KeyMaster

Our system leadership mandated a minimum BSN requirement and won't accept applications from nurses with an Associate degree. Yet they are willing to moan, groan and complain about the severe nursing shortage that is keeping them from filling the HUGE number of open positions we have in our system. One of our busiest acute care floors only has two actual hospital employees - the rest of the staff is agency or travel nurses. Rather than accept an application from nurses who have graduated from one of the FOUR of the Associate degree programs in our area we are bringing in large numbers of contract nurses from outside the country. The total irony is that many of the temporary and contract nurses don't have a BSN, which is apparently OK because we haven't hired them as permanent employees....meanwhile we have a surplus of RNs who can't find jobs in their own city.

OP: "Definitely thinking about different degree, since experience is the only way to open up other nursing positions, but I am not about to work bedside for 10 years. I would rather go back to school." Oh yes, absolutely! What we really need are more Master's and Doctorate prepared nurses who can't stand the thought of actually touching a patient, much less *gasp* their pee or poop. I am really tired of seeing entry level MSNs who make it painfully clear that hands-on patient care is not what they got their master's for and they are only suffering through bedside care until they can land a management/teaching/informatics/sales position. But I guess I am the delusional one, because the job postings I see nowdays make it clear that initials behind your name are valued over experience.

Don't Panic! Words of wisdom there

The downside in my hospital is that a lot of the MDs simply don't want to put in electronic orders. Many are older and although they may be comfortable with a computer they are not proficient with a keyboard, so order entry is time consuming and frustrating for them. When the docs actually do enter their own orders it does work well. The nurses are not supposed to take verbal orders, but we are not supposed to refuse to either. Rather than hold the docs accountable, much time and effort has gone into devising ways to have the nurses enter orders, while making it look like the MDs do so that we can meet our meaningful use goals. We have lots of "protocol" order groups that RNs can enter and have the docs sign later. Or we take one verbal or phone order to enter a pre-built group of orders so the MD percentages for verbal or phone order entry are lower. All in all it creates more work for the nurse because the unit clerks can't enter orders anymore and there are still a lot of docs who won't - guess who's left to do it.......

I teach electronic perioperative documentation to our newly hired associates. It is obvious that many of the more mature nurses simply don't use the computer in any ongoing capacity. I always encourage them to make sure they have glasses that allow them to see the screen clearly and that they have a good understanding of BASIC windows functionality to navigate through the record. For those that need to improve their mouse or keyboarding skills or to overcome their hesitancy to click and navigate I direct them to All Nurses! From this site they can learn how to search different topics, how to improve typing skills, how to navigate through different screens, how to save, copy & paste, etc. And they get to see that there are plenty of nurses in the same boat. The more practice someone has - in a non-threatening environment - the more successful they will be.

Saw it lots when I worked on a geriatric med-surg floor. Sometimes with dementia (back when we called it organic brain syndrome), sometimes with tardive dyskensia, sometimes just because. To prevent patients from picking sores on themselves or irritating their finger tips (if it was really bad) we would place a square of shearling across their lap for them to pick at.

Any credibility to this argument was lost with the opening sentence.

The entire staff of the hospital should obviously have mandatory education provided on how to knock on a door. Of course someone will have to develop a policy on how loud the knock should be and the duration and frequency of the knocking. This will probably require an extensive search of literature to provide evidence for best practice. Additionally, a study should be drafted as to determine which nursing theory is the most effective model to follow. A suitable consequence should be determined for failure to knock on a closed door, with progressive action for repeated failure to knock. The terms "Knock" and "Closed door" should be clearly defined to enable everyone to follow policy appropriately and avoid misinterpretation of the Knocking On A Closed Door policy. Policy should include proper documentation of knocking or the reason that the knock was not performed. Understanding of the policy will be verified through testing and return demonstration. Repeat testing will be allowed for the first failed attempt, and a transcript placed in each staff member's file. Understanding should be validated on a yearly basis.

Wow. I couldn't even begin to imagine. Makes me even more thankful for the good old Diploma program days. I received a stellar education with tons of hands-on clinical time, passed "boards" with ease (like 99% of my class) and went on to work at the hospital associated with the nursing school. Thanks to their "loan forgiveness" program for every month that I worked part of my school loan was paid. After working full time for a little over three years my loan was repaid in total with no impact to my take home pay. Basically, my nursing education was completely free. I have worked at the same hospital ever since - in fact my office is now in one of the old school of nursing dorm rooms :) A couple of years ago I went through an RN to BSN program that was mostly paid for with a tuition reimbursment program. It really makes me question how the media and the public can buy the story about the "nursing shortage". My education was free because the hospital could justify the cost of educating a nurse who would fill a position - if there was such a dire shortage today how come people are having to pay such an outrageous price for their education?

:yeah:well said!! the total truth in a nutshell. there is no nursing shortage. there never has been and with the number of new grads cranked out every year there will not be a nursing shortage in any forseeable future. do not be fooled into thinking that healthcare is doomed because of a lack of nurses when the information is generated from those who profit from the propaganda.

Sadly a lot of places are interviewing, but still not filling positions. If you have a stong education with a string of degrees behind your name, recruiters want more experience. If you are experienced, they want more education. If you have both you are over-qualified. If you have neither you are disposable. Truth is - it's an employer's market. They have plenty of applicants to pick and choose from, yet somehow still find a reason to not fill vacancies.

This article only PROVES that THERE IS NO NURSING SHORTAGE - and that there never has been. There is simply a shortage of nurses who are willing to work in understaffed, underpaid positions. "hospital employment of registered nurses (RNs) increased by an estimated 243,000 full-time equivalents (FTEs) in 2007 and 2008 — the largest increase during any 2-year period in the past four decades" We are cranking out nurses in record numbers, but there is NO WAY that we have graduated more nurses in a 2-year period than we did in the past four decades. The RN's that filled those 243,000 FTEs already existed - they had just opted out of poor work environments. " an economic downturn may have a particularly large effect, since many RNs who were not working or were working part-time may rejoin the workforce or change to full-time status to bolster their household's economic security." There is NOT a shortage of nurses!! There is a shortage of positions attractive enough to be worth working for. If there were nursing positions that provided competitive pay, flexible hours and job satisfaction (without pointless CYA paperwork) there would be plenty of nurses available and willing to work no matter what the state of the economy is.

I once had a very tired resident order foley to low wall suction and an NGT to bedside drainage :) A quick phone call cleared that up with no problem though.

My RN-BSN program through South University was all online. I did not have any clinicals.

Sadly this is a scenario that will repeat itself as more and more emphasis is placed on the number of letters after your name rather than the number of years of experience you have. I have not worked in LTC, but have lived the same situation in the acute care hospital setting. My facility was working toward Magnet status (what a joke) and we were required to have a certain percentage of nurses with a BSN or higher. So, step 1: close the hospital associated diploma school which had graduated it's first class in 1921 and had supplied knowledgeable, dedicated nurses to all five of the facilities in my system for decades. Step 2: require ALL positions above bedside staff nurse to have a BSN within 3 years or else be fired or demoted. Step 3: After 2 years begin eliminating staff that have not started school yet because they will not make the deadline to graduate with a degree. So, take the manager with 36 years experience as a nurse and 12 years experience in a management role and demote them. Step 4: Hire brand new BSN who just passed NCLEX into manager role, because she is the only one available who meets the current job requirements. Step 5: watch my favorite boss waltz out the door (and take her years of experience with her) because she is now expected to mentor the new BSN and to train her for the position that the old manager is no longer qualified for. That is how a new RN with no nursing experience can be a supervisor. But it looks good on paper!

I really don't understand how hospitals expect us to follow evidenced based practices without access to the research and recommendations! I am extremely fortunate to have access to an awesome online database at my facility, but we are a teaching hospital. Are there any nursing schools that do clinicals at your facility? Maybe a quid pro quo for allowing students into the hospital - they could allow access to their database? Good luck!

I never had an MD intentionally hide anything, but I have had med students and residents who threw away the prep sponges because they didn't realize they were to be counted. Easy enough to find in the trash or laundry hamper (that's why trash & laundry should never leave the OR room until after the case) but it was time consuming to have to stop and look. I have also had a sales rep who thought he could help himself to the "clean" prep sponges left over on the prep stand. (NO, take those out of your pocket - I have to keep counting them until the end of the case and the case isn't over just because YOU walk out of the room). My favorite though was the 7-0 needle (about the size of an eyelash) that we looked everywhere for (try finding an eyelash in a bloody sponge bucket) just to discover it was stuck to the back of the surgeon's glove

I actually had an instructor in nursing school who declared that there were three types of nurses: those who were "called" to nursing; "appliance" nurses (her term) who were in it for the money (presumably to buy more appliances?) and nurses who went to school because they thought that getting their RN meant they could get an MD too. (She always laughed at that little personal observation). She made it obvious that unless you were "called" to nursing you were just taking up space in her class as far as she was concerned. That was 25 years ago and it is sad to know that we are still dealing with the same martyr mary attitudes that leave nurses vulnerable to being treated any other way than as an appropriately compensated professional. I have always heard that the justification for high MD salary is because they have so much debt from school. If that is the logic then compensation for nurses needs to be looked at across the board....I'm due a raise!

Then again, in my hospital the managers ask for resumes directly because HR is rather famous for being a resume black hole.

CPOE is only as good as the leadership enforcing the edict. In my hospitals the MDs who don't want to enter their own orders simply find a workaround. They will not hire their own order scribes when they can simply have the floor nurse do it anyway. It has become a rather tiresome game. The nurses are not able to enter verbal orders, but they can enter telephone orders. So doc sits down at the nurses station and calls the desk. The nurse sitting next to him answers the phone...ta da...phone orders. Yes, we have an MD that actually does this. Leadership was concerned that the MDs wouldn't be able to deliver timely care until they learned and were comfortable with CPOE...so we instituted paper "e-orders" for the nurse or secretary to transcribe IF the MD was concerned that he might not be able to enter a critical order correctly. We were going to have them as a bridge for two, maybe four weeks. Of course ALL orders were critical orders to several MDs, so ALL orders became e-orders. Oh, we started that two years ago. We still currently have e-orders, but hear they may be going away soon....

OK, I may be thinned skinned, but is anyone else a little put off by the "Fabulous Nurse" ad with the nurse twirling in her strapless white uniform dress while holding her white nurse's cap with the red cross on it? After all of the threads, blogs, letters and complaints about the negative way the "sexy nurse" stereotype pictures us in a less than professional way, it is disappointing to see it here in an ad directed at nurses.

Nursing Informatics? Staff development/education? Both of these areas require the specialty knowledge and skills you have. Good luck!!

I once had a patient with active TB. The doc ordered "Beer at the bedside" AND an alcohol drip. His rationale was that he did NOT want the pt to sober up and go into DTs/coughing fits. Also when I worked on a Resident-run floor in a teaching hospital, one new doc wrote an order for "Foley cath to LWS" OK, am I inserting a nasogastric foley or does the pt need a rapid bladder evacuation??

After being a Diploma nurse for more that 20 years I went back to school through an RN to BSN program. I had to take Intro to Computers (one of my graded assignments was to set up an e-mail account.....mind you this was an ONLINE PROGRAM to begin with) another mandatory class was Medical Terminology. Really, I had no idea what all those big medical sounding words meant....I've only been charting them for 20 years now. All in all - I can now say I am a Diploma nurse with a BSN. I spent a ton of money and still didn't learn anything that I did not learn from my diploma program and bedside experience. At least now I am officially qualified to keep the job I have held for years. Pfffttt.

I had a NovaSure ablation about 3 years ago. I had it as an OR outpatient on a Thursday and I was back to work on Monday. Some cramping over the weekend, but nothing severe. Prior to my procedure I had circulated dozens of ablations as an OR nurse, so I have seen both sides of the coin. It has been one of the best things I have ever done for myself. Over time, my periods are almost non-existant. Maybe a couple of days of spotting now; at most 2 -3 days of much, much lighter than what I was used to. I was 43 when I had my procedure. I have been out of the OR for the last couple of years, so I can't speak to any improvements over what I had.