The Culture of Nursing

[JohnG77]

Nursing leadership is faced with a very challenging dilemma. In order to drive the profession forward, those in the workforce for many years must adapt to changes in technology and systems while integrating their bedside practice to support an ample amount of time completing all the daily requirements of the job. Newer nurses must learn how to use their technology skills, yet learn to interact at the bedside, again finding the same balance.

Nursing leadership has been tasked to move the profession forward thru education, certification, improved outcomes, and patient satisfaction. Today's nurse must use a variety of tools in order to meet the many needs of the patient of today's standards. The patient has shifted to a customer, where rankings and number of stars can help determine where you wish to receive healthcare services. The new nurse must maintain professional integrity while ensuring customer satisfaction. This concept has lead to job dissatisfaction in terms of the customer is always right, yet the medical staff receive all the training.

The new nurse takes this responsibility in a mannerism that chooses movement, rather than sustainability. Many hospital cultures are facing new nurses entering the workforce who move around frequently. The dedicated old school nurse is far and few in between. The new nurse moves around, gains experiences, and leaves the dedication once viewed as the hallmark of nursing, at the door. The nursing leader must find new methods to motivate, entice, and keep the new nurse engaged and focused in their current practice. As we grow the nursing graduate into a productive nurse, another organization is willing to do the same in a specialty areas. New nurses are finding themselves in environments they may not be prepared for. It is nursing leadership's challenge as a profession to ensure we grow nurses up correctly and accurately prepare them for whatever environment we hire them for.

It is important for leaders to communicate and network to ensure this new generation of nurses does not fall thru the cracks and just move around the profession. We must give them feedback, teach them, mentor them, and not allow them to move into situations they are unprepared for. As customer and patients expectations increase, we seem to have decreased are standards as a profession. By this, we must have policies in place that require minimal experiences and practice encounters before moving around a facility.

This new generation of nursing enters the workforce and after 6 months feel they have the experience to move around. It seems thru the lens of nurse manager, that the plateau affect takes place quickly for many nurses. Mastering a medication pass and charting system seems to be the motivator to judge their readiness to more critical situations. The old school nurse experiences many situations over years of loyal service, allowing them to handle just about anything thrown at them in today's environment. The new nurse lacks the critical thinking and nursing judgement to handle many situations. As hospital's increase their speed of processes, the new nurse struggles to keep up.

I often hear, I had to care for 8 patient's today. This means learning the history and personality of 8 patients during an 8 hour shift on the floor. We discharge patients home much quicker tan just 5 year ago, while emergency rooms flood with those needing to be admitted. The new nurse must learn more than skills and tasks. This constant turnover and lack of longevity, takes away from the overall experiences and ability to problem solve that the older generation nurse has. It is important for the new nurse to learn the whole system, the complete patient experience.

We as nurse leaders must expose the new nurse to the complete patient experience while asking for their dedicated service to learn and gain knowledge. This is not just a job that pays the bills. This is not just a job that can give you the knowledge to be hired in a new area once the old area feels less enticing. We must force nurses to stay put and learn and grow rather than allow them to move around thinking they have the experience and knowledge to be successful in new environments.

[NursesRmofun, ASN, RN]

Bottom line....we work too hard. I'm old school and my opinion is that the information age did not help nursing or make it more proficient, in general. It actually complicated things. That said, the one thing I think is excellent is the ID/medication scanning program. It does help for less errors. The other computer charting is much more complicated than it needs to be, IMO.

The Customer Service driven atmosphere is terrible. I much preferred our professional approach when we didn't have to be all things to all people and we could actually prioritize.

[qnmimi]

I must also respectfully disagree with the crux of your letter. Back when I was a new RN, my manager worked closely with my mentor to make sure I learned my job, not only in technical skills, but the culture of all nursing units I was going to float to. (I was hired into the hospital's float pool) Today? not so much. My manager(Now called a clinical Director) only knows how I do my job through comments submitted once a year for my evaluation. Clinical mentors are not respected. You get a certain amount of time to orient new staff, period. And in our unit(still float pool) nurses who do poorly are left to flail because mentors are not listened to. These are not the rosy years of the working manager. I hear a distinct disconnect in communication that flows from what the managers dictate from "on high" and the reality of what these nurses need to accomplish on a daily basis. When new staff is not supported, they get frustrated, deflated, and have no recourse but to shop for a better job, and this does not cover those nurses who want to climb the clinical ladder.

[Harveyslake]

Nursing Process? Critical Thinking? Best Practice? I remember those things from school, a long time ago. In the current environment, all those lofty academic ideas are left trampled on the floor by all the burdensome documentation and never ending task centered care. Nurses now have little time to do more than the absolute minimum for an absolute maximum patient load. Want to increase nurse retention, patient outcomes, patient satisfaction scores? There is no gimmick or shortcut. The only way is to significantly increase staffing levels across the board. Nursing "Leadership" knows this and so do all the administrators yet nothing is ever done to actually improve the situation.

[Been there,done that, ASN, RN]

OP:

Look up "How To Win Friends and Influence People." But frankly I can't get over the feeling that your words may be tongue-in cheek. Are they?

Please tell me your only kidding about this? I need to know.

I'm having flashbacks to the gulag....

Alas! I don't think he's kidding.

[Been there,done that, ASN, RN]

How's that " forcing nurses to stay put " thing going for you?

[Susie2310]

Nursing Process? Critical Thinking? Best Practice? I remember those things from school, a long time ago. In the current environment, all those lofty academic ideas are left trampled on the floor by all the burdensome documentation and never ending task centered care. Nurses now have little time to do more than the absolute minimum for an absolute maximum patient load.

In my experience, nurses have never had time. I was taught by nurses who used the Nursing Process in their care, and these nurses had very high patient ratios. They had learned to be very good nurses.

Using the Nursing Process - assessment (subjective and objective); nursing diagnosis; planning; intervention; evaluation, is much more than a lofty academic idea that we can forget once nursing school is over; it's actually the foundation of our practice as nurses. Our assessments, interventions (and their appropriateness), evaluations of care provided and re-evaluation/ modifications to the care plan are how the quality of our care is judged/measured from a legal standpoint. A lot of RN's seem not to know this.

Using the Nursing Process should be a habit. Our responsibility as nurses isn't to just rotely perform a number of tasks for the patient, as some nurses seem to think. The Nurse Practice Act for my state specifically mentions registered nurses practicing to the full extent of their authorized scope of practice; the nurse is absolutely required to use critical thinking in caring for patients, and has the right and obligation to refuse to carry out an order that the nurse in their professional judgement does not believe to be in the patient's best interest. Nothing lofty at all; these are our professional responsibilities.

[KCMnurse, BSN, MSN, RN]

. After 5 years, I still have respect for what I DON'T know.

....

After 30 years - I still have that same respect

[TriciaJ, RN]

The tone of the whole article comes across as paternalistic. "We have to grow the nurses up..." Here's the bottom line: if the workplace sucks, people are going to leave in droves. The pennies you save on poor staffing are going to be eaten up by employee turnover. Not to mention the money lost on poor patient outcomes.

How many ways are there for us to say this? We don't want pizza parties and rah! rah! yay us! sessions. We want to not be total stress cases the whole time we're at work. We don't want Service Excellence with ridiculous scripting; we want the resources to be able to provide excellent care.

We want nurse leaders who have actually functioned (and excelled) as nurses. None of this is rocket science for an actual nurse.

By the way, don't use "mannerism" when you mean "manner".

[Here.I.Stand, BSN, RN]

This is not just a job that pays the bills. This is not just a job that can give you the knowledge to be hired in a new area once the old area feels less enticing. We must force nurses to stay put and learn and grow rather than allow them to move around thinking they have the experience and knowledge to be successful in new environments.

Nope. I must not remain at jobs that don't work for me in the name of loyalty to said job, or because of some idea that I can't advance or learn new areas of practice.

If you want to retain nurses long term, you must inspire an environment that encourages growth, supports professional nursing practice, prioritizes patient care over patient satisfaction, supports a healthy work-life balance, supports a healthy life including proper meal breaks and swiftly dealing with aggressive patients/visitors, and is an overall competitive employer in a diverse and dynamic market.

[quazar]

The tone of the whole article comes across as paternalistic. "We have to grow the nurses up..." Here's the bottom line: if the workplace sucks, people are going to leave in droves. The pennies you save on poor staffing are going to be eaten up by employee turnover. Not to mention the money lost on poor patient outcomes.

How many ways are there for us to say this? We don't want pizza parties and rah! rah! yay us! sessions. We want to not be total stress cases the whole time we're at work. We don't want Service Excellence with ridiculous scripting; we want the resources to be able to provide excellent care.

We want nurse leaders who have actually functioned (and excelled) as nurses. None of this is rocket science for an actual nurse.

By the way, don't use "mannerism" when you mean "manner".

Can we put this on a billboard? Can I have it tattooed on my hind end? Can I get that in a jumbo sized bumper sticker? CAN I GET AN AMEN??!!!??

[Harveyslake]

In my experience, nurses have never had time. I was taught by nurses who used the Nursing Process in their care, and these nurses had very high patient ratios. They had learned to be very good nurses.

Using the Nursing Process - assessment (subjective and objective); nursing diagnosis; planning; intervention; evaluation, is much more than a lofty academic idea that we can forget once nursing school is over; it's actually the foundation of our practice as nurses. Our assessments, interventions (and their appropriateness), evaluations of care provided and re-evaluation/ modifications to the care plan are how the quality of our care is judged/measured from a legal standpoint. A lot of RN's seem not to know this.

Using the Nursing Process should be a habit. Our responsibility as nurses isn't to just rotely perform a number of tasks for the patient, as some nurses seem to think. The Nurse Practice Act for my state specifically mentions registered nurses practicing to the full extent of their authorized scope of practice; the nurse is absolutely required to use critical thinking in caring for patients, and has the right and obligation to refuse to carry out an order that the nurse in their professional judgement does not believe to be in the patient's best interest. Nothing lofty at all; these are our professional responsibilities.

Nursing diagnosis and care plans are the most ridiculous, pseudo intellectual drivel ever concocted by allegedly educated nurse leaders. I do them but never, not once, have they actually guided my patients care in in any acute setting. Just more documentation burden getting in the way of actually taking care of patients. All of my coworkers over the years feel exactly the same way. I actually had a nursing instructor in my BSN program call writing care plans "hazing". Meaning, they are useless and unpleasant but we did them so you have to as well.

[TriciaJ, RN]

Nursing diagnosis and care plans are the most ridiculous, pseudo intellectual drivel ever concocted by allegedly educated nurse leaders. I do them but never, not once, have they actually guided my patients care in in any acute setting. Just more documentation burden getting in the way of actually taking care of patients. All of my coworkers over the years feel exactly the same way. I actually had a nursing instructor in my BSN program call writing care plans "hazing". Meaning, they are useless and unpleasant but we did them so you have to as well.

As much as I hated writing care plans, they do have their place. In nursing school, it's to teach students how to think like nurses and organize one's brain according to patient needs. In the work place, it's to have a plan in place so everyone is on the same page.

It does not have to be a drawn out academic exercise that defeats its own usefulness. And how many of us don't think NANDA was the stupidest thing until Service Excellence came along?

It's never a bad idea to have a plan; but what's morphed into the dreaded Nursing Care Plan needs to go the way of the kerosene lamp.