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DoGoodThenGo

DoGoodThenGo

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  1. DoGoodThenGo

    Does the BSN in 10 apply to all nurses or just RN's and why?

    This is probably one of the better articles on how things reached this stage: http://home.nwciowa.edu/publicdownload/Nursing%20Department%5CNUR310%5CBSN%20Required.pdf Also the famous (or infamous) white "position" paper published in 1964 making the case that BSN should be mandatory for entry into professional nurses (holding a RN license). It is important to remember a few facts. As then written the ANA advocated while making the BSN mandatory for becoming a RN, it also called for creating another license for ADN and diploma graduates (technical nurses). Per the paper the BSN nurse wasn't supposed to be at the bedside usually. Rather she (or he) would be in a leading position of the nursing care team (technical nurses, LPNs/LVNs, aides and techs). The BSN nurse would (among other functions) plan and evaluate patient care; the actual work in delivering such care would be meted out to technical and practical/vocational nurses and assistants. This is largely keeping with the (then) thoughts that BSN nurses (via their education) possessed the necessary background to diagnose, evaluate, supervise and so forth patient care, but sort of often thought slow on the uptake of "nursing arts" as it were. That is they were full of theory but short on rationale/practice. You can see how such a proposal was going nowhere in the 1960's and at once drew howls of protest. Diploma nurses who still were in great numbers then largely ran many hospitals or at least floors/units. They were then and for years afterwards as a group on average having highest board passing rates. Diploma nurses also as a group on average (then) ran circles out of the box both in orientation and first several years post graduate over ADN and BSN grads. To tell them they would now be called "technical" nurses was more than many were going to accept. While this mandatory BSN debate raged through the 1970's and well past the 1980's care models changed. Team nursing which by and large was the standard in 1960's had been largely replaced by primary. Also by the 1970's many hospitals began phasing out practical/vocational nurses on first units then floors. This left just RNs and aides delivering care. Obviously without "technical" and practical nurses much of that famous ANA white paper proposed doesn't work. For as hospitals and other facilities are concerned a nurse, is a nurse, is a nurse. Unlike some other countries (such as Canada IIRC) being a RN does not automatically equate to holding a BSN degree in any of the fifty US states. This is what various BSN in Ten pushes seek to address.
  2. DoGoodThenGo

    Does the BSN in 10 apply to all nurses or just RN's and why?

    It is a long and complicated/drawn out story, and don't have time right now to sit you down so here are the basics. LPNs in NYS aren't professional nurses (RNs) so obviously the statue does not apply. Practical nurses have their own educational and licensing requirements totally separate from registered nurses. As to the "why" this all came about, again it is a *VERY* long story. Much of it is covered here: https://www.nurse.com/blog/2017/12/20/new-york-governor-signs-bsn-in-10-into-law-for-nurses/ Long story short for >60 years (or is it 70?) since a famous (or infamous) white paper was published proposing mandating making the BSN the minimum requirement for entry into the profession there have been raging debates ever since. Hundreds if not thousands of students were told all during nursing school (ADN or diploma programs) that the BSN was soon going to be mandated so they had better make plans. It never happened; with many not only becoming fully licensed RNs but worked entire careers and now are retired (or close to it). Only one state (North Dakota) made the BSN mandatory, and it soon backtracked. However the "nurses in white coats) as some like to call them never gave up on their goal. If they couldn't get the BSN made mandatory from the top down (via state government laws), there was another way; from the bottom up. That is convince facilities (mainly hospitals) that somehow a BSN prepared nurse brought more to the table than ADN graduates. In 2013 Linda Aiken, RN. co-authored a study (published in 2014) showing that in many patient care areas hospitals with a higher proportion of BSN prepared nurses had better outcomes. https://www.americansentinel.edu/blog/2014/06/04/how-does-your-nursing-degree-affect-patient-mortality-rates/ https://www.rn.com/headlines-in-health/driving-factors-behind-the-80-percent-bsn-by-2020-initiative/ That study along with some others was behind the push to get hospitals behind increasing their BSN staff. In years that followed across the country places began going with "BSN only" or "BSN preferred" for new grad hires. North Shore-LIJ system (now Northwell) was one in New York, but pretty much all downstate hospitals won't touch a ADN grad (newly licensed or experienced) under most circumstances. As it relates to New York state the rest just came down to politics. Healthcare is one of the largest employers here (Northwell is the largest private employer in NYS), and the various unions representing nurses and healthcare workers hold considerable political clout. The rest as they say was history. Since hospitals already largely had moved to hiring BSN grads only, and the unions (such as 1199) won protections to see that their members are protected (those graduating from ADN programs given ample time to get their BSN), the state had cover it needed to enact the BSN in Ten. It gave Andrew Cuomo more to brag about that NYS is "at the forefront of progressive legislation" and leading the way in matters of healthcare and so forth. Finally should point out the one main reason North Dakota's BSN mandate failed was the huge nationwide nursing shortages of the 1980's through a good part of 1990's. As anyone can tell you while conditions on ground vary locally, there is *NO* shortage of professional nurses (RNs) in NYS or many other parts of the country. In fact if anything for some areas there is a surplus and places are beating back applicants with sticks. This has made it very easy for hospitals to pick and choose. While in the past due to a shortage they had to take any nurse with a license; now thanks to a glut places are free to put in place certain restrictions. In North Dakota the state found that once their BSN mandate was put into place it made a bad situation worse. That is instead of more BSN nurses (either graduates or bridge programs), ADN or diploma nurses could easily find work in neighboring/other states; and they did.
  3. DoGoodThenGo

    Does the BSN in 10 apply to all nurses or just RN's and why?

    Far as NYS is concerned diploma nursing schools long ceased to exist. IIRC there is only one such program left somewhere upstate. Basically the profession and more to the point employers (hospitals) made that call. The latter no longer would hire diploma graduates so schools had to make choices. Many such as Saint Vincent's and Beth Israel simply became ADN programs. Others like Flower and Fifth just shut down. On the profession side there was a push to move nursing programs out of hospitals and into colleges. This included the new community colleges which began offering ADN degrees. Both sides could see and or wanted the benefits of having professional nurses with a "well rounded" education which came from attending college. Spoke with someone working at College of Mount Saint Vincent's nursing program who also had been as Saint Vincent's in Manhattan. Asked her why Saint V's in the Village discontinued their famous and highly regarded diploma program. Reply was quick and short, "no one would hire them". On another front sometime by the 1960's or 1970's (cannot recall exactly) insurance companies began refusing to pay for care delivered by student nurses. That is the old apprenticeship method of teaching nursing (which was still well entrenched late as the 1950's) where much to a bulk of bedside care was delivered by students or probationary (probies) nurses was out. Facilities were informed insurance would cover care by licensed professional or practical/vocational nurses. With that big chunk of money gone hospitals found it increasingly expensive to run diploma (or even ADN) nursing programs. More so as states began mandating standard minimum credit distributions for all graduate nurses needed to sit for board exams. This is how things pretty much rolled across the country. Some states more than others held onto large numbers of diploma programs (Pennsylvania IIRC comes to mind), but overall their numbers have been declining since the 1970's. For any diploma RN who does not currently hold a NYS license, once BSN in Ten comes fully into effect they will be required to obtain their four year degree within ten years after being granted NYS license.
  4. DoGoodThenGo

    Nursing Uniforms: From Skirts to Scrubs and Beyond

    Well that's what things all come down to today isn't it? You'd have all sorts of heck breaking loose if any facility even remotely tried today to get even a largely female nursing staff back into starched whites and certainly caps. Happily for the Millennial age nurses and those near or coming after them in many local areas dress code decisions have been made for healthcare facilities by local governments. Here in NYC for instance it would be nearly impossible to mandate caps unless a place agrees/wants male nurses to wear them as well. Ditto for dresses/skirts and anything else that is gender specific. https://www.newyorkcitydiscriminationlawyer.com/dress-codes-uniforms-and-grooming-standards.html Mandating whites alone (dresses, pants or whatever) is still around for some facilities; mostly LTC, nursing homes and such. IIRC one of the last NYC hospitals that had their floor nurses in whites was Lenox Hill. This was before the place was bought by North Shore-LIJ. Now nearly everyone wears the standard "Northwell" (as NS-LIJ is now known) uniform of blue pants with white top. Ironically the housekeeping staff at then NS-LIJ (who are 1199 union IIRC) voted to wear the same blue dress with white bib that was standard student nurse uniform for many NYC schools for ages.
  5. DoGoodThenGo

    Nurse accused of impregnating women in vegetative state

    Nathan Sutherland is no longer a LPN far as the state of Arizona is concerned. So there is some justice in the world. https://www.dailymail.co.uk/news/article-6634093/Nurse-arrested-comatose-birth-voluntarily-gives-nursing-license.html
  6. DoGoodThenGo

    Nurse accused of impregnating women in vegetative state

    Former caregiver of the young patient in question gave a media interview in which she stated the woman's large and extended family visited often. They are American Indian from a local tribe and (former) caretaker stated often large groups of fifteen or more family/tribe members would visit. This was at least every two or three months. As noted part of being named legal guardian for her daughter the mother at least was required to make regular visits; which she did, at least once per month IIRC.
  7. DoGoodThenGo

    Nurse accused of impregnating women in vegetative state

    Far as Hacienda Health facility in question, that ship has already sailed. Soon as story broke family of patients began telling media that trust was "broken". Cameras are being placed in patients rooms by family. Some family members are moving into patients rooms, and or at least staying overnight. In general what normally happens has done so: all staff are "guilty" until proven innocent. Meanwhile the facility itself instituted new rules basically mandating no male staff member may care for/enter a female patient's room alone. So now male nurses and aides have to buddy up with a female staff member. This obviously is causing issues with staff and they have complained since the place isn't exactly the most luxurious in terms of staffing. As for that "most trusted" profession...., media reports began not soon after this story hit that if people think this is an isolated incident, they'd better think again. If you believe some reports/comments abuse of patients in LTC, rehab, nursing homes and other facilities is rampant and common.
  8. With all this push for making $15/hr. the new minimum wage (here in NY it could happen any day now), am wondering if acute care and other settings where LPs were pushed out will be brought back in lieu of aides and other UAPs. By and large LPNs were phased out of NYC acute care hospitals years ago IIRC. *Think* some places still hire them but they work in other parts of the healthcare network, not necessarily on the floors. Nursing assistants represented by union (usually 1199) here make around $17/hr. so am told. However those with no such connections can and often do make less. Am wondering if there is a point at which hospitals will find that if they must pay more it will prompt changes in job requirements/description that means going with someone who has a license.
  9. DoGoodThenGo

    Why I cannot hate the Affordable Care Act (ACA)

    Despite New York State's participation in the ACA and roll out of its own insurance exchange ER's in City and elsewhere are still crowded. Persons continue to use them as a substitute for PCP and it is causing all sorts of problems including staffing related issues. ERs in critical condition, nurses say; patients cite long waits | SILive.com Leaving aside the question of insurance (or lack thereof) and finding someone to accept there is the problem of physicians keeping "banker's hours". After a certain time of day or on weekends/holidays you often will be hard pressed to get in touch with or see a PCP. The "ER" Lenox Hill opened at the former St. Vincent's campus is 24/7 IIRC, but not everyone lives near or wants to trek down to the West Village.
  10. DoGoodThenGo

    Why I cannot hate the Affordable Care Act (ACA)

    My PCP hasn't accepted insurance since been going which is >25 years. You either pay by cash or check and they will fill out your insurance forms for reimbursement. Here in NYC that has been the standard for many private practice physicians and has been so for some time. Of course those connected with networks or hospital run facilities are a different story. As for why they all give pretty much the same response; the cost of employing staff to deal with insurance companies and or Medicare/Medicaid. They just don't want the bother. Here in NYC urgent care centers like CityMd vary, that place takes all sorts of insurance including Medicare and Tricare (but not Medicaid IIRC), also is in network for a good number of private plans.
  11. DoGoodThenGo

    Do Nurses Earn Big Money? You Decide.

    Not sure if this has been covered or not but compensation for nurses is largely a factor of COL in a particular area. New grads start here in NYC at mid $70K to low $80K per year. Now most anywhere else in the USA that would be "big money", but not so much in New York. High housing, taxes and other costs mean that $80K does not go as far as you might think. High housing costs are a huge problem for hospitals in NYC especially Manhattan. With rents for a small studio apartment on average >$1500 per month (and that won't be in a good building/nice area) to >$2K (better area and building) you can see where this is going. Sloane Kettering is building housing on Roosevelt Island, and IIRC NYP has a few buildings scattered around Manhattan including a new one on Second Avenue. Not sure if Mount Sinai still offers nurse housing. Still off of those efforts are drops in the bucket with nurses stressing they need higher wages to deal with this local economy. Nurses along with physicians and other licensed professionals are at least at the "top of the food chain" so to speak, and thus fare better than UAPs, techs, administrative, and so forth. There depending upon the facility wages can be "decent" to "good" but often no where near what they need to be considered a liveable wage. The head of NS-LIJ was interviewed as part of a news program about young Long Islanders fleeing after college because they cannot afford to remain. The man's point of view was NS-LIJ cannot fill and retain employees for such positions at what it considers very good wages. Now the compensation offered may very well be "good" in the eyes of that network, but considering the COL in LI and NYC some have other ideas.
  12. DoGoodThenGo

    Top 10 Reasons We Get Fired!- Medication Errors

    Has been almost three years and is still my *favourite* (if that is the proper word) example of a medication error and the actions that followed that took the gold for running, standing and jumping. Nurse's suicide highlights twin tragedies of errors - Health - Health care | NBC News We shall never know the full story behind the situation surrounding nurse Kimberly Hiatt. But that a well seasoned nurse with nearly a quarter century of experience under her belt could been treated so badly by her hospital, and apparently the state BON and or everyone else in the profession in that area speaks volumes. Even worse that this same experienced nurse chose to end her life rather than deal with what she saw as the real prospect of being never able to practice again also speaks volumes.
  13. DoGoodThenGo

    Hospital Unit Secretaries

    Though do not think it was his official job description always felt "Radar" from MASH was the perfect unit secretary/ward clerk. Not only skilled in processing paperwork but knew how to work the system and or his connections to find scarce supplies or run a physician to ground to sign an order or some such. Sadly yes unit secretaries are in the cross hairs of many bean counters. That or the real good ones are retiring or won't put up with nonsense and leave. Often what is left are those that act as if they have no other place to use a computer than at "work". However will say in general the secretarial/assistant employment options in general are dwindling each year. Technology has simply made so much of what secretaries once did is now redundant. There was an article in either the NYT or WSJ a month or so ago back at how even legal secretaries are being laid off/phased out. There you have women and men who have been at the job for much of their careers, where are they to find work at or near nearly fifty?
  14. DoGoodThenGo

    Do Nurses Earn Big Money? You Decide.

    Actually in many areas of the USA nurses are out earning physicans, especially GPs. Many doctors especially those just starting out are being hurt financially by cuts to Medicare/Medicaid and insurance rates. Again this varies by practice but GPs, Peds, OB/GYN seem to be feeling the pinch hardest. OTHO some specalities do very well: The Best- And Worst-Paying Jobs For Doctors - Forbes
  15. DoGoodThenGo

    Do Nurses Earn Big Money? You Decide.

    That sort of mindset has been going around for years, there was even a book turned into a motion picture based upon said theme; "Not As A Stranger". Not as a Stranger (1955) - IMDb 1. Not As A Stranger - Robert Mitchum Olivia deHavilland 1955 Drama Romance Full Movie.flv - YouTube Quite a few pre-med and medical students back in the day latched onto nurses. While a she usually didn't earn much a nurse did have a steady income which had it's own appeal, but for some men with ambitions in the medical field such a marriage brought other benefits as well. A well respected and experienced nurse usually had some pull in a hospital and or other connection that could benefit her husband. While the usual choice then for a doctor's wife would be a physican's daughter and or a girl who came from money and social connections (all the better to fund a medical school education and help launch a practice), in a pinch a nurse would do just fine. Of course many of these men turned out to be the skirt chasing physicans we all probably know at least one. Between nurses, secretaries and any other woman laying around spare it was a wonder those doctors got to practice at all. OTHO many of the wives turned a blind eye because they were now "doctor's wives" with all the wealth and status that entailed. If and when things hit the fan and went to divource court allot depended upon the judge. Some former nurses were well compensated in the division of the marital estate when they could show how their contributions in the early years literally built their husband's practice into what it had become.
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