Nursing as a service industry

[RunningWithScissors]

You all may be aware that the service industry has the lowest paid jobs...with all the emphasis being placed on Press Gainey scores and customer service, I fear we are migrating to that end of the career spectrum.

We all like to think of ourselves as professionals and having a license seems to validate that, but if employers stop thinking of nursing in that light and instead see more of a service line, would you still be happy being a nurse?

How would/do you feel being considered in the same occupational class as housekeeper and waitress?

I think that's what a lot of dissatisfaction is coming from, only we haven't quite identified it as such.

[lindarn]

I agree that nurses have a lot more responsibility than most people are aware of. I agree that those with that high degree of responsibility should be paid more. I also think nursing education should train nurses to deal with the realities of bedside care or else nurse residencies should be instituted.

However, so far, when nurses have refused to accept current wages and conditions, facilities simply leave positions unfilled claiming they can't find qualified applicants - as opposed to sweetening the pot and improving work conditions. Some places do offer big bonuses and the like but the conditions are still miserable and they can't find and retain quality staff.

Many nurses find working agency to be a better deal than working for a hospital. Surely, the hospitals should be able lure agency staff to their facility by offering better pay with good working conditions and scheduling flexibility.

I still say that leaving and giving up is exactly what hospitals and nursing homes want. A work force that is mobile, no one staying long enough to effect any change, (like voting in a union, demanding better staffing- when one is on probation as a new employee, and can be fired for any reason, the fear of being fired if one tries to support a union is even greater), and the problems never improve and are "solved" by bringing in foreign nurses from 3rd world countries (the indentured servants of the 20th century), or pressuring our elected officials to dumb down nursing practice. Which, by the way, is what has and is happening. It only serves to perpetuate the problems without solving anything or moving forward as a profession. While other health professionals have moved light years ahead of nursing, nursing fights tooth and nail any and all attempts to fix the problems. Go figure!

Lindarn, RN, BSN, CCRN

Spokane, WA

[Spidey's mom, ADN, BSN, RN]

Regarding assessments . . . . I think it is smart to learn the full head-to-toe assessment first. That makes you better at the so-called "5 minute assessment". You build a firm foundation first. Then go from there.

I also disagree with not teaching bedbaths, bedmaking, etc.

And I am not one of those people who think you MUST be a CNA first to be a good nurse. In fact I argue against that quite regularly. However, learning basic fundamental care of human beings IS the laying the foundation I mentioned for becoming excellent nurses.

I agree with "sweetening the pot". Here in rural California we are hurting for RN's. It is difficult to staff for OB. In order to entice nurses to look at rural nursing we have to explain the benefits (one of which is more autonomy) AND raise our pay. We have been using registry, which costs more than giving everyone a raise.

As to BSN, I too think that should be the way an RN gets a license. I've encouraged several high school graduates to go that route. School, marriage, family . . in that order.

steph

[jjjoy, LPN]

Lindarn, I know you support BSN for entry. How would that help the situation? Then all RNs would be qualified to seek work away from the bedside shrinking the pool of qualified nurses. It seems there'd be an even bigger push to bring in foreign staff with college-level RN training. For them, there would be fewer tempting choices at home than here, whereas the US RN-BSNs would have many choices besides bedside.

I think bedside nursing is different from OT, PT, RT in the sheer NUMBER of nurses needed in acute care. Given that practical concern, I'd instead propose redesigning 'vocational' nursing school. Instead of weeding applicants out before entering nursing, let the programs expand and have students weed themselves out in regard to their ability and interest in NURSING, not pre-req coursework - though I would require a basic math class, a basic writing class and a basic physiology/anatomy class before starting nursing coursework. Throw out nursing diagnoses altogether. Let's talk the same language and work off the same care plan as other health personnel.

Where would LPNs fit in? Not sure. Maybe the first year of nursing school focuses on patient assessment and documentation, common medications, and common chronic conditions (diabetes, heart disease, etc). All clinicals are at LTC facilities and the like. At the end of the first year, everyone is qualified to become a LPN and can work at LTC facilities.

The second year, then, perhaps is acute care. Hospital bedside nursing. Med-surg. At the end of the second year, everyone is qualified for RN.

Maybe there's are optional courses for specialization. You could study another 3-6 months to learn OB, OR, ped, and/or ICU.

Community health nursing, school nursing, occupational health nursing? Hmm... maybe there's a separate specialization for that where you learn more about public health issues and health promotion. Since there's not as much demand for these roles, these might require a bachelors degree and related upper division coursework.

Well, these are just thoughts I've had about alternatives to the current educational system. I certainly don't think anyone's going to run out and implement them tomorrow! And I'm sure there are many problems with my musings on the topic. But it's interesting to think about!

[jjjoy, LPN]

Regarding assessments . . . . I think it is smart to learn the full head-to-toe assessment first. That makes you better at the so-called "5 minute assessment". You build a firm foundation first. Then go from there.

The thing is that we never learned the "5 minute assessment" in school. Anything less than our 4 page assessment was considered poor practice by our instructor. Yep, gotta find out how many spontaneous abortions that 85 in for a hip replacement has had. Then, in the real world, we're told we can't do everything "by the book" and have to "prioritize." I'm just saying this reality of prioritizing and judging what's okay and not okay to put off should be addressed in school.

I also disagree with not teaching bedbaths, bedmaking, etc.

I'm not saying bedbaths shouldn't be taught or that nurses shouldn't have to do them. But the priority of practicing nurses is to assess their patients, to know what to do in an emergency, to know what they should do regarding various changes in patient status, to know when to call a doc, and to administer medications and other treatment-related tasks and monitor and document responses. There are many, many other important things that nurses do.

We spent so much more time in school on "impaired mobility" and "altered nutrition" than on how to handle several patients with competing needs. In school, we're given lists of signs and symptoms and medical and nursing care for a zillion different diseases. In reality, nurses don't keep this all in their head. They learn those that are relevant to their area of practice and be prepared to come across situations where they don't know everything about it and have to look it up, ask their colleagues about it, etc.

[burn out]

Please let's not make this a BSN vs ADN argument...this has nothing to do with education it is all about who is in control of Nursing. As long as we allow hospitals to dictate our job descriptions and what we will do we will not be in control of our professions or our destinies. WHERE ARE OUR LEADERS? How have we gotten to this point? What a great day it will be when nurses take over their own profession and deciede who they are. what they are going to do/what they are about and what entry level they will start at. How can we expect the public to know what a nurse is until we know for sure who we are. Until that day comes we will just be considered nothing more than a "hospital waitress" that no body has to tip and whose service is so inconsequential that hospitals do not even charge for it. My goodness a prostitute charges for her services but no where can you find a charge for nursing service on any hospital bill...therefore who really knows what we are worth.