I don't want a "nice" nurse. I want a strong, compassionate, intelligent nurse who knows what the hell she's doing and who knows what her limitations are. As an ED NM (over me) put it, "Sweet and dumb is dangerous."
Okay...look. I'm not harsh at all (and no I'm not a nursing instructor) ...but my fellow nurses and I are sick to death of nurses coming into the field who should never have graduated. Nurses who don't expel the air in a syringe before going to a patient's bloodline (I personally snatched one out of a new nurse's hand as she put it into a dialysis patient's bloodline with 1cc of benadryl and 2ccs of AIR in it) - nurses who don't know the difference between SL and SQ. Nurses who take heparin drips off pumps to hang by gravity for transport to a hospital 80 miles away. Nurses who give Sufentyl instead of Fentanyl because it "sounds like the same thing" and then go on break and wonder why their patient is CODING when they return. Nurses who draw up Fluvirin for PPD. Nurses who don't think to look up medicines they don't know before giving them. (17 yrs and I STILL never give a med I'm not familiar with until I look it up) Nurses who can't seem to understand the IMPORTANCE of paying attention to what they are doing. Nurses who don't recognize chest pain ("like bricks on my chest") in a CARDIAC PATIENT as something to be concerned about. No exaggeration. These are things they should have learned in school. And I'm sure these things were taught but somehow the IMPORTANCE of it got missed, as if it were all just lip-service. All this I have seen happen within the past year and it just amazes me that these nurses were even allowed to graduate without mastering certain basic concepts such as the five rights of medication administration. They apparently memorized things but they haven't learned (the definition of learning being a change in behavior as the result of new information and knowledge) them. Believe it or not I am very easy-going and I don't expect someone to learn something overnight but I DO expect them to have some basic SENSE and to REALLY try, and I'm not seeing that. Again I am referring to my geographical area here, which is a rural poverty-stricken area and many see nursing as nothing more than a quick way to a better paycheck - I just don't think those people should graduate unless they make some basic changes along the way. Nursing is still a "calling". I take each one on a case-by-case basis but unfortunately I only see maybe one or two out of a class who really take it seriously and really do try. Meanwhile I see many trying to play politics and butter up the nursing supervisors. It amazes me. I see nursing students on hospital clinicals who might change a bed and might give a med or two but that's all they do here. There is no sense of responsibility for the care of the patient instilled in these people. They go socialize and take frequent breaks and try to leave a couple of hours early if they can get away with it. THAT is what I am seeing HERE and it's NOT working. And they still graduate and somehow manage to pass boards and then it's like everything they "learned" is gone. As if, as I mentioned before, they just thought it was some information they were supposed to have to pass a test so they can get a job and nothing more, like none of it's really important. And no, nursing isn't the military but it does still require a certain amount of character and integrity and sacrifice and accountability and for those who may not have that going in, one of two things has to happen - either it develops (which does take a wake-up call to do, like it or not the fact remains that adversity is what builds character) or it doesn't and if it doesn't then that person does NOT NEED TO BE A NURSE. I do not want that person responsible for MY care. I absolutely DO believe in weeding out the ones who can't hang, who don't take it seriously, in making them pay attention to what they're doing. Unless I missed something somewhere, you can't afford too many mistakes in nursing. The average lay person may be used to getting along with an error here and there in other jobs with no really heavy consequences but that's not always the case in nursing...people get hurt, people die, people sue, there's just NOT a lot of room for error in patient care and if you think there is, then I don't want you taking care of me either. I am a very vocal patient advocate and an old-school nurse and I make no apologies for it. I support my nurses and I support new grads but I will also say that if you pose a risk to my patients, I don't care who you are, I will be on you like white on rice. My patients trust me and my coworkers actually enjoy working with me because they trust me too. I'm laid back about a lot of things but quality of care is NOT one of them. I'm not bitter but I am frustrated with this kind of attitude coming into our workplace because it is for the rest of us to pick up after them and clean up their messes and WE are responsible for that. Yes I'd much rather work short than supervise a nurse whose care I can't trust. I would much rather answer what someone may consider to be a "stupid" question than to have that person go and make a terrible mistake. It frightens me when I work with a nurse who doesn't realize that the question should be asked (as happened with the chest pain situation - she went on as if the patient hadn't complained, I just happened to walk up and find out about it, she then told me that she just didn't realize it was important). THAT is what is wearing me out. I don't have a problem with nursing students - I have a problem with nursing SCHOOLS not getting things through to them. They've taken that soft, "nice" approach around here and this is where it has gotten us. Plus the nurses graduating from them are totally unprepared for the rigors of the actual world of nursing. At least we were prepared. Only difference when I graduated was that we had no more homework, no more tests, no more huge care plans, and we got paid instead of paying. So the transition was much easier for us than it obviously is for the new grads these days (who seem to do nothing but complain).
Yes, we had that much reading to do. Granted, many chapters were repeated in future lessons as concepts became cumulatively more complicated. But there's absolutely no exaggeration. It was very thorough. Each one covered chapters from two med/surg books, the nutrition book, the pharmacotherapeutics book, plus others that I honestly can't remember now but we bought many books at the very beginning that went with us all the way through as all total concepts of care were covered - not nutrition here, drugs there, but the entire disease process, the body's responses, compensation by other systems, diagnosis, treatment, complications, therapies of all kinds, prevention, what to expect, assessment, patient education, documentation, nursing diagnoses to go along with, nursing interventions and nursing care involving every possible drug and treatment and what they would do, (and nursing dx to go along with those too) etc etc etc - for EACH section and each major illness and then how that would tie in together with and be complicated by other co-existing disease processes. It was a damned good education. Our instructors/professors took a personal vested interest in the quality of nurses they turned out. My eyes stayed crossed. Books went with me everywhere, never did I have a waking moment (except in clinical) that I didn't have an open book in front of me. Probably read each chapter and each segment of each chapter 6-7 times between studying for tests and searching for the documentation for the planned interventions on the care plans. I read so much I frequently got to where I couldn't absorb another word. And I've have to re-read what I had just read because it I had totally missed the whole thing. If it hadn't been 17-19 yrs ago I'd have been happy to share the syllabus...but I had a big bonfire and burned it all after the pinning ceremony Even so I'm not trying to complain about how nursing school was (though one thing I learned there was - FORGET medical school!) - The starch and the whites and all that was just part of the times (though I still shudder to see nursing students with bright fake nails and tons of jewelry fixed up like they're going out the club but for their scrubs). We had an absolutely beautiful traditional capping ceremony and it was a rite of passage for us. Same for the pinning ceremony. And there was a great deal of satisfaction for me when the very instructor who gave me the hardest time, who pushed me so hard and in so doing, taught me that I could either lay down and die or stand up and be strong and finish on time despite the difficulties and the hardship - and in that, that I really did have the strength in me to fight back and win by shaping up and not giving up and by graduating without having to come back and repeat the same classes same time next year, was the one who put that pin on my starched white uniform and smiled at me with pride. She pushed, and I didn't fall down and die. I despised her, until one day after it was over when I realized what she was doing. She was pushing me so I would be not only a strong nurse, but a stronger person ( I was the baby of the class, greener than grass and had never encountered that kind of hard work and those kinds of expectations before, and I passed the NCLEX-RN at the tender age of 20 - and was charge nurse of a 35-bed tele floor within 6 months - there was a shortage then, too). It takes that kind of gumption to do what we do for the long hours that we do it and to give up what we give up and to still find fulfillment and rewards in it. Nursing school is more than about learning how to perform tasks and give meds and do procedures and do paperwork. It is about learning how to BE a nurse. BIG difference. On so many other threads in this board we mourn the passing of the patient advocacy, of the mission of nursing, of providing care to the whole person (mind, body, and spirit), of the community-centered care model and we express so much frustration at the large corporate "bottom-line"-centered model of healthcare that predominates these days, and all the consequences that we suffer because of it. We still want to stand up and be counted as Nurses, and for the world to recognize that we are still something special and cannot be and should not be dispensable. If we want to continue to be able to do that, then we have to send out competent, skilled, sensible, reasonable, intelligent, caring, thinking people into the profession - and the schools around here aren't doing that. And the patients are suffering, and so are the rest of us. And if nursing students can learn to "fake their way through" as one previous poster suggested, then we're ALL in trouble. The only thing that offended me was that concept right there. If it's even POSSIBLE to fake one's way through nursing school, then the schools have to back up and look at things and are just going to have to make it tougher, not easier. If nursing school is soft and easy, there's no respect earned by obtaining that position - nor is it deserved. Back in my day the community looked at you and respected you because you "made" a nurse. You made it. It was a big deal. It was hard, hard work and required a great deal of sacrifice and we were respected and trusted for having done it. And if we have nurses working alongside us and caring for us who have faked their way through, then God help us all. There goes the whole profession and everything we have worked so hard for, and there goes the care and safety of our patients, who already get lost in a system that considers them merely sources of revenue.