What do you consider to be nursing's biggest setback?

yrmajesty3 · May 11, 2011

I have also wondered-if we paid nurses by the case-would you ever have a nursing shortage? In my area we have cases that require more than one nurse to complete the task. We have some cases where three teams are present, we have cases that are 15 minutes. Simple to complex in task orientation-not patient care. All cases have substantial risk involved, but what if you had a pay scale for specialties? That would be an interesting conversation to have. Make nurses independent practitioners who get paid by the amount of cases they do, patient load, complexity of care, and procedures involved. Not to mention quality of care provided-survey patient and family concerning the care provided. Boy would things change. All nurses would be on their best behavior. Sorry but money drives better care. This may be a calling, but if I did this job for charity I'd have been a nun.

Interesting you bring up that angle. With my extensive pediatric vent/trach/g-tfeed/foley-cath/ IV experience, I'd expect to get paid at least a higher agency rate for complex care than the RN escorting a seizure risk client to school. Turns out that there is no difference in agency pay in spite of the high level of technical skills and care tasks you might perform. Rather, the pay seems to focus more on staffing the more inconvenient shifts (i.e. weekends and nights pay a bit better). Disappointing! I have considered becoming an "Independent Nurse" but have found that the liability and agita factor may not be worth it in the end.

You are correct.....In an ideal nursing world , we get paid for the complexity of care performed ( fee -for -service as lawyers and physicians do). But these days, you see more and more lower level ancillary staff providing that kind of care to get around the costs. An example of this is the MED- TECH who is does wound dressings and med passes in continuing care nursing homes and assisted living facilities. They have very little education and ZERO pharmacology knowledge.

In contrast, I need a Bachelor's degree with an expensive certification credential to be on a wound-care team.

It's always about the cheapest way to deliver bare minimum care....not the best care. The insurance companies that have us by the cajones.

THAT is the biggest set-back with nursing. It has very little to do with our lack of political action or unity as a profession.

gentlegiver, ASN, LPN, RN · May 11, 2011

1. Physicians hiring MA's and allowing them to call themselves Nurses

2. CNA's so underpaid and yet they are our eyes & ears on the floors

3. All Medical businesses seeing Nurses as a cost rather than a benefit

4. Management who blame Nurses to families when they have a complaint

5. Management who expect Nurses to take unsafe patient loads then blame the Nurse when things go wrong

6. Nurses who refuse to work as a team and Nurses who eat thier young

7. Public who have no idea just what we do (we are not educated waitress')

8. Various agencies (ie: JAHCO) who ad increasing amounts of documentation on Nurses

9. Everyone who works in medical field wearing scrubs (play guess who the Nurse is!)

10. Understaffing! So many new Nurses... why not hire a few!

These are just my top 10, I'm sure there are lots more. I agree we REALLY, REALLY need to unify... we could move mountians if we ever got around to it!

nursemike, ASN, RN · May 11, 2011

Is there ANYONE who doubts this is a valid question? That said, I think we may not be quite as bad off as we sometimes think we are. We are certainly not at risk of running out of room for improvement, but I think it's worth thinking about the stuff we get right. There are a lot of people in the world who really do think we matter a lot.

Many thanks to all of you who think I'm saving the profession, but I'm sorry to have to report, I'm as dysfunctional as the rest of you. Some of the other guys I work with really do seem to have it together, but then again, some of my coworkers seem to think the same about me. I'm only about two-thirds kidding when I say nursing should be classified in the DSM as a psychological disorder. More than half, but not entirely. The women I work with are some of our greatest strengths. I have always been attracted to strong, smart, independent women, and God help me, I am surrounded by them.

My biggest complaint? Nurses who'd rather be anything but nurses. And I could live with that, if they weren't running the show. Too much of bedside nursing is dictated by people who couldn't wait to get away from bedside nursing. I didn't get into this business to document a patient's decline. Haven't met a patient yet who cares what his pain score is.

It isn't that new nurses aren't trained. It's just that it takes some time to undo the training. Well, some of it. Nursing education does get a lot of stuff right, too. Really, when you get down to it, the whole freakin' world is kind of imperfect.

eeyorelov · May 11, 2011

10. Understaffing! So many new Nurses... why not hire a few!

:yeah: :yeah: :yeah: :yeah: :yeah:

Say it louder I don't think anyone heard you!!!!

:w00t:

jjdkc · May 11, 2011

RE: "My biggest complaint? Nurses who'd rather be anything but nurses. And I could live with that, if they weren't running the show. Too much of bedside nursing is dictated by people who couldn't wait to get away from bedside nursing"

Imagine if leadership (VPs, Directors, Managers) spent time in the trenches ... instead of sitting around conference tables and attending "committee" meetings - and were required to work an assignment on a regular basis. Do you think that would give them a real sense of what Nursing is like today?I think what bothers me most is seeing more younger nurses moving out of bedside nursing into these management positions after spending less than 5 years doing bedside care. Something's wrong with that picture.

DMspecialist · May 11, 2011

You all have brought up excellent points. We NEED to ban together and get OUR feelings out so the real problems are not discussed and "solved" by those who aren't working in the trenches or have never really dealt with the problems they are solving.

PMFB-RN, RN · May 11, 2011

There have been some great and valid point raised in this discussion. Many very perceptive insights raised. Allow me to go off topic for a second and mention what a great career nursing has been for me.

After 4-5 years of doing CV, trauma, medical, burn and pediatric ICU and ER I now have a really fun job as the full time night rapid response nurse for my hospital. I basically have nothing to do until there is SOMTHING to do. No make work for me. I get to help other nurses and patients when they need it most and I am involved in every single "bad" case that happens anywhere in the hospital on my shift and get to do lot of teaching / coaching / precepting. I actually have fun at work. Nursing (& nursing school) is pretty easy compared to my last two careers (infantry medic & dairy farmer). I have good benefits including health, retirement, 4 days a week off and make a little over $100K without working overtime. I do have a BSN but I didn't when I got my current job and I am not paid more for it in any way. I am grateful to nursing for providing me with a good career.

Yes there are many, many issues and problems with nursing. Unfortunately I see them getting worse rather than better but it's still a pretty good career and I find it useful to remind myself of that whenever I am faced with some ridiculous scheme from upper management.

cdsga · May 11, 2011

I don't know if you have noticed, but there is a trend to hire non-nurses to manage patient care units. Maybe all the complaints about nursing managers have led to this trend. So what does that mean for nurses? To me it means that you have a business side and a clinical side, and the two must be able to coalesce. It does take some time to explain situations to these folks who have never performed clinical duties, but they can listen and try to implement changes that help the department. Nurses need to know negotiation skills with this type of manager and keep factual useful information flowing. I do think that a salary structure needs to be implemented that goes beyond the top out phase when you have reached 15yrs or whatever you have put it to the place of work. I just don't believe in top out salaries. Where's the incentive? There is none except personal satisfaction. There needs to be more than that.

DMspecialist · May 11, 2011

It is a trend right now. Many health care programs Preventing Diabetes, Pre Diabetes, Disease Management Programs, Weight Loss for Diabetics are now looking for lay people to run their programs.

amarilla, RN · May 11, 2011

Lots of good replies in this thread. I agree - poor staffing, poor treatment, the passive aggressiveness tolerated and even perpetuated in many nursing units, unsafe conditions. Lots to talk about.

My gripe is that nursing has come to encompass so many tasks - with more added all the time - that it really has become task-oriented and superficial. No time to sit down with the anxious patient before surgery, discharge plan, do a thorough chart check or the like when there's endless charting to do, forms to fill out, supplies to order, orders to enter, inventory to restock, counts to do, meds to check, equipment to clean, competencies to be done (during your shift), meetings to attend, and patients needing transport. :uhoh3:

Not to mention, I love giving report, saying 'last weekend, he developed a complication and went back to the OR for...' and the oncoming cuts me off, saying, 'yeah, yeah, I get it. History's not important. How's he doing now?' Or...checking the med orders but not knowing (or caring) what the meds are for. Pushing off patient questions to the doctor, who inevitably never shows, and leaves the night nurse with an angry, anxious patient with many questions. I blame our growing responsibilities; there is no time to be a nurse and I can't entirely fault others, though it makes my job more difficult and less pleasant. I want to learn and be helpful to my patients, but I see that others don't seem to care to do the same.

JME.

alphabetsoup · May 11, 2011

Someone asked a while ago about why I have that perception about entry levels and education. I think I have seen these issues posted on the blog, whether it is a nurse with a certain educational background supervising another nurse with a certain educational background or a nurse working in a position without a certain knowledge base. I have completed the ASN, the BSN, and some grad level work. Yes, there are some differences in all of those levels. Was I a crappy nurse when I had just an ASN? Nope. Would I have been able to do what I do today with only an ASN? Nope. I needed the extra knowledge to do what I do today. Could my employer fill my position with an ASN? Sure. Would my employer get the same results? Maybe not. But it's that mindset of a nurse is a nurse is a nurse. We can all tell ourselves that it is all the same but it isn't.

CompleteUnknown · May 11, 2011

Lots of great responses. If I had to pick just one thing I'd have to say the day the chart became more important than the patient and the way guidelines have become rigid rules that must always be followed no matter what.

I suppose lateral violence is the next thing. The way we are so willing to believe the worst about everyone from the patient to the doctor to our co-workers.

The way we are so eager to report every little thing because 'that nurse might be impaired' or 'that doctor was mean and didn't treat me like the intelligent professional I am'.

The way too many student nurses are being encouraged by their programs to believe the hospital is their own personal learning environment and that they deserve special consideration from the nurses on the floor no matter what else is going on at the time.

The way too many student nurses seem to be almost encouraged by their programs to look for examples or poor practice.

Acceptance of passive aggressive behaviour like calling the doctor for ridiculous things at all hours because 'he was rude last time I talked to him'.

Nurses who find fault with everything a new nurse or new-to-the-unit nurse does.

The way we allow ourselves to feel blamed for everything but powerless to actually change anything.