Stop the (Deskilling) Merry-Go-Round, I Want to Get OFF!

[delphine22]

I get frustrated when I have so many patients, I have no choice but to leave the basic care like toileting and bathing to the techs, while I chart and chase docs and call pharmacy and a million other things. Then the oncoming nurse asks about my pt's bottom or the color of his stool and I have to rely secondhand on someone else's assessment.

Can't wait until I start next month in the ICU. I don't mind doing my own baths if it means I get to really know everything about pts myself.

[calivianya, BSN, RN]

Not necessarily. If the person doing the preliminary screening of potential hires is not a nurse, they're only looking for key words in the candidate's resumé. Key words like "degree". So let's say the University of Lower Slobovia has a terrible reputation for turning out very unskilled nurses, but graduates from the program have degrees and have passed the registration exam - maybe on the third try and after spending a boat-load of money to the ubiquitous prep course industry in order to get there. The human resources recruiter has a list of key words, "degree", "registration", "geriatrics", "experience" and out of all the applicants, only Nancy Nurse, a Lower Slobovia U grad, has all four in her resumé. Her application is the only one passed on to the hiring manager who MUST fill the position or be forced to close beds, so despite her knowledge and experience regarding Lower Slob U's reputation she gives Nancy the job. And now the manager's budget is on the hook for maybe 16 weeks of orientation in order to have a nurse who is safe to work on her unit. See where it unravels?

You are absolutely right, and this is why hospitals should do their own hiring instead of using some weirdo nurse recruitment company in the middle of nowhere to screen their applicants, but that is a whole separate problem. One large hospital chain in North Carolina that I applied for uses a company in Wisconsin to screen their hires. Every time I have been called by nurse recruitment from this hospital it has been from a Wisconsin number. How exactly are recruiters in Wisconsin supposed to know how competent people looking for a job in North Carolina are? I also had a company in Georgia use nurse recruiters with Colorado numbers. It's ridiculous.

Maybe if the recruiters were actually local to the area they were hiring for, they would know more about the nursing programs in the area.

[jadelpn, LPN, EMT-B]

There are any number of facilities who will do just about anything to retain a fully BSN staff.

BSN prepared nurses may have some clinical experience, but for any number of them it is a means to the end of either managment or specialties. I am not sure where the programs are that allow students in the US to actually start IV's, etc. But if they are there, it should be the go to school.

Unfortunetely, they keep ADN's, Diploma RN's and LPN's around just long enough to teach a new nurse the very basics of bedside care, then they are on their own, as then everyone else is phased out. And quite honestly, a nurse can "get around" basic care--and it happens every day--there is more than one school that has a whole class on "delegation" and well, if there's no one to delegate to--ah, well, they are going home tomorrow anyways.

Local community or state schools should not be discounted. Many have excellent programs. As noted by their long waiting lists. This adds to the elitist nature of private expensive schools. They all teach the same thing, however, the "label" makes it better? I am not so sure that is the case.

[Gentleman_nurse, MSN]

One college my workplace deals with is hit and miss. Some of the students are great, but most are awful. One RN student, about two months away from graduation didn't know how to drain a catheter bag.

Perhaps I can explain. For many programs I've seen the classroom academics are the priority. Book smart students with poor clinical skills will succeed through over those who display superior skills but have trouble on written exams. I'm told it's because the goal is to prepare for NCLEX. The hands on skills will come with experience.

[eagle78]

I did one year of a two year BS program in Radiation Therapy. The school I went to had 5 clinical sites that we rotated to. The hospitals were very sensitive to the assessments of the therapists regarding the students. Also they were more concerned with clinical aptitude than academic. Now I excelled academically, but I got behind in my clinical competencies, so in the best interest of the patient I resigned my seat.

Radiation Oncology from a therapist perspective is a small field, yet all the students know that when you apply for a job the powers that be go to the floor and inquire about your clinical competence. Maybe that is what is happening in nursing, to many pots to pick from???

[loriangel14, RN]

Perhaps I can explain. For many programs I've seen the classroom academics are the priority. Book smart students with poor clinical skills will succeed through over those who display superior skills but have trouble on written exams. I'm told it's because the goal is to prepare for NCLEX. The hands on skills will come with experience.

This student also made it clear that she had no intention of learning bedside skills. She stated she was going to go into management so she didn't need to learn how to care for a patient. Ultimately she was failed from the program 2 months from graduation. The school was very surprised to discover she couldn't perform basic skills.

[LadyFree28, BSN, LPN, RN]

This student also made it clear that she had no intention of learning bedside skills. She stated she was going to go into management so she didn't need to learn how to care for a patient. Ultimately she was failed from the program 2 months from graduation. The school was very surprised to discover she couldn't perform basic skills.

What's even more concerning are the ones that slip through and are licensed nurses as STILL have no desire to grasp this business.

[Esme12, ASN, BSN, RN]

We the unwilling,lead by the unknowing, are doing the impossible for the ungrateful. We have had to do so much with so little,for so long, we are now qualified to do everything with nothing.

My favorite quote and it becomes truer all the time.

Amen sister!

You go Jan I can't like this article enough!!

[tokmom, BSN, RN]

I get frustrated when I have so many patients, I have no choice but to leave the basic care like toileting and bathing to the techs, while I chart and chase docs and call pharmacy and a million other things. Then the oncoming nurse asks about my pt's bottom or the color of his stool and I have to rely secondhand on someone else's assessment.

Can't wait until I start next month in the ICU. I don't mind doing my own baths if it means I get to really know everything about pts myself.

I worked with a nurse who refers to baths and toileting as CNA work. Totally blew me away. You can find out so much about your patient if you actually touch them beyond a simple assessment of breath and bowel sounds.

[tokmom, BSN, RN]

Loved this article! I started out as a CNA in 1980-1981 and was laid off a year later because CNA's were no longer permitted to work in a hospital. The skill mix went to LPN/RN only.

1984: Obtained my LPN because of wait listing to an RN program. I worked as an LPN for 4 yrs in a hospital and LTC per diem. Around the early 90's, the LPN were being slowly phased out of hospitals and going to a strict RN skill mix. Still no CNA. Mid 90's, I saw the LPN phased completely out in my area and an RN/CNA mix back in style. LPN's were left to work in LTC.

This has seemed to stay this way with select few hospitals retaining LPN's, but the vast require RN or CNA.

So, just when we think we have it figured out, hospitals throw in the mix the ADN vs BSN controversy.

I feel as though my life has been a pig pile of nursing degrees. I initially started out as a CNA, then obtained my LPN, because CNA work was becoming increasingly rare in hospitals. Once an LPN, I was relegated to the bottom of the heap, because the LPN wasn't good enough, so I went back to school to earn my ADN. The safety net of the RN started becoming full of holes, because even though I had my ADN, I still was at the bottom of the pile. I realized to get to the top of the pile a BSN was necessary. I went back to school and achieved my BSN. For now I feel safe, but if someone even mentions needing an MSN at bedside I'm going to hurt them.

[Rose_Queen, BSN, MSN, RN]

Perhaps I can explain. For many programs I've seen the classroom academics are the priority. Book smart students with poor clinical skills will succeed through over those who display superior skills but have trouble on written exams. I'm told it's because the goal is to prepare for NCLEX. The hands on skills will come with experience.

And I think this is where some BONs and accrediting boards have it wrong. Placing the responsibility for X number of students passing NCLEX takes away a lot of the personal responsibility of the student, and places a large burden on the schools. Instead of focusing on how to be a nurse, schools have to teach how to pass NCLEX in order to maintain accreditation. There has to be some middle ground on making schools accountable for NCLEX pass rates while still focusing on graduating competent grads.

[tokmom, BSN, RN]

And I think this is where some BONs and accrediting boards have it wrong. Placing the responsibility for X number of students passing NCLEX takes away a lot of the personal responsibility of the student, and places a large burden on the schools. Instead of focusing on how to be a nurse, schools have to teach how to pass NCLEX in order to maintain accreditation. There has to be some middle ground on making schools accountable for NCLEX pass rates while still focusing on graduating competent grads.

And IMO (I probably will be flamed for this) but the NCLEX has been simplified over the years. I remember the 2 days from hell and hundreds of questions (400?). Now a new grad can pass at 75. If healthcare has gotten increasingly complex, how can a new grad only be tested with 75 questions?

I know..minimal entry as an RN, but still, IMO it's not enough.

I agree, I think nursing school focused more on passing the NCLEX, so schools look good.