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I'm having difficulty with students struggling to find the exact NANDA dx for their patient's problems. Rather than reason through their assessment data and synthesize in their own minds their patient's problems, I see them thumbing through NANDA to find a diagnosis that "fits". Language has two functions (it seems to me): First... we communicate our thoughts to others (I think this is where NANDA is most significant) and second... it is the way we put sensory data together, retain and categorize it in the cortex. Here I'm finding NANDA to be a hindrance. I don't think this is what the originators intended. Am I the only educator encountering this?

[TABLE=width: 100%] [TR] [TD=bgcolor: #f3f1f0, colspan: 2]1973: Kristine Gebbie and Mary Ann Lavin call the First Task Force to Name and Classify Nursing Diagnoses. Members plan to meet biannually in St. Louis, MO.[/TD] [/TR] [TR] [/TR] [/TABLE] My question is... why? What was the pressing social or professional impetus to standardize nursing diagnosis?

I teach at a proprietary school and there is a genuine equality in the sense that faculty in general ed are paid comparably to nursing faculty. It has to do with how many "face hours" you have, plus a factor for committee work, lecture prep and paper work (grading.) Across the entire company, there cannot be radical differences in the way employees are remunerated. AND, we are paid better than our university and community college colleagues.

Hmmmm... interesting conversation. There hasn't been any "Xtian" input yet so, since I qualify, I'll put in my 2 cents worth. I think what some of you have experienced is "being witnessed to." If you view it from the stand point of the witness' beliefs that unsaved people will suffer terribly forever (and this is very real to them) it is (not always, but often) genuine concern for you that they take the time to try to explain their faith and the Bible etc. to you. So, that is the best spin I can put on it. We live in a secular society and the social rules about discussing politics and religion with strangers is probably good policy. But there are so many variants and shades of Christianity you just can't generalize. My beliefs arise out of the Genevan Reformation. The major point there is that God is sovereign over his church (duh!) and will gather its members as it pleases Him. Meaning, if God wants to save you, you will be saved. If not. You won't. It's refreshing for me to know that He is in charge of these things and not me. I used to be an "evangelical" like the ones you describe and I remember the heavy pressure that is put on everyone to go out and "witness". It's not that I won't do it... we are to be competent to explain our faith when asked to do so. (And yes, sometimes Christians are asked about these things.) The real irony here is that all of this means I'm a Calvinist, and most Evangelicals are more suspicious of us than they are of Pagans. Brainkandy... I was a sailor (or at least in the Navy) and I sometimes use very earthy language. But I try very hard to avoid profanity. I might get "earthy" at times, but would feel horrible if found myself useing God's name in vain. I don't know if puts me in the hypocrite pew or not. I figured it might help to give you a real target so you wouldn't have to keep working over your straw men.

Testing policy is in the student handbook and specifies much of what was stated above. All of our tests are on our website so it's done on line. We scramble the questions and the distractors. Same deal with water bottles, pens, scratch paper, calculators, hoodies, books and so forth. We let them use the calculators in the desktop of the computer. Per our policy... proven cheating and you're gone. Can reapply in a year but basically get to stand at the rear of the line. We had a terrible time a year and a half ago. Very ugly. Since firm policies put into place, it's gotten much better.

I'm full time and 3 hours prep for 1 hour lecture is maybe close to fair. I'm OCD about this and may take longer. Takes longer especially if you're starting from scratch on a new topic. Gotta question if your employer is using part-time people appropriately. Just doesn't seem right. Where I work, only full time people are in the classroom. If the school does this a lot (using part-timers to lecture) then there isn't much continuity. A lecturer should be part of input on curriculum development and testing and grading. It's more than just standing and delivering.

Thanks much... I'll talk to our librarian tomorrow! J

Excellent. I think we should make our CET more expansive in regards to all the people in the patient care environment, including other care-givers, significant others, family members and so forth. But, what sorts of verbs do you use to describe these caring behaviors. I find that males demonstrate concern for patients differently than females. Some ethnic groups are much more emotive than others. (Our native American population does not typically make eye-contact in the way other folks do...) Some individuals are, because of personality or the way they were raised, very nurturing in the way they interact with others. Maybe I'm over-thinking this issue and making harder than it has to be.

Your question seems odd to me. What do you mean? In a hospital, a spa, cruise-ship??? The days of the boutique general hospitals as I remember them, is pretty much over.

Our Clinical Evaluation Tool has an item that requires a rating on Caring behaviors. There's no definition of the term, not in the tool itself, or any syllabus, handbook or catalogue. Consequently, I don't think it's legitimate to rate the student in this regard. If a student was objectively cruel, well, sure... I could rate that (and fail the student.) But the language is too vague to use for anything else. It could never survive an appeal. We are an ADN program and at this time we don't have any content on nursing theory or theorists. This "caring behavior" element is probably a nod to Jean Watson, but that's just my assumption. (I should explain that the CET was pretty much pirated from a BSN program in which a faculty member taught. It's an awkward fit for us.) So, here is my question: Do you evaluate your students on their "caring behaviors" and, if so, what are your criteria for passing or failing?

Not sure what you mean by nationally accredited. AACN is the agency that accredits schools awarding the BSN (like yours). NLNAC accredits ADN programs around the country. There are no other credentials that we can get. We've gotten them all.

Our retention rate is very high. the vast majority that get into the clinical semesters will graduate... though sometimes they may need to repeat a course. We're even seeing that go down as a % because we're doing early and vigorous intervention. I recall when the auditors from ACICS came by they thought our retention rate figures were a typo or something... but they're for real. Are you counting (in terms of retention) students from their freshman year through to graduation? We have to include everyone from the day they walk through the doors to the day they graduate. I understand your University having admission standards. The University in question does also. But ONLY the school of nursing has this bias. THey appear to be in violation of their own rules.

We are a proprietary nursing school that is doing a bang up job producing well respected graduates. Our first time pass rate is 91.4%. Our placement rates are excellent. Our students are in high demand and doing well. 4 of our best decided to earn a little money and then go right back to school at our local university. They all did well and are about to graduate with their BSN's. Suddenly that nursing program (whose NCLEX pass rate is significantly less than ours) has decided they don't want to accept credits from our school. Just ours. Credits from other ADN programs... no problem. Ours, not so much. And (isn't this wonderful) after our students have been there, meeting all requirements, doing very well academically... the University told them... ah, too bad guys. We've decided we don't like your credits after all and we're not going to give you the degrees we promised you. You would think this was a University Campus-wide policy. But it isn't. Credits from schools like ours are accepted in any other department. It is only the School of nursing doing this, and it is only doing it to us. Bigots.

There was a post from a former HR person who said any resume that mentions U of Phoenix or other proprietary school is dumped no matter what else the applicant has to offer. And speaking of which... I work alongside a bunch of faculty members that got their MSN's from Phoenix. I'll bet a lot of the people who posted here don't realize when they take their certifcation exams in their specialty, they are answering questions authored by one of our current faculty members who graduated from U of Phoenix. Everything in nursing education is web-based now (even in brick and mortar schools.) and I'm here to tell you, those Phoenix grads know their way around all that stuff... and the ones that work here are incredible when lecturing in their specialty. As you say, I think the OP mentioned the advertising campaign (which, yeah... I see those ads also, though I've never seen one for the school in which I work.) However, it was a very short hop-skip-and-jump from the advertisements to the nature of people dumb enough to believe them. The whole thread has been an interesting display of snobbery from people who hold themselves in very high esteem.

It's not so bad and I'll bet you ramp up more or less gradually. Hopefully you get a good orientation and a good preceptor. In my view, the thing that makes the biggest difference is the team-work. Do you like the management, are your co-workers fun and helpful and is their unit cohesion? If it's a supportive environment... you'll do fine. (And just watch... people will be turning to you with questions about their patients with renal issues!)

It's sort of happened before. Mary's went a long time with the fiction that they would NEVER reduce their number of "bedside nurses"... it looks bad to the public, don't you know. Bur what they were doing was getting rid of nurse educators, nurse managers, clinical specialists, etc. etc. "The other guys" picked up a lot of master's prepared nurses, don't know if they got them on a "fire sale" basis. I know that life at the big hospital in middle management is dicey. So, they probably offered them less, used them to beef up their Quality programs and then dumped many of them. It is not unusual there to see someone named "employee of the month" and then find out that in less than half a year, their star employee has been urged to "pursue other opportunities". It's tough out here. Interestingly... there is one little town in the Eastern part of our state where there is a lot of Gold mining. Everyone is employed, big multinational businesses... and their hospital is going gang-busters. I'm in education. With the trickle down effects of economic realities, I'm not assured the circumstances here won't touch me. But, I'm also old enough I can retire... if I can get health benefits somewhere. Oh well... if I can just stay employed another couple of years, I'll be out enjoying my golden years writing my memoirs.

I'm a Vietnam era vet and was in the NNCCP (that's what it was called then.) I only had to pay for one year of college education, the Navy picked up the rest, and gave me a stipend while I was still a student (E3 pay.) 6 months before I graduated I became and Ensign and my "stipend" increased by orders of magnitude. I was stationed at "Balboa" in Sand Diego. It was tough, it was tragic at times. I was 22 when I started and looking back, was very, very sheltered and immature. It was an experience that shaped my life and I'm not sorry, never sorry I did it. (Plus I did my MSN on the GI bill. Two degrees for the price of one year's tuition, and 3 years of service for which I was paid pretty well.)

OK... let me take you guys on. I am on the faculty of a "for profit" institution. You are all right. We take the students others don't want. To me, that is a badge of honor. Ours is a 2 year program. 6 semesters from start (HS education, zero credits in college) to finish. We meet a very pressing need in our community. NV is the state with the highest unemployment rate (I think we are still over 13% OFFICIALLY unemployed. Add those that have given up and those that are underemployed and you have a devastated economy for young adults.) Our state budget is bleeding it's so deep in the red. Consequently they have cut back almost every department in every university and CC in the state, including nursing. So, we have lots of unemployed and underemployed citizens and we still have a nursing shortage in our part of the state. Our local CC has a massively long waiting list for the nursing program and if you don't have a 3.8 GPA, you're toast. What would you have these people do? We are really their last chance. So the next question is... are we any good. Our NCLEX first time pass rate is above 91%. (We beat the pants off the 4 year college in town.) Three new nurses in one of our recent graduate cohorts were nominated for "rookie of the year" by the largest hospital in town. Our placement rate is in the 90's% and that is artificially low because we've just had 4 graduates who left one job before some 6 month cut-off (they didn't like their positions in a rural LTC and got job offers in the big city instead.) This dings our "placement rate" statistics. Our retention rate is hugely, massively higher than any other program (there are 3) in our area. Meaning, if you start with us, you have above a 75% chance of graduating ON TIME. No one else is doing that. We are accredited by ACICS and NLNAC. We got glowing evaluations from the examiners for NLNAC. Our state board gave us their blessing shortly after that. From nothing to fully accredited in less than 4 years. I wish you could meet my students. One is a recently discharged Navy diver... one of those guys who either set explosives or disarm the ones the bad guys left. Incredible young man. I had him in the ICU and started explaining about alveolar ventilation and tidal volume and pCO2 and he immediately began explaining back to me about Oxygen and CO2 in the tanks he wore, CO2 narcosis, the bends, solubility quotients of gasses in solution... Whoa!!! I get to teach this kid because the state schools didn't want him. You want to hear about the young lady who drives 90 minutes to and from school 3-4 times/week? She leaves her rural community between 3:30 and 4:00 AM (depending upon road conditions) to get to clinical on time. The nursing home where she worked as a CNA is putting her through school. She could NOT have made it through the CC because there would have been no guarantee she would have matriculated to the nursing major. Or how about the single mom with two kids who works full time AND drives from South Lake Tahoe, a similar distance... same situation. Her classmates collect cans and other recyclables to help her pay for her gasoline. Now, then there's Randall (name changed for FERPA purposes)... an older guy who was a restaurant equipment salesman who in midlife found himself with no job, no prospects and not even 10 minutes of higher education. Do you think the State schools would have given him the time of day? Pfffft... In his second semester he came to me having a lot of difficulty with A&P II (the teacher in that class is very rigorous.) I started showing him some study techniques and he is now getting high B's and A's and has become a class leader, running study groups for other students. I could go on and on and on. You have no idea how determined most of our students are... or how elitist your posts sound. You don't know our school and you sure as hell don't know my students. Honestly people... you don't know our faculty... you've never looked at our syllabi, our curriculum... never talked to the nurse managers who rave about our graduates. You see the words "For Profit" and all of a sudden you know you're better than we are. Just because in your life you were graced with better opportunities than my students. Shame on you. Really. YES... there have been horrible abuses of government largess and some schools have been exposed as scams. Consequently the Federal Department of Education has all For-Profits under a microscope. We are forced into a system of accountability that I don't think any state school could satisfy. Their retention and matriculation rates stink compared to ours. Get your facts straight. And to all the "for-profit" grads who have timidly and apologetically responded on this thread... I say hold your heads up. Be proud of your accomplishments. Did you pass the NCLEX? Then in the eyes of God and the State you are as good as anyone else. Some elitist HR snot throws your resume in the trash? Screw them. Would you want to work for an organization that judges you before they even MEET you??? Just move on. I'm pretty angry at all of you right now. I suspect you are all better people, fairer people than you appear on this thread.

Here's one wrinkle. Even though this is NV, the nurses at Mary's were organized/unionized by the California Nurses' Association which meant these nurses were being paid California wages... significantly more than across town at the other hospital. The best outcome would be that they only bring RN pay down to local levels. But, I'll tell you what... they may try to drive hourly pay way down, in which case the other hospital would take the next opportunity to do the same.

Yeah, there are indeed quite a few positions out there for MSN/PhD's in nursing education. But very honestly, I think your plan would put you in a Catch-22 situation. It is a BIG, IMPORTANT school that accepts faculty that cannot switch-hit (do clinicals, teach, research and write.) I have a PhD and interviewed at about 5 or 6 places. There was always that moment in the interview process where one search committee member would ask how I would feel about "taking a clinical group." I always said NO. I didn't get any of those jobs. In order to be on a faculty, even if you do NOT take students into the clinical area, you will absolutely need to be ready to lecture. You are going to have to do face time with students. End of story. Ideally the lecture content for which you'll be responsible will be something that relates to your specialty... but often it's only a tangential relationship. (You're mental health... hey! You get to teach the nursing care of dementia patients to undergraduates!!! Oh, and Parkinson's disease, too. Congratulations! And while you're at it, your objectives need to cover the drugs used to treat these conditions. You better know a lot about Dopamine neurotransmission in the substantia nigra!) If you come on board with a grant that pays your salary, you can probably name your terms and stipulate that you will not teach students in the clinical area. But do not plan on getting a research position, sans clinical rotations, without having that funding in hand from the get-go. Bottom line, in order to be a professor of nursing, you need to be a nurse. You can be a molecular biologist/pharmacologist (me) but please... don't aspire to teach if you aren't ready to be a professional role model for nursing students.

I live in a town that has had two hospitals for as long as anyone can remember. One was the county hospital (now is run as a business, has share holders etc.) and the other was the Catholic Hospital. St. Marys was a mission of an order of nuns for eons, until they turned it over to Catholic Healthcare West and those people just ran the thing into the ground. Bad, bad business decisions, running it from a city on the other side of the Sierras, no local decision-making, tried to undercut the other hospital in town and lost bazillions in contracts (both hospitals are in the health-care insurance business). So bad was the situation that it looked like the place was about to be shuttered. (A hospital that has been here since the 19th century! Out West that makes it archeologically old!) Even though the other hospital is really large, the closure of St. Mary's would have left our town seriously under-bedded. But at the last minute another company swooped in and bought it! This past week, the new owners told every employee of St. Marys that they were fired. (Maybe they had a more delicate way to put it, but why quibble). Employees (former-employees) were told to submit new applications. If they hadn't heard back from the hospital in 8 weeks, forget about it. AND of course, they would be hired back at much lower wages. It has REALLY shaken our whole town. The news just came out Friday and I don't know if there are still patients in house, or if they hired temps for these next 2 months or what. This is going to really produce hard feelings in this town. I don't know if the new guys understand that folks around here hold grudges for a long, long time. What a boon to the other hospital!!!

I'm married to a doc so take what I say with that in mind... If doctors could deduct some % of no-pays (or can't pays) from their taxes, they would be willing to see more of them. When my husband has ER duty, he will see anyone. If the person is admitted, he will follow them. If the person is indigent, or a veteran (I'm not making this up) or on medicaid, he will not be paid a thin red dime. The hospital has a relationship with the county and they are reimbursed, but the physician is not. But, in spite of all this, when these people are discharged, they want to continue following up with my husband in his office. He tells them no. He doesn't like doing this. He has no animus toward them. But we cannot afford to give away that time when his overhead is obscene. It literally costs him money to see these people after hospitalization. It costs him a great deal of money. And he cannot deduct any of it. If there was any slack, any small % of break for him on his taxes (yes, we owe the IRS 13K this year because I work and earned too much) then there would be some patients he could follow. I think if you do this for every PCP and specialist in the country... you BET it could make a difference. Cost shifting? Perhaps. When tax $$ go to DC, the amount that returns to the people for things like medical care has been so shriveled by the government's take, their inefficiency and graft, the returns are a pitiful shadow of what we paid. Just a small degree of freedom to see indigent patients and defer some of the expense... it's a direct benefit to the patient and the community.

I would love Universal health care. I could retire! The only reason I'm working is to have health insurance. I love my dogs and I'd be out training every day and most weekends, I could be off running an AKC hunt-test or field trial. Wow. That would be great. As long as you can PROMISE me there would be no rationing, I could have whatever doctor I want, and he and I could have any care, medicine or tests we thought was necessary. Excluding of course, cosmetic stuff. Very honestly, I have two artificial knees. I don't know how long those things last. But if in 20 years I need to have new ones put in... I don't want anyone telling me I'm too old. But for the non-US members here... we do have an obstacle in the form of our Constitution. If we are going to have Universal Health Care, it has to be able to pass Constitutional muster, and the way the Congress went about this Affordable Care Act was dubious on many fronts. A lot of smart people say that a truly Universal Care, with single payer, would be Constitutional. But politically, the Democrats did not think they could get it passed. So they came up with a hybrid approach that satisfies very few.

I have a need for 21% oxygen atmosphere. If that's turned into a right, will everyone get room air oxygen? To be fair those who need 25% or more should be cut off. Really, the "reductio ad absurdum" has been overplayed on AN.com and for that matter this thread. It is absurd, Woodenpug. But there is no "reductio" about it. I don't know if your O2 is going to be cut off... but watch out. The environmental lobby would be pleased if you'd let your kidneys make more HCO3 so you could exhale less CO2. (That is satire. It is reductio absurdum. But the other stuff I related... well... it's history.)

This is not an issue of American health care. This is an issue of humanity. We humans have evolved to the point where health care should no longer be a privilege, but a right. It's a necessity, just as much as food, clothing, or shelter is. OK... let me try to break it down for you. From the late 20th C forward there has been a lot of attention given to equality. This equality has been understood in the context of "Civil Rights" now expanded to "Human Rights". When the border of "rights" and equality has been pushed forward, it has required exact (for lack of a better word) "sameness" of each right to each human or citizen. Public schools were desegregated, but there were still inequalities, so wide-spread, court-inforced busing was required. Eventually, with regard to race, disparities were blamed upon historical discrimination, so we have come to accept affirmative action as a way to do penance as a people, thereby achieving justice. All of this was imposed by a government as a means to promote equality of rights. In the last 50 years, we've seen an avalanche of government action to create some sort of cosmic fairness... a fairness that is never defined. The minimum wage is never enough... because it's never fair. Men advance in the military on the basis of war-zone billets... so women must serve at the front line or it's not "fair." Our prison population is disproportionately minority which is clearly NOT "fair". Something must be unjust about that and as soon as the government figures out what it is, we'll see a proportionate percentage of felons from each race and nationality behind bars. Similarly, in the ACA, each American must have the same insurance, even though this makes no sense at all. We cannot risk the fact that one American would have a benefit that another does not. Because it wouldn't be "fair." That is what equality of "rights" in the world of centralized political power is all about. It doesn't have to make sense, Kandy... it is just how it works. YOU were the one who said food and shelter are rights, just like health care. Apply the methods of the Affordable Care Act to these commodities. Same insurance for you and me? Similarly, same food as well. And if you and I must have identical policies to provide equal access... then you and I should have the same square footage to live in. Health care, food, shelter, clothing... it's all the same. It's all about justice and equality. I agree with you. This is completely asinine. But this is how it is done. As soon as you turn a necessity into a right, you create a moral imperative for fairness, equality, justice and sameness of that right to all people. Whenever that has occurred in any culture, it has required forced redistribution. Welcome to Cuba, amigo. (Didn't Michael Moore tell us the best health care is in Havana? Made a whole movie about it. Why do you think I'm so far off base? I think the facts are on my side.)