assess, monitor, intervene for, advocate for, and document for.
Having more patients to care for is having more patients to carry out the medical and nursing plans of care for, and to evaluate the effects of those interventions for.
Having more patients to care for often means having more family members/visitors to interact with.
Of course prioritization is necessary, but the RN cannot delegate aspects of care that the RN is responsible for performing, by virtue of the RN's scope of practice.
And why are doctors paid more? Because they have more education and training than, say Family Medicine Physicians.
I wish that I had a nickel for every physician who told me that he/she, transferred their patient to the ICU, because the floor nurses don't know how to care for their patients, when they become more complex.
Physicians are paid base on their specialty, which often require more education and training that is not provided for in their basic medical education.
ICU nurses take training classes, that can take up to 6 months. ICU skills, are NOT taught in nursing school.- titrating drips, reading monitors, Swan Ganz Catheters, Hemodynamic calculations, CVVHD,etc. The same with dialysis.
Med Surg skills are taught in nursing school. Physicians charge more for their additional educational education, and training. Neurosurgeons, charge more than neurologists, Cardiac Surgeons, charge more than cardiologists, etc. WHY is it not the same in nursing??
Because nurses need to validate their self worth and self esteem by perpetuating the lie, that nurses are all the same, with our skill sets, when we are not. Higher skilled, trained skills, should be paid more than basic nursing skills, learned in nursing skills.
Having more patients to care for, is a matter of learning to prioritize your workload for the day. Learning to delegate to lesser trained personnel, etc. They are skills that are taught in a basic sense in nursing school. Titrating vasactive drips, while weaning someone off of the IAPB, is not taught in nursing school.
I stand by my original statements that nursing should be paid based on their education and training, not by, "well, we are all the same".
We sometimes had floor nurses float to ICU to work as "functional". nurses. They may not be able to take critical ICU patients, but they can help with baths, hanging IVs, giving medication, etc. We welcomed any help we received, regardless where it came from.
An experienced Med surge nurse who attends conferences, continuing ed, is still not qualified to care for a critically ill ICU patient. They are developing and improving on their already gained med surge skills and knowledge base, not learning new skills. The hospitals and insurance companies are the ones who make the decision to charge more the ICU care, than med surge care. They pay more because their is more bedside care, in addition to all of the bell and whistles of being a patient in ICU. Just like they pay more for a Specialty Physician, or Surgeons, than a Family Practice physician. They are paid because of experience, skill,education, and title. We should be too.
JMHO and my NY $0.02
Lindarnm RN, BSN, CCRN, (ret)
Somewhere in the PACNW
You seem confused as to the reasoning you want to stick with for ICU nurses being paid more. Perhaps you are the one with your knickers wound up a little too tight.
At the risk of wasting my time, I will throw out some random thoughts that come to mind as I digest your last post:
Perhaps the med-surg nurse couldn't take care of a physician's complex patient because they had 3, 4, or 5 other complex patients to see at the same time.
You are really out of touch and behind the times if you think a nurse is a competent med surg, oncology, pediatric, L&D, dialysis, etc. nurse coming out of school, or that a physician can decide on their own he/she can transfer their patient to the ICU because the floor nurse isn't up to the task.
Specialty surgeons charge more because there are fewer of them, which goes back to them having to shell out 10's of thousands of more $$$ and more time for that addl education and training. Basically, it's a supply and demand issue. There is no shortage of ICU nurses or people who are qualified and willing to be trained to be ICU nurses.
True, as a med surg nurse there are many ICU patients I would not be qualified to care for. But, I have sent to and received from the ICU enough patients to know that there are many I am more then qualified to take care of if I had only 1 or 2 patients and the additional resources available in the ICU.
The next time I work with an ICU nurse floating to my med surg area will be the first.
It seems to some, when med surg nurses are overwhelmed, it's because they don't know how to prioritize their work load, manage time, or to delegate. When I get a transfer from the ICU who is a mess and whose care isn't up-to-date, it's because the nurse's 1 other patient was an extremely busy one.
As someone (maybe several others) have said, your ICU skills aren't better, they are different. Your ability to titrate vasoactive (forgive me if it really is vasactive, you are the expert after all) drips and care for swan ganz catheters isn't very valuable on the med surge, oncology, and L&D units.
I spent a few years on an adult cardiac step-down. Now I'm a peds med surg RN. Thank god I didn't have your attitude. I hate to think what would have happened if I went to peds thinking I had superior skills to those nurses because of what I did on the step-down unit.
Your anecdotal stories are irrelevant. I have a few of my own that would illustrate that in some cases ICU nurses are not always what you think they are. Those stories would also be irrelevant. Neither of our stories would be an accurate picture of what med surg and ICU nurses are.
Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.
I'm going to take just a quick moment to counter your argument Lindarn. Can you, as an ICU nurse, read fetal monitoring strips? Do you know when a fetus is in distress or how to deliver a precipitous labor baby? Can you hang chemotherapy? Can you tell me the assessment guidelines for Rituxan or what to do in a chemo spill?
I agree with you that ICU nurses are amazing and I respect their skills; I know what I don't know. But, nurses need training in whatever area of nursing they enter for the first time. New grads have been trained in ICU successfully. I have skills I could teach you and you have skills you could teach me. And BTW, I've had Oncology patients that are appropriate for ICU care that the Oncologist will refuse to transfer. They state that the ICU nurses are not competent enough in Oncology.
Y'all are not going to break through that ironclad superiority complex that lindarn has going on, but I applaud your efforts. Don't worry, life has a way of teaching lessons when needed....
Specializes in Critical Care, Emergency, Education, Informatics.
After all this discusion, I was wondering if I was the only one that remembered that Nursing Dx came about in the 70's as a prep for us to be able to bill for services. Didn't work so well.
It did not work so well, probably because the PTB did not want nursing to bill for our services. As I have stated in previous threads, the PTB prefer nurses to remain, "barefoot and pregnant", our services and contributions to positive patient outcomes, to remain invisible.
If nurses professional services remained invisible, then we cannot claim that our services deserve better financial compensation, and rewards.
As long as our professional services remain rolled into the room rate, housekeeping, and the complimentary roll of toilet paper, we will never have worth or recognition. We will be remain on the, "costs list", on the financial Balance Sheet.
Specializes in Management, Med/Surg, Clinical Trainer.
I want to go back to the OPs original question.
So I am taking a graduate level research class, and my textbook keeps talking about how there are all of these great care models shown to improve outcomes for patients that aren't being utilized in practice. I just keep thinking about how nurses NEVER have ANY time, and this is probably contributing greatly to the lack of research in practice. It seems like the problem is getting worse and in some cases practice is not only not evidence-based, it's not even safe. Then good nurses stop being nurses because expectations are impossible.
Your 'textbook keeps talking about' care models to improve outcomes? What care models elaborate please.
Nurses 'never have any time' and this is contributing to 'lack of research'. Again elaborate, this is making the assumption that if the floor nurses had time they would do research on ....what???
I guess I'm wondering if anyone has any ideas on how to improve staffing ratios? There is evidence out there that the role of the nurse as an educator is as important. How do nurses get the time they need to serve as effective clinicians?
I've read other posts with suggestions like, "cut the CEOs salary", which is a nice idea, but not likely to happen without some sort of catalyst. Does anyone know what the catalyst could be?
There are many ideas on improving staffing levels, many of which include more money to hire more nurses. There is also a great many ideas out there about adding in efficiency such as a better charting system, streamlining tasks or better utilization of support staff.
Cutting a CEOs salary, while desirable to many people, is short sighted. Many CEOs make the bulk of their money from stocks and bonds. For average CEO salary see below:
"The New York Times by Compdata Surveys:
$386,000 for a hospital C.E.O. and $237,000 for a hospital administrator,
compared with $306,000 for a surgeon and $185,000 for a general doctor."
Sources: Compdata Surveys (salaries); the Commonwealth Fund and the Organization for Economic Cooperation and Development (administrative costs)
SmilingBluEyes
20,964 Posts
Linda, in ANY specialty, skills used everyday are NOT taught in nursing school. I used MANY skills in OB that were not taught in school.
Nursing school is just a foundation. None of the specialities are covered well nor taught really, in school. That is why I tell new grads that the REAL learning is about to begin. Because it's true.
Skills are different, not more valuable. As a dialysis nurse, I had to attend months of classes just to learn to be a dialysis nurse. NONE of the skills I use (except taking BPs etc) were taught in school. We are not doctors, and our specialties don't compare. I would expect a doctor who spend 10 to 12 YEARS in residency to earn more than the family practice guy who spend 1/3 or 1/4 of that. But again,we are NOT physicians.
Don't backpeddle. You said ICU nurses deserve more pay, by virtue of their specialty. That has nothing to do with the original topic and besides, that is simply untrue.