What Happened To The Nursing Profession?

MP5PDW · Mar 24, 2009

I must say, I have to agree with him or her about the lack of critical thinking skills. I lay the blame on the maternalistic manner in which most nurses are taught... and then managed once they graduate. I do not think malpractice is a cause, as suing a nurses is pretty rare. Many nurses blindly follow protocols without questioning anything. If you are given a stupid protocol to enforce, you need to say... wow this is pretty stupid, I think I will find employment in an environment that does not take me for an imbecile.

Let me give you an example of a lack of critical thinking skills.

I do neurosurgical anesthesia in a huge medical center. The "Desk people", these are nurses who do not like patient care and sit at the desk all day with headsets on like air traffic controllers, have been given the task of insuring EVERY SINGLE PATIENT has a surgical cap on before they are taken to the room. Did I mention this is neurosurgery? they get back to the room , the cap is removed and the head is shaved IN THE ROOM.

That, my dear friends is a serious lack of critical thinking.

travel50 · Mar 24, 2009

I have to agree with the doctor. I am the director of nursing at a rural nursing home. I have some exceptional nurses. However, I recently fired one because she was so stupid....and that is the only word I know to use. She would give a resident their blood pressure after just noting that their b/p was 92/40, gave insulin with a blood sugar of 32, etc. I simply will not tolerate such a lack of thinking. Her excuse was that the medication was due. She could not reason that the medication should be held for obvioius reasons. Once in the middle of the night, a nurse called me saying, "Mr. P just fell. What do I do?" I really wanted to ask her what the hell did she think she was supposed to do, I mean good grief! If you can't think, just don't come to work for me. But those nurses really are out there.

RN1982 · Mar 24, 2009

I do have to agree. It's like an ICU nurse waiting for the resident to arrive to write an order for a fluid bolus on a hypotensive patient. I start the bolus before calling the resident and let them know what's going on, that I started a bolus, do you want a different fluid, LR or NS and how much. I'm not gonna sit there and wait around for the resident and let my patient's BP sit in the crapper. I just hate when some of my fellow nurses say, "I need to wait for the doc" when something like what I just described happens. Or they call the doc and ask them if they want the levo restarted instead of just restarting it and THEN calling the doc to let them know what's going on.

allnurses Guide · Mar 24, 2009

I think what the problem is, is that doctors don't realize that for the most part, nurses aren't allowed

to sneeze without a doctor's order.

Seriously though, there are a lot of interventions that requre a doctor's order, that doctors feel shouldn't require an order. So they get mad when the nurse calls them for an order.

I think I can still see where the doc is coming from though. Doc's appreciate it when you have examined the situation thouroughly, have already come up with what would probably be the best solution, and THEN call them for the order, instead of calling them in a panic "what should I do, Dr. Jones??" whenever you have a patient that can't pee.

RN1982 · Mar 24, 2009

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I think I can still see where the doc is coming from though. Doc's appreciate it when you have examined the situation thouroughly, have already come up with what would probably be the best solution, and THEN call them for the order, instead of calling them in a panic "what should I do, Dr. Jones??" whenever you have a patient that can't pee.

Good point. I find that docs are less snarky when you've examined the situation and have a plan to resolve it and then notifying them. For instance, say you have a patient with some respiratory distress, you assess their lung sounds which have wheezing throughout, you check your MAR and see that the patient does not have nebs ordered. You should always examine your patient before calling the doc for orders because they want to know the entire picture. You are part of the team, there's nothing wrong with saying "hey doc, I think this patient needs a breathing treatment and here is why" .It makes it easier for the patient to get the proper treatment they need.

Trauma Columnist · Mar 24, 2009

Great discussion - yes, critical thinking skills are really necessary. And...if you think about it, its just old-fashioned common sense! When I get called by a nurse, I expect that they've done an assessment and have an idea as to what they are calling about. Or...if they are calling to report a change in condition and they don't have a plan, I expect them to say that too. Don't waste my time and yours by calling without doing an assessment - you are delaying pt care that way.

hypocaffeinemia, BSN, RN · Mar 24, 2009

I agree with the comment on the blog that states, "critical thinking is the politically correct term for what used to be called thinking."

I'm just a lowly student, however, I see this thinking vacuum on a near-daily basis at work and at clinicals. At least it's teaching me what not to do.

red-diamonique · Mar 24, 2009

There are nurses who are just plain rude. I know of one recruiter I honestly believe she is going through sexual frustration and she is taking it out on everyone especially ones who are looking for employment. she sent me a very rude email telling me that i should have never applied at HSS and she does not want anyone who is flexible to work. It is attitude like that which makes me wonder if she has a mental problem if her husband left her. In no way shape or form should she talk to me like that. I am not a child who lives with her. I have no respect for her and she does not deserve respect. AS A NURSE ACT PROFESSIONAL AND NOT LIKE A DOG

FireStarterRN, BSN, RN · Mar 24, 2009

Yes, I see quite a bit of this, I have to agree with the doctor. There is a lot of variety of abilities in this area of nursing. I think a more formal internship would help, but there is always a rush to get warm bodies out there quickly and then count on the inexperienced nurse to learn on the job. You read about disorganized precepting of new nurses all the time here on allnurses.

lovehospital · Mar 24, 2009

As a non-health care provider, I don't understand this doctor's complaint about nurses. But I'm sure there will be rebuttals from some of you here.
http://thehappyhospitalist.blogspot.com/2009/03/what-happened-to-nursing-profession.html

I could say the same thing about the doctors,some are "C" doctors and some are "A" doctors.

How about a doc who prescribes a synthroid to the patient who JUST had a heart attack and this drug should not be taken after recent MI,is that a critical thinking?

GilaRRT · Mar 24, 2009

Yes; however, the OP is specifically addressing nurses in this thread. This is infact a great topic and people seem to agree that problems in fact exist. The conversation has been good until now, and I would not want to see this thread end up like a recent thread about who works the hardest.