What would you change about Nursing to make it better?

nursemike, ASN, RN · Dec 28, 2009

lobbyists
One type of schooling to become registered nurse, not fifty different ways.
That would be great
Honestly, I think that would be losing one of the potential strengths of nursing. I really feel the inherent diversity of people with different backgrounds entering by different routes is something we need to build on. Uniformity is important to a business like McDonald's or WalMart. Customers want to know they can walk into a franchise anywhere in the US--pretty much anywhere in the world--and know what to expect. Which is fine. McDonalds and WalMart excel at what they do. The trouble is, what they do is mediocrity. I shop at WalMart, and I eat at McDonalds, and I appreciate what they do. A lot of times, what they offer is good enough.
But I don't think that model is as appropriate to the work I do. "Good enough," isn't good enough. People need the best they can get. To me, that means a plan of care that fits the individual patient. You have a patient in for a week with complications r/t uncontrolled diabetes. Do you put them on a weight loss diet for that week? Wouldn't it be better if you could introduce them to a menu of pleasing foods they could eat every day? You know, you KNOW, they aren't going to eat boiled turkey after discharge, so why serve it to them in the hospital? Or you have a patient with a knee replacement who has been in chronic pain for five years, and now they don't want to get out of bed, because it hurts. What if nursing, ortho, and PT could get together and figure out a way to manage the pain a little and increase activity from nothing to a little? What if it didn't matter that the average patient would have been ambulating with a walker two days ago, and it's okay if this patient sits up on the edge of the bed for a minute without excruciating pain, and tomorrow we'll try standing?
Management wants us to nurse by templates, because it's more "efficient." And if we could produce nurses by templates, so they were all the same, maybe they'd be better at nursing by templates. Which would be great for the lawyers and accountants, and just lovely in terms of evidence-based nursing. We could crank a lot more people through the mill and call that cost-effective, and it might even be a way of reducing instances of sub-standard care. But I think it would come at the cost of those moments of art when just the right nurse meets the patient who needs him or her to do just the right thing at just the right time and something great happens.
What we need, I think, is time. Time for well-meaning but naive GNs to learn the trade. Time for competent, hard-working nurses to stop a moment and listen, or even think. Frankly, even though I favor a national mandate for a 5:1 ratio in acute care and would support similarly realistic ratios in LTC and other settings, I see that more as a compromise than a solution. Nights when I've had five patients, I haven't had all the time in the world, but I haven't had to feel that if one of my patients needed a little extra time, I had to rob it from another.

RNman09 · Dec 29, 2009

"What we need, I think, is time. Time for well-meaning but naive GNs to learn the trade."
You are right nursemike, but only if we new RN's were afforded the opportunity and given the time to orient. Instead as some of my RN friends have told me, they go home feeling discouraged and wondering if they are going to make it in this profession. Anyway good post nursemike:smokin:

lee1 · Dec 29, 2009

I still strongly believe that the BSN is the way to go for education. Eliminate the diploma, ADN. look what is required now for PT, Pharmacy. We want to be considered as professionals, which I agree we are all, BUT, we need a uniform education pathway.

Standards of care are just that, it is always possible to individualize them and we are expected to do just that.

nursemike, ASN, RN · Dec 29, 2009

"What we need, I think, is time. Time for well-meaning but naive GNs to learn the trade."
You are right nursemike, but only if we new RN's were afforded the opportunity and given the time to orient. Instead as some of my RN friends have told me, they go home feeling discouraged and wondering if they are going to make it in this profession. Anyway good post nursemike:smokin:
I'm afraid a certain amount of discouragement is inevitable. It's a hard transition to make, and if you don't doubt yourself, you probably aren't thinking hard enough. Still, hiring a nurse is a pretty big investment, and without nurses, you don't have a hospital. So it seems to me that an adequate orientation in a supportive environment is about as fundamental a need as any in the profession. If that were the norm, the whole "what kind of degree" question would probably be moot. I truly think NCLEX does what it claims to: if you pass, you have the minimum knowledge necessary to become a competent nurse, even if you got your degree from Joe-Bob's Skool of Nursing and Diesel Repair. But that knowledge is a foundation. Your real training is OJT, and tossing you in the deep end to see if you can swim is a poor form of OJT.
I got the sort of orientation I needed, by the way. 9 weeks, officially, with preceptors who wanted me to succeed, and for most of the first year, my CN's were careful to give me assignments I could handle. I still threw up while getting ready for work, occassionally. I can't think of a time in my life when I had more anxiety. But I didn't get eaten, I got nurtured. When I started doing charge, a few months ago, it was a bit like starting all over again, because there were so many things I didn't know--and our orientation to charge is three shifts--but I had almost no anxiety. I got through my first year as a nurse, so I know there isn't much in this world I can't do. In that respect, orientation as a trial by fire probably does give you confidence, if you survive. But, again, I had a very good orientation, with no one on my unit who wanted me to fail, and it was still a trial by fire. If every new nurse was treated the way I was, that in itself would be a big step toward making this a better profession. And that's something all of us here can implement, without letters to Congress.
So, what say, gang? Are we ready to take a pledge? From this day forward, I will help a newbie make it. Because every working nurse whose spirit isn't crushed before they start is going to be a voice when we tackle all the other crap.

nursemike, ASN, RN · Dec 29, 2009

I still strongly believe that the BSN is the way to go for education. Eliminate the diploma, ADN. look what is required now for PT, Pharmacy. We want to be considered as professionals, which I agree we are all, BUT, we need a uniform education pathway.
Standards of care are just that, it is always possible to individualize them and we are expected to do just that.

I think the perception that pharmacists and physical therapists get respect is mostly based on the fact that we aren't pharmacists or physical therapists. Grass is greener kinda thing. In their shoes, we'd probably be wondering what we could do to be treated like professionals. I've seen people take a magazine and a can of pop to the pharmacy register at my local pharmacy, because the cashiers up front were all busy. And don't get me started on the abuse I've seen our PTs go through.

RNman09 · Dec 30, 2009

I would change the apply on-line attitude from HR because that is how your first impression gets deleted the majority of the time with the click of a button. Even if you go in person you are told to fill out the application on line.Lets just go back to the old way (hiring) of doing things.

StayLost, BSN, RN · Dec 30, 2009

if they are unable to master the basics (as i believe i stated) perhaps they ought to think long and hard about their dream of becoming an advance practice nurse.

i must say that the majority of my graduating class have landed jobs in an icu or er in the local level-1 trauma/ magnet hospital. it is a paradigm to believe that you need the 'ole 2 years of solid med-surg experience under your belt in order to be a good nurse in critical care.

as for advanced practicing nurses, about 4 of the students in my class were already accepted to the dnp program with zero rn experience (not even a license yet).

Ruby Vee, BSN · Dec 30, 2009

i must say that the majority of my graduating class have landed jobs in an icu or er in the local level-1 trauma/ magnet hospital. it is a paradigm to believe that you need the 'ole 2 years of solid med-surg experience under your belt in order to be a good nurse in critical care.
as for advanced practicing nurses, about 4 of the students in my class were already accepted to the dnp program with zero rn experience (not even a license yet).

i guess i'm wondering if you're thinking this is a good thing?

lee1 · Dec 31, 2009

I think the perception that pharmacists and physical therapists get respect is mostly based on the fact that we aren't pharmacists or physical therapists. Grass is greener kinda thing. In their shoes, we'd probably be wondering what we could do to be treated like professionals. I've seen people take a magazine and a can of pop to the pharmacy register at my local pharmacy, because the cashiers up front were all busy. And don't get me started on the abuse I've seen our PTs go through.

There is only one type of training, now both are requiring PhDs while we still are barely educated with our ADN and Diplomas. Don't get me wrong, both programs produce excellent nurses but it is now all about standarization. Also, many ADN, diploma programs take many more years to get to the BSN which upfront is only 4 years, not 6 or 7. So, who is wasting whose time???? BUT, don't worry, we have given away so many of our jobs, that pretty soon there won't really be RNs, just tech this and tech that.

RNman09 · Dec 31, 2009

BUT, don't worry, we have given away so many of our jobs, that pretty soon there won't really be RNs, just tech this and tech that.

This why we need to enforce the RN to patient ratio 1:5 and rally to make it national law. That is something I would like to see change for the better of our proffession on a national level. :twocents:

nursemike, ASN, RN · Dec 31, 2009

Don't get me wrong, both programs produce excellent nurses but it is now all about standarization.

Yes, but I think we'd be a lot better off if it was all about excellence.

And, honestly, I think we hurt ourselves with all the concern about status as professionals. The whole concept is outdated. There was a time when a professional was a gentleman, apart from the common rabble, and a landowner was an esquire, the next thing to a nobleman. Today, we're all pretty much common rabble, and I think that's a step forward, as evidenced by the fact that most nurses aren't gentlemen at all, although I'd hope most of us were gentle.

When I was a tradesman (carpenter) I was respected, because my services were in demand and I was good at what I did. Of course, I was self-employed, so my boss respected me, even though he could still be kind of a jerk, at times.

lee1 · Dec 31, 2009

Yes, but I think we'd be a lot better off if it was all about excellence.
And, honestly, I think we hurt ourselves with all the concern about status as professionals. The whole concept is outdated. There was a time when a professional was a gentleman, apart from the common rabble, and a landowner was an esquire, the next thing to a nobleman. Today, we're all pretty much common rabble, and I think that's a step forward, as evidenced by the fact that most nurses aren't gentlemen at all, although I'd hope most of us were gentle.
When I was a tradesman (carpenter) I was respected, because my services were in demand and I was good at what I did. Of course, I was self-employed, so my boss respected me, even though he could still be kind of a jerk, at times.

Nursing is a job like everyone else. Why should there be multiple types of schooling to get your RN? There are NOT multiple types of schools to become PT, OT, Dieticians, social workers, pharmacist, the list could go on and on.

Plus the FACT the many of the so called diploma and ADN programs are deceiving. When those students try to go on they find they need this and that prerequisite which now takes them twice as long as they first intended to get to that BSN. At the minimum the bachelor's degree. I have also seen many students with BAs change their minds about what they want to do and do the change over to BSN.