What solutions do you offer for stopping nurse abuse?

gwenith, BSN, RN · Jul 24, 2003

Thank-you Vicky I do believe that we have to share and pool our knowledge and you are right - nursing abuse often starts in the school but even when it doesn't it may be absorbed from the "hidden curriculm" of the clinical area.

I have read the bullying thread and what is obvious is that often we have poor response techniques to bullying. we end up fighting fire with fire and wondering why we are sitting in the middle of a conflagration.

One I forgot ot mention above and I know you will understand.

We HAVE to adress the theory/practice gap. I see this and it's persistance as being a major problem with our profession. Recently I was reading a thread on vital signs and medications and marvelling at the disparity of opinion. Some are wedded to the "party line" of "you must assess all patients before you do anything else whilst others acknowledge the workplace restricitons and assess as required. I think it comes down to the basic difficulty in defining our primary role.

live4today, RN · Jul 24, 2003

Wow! Nurses, you rock! Thank you ever so much for the great input on this thread. You all have given some excellent tips to resolving various issues that nurses deal with on a daily basis.

Collectively, we could put together an "e-list of solutions" to problems many of us face in nursing, then perhaps we could each take these solutions to managment where we work for round table discussions in hopes that some of these wonderful solutions could be implemented to make nursing an all around better profession to be a part of again.

This is exciting, so keep it going! It's also very helpful, and a great way to learn from each other as nurses. We may not get to sit down much and do problem solving at work, but we sure can do that here and still be able to take these solutions to our place of employment.

It's late, and I need rest after another long 13 hour shift at work, so nighty night to all. I look forward to reading and sharing more here tomorrow! :nurse:

ainz · Jul 24, 2003

cheerfuldoer: You asked us to state the issues and then solutions concerning our ideas about the issues confronting nurses in the hospitals. I hope nurses will take action and stop being "helpless victims."

PROBLEMS

1. Lack of recognition for nurses' contribution to patient outcomes.

2. Lack of fair compensation to nurses' for nurses' contribution to patient outcomes as compared to the reimbursement hospitals and doctors are getting. (You would be surprised to actually see how much profit for-profit hospitals are making every month and how much not-for-profits are wasting).

3. Corporate and hospital administration view of nursing as a large line-item expense that must be "managed."

4. Nursing's (collectively) inability to define what "nursing" is (in the USA, see ANA's definition compared to reality and state boards of nursing definitions, then look at the UK's latest definition).

5. Nursing's (collectively) inability to define a "professional" nurse and the education required to become one.

6. Nurses are paid by-the-hour rather than reimbursed for professional services like professionals should be.

7. Nursing's (collectively) inability to unite, clearly define the challenges facing the profession, and taking effective action to change things (phenomenon of complaining to each other and not taking action to solve).

8. Nursing's inability to communicate effectively with the people who are actually running the healthcare system (lack of business and financial skills).

9. Nursing's inability to muster the political and financial power/clout to make changes that will ensure the survival and position of the profession in our healthcare system.

10. Lingering perception of nurses by administration and physicians as "handmaidens" or "an extension of the physician."

SOLUTIONS

1. Conduct meaningful research that links nursing actions to patient outcomes instead of the doctors getting the credit for positive patient outcomes. Please nurse researchers--no more studies of ourselves and the characteristics of nurses and other meaningless stuff just to get a grant. How much of a patient's improvement do you think comes from what a doctor actually does? Kind of like our advancements in the health of our society, is it from medical science or improvements in our sanitation, water treatment, food handling, waste collection, cleanliness and so on.

2. Clearly define nursing interventions (backed up by meaningful research that links to outcomes), assign "codes" to the interventions, bill payors for nursing services.

3. Again, conduct meaningful research that links nursing interventions to patient outcomes in a quantitative fashion (with financial data as well) so that administration sees nursing as a revenue generator and not merely as a resource consumer.

4. Many definitions of nursing have been put forth but I have not seen one that seems to capture the essence of all that nurses do. The Royal College of Nursing, UK has a good definition but is rather lengthy. Perhaps more direct patient care nurses and less "nurse theorists" and less PhD-type faculty should write the definition (sorry PhD-types, nothing personal). ANA's definition is . . . well, see for yourself, and these guys claim to represent the 2.7 or so million nurses in the USA.

5. Once nursing is defined, and the interventions that nurses perform are defined, then perhaps we can determine what the definition of a "professional" nurse really is and what kind of education it takes to become one. Why are there so many educational routes to become an RN? Why are LPNs, ADNs, BSNs, MSNs, DNSc, all called "nurse?"

6. Define nursing interventions, assign codes, bill payors directly for professional nursing services (but wait!! we don't know what that is yet!!)

7. Quit viewing ourselves as helpless, powerless, victims of administration and bully physicians. Nursing is the largest single discipline in the American healthcare system. The need for professional nursing care (what is that?!) is the only reimbursable justification for hospitalization in America. We have an association that claims to represent all of us but how many of us are members? How many of us want to be members? How many of us agree with the position of the ANA on various issues? How many of us agree on ANA's proclaimed "Nursing's Agenda for the Future?" We need to join ANA, all unite for the common goal, quite backstabbing each other, have ANA truly represent the majority of nurses, not just those that are members, and become an effective lobby and voice for nursing. The AMA has done it very effectively and they have less than half of the number of people that we do.

8. Some of our nurses are going to have to learn the business and financial skills necessary to effectively communicate with the businesspeople that are actually running our healthcare system. These guys are not clinicians, don't understand clinical issues, don't adhere to the same values we do (unless its their mother, wife/husband, child, sibling, lying in the hospital bed), speak in the language of revenues, expenses, return on investment, and are motivated to do what they learned in school and what business people in a capitalistic, free-market society/economy do-----work to make a profit any way you can without breaking the law. Nurses need to stop viewing these people as evil, greedy, people and understand they are trained, educated, and paid to "look at the numbers," its what they do, nothing wrong with it, so get off of your moral high-horse and learn to communicate with them. Prove the finanical worth in your requests. Show them the numbers of how it will pay off, and it will.

9. We need people to lobby for nursing that know how to work the system and aggressively pursue nursing interests. I do not know much about how this works, I just know that other professions are successful at getting laws made and changed that advance them, where are our lobbyists?!?!?! And, why do we not see a hospital corporation owned and operated by nurses rather than doctors and businesspeople. We can borrow the money and convince people to invest in our company just like the other people can.

10. We need to engage in some public image advertising to advance the perception of our profession. Perhaps flood the networks with informational ads that promote nursing as a profession. Where is the ANA on this one?? This may offend some of you, but, reality is what it is. In American society, males have clearly had unfair advantage over females in our history, higher pay for the same work, more opportunity for advancement, the whole equal rights thing. Women have struggled throughout American history for many rights, like to vote, and more equal treatment and opportunity. In many ways, advancements in nursing have paralleled women's advancements in society. Why? Nursing is 94% female. Physicians have traditionally been male, nurses female. Physicians have been viewed as the leader and authority in healthcare decisions, nurses followed orders, and swept floors, washed windows, and so on. Nurses have not traditionally been included in "higher level" decision-making meetings, social gatherings, and so on. To counter this:

-nurses obtain additional education to gain the business and financial skills needed to become administrators of hospitals and corporations

-nurses conduct themselves as autonomous professionals while at work and shed the "hourly employee" mentality

-stop complaining and griping about how bad everything is and take effective action to make it better

-join ANA, let it become truly representative of nursing

-we need an advertising campaign to alter the public's perception of nursing

-demopraphics are changing, I believe there are more female medical students than male currently enrolled in American medical schools

SmilingBluEyes · Jul 24, 2003

excellent post ainz!

live4today, RN · Jul 24, 2003

Would anyone else like to take a stab at the solutions to problems in nursing as they live and breathe it each day?

I'm learning a lot here...as I hope many other nurses are too...so please continue sharing from your own wealth of knowledge for millions of nurses reading this forum. We can only benefit from putting our heads together in this way.

Thanks again nurses for your input here thus far. :nurse:

mattsmom81 · Jul 24, 2003

Wow, ainz, ya didn't pull any punches, but you are right on target. :)

llg, PhD, RN · Jul 24, 2003

While I don't agree with 100% of everything you write, ainz, I heartily agree with your general point. If nurses want things to improve, they have to stop complaining to each other and start taking on the responsibility themselves to improve things.

Too many nurses whine about "them" in administration who are evil, waiting for some fairy godmother to come along and "fix them" and make everything perfect. We need more nurses to become leaders themselves so that they work on the needed improvements. Yes, that might mean going back to school and/or learning how to view the world and interact with others in new and different ways. Yes, it means learning to see issues from alternate points of view -- sometimes, points of view that may be unappealing at times. Yes, that is hard to do. But that is what is necessary to get the job done.

llg

live4today, RN · Jul 24, 2003

mattsmom81...it pays to be very passionate about making positive change in areas that have great need of being changed. If one isn't passionate enough about what they believe so strongly about changing, then change may never take place.

I believe in solutions. Problems are alive and well for a reason. Change must come to our profession, and it is going to take passionate nurses to make those changes. We may not all embrace the same theories to how that change should come to be, but this is a great start right here on this thread.

I want to make changes for the better in nursing...not just in my own little corner of the world, but universally. Change in nursing is looooooonnnnngggggg overdue, and I believe many nurses believe the same.

It's one thing to state a problem, but another to implement a resolution to a problem. I liken it to family issues. To live peacefully happy with one another under one roof, change must mean solving issues that arise with everyone's input so as not to leave any issue unaddressed or left hanging.

I, for one, consider myself an activist in anything I am passionate about. It's not easy for me to stand by at the sidelines and just watch things happen. I must in all sincerity make things happen...not just anything in anyway...but really make some positive changes for the entire body of nurses. Starting where we work and live is a good place to start. Cleaning house in our own backyard before cleaning house elsewhere. Know what I mean? :)

pickledpepperRN · Jul 24, 2003

Attended a meeting this morning after working last night.

Does this sound familiar?

"I am new, give me a chance."

Well, the RNs have a lot of say because we are together. The protections of the LNRB and our state whistle blower law that our union lobbied for protect us from retaliation.

STILL this works when the staff on the individual unit join together and support each other.

(Lobbying is done by staff nurses who are not paid)

One RN was suspended for a bogus reason. Something like being 20 minutes late when she had to take a cab because her car wouldn't start. She was an outspoken activist.

The day of her meeing with management and a union representative about 100 of the staff who had just gotten off shift and who had that day off called a press conference in front of the hospital. They had signs and flyers to give the people.

Administration lookes at her supporters and recinded the suspension, paid her for the day, and told her it was just a misunderstanding.

UNITY!

Care is much better at that hospital than others in the for profit chain. (One of the big two).

Nurses at that hospital have met with JCAHO, refused unsafe assignments until provided another nurse, and gotten extra education prior to floating. They were NOT losing this leader! Not without a fight the management could not win!

live4today, RN · Jul 24, 2003

Originally posted by spacenurse
UNITY!

Nurses at that hospital have met with JCAHO, refused unsafe assignments until provided another nurse, and gotten extra education prior to floating. They were NOT losing this leader! Not without a fight the management could not win!

Now THIS is what I'm talking about! You said it all in a few short sentences spacenurse! Bravo!!! :kiss

Not being united gets us nowhere fast. Being united and taking a strong stand against abuse in the workplace is the answer.

I believe most nurses were called to the profession of nursing.

I believe that most nurses want to stay in nursing because it is a "chosen profession" by those of us who want to help the sick transition from one point of wellness in their life to a new and more improved point of wellness in their life.

In order for us to continue doing this with respect and dignity, we must not be afraid to unite and take a stand against the darkness hovering over nursing today. What affects us...truly does affect our patient population! :nurse:

jnette, ASN, EMT-I · Jul 24, 2003

Originally posted by mattsmom81
Wow, ainz, ya didn't pull any punches, but you are right on target. :)

WOOOOOOOOOOOOOOOOT !!! Well said, Ainz ! Thumbsup to you !

I do love the "bill payor for nursing interventions performed"...

Heck, every day I enter the "codes" to our billing dept. for which services, meds, and txs. were given/provided. But who GIVES the txs./meds, etc.? Where is the FACE behind the services provided?

If we were to bill separately for nursing interventions, I really believe we would begin to feel more HUMAN and less like vending machines/dispensors.

Very true as well re the business end and the ability to communicate in financia/businessl terms.. so we're on the same level and able to speak the same language... give them some competition. Us more autonomy.

Yup... nursing needs some major revamping... I LIKE your ideas !:)

glascow · Jul 24, 2003

ainz,

I am impressed with the way you presented all the problems facing nurses. Very matter of fact.

I have been a nurse for 11 years. I agree with you about ANA. Everyone needs to join, and then we will have the voice to make change.

Here is what the nurses in my area are doing:

Created our own nursing group:

Our Mission

Empowering nurses to stand together and be advocates for our patients, our profession and for ourselves.

Our Goal

Create public awareness of current health care issues to affect changes through legislation, organizational and/or practice changes.

Our Vision

We believes that healthcare related decisions should be ethics-driven and every person is entitled to safe nursing care.

We are encouraging the nurses that attend our meetings to join ANA. I just joined for the first time in my nursing career.

Our state association has even extended an invitation to us to join at ½ price. We invited a state rep from the association to come speak to our group about what ANA can do for us. Our district level nurses association is composed mostly of administrators and educators.

There are 5 members on our steering committee, all bedside nurses. We plan on running for positions in our next nurses' district group. Elections are in December.

It has been a lot of work for the nurses actively involved in putting this group together. We have educated ourselves on our rights and are not being intimidated by the suits.

In order to effect change, I think this is the only way to go. A group (ANA or any other group) is only as strong as its members.

I have learned much from joining this forum and think everyone here has great opinions.

I have another idea: Why don't the nurses in this forum all get together, buy a hospital, and run it like WE want :cool: