What Do You Think? Can You Be A Nurse If You Can't Do Bedside Care?

[Kooky Korky]

Should a student have to be able to do direct care in order to become licensed as an RN?

Must an RN be able to give direct care in order to stay licensed?

This topic came up in a discussion at work recently when one of our techs was involved in an accident that left her unable to give hands-on care.

I think that a person who can learn what a nurse needs to learn (chemistry, anatomy, physiology, biology, etc.) and can pass the exams, there is no reason this person can't be licensed as an RN.

Feasible work would include teaching, doing the questioning part of Admissions, maybe other tasks.

What do you think? What are some other tasks this type of RN could perform?

[Susie2310]

elkpark said:

Being licensed as an RN involves being legally accountable for a basic set of nursing knowledge and skills. Of course there are individual nursing positions that don't involve performing any bedside care. But I would hate to see us start letting through school and licensing people who are incapable of basic nursing practice and skills. There is a huge difference between "observing" and actually functioning in clinical.

In reality it appears this situation has been happening for some time. It is not uncommon to read on this forum how students/new nurses clinical training/experience in nursing school didn't prepare them to practice as nurses. I read one student's account where his/her clinical experience consisted almost entirely of observation; another student's clinical group spent a large amount of their clinical time in a conference room writing their care plans; yet another student's clinical experience included, as I recall it, a large amount of Sim Man experience. There are many more examples. I actually heard these complaints for the first time over 20 years ago during my final semester of an RN-BSN bridge program at a state university from some of the generic BSN students, who said they had received hardly any clinical training and didn't feel prepared to be nurses. New nurses frequently require prolonged orientations and are often far from being clinically ready straight out of nursing school to function safely at a basic level in their first jobs.

[erniefu, BSN, RN]

Certainly there are positions that don't involve bedside nursing care (Infection control, public health), but every nurse has to learn to do the nursing process: Assessment, analysis, planning, implementing, evaluating care. It doesn't matter if it is treating a pressure ulcer or reducing the incidence of chlamydia among teens.

[HeySis, BSN, RN]

Kooky Korky said:

I guess the person who has never done bedside care would not be teaching skills. I agree, that would not be a good idea.

But he could teach theory/lecture. Or History of Nursing/Fundamentals/Introduction to Nursing or other subject he has mastered.

Also, I envision the person would observe in the clinical arena, so would have at least some knowledge of that setting. It wouldn't be the same as actually doing the hands-on care but would be at least some exposure to actually doing it.

Some of my best instructors were the ones that were still working at the bedside, why? Because they had practical experience and the stories of those experiences that helped us learn why we do those things and helped my remember because of the stories. They also understand what real life nursing is like today.

I wouldn't want to be observed by someone that has never done those skills, what if I need to see one? (see one, do one, teach one). What if I'm doing it wrong, will the nurse who hasn't had the practice of doing it be able to do anything but stop me? Would they be able to step in and make sure it still gets done safely? Would they be able to teach me any of the "tricks" they learned (example: wrapping warm towels and letting an arm hang down for hard IV starts) These things are super valuable to the student nurse.. not just speaking out load what the text book says.

[elkpark]

Susie2310 said:

In reality it appears this situation has been happening for some time. It is not uncommon to read on this forum how students/new nurses clinical training/experience in nursing school didn't prepare them to practice as nurses. I read one student's account where his/her clinical experience consisted almost entirely of observation; another student's clinical group spent a large amount of their clinical time in a conference room writing their care plans; yet another student's clinical experience included, as I recall it, a large amount of Sim Man experience. There are many more examples. I actually heard these complaints for the first time over 20 years ago during my final semester of an RN-BSN bridge program at a state university from some of the generic BSN students, who said they had received hardly any clinical training and didn't feel prepared to be nurses. New nurses frequently require prolonged orientations and are often far from being clinically ready straight out of nursing school to function safely at a basic level in their first jobs.

I agree that there is far too little clinical practice in nursing school now, which is why I would hate to see us throw in the towel entirely and start graduating people who have officially "observed," rather than practice, all the way through school.

[brandy1017, ASN, RN]

Sure anyone that can pass nursing school and boards can be a nurse. The problem is getting a non-bedside job. Usually for office or teaching jobs you need at least a year or two of bedside nursing. I wish there were more opportunities for nurses to use their brains and not their bodies, but most places do not offer a safe no lift environment. Most of the corporate bean counters don't want to offer jobs like being an admit discharge RN or stat nurse where brains and not brawn are needed. They want to cut all but the "essential" jobs to save a buck for the CEO and his buddies at the top, the better to get their bonuses!

Truthfully if someone finds themselves in a position to not be able to work bedside, they almost need to get a Masters either NP or MSN to find a job. NP is the way to go if you can. The MSN ie nurse educators are the first one on the chopping block when corporate comes in looking to save money.

[Ruby Vee, BSN]

dishes said:

There are a number of nursing specialties that don't require hands on care such as; infectious disease, case management, public health, quality improvement, telephone triage. Suggest your colleague look up the requirements for the individual specialties, many do require previous bedside experience but some employers will make exceptions for employees with a disability.

Also suggest your colleague speak too an academic adviser as they can advise them if it is possible to complete a nursing program without hands on clinical experience, if not, they can advise them of suitable education programs.

The website exceptional nurse com might be a good resource for a potential nursing student with a disability. The more knowledge they have about navigating their career path with a disability the better, as they are likely to encounter attitudinal barriers and people who will try to dissuade them.

Most of those specialties that don't require hands on care require some experience with hands on care to get the position. I cannot say that I disagree with that. There's a difference between a licensed nurse who becomes disabled and unable to do the hands on care and someone who knows they cannot do the care and wants to start nursing school, complete the requirements become licensed anyway without ever having done hands on care.

[LovingLife123]

I will give my two cents. In order to do the non bedside positions, you should have a little bedside experience.

Say an RN gets hired to do phone triage in a doctors office. How can they properly assess what is going on with a patient if they have never seen it or done it. That makes me nervous.

I'm sorry this person that had an accident so severe it affects their ability to perform bedside care. But let's be honest, not everybody can become a nurse,

I would have loved to have been the first female president. Unfortunately, I have a heart and morals, unlike every single politician out there. My feelings and moral compass prevent me from doing that.

For a better example, I could not work for my husband's construction company. I'm not coordinated enough to walk on stilts and simultaneously doing work.

We need to get rid of the mentality that you can do whatever you put your mind to. When in reality our physical or mental capacities limit us from doing lots of professions. It's not a bad thing. But unfortunately life happens.

[Susie2310]

As others have mentioned, one needs to be physically able to meet the demands of providing hands on care to patients (which is what the majority of nurses are employed to do) in nursing school. This includes assessing patients (where it may be necessary to physically move patients), doing clinical procedures (where it may be necessary to move a patient into a certain position), moving, turning, transferring patients from their bed to wheel chair/gurney/chair and vice versa, toileting/assisting patients from their bed to the bathroom and back to bed again, changing diapers, bathing patients, changing patients gowns/bed linen, etc. Nursing school is where one learns the components of patient care that comprise professional nursing, and there is no substitute for this practical experience on live patients. Nursing is a physical job for most nurses.

The Nursing Process - assessment, nursing diagnosis, planning, implementation, and evaluation, is the nurse's critical thinking process, and is how the quality of nursing care is evaluated. The nurse's use of the Nursing Process is also how the quality of a nurse's care is judged from a legal point of view. One first learns how to use the Nursing Process in nursing school and practices this during nursing school clinicals' on live patients.

Once you become a licensed nurse, not being able to do bedside care does not make you not a nurse; the exception being that some states have a practice requirement for license renewal.

Most positions that do not involve direct patient care require some paid nursing experience. These positions usually are not beginner level nursing positions, and previous nursing experience (sometimes a significant amount) is necessary in order to perform adequately in these roles for the safety of patients, i.e. case management and telephone triage.

The majority of nurses provide hands on patient care in hospitals. This is the basic function of the nurse:- to take care of sick patients.

[Kooky Korky, BSN, RN]

I really appreciate everyone's input. Thanks

KK

[Here.I.Stand, BSN, RN]

I didn't see this thread when you first posted, bit I'll echo a lot of what has been said. Can one still function in a nursing capacity if stricken? Of course.

However, the person in question isn't a nurse.

That we can do anything we put our mind to is unfortunately not realistic. Some areas of nursing are more accommodating than others; e.g. the blind Nurse Navigator. I don't see how that is LESS reasonable to accommodate than any other job that a blind person can do. Could an ICU or OR or a helicopter accommodate blindness? Absolutely not.

Non-bedside jobs are usually not available for new grads.

I completely disagree that education is an option. 1) you know and I know that nursing can't be mastered by book knowledge alone. If it could, why have clinicals? Why do we advise new grads that it's ok to be overwhelmed -- it takes a good yr or two to really become competent. Why in hades should a not-yet-competent RN teach?? 2) Why would a school hire faculty who is so limited in what they can teach? Thinking back to my beginning nursing education, e.g. fundamentals, pharmacology, etc -- those who taught those classess also led/taught/evaluated clinical groups.

How can one satisfactorily complete the skills portion of school if unable to provide bedside care? And is it truly a reasonable accommodation to waive such a HUGE part of the program?... while for as long as formal education has been required, nursing students have been getting up at 5 a.m. and caring for pts?

Nursing school is a huge commitment -- in time and in cost. If I were the one being asked for advice, I would make it very clear that their new grad job prospects will be extremely limited, and to consider if the risk of a wasted education is worth taking.

[llg, PhD, RN]

I once knew a person who was a nationally known expert in another health care field that involved working directly with patients in a coaching, teaching, counseling role. Then she was injured in a car accident and needed to use a wheel chair. She integrated that into her career and became known for her extensive work with patients with limited mobility, paralysis, etc. She decided to get a nursing degree so that her work could be more inclusive -- adding pharmacology, nutrition, skin care, etc. to her knowledge base. Nursing was the best match for her needs as no other discipline provides such a comprehensive perspective of total patient needs. I don't see anything wrong with her adding a nursing degree and license to her credentials. The fact that there are some nursing jobs that are not a good fit for her is not the most important thing. She is VERY capable and quite qualified to some jobs -- and she should not be denied the opportunity to pursue that type of work.

There are blind physicians, deaf physicians, mobility-impaired physicians, etc. They "fit" better into some jobs than others. Isn't that true of us all? There are nurses who have all sorts of short-comings and/or handicaps -- and they don't lose their licenses. And note, I am old, fat, have arthritis in my feet, bad knees, diabetes, hypertension, and an inner ear problem that gives me balance issues and a hearing impairment. I still have my license and still work as a nurse.

We should allow people to do what they can do -- and not exclude them because they can't do everything. If there are jobs they can do, then they should be allowed to do them. However, they should be counseled on the realities of getting a job that will suit them without appropriate experience. Some jobs require bedside experience. Other jobs don't. As long as everyone if honest and has realistic expectations, I don't think we should exclude people unnecessarily.

[Susie2310]

I don't really think that the issue is about excluding people unnecessarily who can't physically provide nursing care to patients. I think it's about more than just whether a nursing eduation/licensure would be of benefit to the respective individual seeking to obtain the licensure.

The process of providing nursing care to patients is where one utilizes one's nursing school training to become first competent at providing nursing care to actual patients, and ultimately experienced at doing so. The nursing school clinical experience in providing direct care to patients cannot be omitted or individually customized to suit an individual student's needs, or we have nurses with the title/license who are unable to perform the role they were trained for i.e. providing professional nursing care to sick patients (the majority of nurses provide direct patient care to sick patients in the hospital).

The public pays to fund nursing programs. The issue is really about graduating nurses who have received sufficient training/education in nursing school and who are physically able to take care of patients, and, last but not least, who want to provide bedside nursing care. It is very much in patients interests to have nurses who have developed experience and proficiency in taking care of them, and becoming experienced takes time (many years).

I can't think of any non-bedside nursing jobs that don't require actual hands-on nursing experience: Case management, utilization review, informatics, insurance company nursing, telephone triage, nursing education, clinical documentation review, all require bedside nursing experience.