I am sure many people have heard of the social issue/ cause "school to prison pipeline" that many civic groups are trying to eradicate. I am here to draw attention to a similar related problem , the college to welfare pipeline.
Due to an intricate , intimate, and covert relationship between big government politicos, higher education, Bureau of Occupational affairs, and the Federal/ State Department of labor, we have a serious student debt problem in the nursing field that is only going to get worse. Nurses need to wake up and take note of the LPN to RN hoax, and the RN-BSN hoax. These are all well publicized , propaganda driven falsities that are crushing nurses into debt driven higher education requirements. These propaganda driven requirements brainwash nurses into believing that without the extra education, they will not be employed.
And to a certain degree, they are correct, but its important for nurses to see the pitfall, before taking the dive. There is little to no difference in responsibility or pay rate from LPN to RN, and most RNs are taking the lower wage, just to have a job. There is zero difference in job responsibility or pay from RN to BSN, but the dollars spent to get there are substantial. The RN to BSN pipeline is a grotesque narrative that is being sung, for the sole purpose of enriching nursing schools. The NCLEX exam is identical for RNs and BSNs, the scope of practice is identical, and so are all the pay rates. A staff nurse is a staff nurse, is a staff nurse, too.
So why go for your BSN? Its because the hospitals and other various 24/ 7 institutional care providers say so. They have all built a united wall against the ADN RN. We are becoming an extinct species, because no one will hire us. Is the BSN a job guarantee? Of course not. Is any higher education a job guarantee? Nope. Big government politicos want student debt to skyrocket , so that they can fly in and save everyone with free bailouts, loan forgiveness, and thousands of more votes on election day.
May the buyer beware, until that utopia comes to fruition. In the meantime, take a serious look inward into the pitfalls, tricks and traps of higher education in the nursing field. The powers that be want you to keep jumping hurdles , spending more and more money, hoping to get hired, and falling deeper and deeper into debt, during the process. The higher you jump, the more you spend, and the less you earn. For many nurses who fell for these schemes, the financial devastation has been both swift and severe.
We use PCC as well and while it's probably no worse than any other charting software out there I agree it's pretty horrible. Switch to EMARS/ETARS they said, it's more streamlined and will save time they said. Yeah, right. I have been around long enough to have used the paper MARS/TARS and it took way less time to initial every box on every page of a huge book than it does to sit and do that incessant clicking! Many of those unnecessary pop-up secondary charting boxes can be eliminated by the way by editing the order.
I've seen, worked/ used it at enough places to know that the only efficiency PCC brought to the SNF industry was the cessation of the manual monthly turnover (night shift). In rare cases, the facility has the full program , which has the bag system for dispensing the pills, which allows the scanning of the barcode, and re-ordering of the med is then automated. But very very few actually have the full integrated system, because they say its too expensive.
I have also seen a horrific problem of CNA tasks appearing on the ETAR, and do not get me started on the "order sets" which someone innocently enters, which then drives about 10 pop up boxes when the nurse tries to chart a med.
I've seen, worked/ used it at enough places to know that the only efficiency PCC brought to the SNF industry was the cessation of the manual monthly turnover (night shift). In rare cases, the facility has the full program , which has the bag system for dispensing the pills, which allows the scanning of the barcode, and re-ordering of the med is then automated. But very very few actually have the full integrated system, because they say its too expensive.
I have also seen a horrific problem of CNA tasks appearing on the ETAR, and do not get me started on the "order sets" which someone innocently enters, which then drives about 10 pop up boxes when the nurse tries to chart a med.
We have the full system. The ADU [automatic dispensing unit] for meds is nice I'll admit. Most dispensed meds are automatically re-ordered, the exception is controlled meds. There are actually a crazy amount of meds in that machine, I'm usually pretty impressed by the even relatively uncommon meds we can pull from the machine's e-kit when we get a new order. It does have technical issues more often that it should but overall the ADU has been the one positive thing to come from this.
I fully agree with the tasks we have to sign off on the EMAR/ETAR that we don't actually do. Do I really need to sign off that a foley bag is being emptied, that a resident is being turned every two hours, that oral care is being done, that the resident is receiving the special supplement that dietary provides and I have no way of knowing if they actually had it without tracking down someone to ask? And don't get me started on the need to sign off our O2 orders four different ways! Why on earth do I need to sign O2 by concentrator in room, O2 by portable tank out of room, separate orders to check the settings on each, along with sats to enter every single time! It's insane. At least on my primary wing I've been able to delete a lot of those system generated pop-ups. It's actually pretty easy to do. I've never asked permission to do this, but I've also never heard anybody complain about it when a bunch of those pop-ups magically disappeared!
I honestly think that if you do not go to an overpriced school, you should not be in that much debt. For example, I am completing my pre-requisites at a community college and I will also be getting my RN degree there. So far, absolutely no debt. A lot of people, from what I've seen, that go to private nursing schools and accumulate so much debt are the ones that did not have a competitive GPA. You need to be smart about the choices you make. I do not care about what anyone has to say about getting my degree from a community college. My community college also has a RN-BSN program which is so much cheaper than getting a BSN at a university or a private school.
I'm confused a little- can you clarify something please? You wrote that there was no shortage 20 years ago and there's the opposite today. Is there a really good job market for nurses where you are?
I have never believed there was any shortage of nurses in the 3 states in which I have lived.
Nurses were always coming in from the Philippines. They were darned good nurses, don't get me wrong. But why were immigrants brought in when we had, from what I could tell, no shortage of nurses who were US citizens born right here in the US? I know the US had some special relationship with the PI, don't know how that worked. Same with Puerto Rico, I think.
The Filipino nurses I worked with had all come in through Canada then Chicago then to wherever they wanted to live in America. Not quite sure why the Canada route was necessary. Or preferred, or whatever.
I guess there is a shortage of nurses willing to work in certain conditions or at certain low rates of pay, but no actual shortage of licensed nurses. There is a shortage of good managers for sure. That's another reason for any so-called shortage of nurses
.
So should RN's all be BSN's or what? I do think it's deplorable that so many new grads have had so little hands-on exposure to various skills. Theory is great, but it doesn't really help you put in and manage various tubes, change dressings, start and manage IV's, and deal with techs/aides/ UAP who think they don't have to answer to the licensed nurses, and with incompetent bosses, or with Administrators who usually have little or no knowledge of bedside work.
I honestly think that if you do not go to an overpriced school, you should not be in that much debt. For example, I am completing my pre-requisites at a community college and I will also be getting my RN degree there. So far, absolutely no debt. A lot of people, from what I've seen, that go to private school nursing schools are the ones that did not have a competitive GPA. You need to be smart about the choices you make. I do not care about what anyone has to say about getting my degree from a community college. My community college also has a RN-BSN program which is so much cheaper than getting a BSN at a university or a private school.
You are fortunate that you have the option to continue to your BSN at a relatively reasonable cost. Most of the reason the "BSN only" requirements for being hired in my area failed is simply because there are not enough BSN prepared nurses here. In a roughly 100 mile radius we have five schools with ADN programs and the only BSN option is the very expensive private university. Even enrolling in the RN to BSN course there the tuition is roughly the same as it was to get the ADN degree at one of the community colleges thus doubling the cost of school. So if a student wants that BSN and either wants to or needs to stay local for schooling the options are limited to one school and that school just happens to be the most expensive around.
I fully agree with the tasks we have to sign off on the EMAR/ETAR that we don't actually do. Do I really need to sign off that a foley bag is being emptied, that a resident is being turned every two hours, that oral care is being done, that the resident is receiving the special supplement that dietary provides and I have no way of knowing if they actually had it without tracking down someone to ask? And don't get me started on the need to sign off our O2 orders four different ways! Why on earth do I need to sign O2 by concentrator in room, O2 by portable tank out of room, separate orders to check the settings on each, along with sats to enter every single time! It's insane. At least on my primary wing I've been able to delete a lot of those system generated pop-ups. It's actually pretty easy to do. I've never asked permission to do this, but I've also never heard anybody complain about it when a bunch of those pop-ups magically disappeared!
Don't forget the vitals signs, that a really greedy doctor will order in LTC, Q-shift, as if this is a hospital. Totally unnecessary, and instead of 10 seconds to chart those like we did on the paper MAR, now we enter the temp 97, and have to check off "tympanic, , right ear, left lear, oral, rectal, axial" and a BP 120/80, right arm, left arm, standing, sitting, laying, and BS 100 right arm, left arm posterior, abdomen, right quadrant upper, right quadrant lower, left quadrant upper, left quadrant lower...etc..etc..etc...
And when you have an assignment of 30 to 1, not only is this impossible to get done, the time it takes to make them up, and enter them into the PCC system is also impossible. I have seen the new grad nurses literally crying at the change of shift, due to being so overwhelmed.
All you have to do is follow the task list? How does using critical thinking fit in with following the task list? How do you prioritize patient care when you are following the task list? What kind of activities are on the task list? What happens if you don't follow the task list and use critical thinking and set other priorities for patient care?
I think that was a bit tongue-in-cheek.
Point-of-care nurses are generally not the ones advocating these things.
We all are bolstered by news articles saying nursing is the most trusted profession and we play the martyrs in a worldview that all nurses go to heaven, but then we have to keep in mind CRNPs and PA-Cs are mid levels, guess what that makes us. I became a nurse in '89 and we were constantly told ADNs would be grandfathered in, what a lie. My entire education was made back in 6 weeks of work, net. Student loans have done to higher education what government money does to everything, corrupted the one receiving it. BSNs enter the workplace the least equipped to function yet are highly desired by hospitals because we value a degree more than competence. The difference in ADN and BSN is leadership training, so we have a bunch of chiefs trying to be warriors, no wonder nursing has foundational cracks.
We all are bolstered by news articles saying nursing is the most trusted profession and we play the martyrs in a worldview that all nurses go to heaven, but then we have to keep in mind CRNPs and PA-Cs are mid levels, guess what that makes us. I became a nurse in '89 and we were constantly told ADNs would be grandfathered in, what a lie. My entire education was made back in 6 weeks of work, net. Student loans have done to higher education what government money does to everything, corrupted the one receiving it. BSNs enter the workplace the least equipped to function yet are highly desired by hospitals because we value a degree more than competence. The difference in ADN and BSN is leadership training, so we have a bunch of chiefs trying to be warriors, no wonder nursing has foundational cracks.
Yes, and I am repeating myself, but for the sake of point on point, I am a second career RN, with a BS and MA in other fields, prior to becoming a nurse (when that field was abolished through automation). I bring a wealth of information, leadership, knowledge, perspective, critical thinking, and judgment that evolves with experience in the workplace. Yet, since its not that "magical BSN" piece of paper, I am deemed worthless. Yet a hospital will hire a 22 year old wet behind the ears new grad BSN, not because they hold the degree, but because they will work cheap, and hopefully keep their mouth shut, like an inexperienced nurse usually does. Its aggravating enough to just leave the field entirely.
We have the full system. The ADU [automatic dispensing unit] for meds is nice I'll admit. Most dispensed meds are automatically re-ordered, the exception is controlled meds. There are actually a crazy amount of meds in that machine, I'm usually pretty impressed by the even relatively uncommon meds we can pull from the machine's e-kit when we get a new order. It does have technical issues more often that it should but overall the ADU has been the one positive thing to come from this.
I fully agree with the tasks we have to sign off on the EMAR/ETAR that we don't actually do. Do I really need to sign off that a foley bag is being emptied, that a resident is being turned every two hours, that oral care is being done, that the resident is receiving the special supplement that dietary provides and I have no way of knowing if they actually had it without tracking down someone to ask? And don't get me started on the need to sign off our O2 orders four different ways! Why on earth do I need to sign O2 by concentrator in room, O2 by portable tank out of room, separate orders to check the settings on each, along with sats to enter every single time! It's insane. At least on my primary wing I've been able to delete a lot of those system generated pop-ups. It's actually pretty easy to do. I've never asked permission to do this, but I've also never heard anybody complain about it when a bunch of those pop-ups magically disappeared!
I'm curious to know how you would defend an allegation of care not provided, if you cannot state/show (by said documentation) that the patient was in fact turned? Referring of course to the point that "if it isn't charted, it isn't done"
I'm curious to know how you would defend an allegation of care not provided, if you cannot state/show (by said documentation) that the patient was in fact turned? Referring of course to the point that "if it isn't charted, it isn't done"
Basic care requirements like turning/repositioning residents along with all other aspects of ADL's are individualized in the residents care plan and noted on each residents care card for staff to to refer to. No need to have individual orders for basic cares, just follow the care plan. Can you imagine a world where every item care planned was converted to an order that must be clicked off during charting? Like what we have to chart on already isn't bad enough.
Basic care requirements like turning/repositioning residents along with all other aspects of ADL's are individualized in the residents care plan and noted on each residents care card for staff to to refer to. No need to have individual orders for basic cares, just follow the care plan. Can you imagine a world where every item care planned was converted to an order that must be clicked off during charting? Like what we have to chart on already isn't bad enough.
I was not referring to an individual order, I agree, that is implied in the plan of care. I'm talking about in the event there is a non healing bedsore that leads to sepsis. When questioned by malpractice lawyer, asking on behalf of the clints family, how can you say if the care detailed in the plan was provided, if it is never documented as such?
panurse9999
1 Article; 199 Posts
I've seen, worked/ used it at enough places to know that the only efficiency PCC brought to the SNF industry was the cessation of the manual monthly turnover (night shift). In rare cases, the facility has the full program , which has the bag system for dispensing the pills, which allows the scanning of the barcode, and re-ordering of the med is then automated. But very very few actually have the full integrated system, because they say its too expensive.
I have also seen a horrific problem of CNA tasks appearing on the ETAR, and do not get me started on the "order sets" which someone innocently enters, which then drives about 10 pop up boxes when the nurse tries to chart a med.