AttagirlRN

James, I recall a meeting where an administrator said "how can we identify problems within a field that has the most general of definitions and encompasses the largest group of health care employees?" Of course he was referring to nurses, and the definition remains difficult to quantify. In my current position my job description is over 9 pages long and it still doesn't scratch the surface. I've always had a suspicion that administrators like to keep this vague definition in order to continue expecting nurses to carry out every clinical program, new form, increased charting initiative, tracking device, wacky idea, etc., not to mention the wage control this takes out of our hands. With that said, I still find nursing to be one of the most mentally challenging and difficult careers one could attain. I've never liked the catch phrase "it's a calling" or "it's so rewarding taking care of patients". It all sounds so light and fluffy, like all we do is float around touching the hands of patients, soothing their concerns. The inability to attach to us a concrete and well-defined job description only adds fuel to the fire. Epona, If your health is of concern, nursing may not be for you. It is 12-14 hours on your feet, running, bending, pushing, lifting, you name it. And as far as your back goes, it's not a matter of "if" but "when" you blow it out. I have several NP friends and two PA buddies. The PA's make double what the NP's make, so if money is on your list of priorities, PA school may be the best route. One of these two friends had a BA in English, the other had a BS in Biology. Both were accepted into PA school upon their first attempt. With the NP's, all but one had over 5 years experience, and most of the graduate programs in my area require lengthy experience as an RN first. Besides, I can't imagine how difficult NP school would be if you hadn't worked as a nurse first. I no longer do bedside nursing but instead work as a care manager. I am assigned to a physician for a week at a time and round with him/her on all their patients. He/she often asks my opinion, discusses the individual disease process or illness, has me write orders (under the MD name) or call family members to discuss the pt case. I often attend family meetings and speak on the MD's behalf. In my "spare time" between rounding I QA charts, do blood review, perform utilization review (insurance) on my case load, order all the DME or out patient workup...I could go on and on. I have a ton of authority and am respected by my peers. I am not an NP, but an RN with a BSN. So it's not always the title that gets the authority or respect. I guess what I'm saying is you take that education/degree/experience and mold it into what you want out of your career. Should you end up not liking bedside nursing, there are hundreds of other jobs out there that would value a nursing background. The most highly regarded skill you'll learn being a nurse is the ability to multitask in a very stressful environment, a skill that will get you into a myraid of other fields should you find nursing isn't for you. All my best to both of you!! Lisa

I don't get it...as nurses we should expect ongoing education, however the wording on this memo was counterproductive to the end goal. Hospital Quality Alliance (HQA) is the quality measurement division within Medicare. They measure reporting hospital's clinical programs (currently Pneumonia, Heart Attack, Heart Failure, and Surgical Infection Site); these numbers are then reported on Medicare.gov's website. There are many other clinical programs coming down the pike: DVT, Stroke, etc, so expect training programs/inservices to increase (if you work in a reporting hospital). The clinical programs are only as good as the doctors and nurses who carry out the care plans. Yes, the doctors write the orders, but nurses are responsible for other measureable markers, i.e. smoking cessation packets, PNA/Flu shot history, the CHF education materials, making sure the patient has the antibiotic prescription in hand, and a thousand other details. I'm one of those nurses who extracts all that data from charts. Believe me, all that you do is viewed under a microscope. Ultimately it's about Medicare ratings and how the hospital is marketed to the public using high scores. Too bad this manager didn't emphasize the essential role the nurse plays in the bigger picture. Lisa

I was 39 and looking at a 2 year waiting list, too. The list was comprised of reserved seats for those high school sterling scholars with a perfect SAT and thousands of hours of community service. The handful of remaining openings were reserved for us non-traditional students. By the time I got in, I was 41. In retrospect it was a blessing...I was able to complete all the pre-reqs, general university education requirements, plus tackle a good 50% of my bachelor's degree requirements, too. Trust me, you do NOT want to be taking anatomy and physiology while you're in nursing school. Your nursing core homework load and clinical load will be overwhelming enough. I graduated with my RN at 43, my BSN at 44. I've just turned 49 and have not regreted my decision one bit. Being the oldest in my nursing class, I found I had an advantage. While I hadn't figured an algebraic equation in decades, I did have 20 years of work experience in the legal field. Learning to work within caustic and political environments prepares you for the unknown. And there is nothing more unknown than nursing school!!! As other posters have written, the one disadvantage that is age-related is not the nursing school, it's that first nursing job. The younger nurses want friends their own age, the older ones have long standing friendships and don't want a newbee hanging around. Nurses, as a whole, are incredibly territorial and very passive/aggressive. Just prepare yourself and know (in some cases) they won't be so welcoming. And the best part about becoming a nurse? It's a career that is wide open. With some experience under your belt you can choose to do floor nursing, case management, insurance, corporate nursing, clinical research, pharmaceutical sales, and on and on. The choice is yours to make and yours to follow. Good Luck to you - you'll do great!! Lisa

Jnette, Your right, that's probably the biggest concern facing Hospitalist medicine...what is a reasonable load? I personally think 20 is too much, maybe 15 is a more manageable number. I've heard of one program that caps their Hospitalist's at 30...now that's dangerous. Can you imagine? 30 acutely ill patients??? Attagirl RN, BSN

There are officially 90 family practice physicians/NP's/PA's signed up for Hospitalist coverage. In addition, they "unofficially" cover everyone from the cardiologists to ortho to neurology who have requests for a Hospitalist to help them admit or consult. We have 3 on during the day, two of them carry a load of about 20 patients a piece, the 3rd one carries a smaller census but has the ER cell phone and admits during the day, does procedures (like LP's or central lines), and does consults for a variety of other physicians who need an internist to handle, for instance, a total knee that has diabetes or hypertension or whatever. That 3rd Hospitalist also will run to the code blue calls. The census varies from day to day, but averages around 50. They don't do peds, OB, or babies. At night, there is usually one admitting from 5pm to 5am, covering the folks who are in house, plus code blues. The ones who are on their 7off schedule take turns keeping their cell phones on in case they need to come in a help the night Hospitalist if he/she gets slammed. As you can see, it is a stressful job. Still, I can't imagine going back to the way it used to be... Attagirl, RN BSN

Jnette, Lord, YES!!! Especially the 80 year old who has had Dr. So&So for the last 5 decades as their primary physician. They want to see that familiar face walk through that door, even if he comes through the door on a walker and doesn't know how to write orders for an insulin drip (I've seen that happen)! Funny thing, the daughters/sons of these 80 year olds actually appreciate these Hospitalists (even if their mom doesn't) and the fact that these doctors are there 24 hours a day. Familiarity can be a hard hurdle to cross. It's been so interesting to see this shift in how medicine is delivered, watching nurses who were quite leary of these new "specialists" taking over the entire hospital. Then finding out how much patient care and patient satisfaction increased, and seeing their own jobs get easier to perform. Again, that's been my experience. There have been a few hold outs, doctors who do not want to sign up for the Hospitalists to care for their patients. They feel they can still see 40 patients in their clinics plus come back and round at night or early am and be on call. I'm sure it's an ego thing. Then there's the docs who refuse to ask for Hospitalist coverage, but refuse to answer their ER pages...have their cake, eat it too mentality. Anyway, five years ago I didn't know what a Hospitalist was either!! Glad to oblige! Attagirl RN, BSN

[OK.. so just what IS a hospitalist, anyway? I don't work in a hospital, so this is something I've not come across.. a new term to me. Just what do they do? Hospitalists are usually Internists (in small hospitals they often use GP's) that specialize in hospital medicine. In my hospital, clinic physicians, NP's, PA's, etc. sign up for these physicians to cover their patients should they need to be admitted to the hospital. The Hospitalists will admit, round on, and discharge these patients on behalf of the clinic docs. The clinic docs will receive a faxed admission notice (that their patients have been admitted to the hospital) and a d/c summary (telling them what happened during their patient's hospital stay and any outpatient followup needed). The patient then follows up with their clinic doc for routine care following their hospitalization. The Hospitalists are in the hospital 24/7, round and re-round of the patients as needed, and the nurses have them at their fingertips if the patient starts to fail or needs additional orders. The Hospitalists at my hospital work 7 days on (12 hrs) then 7 days off. The clinic docs love it as it gives them a life (they're not on call at night or weekends), and they still get their patients back after their hospital stay. Our program is so well known, patients actually come to our hospital because of the Hospitalists. Hospitalist is a fairly new term, though it's been around on the east and west coasts for about 10 years, and now only finding it's way into middle America. None of the 9 Hospitalists I work with have their own clinic practice (though patients ask me how they can make an appointment to see "that great doctor who took care of me"). They are in hot demand though the burnout rate is high. They have to be a specialist in everything, and they usually carry a census of around 20 patients a day. Alot of physicians who get into Hospitalist medicine find out it's not for them, and usually go back to either clinic work or find a fellowship. For the doctors who do excel at this high-paced high-stress life, they are worth their weight in gold. If you look through any New England Journal of Medicine, 90% of the jobs are recruiting for Hospitalists. Attagirl RN, BSN

I'm sorry to hear of this lousy doctor. Most internists are NOT cut out to be Hospitalists, and certainly this guy is one of them. It's a hard job, long hours, and incredibly high stress. All hospitals are required to have a mode of communicating problems. You need to file a complaint, but how you do it depends on a few things: If the Hospitalists are employed by the hospital, nurses have alot of input on how they perform and interact with staff. There should be a method of event reporting in your hospital, bypass your manager and call your Risk Management office, they will direct you. If the Hospitalists are employed as an LLC (a privately owned group of physicians), they are still on staff so follow the same complaint route. And finally, if they are employed by a Hospitalist company that provides physician staff to the hospital, again use the same complaint method but you might also feel compelled to write to the Hospitalist staffing company. In addition, set up an appointment with your Risk officer, he/she is required to listen to your concerns. If your complaints are legitimate and this doc is truly a danger to your patients, they will listen and help the documentation get to the right people. Believe me, written complaints/event reports are recognized by administration as a red flag. It just takes ongoing documentation to get a physician reprimanded and/or fired. No hospital wants a dangerous doctor due to increased liability, but admin needs proof...they rely upon nurses to let them know what's going on. Please continue to document what you see and report this physician. On a personal note, I feel Hospitalists are the best thing that's ever happened to hospital medicine, and have been a godsend to nurses and improved patient care. In my hospital they run the code blues, are there in an instant when a patient crumps, and nurses don't spend 3 hours paging a clinic doc trying to get a simple order. They admit the homeless, indigent, uninsured, ETOH w/d, OD's etc., where most of the other docs in the community refuse because they won't get reimbursed. With that said, I know not all Hospitalist programs are alike, but the ones run well make a mediocre hospital into a 5-star facility. AttagirlRN, BSN

My hospital is in the process of filing for Magnet status, though it takes about 2 years from filing to complete accredidation. My understanding is less than 2% of US hospitals are Magnet. It's a designation, cream of the crop of all hospitals so to speak. In my hospital LPN's are not let go or demoted as they are not in a managerial role, at least not in an acute setting such as a tertiary or Level I trauma hospital. The talk of "demotion" or "being let go" is always associated with Magnet due to the number of employees who choose not to seek higher education in order to keep their managerial jobs. I am a case manager and luckily I have a BSN, otherwise I'd be required to go back to school or face demotion. One of my coworkers (RN for 28 yrs) is having to go back to school for her BSN in order to stay working in case management. My boss, an RN with 34 years experience who has a BSN, will be required within 5 years to attain a Master's in either health adm or MSN. Anyone in a managerial role and without the required degree has been notified that if they do not start the process of getting that higher degree, they will be asked to step down to a lower position once Magnet status is obtained. There is no "grandfather" clause when it comes to Magnet. You're required to obtain the education equal to your job title according to how Magnet rates your specific job. OTJ experience doesn't count. I was told there has to be so many PhD's, Master's, Bachelors, etc. managing the hospital to qualify for Magnet, along with a zillion other requirements. Guess that's why it takes 2 years to actually get the accredidation.

I've heard that too. This "come with the room" mentality is what keeps nursing in the oppressive shape it's in. As a profession, we haven't done ourselves any service by allowing others to dictate our worth. After all, how many beds can you fill without a nurse? A physician friend of mine has often said the only way for nurses to achieve respect (from administrators et al) is to be allowed to bill our services similar to how physicians bill (of course not at the same rate). You're right...a topic for another thread!!

Well said! I, too, believe the bigger problem lies with the employers who do not have the time nor the staffing models to accommodate the new nurse. While my university required a CNA certificate to accompany an application plus a high GPA and SAT score, it still took two years of university/nursing gen eds while applying every winter to enter the following Fall. Once accepted on my second try, two more years for the RN of which students had the option to take LPN boards after the first year. Following the RN program and boards, only then could we apply to the BSN program with a copy of our RN license; there was no optional 4-year BSN. With that said, I feel my six years in school, plus hundreds and hundreds of hours of clinicals, taught me the "art" of nursing and how to write a great care plan (sarcasm implied). But by no means was I prepared for 21st century nursing and the demands put upon the floor nurse that are solely based upon a profit-driven healthcare system. As I was once told by an uppity administrator "nurses do not generate money, but doctors do"...the light went on. I am now in Case Mangement with a focus on Hospitalist Medicine at a large tertiary hospital. Had I not found this niche, I would have left nursing altogether. As a side note, I've been in nursing 8 years. Of my close group of nursing school friends, there are only 3 of us left in nursing. The other 7 have gone on to other non-nursing jobs or are unemployed with no desire to re-enter the field. Statistically, that's a dismal showing for a profession that's trying to figure out a way to keep their graduates from leaving in droves.