Protect your profession...

[markdanurse]

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

[BBFRN, BSN, PhD]

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!).

I totally agree.

[BBFRN, BSN, PhD]

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?

Linda Aiken did one called, "To Err is Human: Building a Safer Healthcare System." I believe it was printed in JAMA, and was used to promote the Calif. ratio laws.

[lindarn]

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!).

I also agree with you. However, I would add classes that "think outside the box", so to speak. Nurses need classes in subjects like "Employment Law, "Administrative Law", and "Political Science". Why do nurses need these type of classes? Because they are thrown to the wolves when in any type of employment situation, and have no clue what they rights are in the workplace, nor do they know how to react/defend themselves when they are challenged by abusive employers.

For instance, twenty years ago, when the failed concept of "patient focused care" was introduced into hospitals, nurses just caved in at adminstration heavy handed attitudes, and most of us were clueless as to how to respond, and/or "attack back". If we were prepared for it in nursing school, with the laws, and state statutes, had involved the public, just like teachers do, we wouldn't be in the position that we are now.

Unfortunately, there is not enough time in an ADN program to include these type of classes. Also, PTs, OTs, etc, also have business classes that include, how to start a business, business principles, etc, that prepare them to open their own businesses. Independant Contracting can also be included. When I attended Cal State Long Beach, they included classes by nurses who opended their own businesses, and who worked as Independant Contracters. This, by the way was in the mid 80's when I went to school there.

Think how much better nurses' lives would be if we knew how to assertively respond to abusive employers, and, from the get go, formed "Nursing Practice Groups". Hospitals would have to work hard to encourage nurses to stay in hospitals, to employ them for patient care settings.

As is stands now, nurses have gained little with the "nursing shortage". Everyone but nurses are benefitting from the nursing shortage.

We are a dime a dozen and that is the main reason that hospitals don't care if nursing is a revolving door career. They are happy to get rid of the unhappy nurses who graduated last year after the "rose colored glasses" came off. They can just bring in the next group from ABC Community College, and when they start leaving, it is only six months until the next group graduates.

A BSN as entry into practice would shave the number coming out of school, and make hospitals have to wait more than six months for the next class. That, by the way, is part of the strategy of Physical Therapists, and Occupational Therapists. The less of them there are, the more in demand they are. The longer it takes to get to graduation, the less appealing it is to potential applicants to the schools. They attract a large number of individuals who have to work very hard and for longer years to get to graduation, and thereby have MUCH MORE OF A STAKE IN THEIR CAREERS THAN NURSES DO, WHO ATTEND ABC COMMUNITY COLLEGE FOR TWO YEARS. They are much more willing to fight for their profession, and prevent de- skilling, because it takes so much longer to ge through. And that is not including the internship that they have to do before they can practice.

Nursing should also have a mandatory internship at least six months long, before nurses are let loose to work by themselves. A BSN and a mandatory intership would go a long way to ease the transition to practice after graduation. It would also inprove our credibility. Part our image problems, is that it takes just two short years to be a nurses, and it has given nursing a 'blue- collar tinge" that will not be easy to eradicate. And image is a big part or our problem.

Also, the above classes will also help nurses in workplace issues. Nothing makes an employer quiver with fear when he has an employee who knows the law, calls the employer on it, and will not hestitate to turn to the law, if they have been wronged, or with staffing/workplace issues, etc. It has been my experience, that when the hospital know that you know the law, they back off immediately. The problem is that too few nurses know the law, and in this case, ignorance is not bliss. It is deadly.

Nursing has a long way to go to achieve the power and control of our profession, like other health care professions have. When you fight the increase in the educational requirements to become a nurse, when you fight BSNs earning more money because, "we all take the same exam, and do the same job", you play right into adminstrations' hands, and undermine the best way nurses can achieve power, unity, and credibity.

Of course hospitals don't want to pay BSNs more money. Then there would be an incentive to earn a BSN, they would be pressured to provide on site BSN programs to nurses (which, by the way, they were happy to provide to Pharmacists, when they went to a Doctorate as entry into practice, and wanted a convenient way to earn this).

Nurses in desperate need of a means to improve the profession, and take control of it. As it stands now, everyone controls nursing except nurses. It will never change until we take the same steps that other health professions have done.

When DRGs came about other health professions jumped in and grabbed their piece of the pie. That is also the time that PTs, OTs, and Pharmacists, increased their entry into practice. They saw how nursing was getting taken over by a plethora of inlicensed individuals, and how RNs professional practice was being de- skilled by these individuals. They saw the writing on the wall, and responded positively and proactively, and instead of sitting back and letting others take over. That, by the way, is the mark of a true professional.

Lindarn, RN, BSN, CCRN

Spokane, Washington

[llg, PhD, RN]

.......

Nursing has a long way to go to achieve the power and control of our profession, like other health care professions have. When you fight the increase in the educational requirements to become a nurse, when you fight BSNs earning more money because, "we all take the same exam, and do the same job", you play right into adminstations hands, and undermine the best way nurses can achieve power, unity, and credibity.

.....

Lindarn, RN, BSN, CCRN

Spokane, Washington

:yeahthat:

Personally, I am in favor of keeping both the 2-year and the 4-year programs -- but making the differences between the two levels more clear so that people would not see them as interchangable.

Also, with the 2 levels more clearly differentiated, schools could stop taking advantage of ADN students by continually adding requirements without awarding a higher degree. Some of the programs now require 3 years to complete -- for a 2 year degree! Come on! If you are only going to award an Associate's Degree, the entire program should be doable in 2 years. If you add requirements, then you should upgrade the program to a BSN. You shouldn't try to have it both ways -- at the student's expense.

But I think LindaRN makes some very good points.

[jnette, ASN, EMT-I]

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?

:yelclap: :yeahthat:

Agree wholeheartedly. We are kept so busy with all the above plus all the "paperpushing" there is little time left to do perform those skills mentioned by the OP. Sad, but true. Yes, these skills are rapidly being turned over to other "specialists", and nurses are losing out, IMO.

If the patient load were appropriate, nurses could, and (I believe) willingly WOULD perform all those things that are now but a distant memory.

I don't understand why there couldn't be nurses who do nothing BUT admits and discharges. There are many nurses who prefer the charting and paperwork as opposed to the hands on care.. allow them the option of strictly doing admits/discharges. Allow the others to intervene more with the patient care and utilize their skills in more areas than "pushing pills" and hanging IVs.

I don't like these skills subtly going by the wayside.. or worse.. being turned over to "specialists". These were and ARE nursing skills.

I think the OP's concerns are valid... but we need to reorganize and fight for acceptable patient loads so we CAN hang onto those skills and make nursing more than what it is now. No way can we do what we once did with all that we are required to do now... with the current absurd staffing ratios.

THAT is the part that makes me wonder... as one poster mentioned above.. is this intentional and are we blind to it by being kept too "busy" to notice?

[Corey Narry, MSN, RN, NP]

One of my biggest beef about being a nurse at the staff nurse level is that we never get reimbursement for our nursing services. We work 8 or 12 hours shifts performing all sorts of activities directed at making patients better and yet our salaries are factored in the general overhead of running a healthcare facility - in the same category as porters, housekeepers, and maintenance personnel.

On the other hand, physical and occupational therapists send their paperwork to the insurance companies and the hospital is paid for the services they provided.

[BBFRN, BSN, PhD]

:yelclap: :yeahthat:

Agree wholeheartedly. We are kept so busy with all the above plus all the "paperpushing" there is little time left to do perform those skills mentioned by the OP. Sad, but true. Yes, these skills are rapidly being turned over to other "specialists", and nurses are losing out, IMO.

If the patient load were appropriate, nurses could, and (I believe) willingly WOULD perform all those things that are now but a distant memory.

I don't understand why there couldn't be nurses who do nothing BUT admits and discharges. There are many nurses who prefer the charting and paperwork as opposed to the hands on care.. allow them the option of strictly doing admits/discharges. Allow the others to intervene more with the patient care and utilize their skills in more areas than "pushing pills" and hanging IVs.

Jnette,

If you're interested, there's a book by Dana Beth Weinberg called Code Green: Money Driven Hospitals and the Dismantling of Nursing that addresses this very point. It uses Beth Israel Hospital in Boston as a case study- they used to do the kind of nursing you describe, and had the best nursing satisfaction rates during this period.

I don't recommend it for those who don't enjoy reading case studies, though.

http://www.amazon.com/Code-Green-Money-Driven-Hospitals-Dismantling/dp/0801439809

[passgasser]

Mark

Mostly, I agree with what you write, but would like you to be aware of a few things:

1. You are correct that the first full time anesthesia providers were nurses. But nothing there has been taken from us. A few statistics: In the US today, something like 60% of all anesthetics are administered by CRNA's. In rural areas, that number rises to 95 to 98%. Nurses provide anesthesia services safely, by themselves, all over the country every day.

There is nothing new about Anesthesia Assistants. They have been around for at least 20 years, and they do not have the independence that CRNA's have. They must work under the supervision of a MD anesthesiologist. I am under no such restriction. Recent court cases have limited some of the anesthetic procedures they may perform. And they cannot practice in all 50 states. In fact, last time I looked, there were only 5 or 6 states where AA's were allowed to practice. And generally, they get paid about the same as CRNA's working at the same place. But they do not have the opportunity to go to the places that pay non-MD anesthesia providers higher salaries. I guarantee that there are no AA's today earning what I earn.

5. Nurses cannot place ET tubes because they are not trained to do so. It is a physical skill that requires training, experience, and finesse. Someone without adequate training stumbling around an airway can make a bad situation far worse. Not to say that nurses could not be trained on intubation, they can. But, like many skills, it is one that requires frequent use to stay competent. Most nurses simply won't get the necessary intubations to keep the skill current. I do it several times, every day. It ain't as easy as it looks.

[NeosynephRN]

I am a nursing student at a community college...I have read the entire thread and just wanted to add that not one person in my class will have finished thier ADN in only 2 years!! We have approximately 2 years of full time pre req's at my school before we can even be accepted into the Nursing portion which is then another 5 semesters...so yes I will have gone to school just as long as someone that gets a BSN...no I will not have taken all the exact classes...why would I go to school for 4+ years and get a lesser degree??? Because I could do it for less money and I could get into a night and weekend program which works better for me and my family!! It was not worth it to me to pay so much more and get done with school and only make 500 dollars more a YEAR!!! I am not saying that it is not worth getting a BSN..and I will get mine eventually...all I wanted to say is that I doubt many go directly into a CC and graduate exactly 2 years later with thier ADN...at least not around here...I am sure other programs are run differently!!!

[medsurgnurse, RN]

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.

I agree. Other professions are continuely advancing themselves as a profession and getting the respect. Nursing stubbornly refuses to advance the educational requirement. I started as an ADN nurse so all of the ADN will say "i'm just as good." But really the ADN requirements are just a few credits short of BSN. I'm all for upping the ante and getting more respect.

[Cattitude]

nurses in desperate need of a means to improve the profession, and take control of it. as it stands now, everyone controls nursing except nurses. it will never change until we take the same steps that other health professions have done.

when drgs came about other health professions jumped in and grabbed their piece of the pie. that is also the time that pts, ots, and pharmacists, increased their entry into practice. they saw how nursing was getting taken over by a plethora of inlicensed individuals, and how rns professional practice was being de- skilled by these individuals. they saw the writing on the wall, and responded positively and proactively, and instead of sitting back and letting others take over. that, by the way, is the mark of a true professional.

lindarn, rn, bsn, ccrn

spokane, washington

i applaud your whole post, just edited for length. thank you, you make so much sense, it's incredible. how can others not see this???

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[color=#483d8b]nurses have so much power, it's so frustrating to have it and not use it. we could have so much more than we have. sometimes i really have to laugh at my so called union fight for our paltyr 3% yearly raise :chuckle . what a joke. oh yes, i am told frequently by my boss to keep productivity up. the hospital must be able to bill! so what if my paperwork gets done on my time. i am told that "all the other nurses do it". well i don't care!! i told her they can fire me then! i will not give my free time to any employer that values me so little! too bad.

[color=#483d8b]

[color=#483d8b]and that my friends is what they truly think of us. we are expendable at the drop of a hat.

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[Tweety, BSN, RN]

:yeahthat:

Personally, I am in favor of keeping both the 2-year and the 4-year programs -- but making the differences between the two levels more clear so that people would not see them as interchangable.

Also, with the 2 levels more clearly differentiated, schools could stop taking advantage of ADN students by continually adding requirements without awarding a higher degree. Some of the programs now require 3 years to complete -- for a 2 year degree! Come on! If you are only going to award an Associate's Degree, the entire program should be doable in 2 years. If you add requirements, then you should upgrade the program to a BSN. You shouldn't try to have it both ways -- at the student's expense.

But I think LindaRN makes some very good points.

I agree with you here. They've taken advantages of students times on the waiting list by having "pre-reqs". The only pre-reqs I had to have back in a day was high school biology, algerbra, and chemistry.