Protect your profession...

Indy, LPN, LVN · Feb 11, 2007

About emergency drugs: the hospital needs a pharmacist 24/7. One, some emergent drugs are in the code box, which is when we need them. Two, we have some floor stock, and it's clearly labeled (only one strength of heparin goes in there) and we know what these drugs are for. Three, if I call pharm and say I want X drug here now for an emergency they will send it and I'll write their orders when I have time. I've gotten dopamine bags in under five minutes, from four floors down.

llg, PhD, RN · Feb 11, 2007

Here I go again, it seems I always take the opposite side of the argument on here. However, I believe that if paramedics take over the nurses job in E.R. it is because the E.R. nurse is letting it happen. The E.R. nurses at my hospital have totally isolated themselves from the other departments to the point that they seem arrogant. They never get pulled to do bedside nursing on the floors or units because they are ER nurses (does that mean they don't now how to do pateint care?) When patients have been admitted and they are being held (sometimes a day or two ) in ER for a bed, the nurses never even touch the admission orders because they are ER nurses. Once the supervisor told the ER nurse that a patient needed a bedpan (the nurse was reading the paper at the desk). The ER nurse replied "I didn't spend 60 thousand dollars to go to nursing school to put people on the bedpan." If all ER nurses have this attitude someone has to do patient care in the ER and it looks like the paramedics are going to try. We all take the same test and we all go to the same schools and learn the same things but it seems that the ER nurses are putting themselves in a very tight and limited position. If you are not going to "Nurse" then it proves that you are not needed and will be replaced with something else.

Do you work for the same hospital I do?

About the original question .... The professions are evolving, as well they should. If we stay stagnant we will be left behind. In the olden days, nurses also did most of the housekeeping, sterilized the equipment, cooked the patients' meals, etc. We don't want to cling to the past (or the present) just because it is what we are accustomed to. Roles change and nurses need to change with it. Nurses need to identify what we have to offer the patient and the employer that is different than what is offered by other disciplines -- and then market ourselves and our profession accordingly. If another discipline can provide a needed service better, or cheaper, or more consistently, or whatever, then we need to acknowledge that employers will be interested in hiring people in that other discipline to provide that service.

Dinith88 · Feb 11, 2007

Here I go again, it seems I always take the opposite side of the argument on here. However, I believe that if paramedics take over the nurses job in E.R. it is because the E.R. nurse is letting it happen. The E.R. nurses at my hospital have totally isolated themselves from the other departments to the point that they seem arrogant. They never get pulled to do bedside nursing on the floors or units because they are ER nurses (does that mean they don't now how to do pateint care?) When patients have been admitted and they are being held (sometimes a day or two ) in ER for a bed, the nurses never even touch the admission orders because they are ER nurses. Once the supervisor told the ER nurse that a patient needed a bedpan (the nurse was reading the paper at the desk). The ER nurse replied "I didn't spend 60 thousand dollars to go to nursing school to put people on the bedpan." If all ER nurses have this attitude someone has to do patient care in the ER and it looks like the paramedics are going to try. We all take the same test and we all go to the same schools and learn the same things but it seems that the ER nurses are putting themselves in a very tight and limited position. If you are not going to "Nurse" then it proves that you are not needed and will be replaced with something else.

Your experience with ER nurses is sad i agree. But people are people and you can see this type of behavior on any nursing unit/facility, etc...dont let these dummies give you a bad impression of ER nurses. (besides, she should have made the paramedic put the patient on the pot! that'd probably be the only way an ER-paramedic could impress me )

-i also agree with the OP's statements. As far as meds go, i can see where alot of mistakes have been/could be made by busy nurses. But i think it's even MORE dangerous if certain emergency-type meds arent on-hand in the unit. I work in icu, so we have access to lots of stuff that we can mix on the spot (rather than wait for the pharmacist to get notified, drop what he's doing, mix the med, place the 'proper' labels, and transport it...). I'm not aware if this is the same nation-wide(in icu's), but it should be.

AND i'm a firm beleiver that ALL units should be set-up in this way (even if limited only to 'emergency-type' drugs)... it's kinda like a turf-war between pharmacists and nurses that echo's the op's statements (we musnt let nurses mix meds..they'll take our jobs in the end!)

-i agree we should all be very territorial with what we do... If not, the profession could become a bunch of 'well educated' pill-pushing slop-cleaners.

OC_An Khe · Feb 11, 2007

The OP brings up many valid points and I tend to agree with all of them. Yes nursing as a profession is evolving and will continue to do so. But the profession is under attack. The basis of the attacks both preventing the RN from expanding and from the opposite side like the CRNA and AA is about control and money. The RN can practise indepentently in their own right and are thus an economic threat to the MD.

Nurses and paramedics are not interchangeable. Granted that they have some overlapping skill sets and responsibilities but there is a tremendous amounts of areas that are different. MDs and RNs have overlapping skill sets does that make them interchangeable also?

Bethy-lynn · Feb 11, 2007

3. Midwives originally birthed babies, not physicians. In fact, the first known

male physician to witness a live birth dressed up as a woman to see the event, and when it was discovered, he was burned alive at the stake. Yes, we still have nurse midwifery, but it never should have been given to the male physician group. And also look at what CNM's get paid compared to OB/GYN physicians...for pretty much the same job.

Um, I feel the need to remind you that back in the day when only nurse midwives delivered babies, the mortality rates were extremely high. When was the last time that you saw a nurse midwife do an emergant c-section on someone with HELLP? When was the last time you saw a CNM take care of any high risk pregnancy? There is a reason that this profession has moved over to physicians- Its requires the amount of time and training that physicians put into it (I.E. 4 years med school, plus at least 4 years of specialized residency). And to respond to the question of pay, If one bothers to look at the actual amount hours worked in a week, v. the overhead of running an office, minus malpratice insurance, physicians (on average) make less than we do per hour. Do the math.

People, if you want the responsibility, and the pay, and the headaches, and the ability to do procedures, and go to med school. I, personally do not feel that I have given up any nursing responsibility or duty or role to anyone else. Remember the term "deligate"?

abooker · Feb 11, 2007

Mid-nineteenth century physicians did lots of things that weren't in the best interests of their patients. Mercury in meds, bleeding, ignorance of sterile technique ... the social prestige they commanded didn't seem to arise from their helpfulness to the patient, but on their ability to weild social power. Midwives did used to be safer than physicians; the midwives knew to wash their hands. The original basis of medicine's high status was based on authority, not competence.

There seems to me to be a lot of "cliquishness" in nursing, a lot of sectarianism. I see bullying, hazing, abusive language ... what does that accomplish for us?

To strengthen the nursing profession we must exert occupational control as well as give evidence of clinical competence. They're both important, I think ...

Franksters · Feb 12, 2007

Hello fellow professionals,
May I have your attention please. An allnurses.com user by the name of nursebrandie made a valid point in the emergency nursing subforum that I would like to discuss with all of you. We were discussing the use of paramedics in the ER, and it was mentioned that the two professions were interchangeable. This is alarming to a professional nurse such as myself. We must not give give up our career roles to other specialties. Any of you that do not believe this is an issue, please consider the following:
1. Anesthesia started out being administered by nurses, that's right, nurses...not physicians. Nursing gave this role up to physician anesthesiologists. Yes, we still have the CRNA profession, but now there is a new role out there called the Anesthesiologist Assistant (AA). It is a master's degree program that physicians created to keep the midlevel anesthesia providers under their thumbs. The position pays as well as, if not more than, a nurse anesthetist.
2. Physical Therapy and Occupational Therapy started off as subspecialties of nursing. Yes, PT's and OT's were orginally nurses that received specialty training in the activities of PT and OT. But we gave these positions away too and now the PT has become a clinical doctorate degree and the OT has become a master's degree.
3. Midwives originally birthed babies, not physicians. In fact, the first known male physician to witness a live birth dressed up as a woman to see the event, and when it was discovered, he was burned alive at the stake. Yes, we still have nurse midwifery, but it never should have been given to the male physician group. And also look at what CNM's get paid compared to OB/GYN physicians...for pretty much the same job.
4. RN's used to be able to mix drugs in piggybacks for I.V. administration. Now pharmacists have completely taken over that arena too. Why is this important? Well, just this...did you ever need a drug in an emergency situation, like Mannitol, but had to wait for a pharmacist to mix it and you get it back in 30 minutes when you could have mixed it in 5 minutes flat? Look around you...nursing's skill set is being taken away, but our nursing leaders are demanding us to have more education. Why? Nurses aren"t smart enough to use strict aseptic technique to mix drugs in an emergency situation?
5. Why is it that nurses cannot endotracheally intubate except in an ambulance or flight nurse role? Why is it that a paramedic can put in an EJ IV line, central line, or chest tube but nurses cannot except if employed in a flight nurse or ambulance role? Why is it that are profession seems to want us more educated but we have allowed ourselves to become "dumbed down"?
So yes, the idea of paramedics taking over the ER nurse's role is a real threat, and it should not be taken lightly. Paramedics are great to have in the ER...but paramedics are paramedics and nurses are nurses.
Embrace your skill set, and do not allow others to take anything more away from you! You went to school. You learned the skills. You know how to critically think! Nurses are more than just well educated technicians. I am more than a butt wiping, pill pushing, bed making technician. So are all of you.
Keep this in mind as you move through your career. Nurses need to come together, not grow apart if this profession is ever going to be something more.
Mark

Thank You

lupin · Feb 12, 2007

OMG!

I work on a spinal surg unit and I could not imagine doing all of the PT/OT for my 4-6 pts as well as run physian's orders, give meds, do my assessments, chart, do preop checkoffs, hang/start IVs, help the unlicensed staff (because we work short), discharge and admit, and change dressings. That's all on a ggod day too, with no one having problems after surgery or needing a couple of units of blood. I am grateful for our PT/OT and our pharmacy. With the nursing shortage these days we don't have enough time to do what we need to, which is take care of the pt. Adding all these other responsibilities would just bog down our time with the pts and would lead to a lot more people leaving the nursing profession.

**canoehead, BSN, RN** · Feb 12, 2007

OMG!
I work on a spinal surg unit and I could not imagine doing all of the PT/OT for my 4-6 pts as well as run physian's orders, give meds, do my assessments, chart, do preop checkoffs, hang/start IVs, help the unlicensed staff ....

I think that's part of the point too, that if admin keeps nurses too busy to think they won't be able to protest. A heavy assignment is a heavy assignment whether you are doing PT, OT, RT, anyone else's duties. Please note that we are able to do all of the above during the weekends or at night. Perhaps we should address the dangerous workload and responsibility, instead of being grateful for any assistance that comes by and removes part of our job. Remember that even if someone else takes the job, whose butt is on the line if the neb doesn't get given, if the swallow study doesn't get done, if the med is mixed incorrectly. We may as well do it ourselves and have a decent patient load.

Have there been any studies as to whether mistakes go down when the nurses have a decent load, as opposed to farming out tasks and having a higher patient census?

KMSRN · Feb 12, 2007

If you notice, pharmacists and physical therapists now require a doctorate for entry level. OTs, dietitians, social workers require at bare minimum a bachelor's degree and most have a masters. Nursing has refused to raise the bar on education and is consequently being left in the dust.

It is my opinion that a minimum of BSN is required for the job because there is just too much to learn in 2 years. It is also my opinion that the BSN programs as they stand need to be revamped. Who needs nursing theory, management and research at this level? We need assessment, pharmacology, lab values, disease processes, wound care and hands on experience in more than bed baths, bed making and toileting. The last semester needs to be a practicum to put it all together while caring for patients.

Is this going to happen? Highly unlikely.

I'm sure there will be angry responses but this is my opinion and I'm sticking to it.

OC_An Khe · Feb 12, 2007

KMSRN

I actually agree with your post, so no angry replies from me. I would however not completely eliminate theory research and management

SharonH, RN · Feb 12, 2007

It is also my opinion that the BSN programs as they stand need to be revamped. Who needs nursing theory, management and research at this level?

At the level of a BSN, theory, management and research are absolutely necessary. Nurses need to have a firm foundation in theory to understand why they do what they do, they need management in order to deal not only with ancillary staff but other departments and besides RNs as team leaders need management skills at this level and research is an absolute must in order to continue to be a profession with credibility and a scientific background. Absolutely all of these are needed, in fact it is my opinion that registered nurses do not get enough of these courses and it translates not only into their professional practice but into their demeanors and attitudes.

In fact, I think this is what is at the core of what ails our profession in addition to the multiple entry points which undermine our credibility as a profession. The threats do not come from other departments taking over what were once under our domain (which I am glad to let PT/OT and RT have it!).