What Happened To The Nursing Profession?

[Anxious Patient]

As a non-health care provider, I don't understand this doctor's complaint about nurses, as it's beyond my scope of knowledge. But I'm sure there will be rebuttals from some of you here.

One of my biggest irks about the nursing profession is their failure, at times, to use critical thinking skills. Some nurses are much better than others. Some floors are much better than others and in fact, some floors I give rock star status. I would trust them with my life to do the right thing. And then again, some nurses are incapable of comprehending what critical thinking is. I'm not sure if this is because of the rules and regulations by the hospital or government imposed safety regulations or simply something that isn't remembered from their school days or even that it isn't taught anymore (a scary thought).

What happened to critical thinking in the nursing profession? Is the nursing profession to blame for turning some nurses into robotic like documenteurs, void of any critical thinking skills? Or is it the toxic malpractice environment that drives robotic like activity?

http://thehappyhospitalist.blogspot.com/2009/03/what-happened-to-nursing-profession.html

[JustMe]

Let's spend more time thinking of other things, like "Hmm... should I really give this guy 50 mg of PO Lopressor when his BP is 86/50?... Oh wait, I need to make that bed!" Yeah, how many times have I seen that happen because people don't put 2 and 2 together? I'm far more worried about my patient's condition than how their bed looks, but for some reason, we seem to focus on these ridiculous things.

Except now management thinks it's more important that we make our surveys look good. Patients themselves are more focused on how well nurses cater to their every need--somedays I feel more like a waitress than a nurse. But I do it with a smile and rush off to consider calling the MD about my crashing patient or call the ER about my new admit who doesn't belong in the ICU anyway. Except there's another call light and the patient's family member wants another cup of coffee. But if I don't get it then they make us look bad on the survey. ARRGGHH But then management wants to know why I didn't call the MD with the critical value troponin of .08. AAAARRRRGGGGHHHH!!!:banghead:

Sorry about venting but sometimes I don't think my "critical thinking" is valued by anybody---my employer, my patients, my coworkers, or the Docs. Just my

[WalkieTalkie, RN]

"They don't order it, I don't do it" has become a big mentality on my unit. Which is terrible IMO, b/c it ignores an important part of assessment and critical thinking. I stopped "asking" for orders a long time ago, and started "telling." I find that and a call to a higher-up if there's an issue, works nicely.

Ugh, this is annoying. You can bet your paycheck that if my patient's last K+ was 2.2, and they are on a Lasix gtt, and I replaced it with only 40 mEq of K, then I will recheck it and then call if it's still really low.

I've learned which docs I can do this with and which I can't. Some really don't want to recheck an ABG until they come in, and some want you to do them daily. We have some cardiac surgeons who want everything in the morning, and some who want the bare minimums. I'll sometimes get labs for people who have forgotten to order them if I know that they typically do get them, and on others I will wait until they round. Just a trick of the trade, but a lot of people don't know what to do in this situation. It's hard to imagine given how unclear it is!

[SoundofMusic]

Well, let's see. In nursing school, we started with bed baths, then moved to, uh, hand washing. Then it was an entire week spent on vital signs and the corresponding "check outs" where they round you up and terrify you into checking off on all these "skills" that could be taught in about five minutes. Then there are classes in pharmacology and assessment, although all isolated from each other, and nothing taught in any sort of integrated manner. AT the end, you finally get to pathyphysiology, but again, all patho "issues" taught in isolation -- no patients with multiple disorders are discussed, very few case studies, etc. Then there is the heavy emphasis on public health, ethics, and research. Then it's time to study for the NCLEX which is a million nilly willy questions, nothing tied together or about application of anything. Don't even get me started on clinicals -- I mean, there is just no emphasis on it in school. The first time you really get to it is on your unit, maybe with a preceptor.

I mean -- you ask what happened to the profession -- I'd say start with what happened to nursing education and go from there. It's not that the people are any less intelligent. They're just going with what they've been taught. Perhaps it's time to look at the pioneers of the education process nowadays -- who are they and why have they set up the curriculim as they have? Why dont' we have diploma schools anymore? Why such a lack of clinical time?

[SandraCVRN]

random thoughts on why critical thinking seems lost...

CYA,

nurses on the floor are not allowed to use judgement, I heard "someone" telling one of the doctors he could no longer write and order for 1 or 2 whatever pain med. talk to joint comm,

ICUs "do" interventions because like someone said, they have to do it now!!

Hopefully they "know" their docs.

Some docs don't care if you cath a pt at 3 am and some do.

It seems as nurses either have 20 years of experience or less than 5, newbies don't always know which docs to trust. I've seen it happen.

[esra_hms]

I think we haven't any autonomy. we would only do said the doctor. If we do nursing care ordered by the pychican. We have no trust ourselves.We do not have confidence in our professional knowledge.

[oramar]

Everytime I have failed to use my brain it was because I was being pulled in so many directions at once I could even spell my own name let alone think in a coherent manner. Docs can complain all they want about lack of critical thinking skills but let us face it, it is not going to change unless something is done about these ridiculous patient ratios.

[blondy2061h, MSN, RN]

His blog topic and rationale lack evidence of basic critical thinking......this from someone who usually enjoys that site.

That's how i feel about almost all of his entries.

[HippyGreenPeaceChick]

I am young and a fairly new nurse. Just 2 yrs out of school. I do not know what nursing was like. I hear from the older nurses how much better everything was about nursing. How they worry about us young nurses taking over for them. Personally, I do not see this. I see nursing as a bold and growing new venture. We are ,earning new ways and new pathways to take us and our patients into the future. Things are changing yes, But I see them as changing for the better. All the new changes are just a new challenge. So as regards to the original poster. I believe nursing is getting better and stronger all the time.

[blondy2061h, MSN, RN]

The problem is that, especially in ICU, we're in a catch-22. Intervention needs to be done without delay, but if anyone actually made a stink about it, your license could be in jeopardy. At least in the ER, you can grab a quick verbal and everything's kosher, but at this community hospital ICU, without interns and residents, the ICU nurses have to act decisively before there's even time to page the attending, let alone waiting for the callback. Somebody's seizing, you grab some lorazepam, give it, and then call. Technically, it's practicing medicine without a license, but it's what needed to be done. It'd be nice to have a 24/7 NP/PA in-unit to cover butts for emergencies and stupidly routine stuff. Why call some poor asleep dude at 4 AM for a stool softener or a quote-unquote "critical" lab when you can just bounce that stuff off the intensivist PA/NP (glorified permanent intern)?

That's one thing I like about where I work. I can do something about most things without an order. If my patient has been having decreasing blood pressures, I often have a drip I can titrate up to try and address it. We have standing lasix orders. We have standing insulin/d50 orders. We have standing blood/platelet/FFP transfusion orders. We have standing antibiotic orders. All of our patients are admitted with orders for pain, nausea, and sleep. It really cuts back on the amount of calling.

Most other stuff can wait. Our charge nurse makes scheduled calls to the covering doctor (who is in house, and just covers nights- doesn't work a day job too) q2h and addresses any other issues then. Most of them also routinely stop by our floor and ask how things are going.

Sometimes, when reading threads here, I often feel like I work in a Utopia compared to most of you.

[VivaRN]

This reminds me of the whole "is nursing a profession" topic. I've often felt that in some nursing schools that professional demeanor is not established, that would lead a nurse to take pride in their work, be a life-long learner, communicate effectively with other members of the team, and generally function as a thinking professional.

Also, there are some countries where nurses do not have the same role and expectations as in the US. If as a nurse in their country they functioned as a handmaiden and were not expected to critically think, why should nursing here be any different?

There needs to be more guidance other than passing the NCLEX to help these nurses assimilate to new professional expectations. This is not a slam on foreign nurses, just a suggestion towards more help adjusting to the role.

[lsyorke, RN]

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.

While this is true, I think that it can be handled. I've had the pleasure of working with some excellent docs for many years. Most appreciate when they are approached with the problem and with a potential solution. I think they appreciate a nurse who can determine "if" a call to him is truly needed. I've heard nurses call doctors for the most ridiculous things and then get mad when the doc is less than nice on the phone. Really, do you need to call a doc at midnight for a wound care consult that you KNOW isn't going to happen until the morning?

I'm finding a real lack of a solid anatomy and physiology background in new nurses. Without that critical thinking isn't going to happen.

[southernbeegirl, BSN, RN]

i work in rehab/LTC. recently i had a LTC pt go south on me rather quickly one morning. i noticed him wheezing and trying to stand up to get a better breath. a quik check found his sats below 80. i put him on O2, started a neb tx, ordered a CXR , drew some stat labs and then i called the doc. i know i treated the pt without orders but using my critical thinking i had to anticipate what the doc would order. thats what i was taught in nursing school years ago. the doc, thankfully, was very pleased and said "well what do you need me for?", lol.

pts coming to LTC are so much sicker than they used to be that the nurse has got to be fast on her feet. the problem is, so many of them arent.

i try and try to get them to use their critical thinking cap but when i cant even get them to look to see WHY a pt is on an antibiotic...sometimes it's less painful to just beat my head on the wall.