Whatever happened to going to school to be a nurse?

Quickbeam, BSN, RN · Dec 3, 2016

My Accelerated BSN program was 25% people who wanted to be surgical/OR nurses. They all felt that the curriculum was 80% not relevant to their career goals. It's too bad there is not a more specialized way of getting credentials for that rather than so much training that isn't relevant.

BeenThere2012, ASN, RN · Dec 3, 2016

I've been nursing for 25 years and I've seen the changes over nearly 3 decades. What is different now is that medicine has become part of a corporation. It's not healthcare in the old sense of the word. It's now about staffing numbers and costs and heads in beds. All this translates into management squeezing every last drop they can out of every nurse, bed space and stock item. Nurses are pulled, floated, called off, given a bunch of different admits as patients are constantly moved to a cheaper level of care. Nursing has become extremely hard work. Not that it wasn't before, but it was honest hard work. These days it's just stressful. When I was a young nurse I would come in to work, get an assignment and leave with the same assignment, never floated, had lunch and tea breaks and if the unit was quiet I wouldn't be sent home without pay, I'd help the other nurses. That doesn't happen anymore and so nurses have gotten clued into this and want more autonomy, better working conditions and less stress. It's inevitable that this has happened actually. Administration have created this with their business practices. And me...after 25 years...am in school to be an NP because I have had enough.

Exactly....it's the corporate influence that has caused the bedside work to be next to impossible to do well. Meaning, to give the care people need. It isn't about hard work, it is about the tremendous stress of juggling the ever changing assignments and unit floating. You barely complete care, let alone charting, on one group of patients before your assignment is changed. It is too much information to keep in your head. Juggling all the priorities, planning out the care, dealing with new orders and order changes, and so on. You give report on a patient you hardly even got to know yourself. This "juggling" of patients is very dangerous. Information gets lost in the shifting, and things change with the patient before anything is even done for them. I couldn't take it anymore. I still want to do direct care, but in a different environment. That doesn't leave much as far as alternatives, but Im not giving up.

globalRN · Dec 3, 2016

I agree with comments from many here....the bedside nurse (at least in Alberta) is required to work shiftwork as part of the union rules.

Frankly, after years of not being able to have Christmas, Thanksgiving, Easter or New Years with your loved ones....who wouldn't look for greener pastures.

Second, the lack of staffing, staffing with the lowest number of RNs, LPNs, the high acuity and complexity of the patients admitted today....no, I don't blame new nurses for looking forward to other nursing opportunities.

For myself.....I left bedside unit nursing because the shiftwork was taking a toll on my wellbeing.

I moved to a RN setting that was days, no weekends and no holidays required in 1986. However, the catch was

the job required BSN: that was why I got the plum job....in those days only 10% of RNs had a BSN...if it was based on

seniority...I would never have been considered.

I did love that direct care job and the patients and would probably still be there now if I had not relocated in the 1990s.

I am a NP now because the alphabet soup after my name and my NP experience gives me flexibility to work in the areas I want.

I am at the stage now where I don't have to worry about losing my job, having my hours cut etc. I did the NP route because I wasn't

interested in shiftwork at age 40 as a RN, didn't enjoy being management, and realized that I didn't like the atmosphere in an academic institution when you are the 'nursing instructor only'. I do prefer the direct patient care I provide as an NP, the mutual respect from my specialist MD colleagues and the degree of autonomy.

Having said that, my organization has frozen our out of scope wages for several years while the union staff: RNs, LPNs, multidisciplinary staff have been getting increases and lump sums annually.

BeenThere2012, ASN, RN · Dec 3, 2016

Emmy 27. I would argue patient ratios have gone down over thirty years, where on medsurg I had six on evening shift and ten on nights, the last med sure unit I was on was four on days/evenings and max six nights. Acuity also has gone up in that you can't be admitted for "general mailais anymore, or admitted the night before surgery for prepping and teaching or stay as long. But nursing has always been physically hard, emotionally draining and plain old hard work. I change up where I work about every ten years, specialty wise. PACU was always on my want to do list and after just working a ten hour shift with one twenty minute break because of all the emergent add ons I would disagree that it is
easier than the floor. It's different, but just as stressful and I've been there about a year and a half so not long enough to get a un realistic view.
I agree that longevity is not something appreciated by the big business of healthcare, if anything it's almost a liability. I don't believe I blamed it on generational caliber. I just asked the question, why are people not satisfied to be nurses? Expierence at the bedside can be the difference in life or death in some situations, but it seems to just be a launch pad to something else. My point was thirty years ago going to nursing school was to be a nurse and take care of sick people. Now it's a career path

I understood the main point of your post. I just want to say that for many of us who started out intending to stay at the bedside, we are leaving now for a variety of reasons, but most I know, including myself, are leaving because the "job" is impossible to do well in terms of what I was taught and believe should occur in caring for patients. For me, the safety factor in particular cannot be carried out to my satisfaction. And, this is extremely stress producing. I'll give another example, as a critical care nurse, I accepted a position in a unit and was told I would float on occasion to the med-surg floor. (This was PICU and Pedi). As it turned out, I was on the Pedi Med-Surg floor 90% of the time. There were several of us in this position. This hospital wanted to be able to float just about any nurse in Pedi, to PICU when needed. Only the most senior had regular assignments in the PICU and it would take 5 plus years to get to that point with attrition. I considered this a bait and switch. And the longer I worked there, the more stale my PICU skills were becoming. So, I quit. It has become so difficult to get what used to be a "normal" position anywhere. My years of experience, certifications etc make me very desirable , hence the constant emails and calls from recruiters, but I just won't go there anymore. It has become too stressful.

Elinor · Dec 3, 2016

I personally know many nurses who are in grad school, applying, or want to apply in the near future. Out of dozens, I only know two who don't want to work directly with patients. Why is it not "caring for people" when you're an NP? Believe it or not, you are still physically touching your patients, looking into their eyes, hearing their stories, becoming part of their lives -- maybe for decades and across generations in primary care.

It's not a zero-sum game. We have way too many nurses entering the workforce now, thanks to shortsighted decisions made years ago, and that will continue for a while. And we need more primary care providers in the US, which is what most NPs become. We will need more nurse midwives and CRNAs as well. The nursing profession can afford to send nurses to grad school.

When I hear this complaint -- which is often -- I wonder if the complainer is really upset because she feels that the value of her own career and raison d'Ãªtre is being called into question. Like that, if other nurses want a different job, that must mean she's a fool for sticking around -- or somehow the work is less meaningful because other people don't want to do it. I have two answers to that.

1. Your work will always be meaningful. We need you. The world needs you. Every kind of nurse matters, from school nurses to floor nurses to flight nurses to APRNs. Patients can't survive without you, and you've personally saved lives doing what you do. You know this.

2. The other side of the coin is that nowadays floor nursing is really difficult and unpleasant for a lot of people, in a lot of places -- not because of the nature of the work, but for all the reasons that it's difficult and unpleasant for you too sometimes. Poor nurse staffing, EHR demands, administrators, etc. I don't need to elaborate. If some people want to leave, it's not necessarily because they don't like nursing, or caring for people; most of the time, it's because they hate all the BS.

So don't make other nurses the bad guy. We need to work together to make every part of nursing better for nurses, which means recognizing the value in each others' work.

aaronrock · Dec 3, 2016

I agree, but I would say that a lot of physicians, dentists, physical therapists, pharmacists and speech language pathologists entered the professions mainly for security and financial prosperity, too. However, it may or may not affect their professional skills. I know some nurses who are nurses mainly because the profession brings an okay range of salary, but they are good nurses. On a side note, who really thinks a $60,000 yearly salary is survivable? Studying computer science will bring a 100K+ salary easily.

Ione H · Dec 3, 2016

I don't know when it changed but, I worked as a nurse for 43 yrs before retirement. I worked in hospitals for most of the first 18 yrs. I did bedside care, medications, I was a charge nurse and worked as a shift supervisor and Head nurse. I loved both beside nursing and mentoring young nurses but, I grew tired of being responsible for oversight of less experienced nurses who either didn't want to be at the bedside or didn't admit that there were things they didn't know. I left the hospital and spent the rest of my career in Home Care, which I found to be most rewarding.

Over the years I talked to many nurse educated in colleges and hospital schools. Many wanted to become office nurses, or higher practice nurses to get away from working evening nights, weekends and holidays. For many college educated people the goal is to acquire more degrees and climb the career ladder. It is hard to admit to your college friends that you have found your career and want to stay, or simply move to a different area within the hospital.

I agree the financial end of health care as made bedside nursing more difficult. But there is no greater joy for me than seeing someone recover because of what I did.

Tccowboys · Dec 3, 2016

Not a nurse yet but I can't imagine going through all of that just to sit in an office. Isn't that the whole point of going into the medical field?

MagicShell · Dec 3, 2016

I'm not sure where you live, but here on the west coast, it's unimaginably difficult to get into nursing school due to the high numbers of applicants and prerequisite criteria.

sv12b · Dec 3, 2016

Good money!!?$? $? $???!!!

The pay is terrible - for the responsibility, knowledge and expertise required. Nurses must know so much more than when my mom and nan did it.... the pay hasn't risen EQUATIBLY with expertise requirements.

Nurses in management aren't taught how to manage staff.... they may have been great nurses, or just senior but that doesn't mean they know how to truly manage humans.

N.B.....You might think your manager is/was good but it's probably because you are mostly self managing. As have most nurses been for years

Couple poor people managing together with a new generation.....who are, as a collective driven and entitled. The problem with these 2 things is they have no idea what they don't know and think they can do better than those doing the positions they want.

So they need VERY strong management which isn't available in nursing, that drive and ambition is needed.....managers need to learn how to use it.

Gen-Y are like this in every industry, not just nursing

What's more...the RESPECT I started to get when I left the floor skyrocketed. I didn't even know it was missing! Sadly, I look back now and I can see it. Floor nurses should be the highest respected. They keep the whole place running and people alive.

CALL TO ACTION!!! Nurses, we all need to promote our expertise, and the respect our work deserves if pay is to ever be properly reflected (What this world pays each person is unfortunately usually coupled with the level of respect).

We also need to respect each other more! Don't ASSUME everyone leaves because they don't want to do patient care, I still care....patients still get help from me....just not on the ward.

Thought for the day.... once, not that long ago actors did what they did for the LOVE of it and were looked down on by society...... now with a little PR and a lot of climbing..... nurses don't need to climb as much as that.....but a climb is needed.

JustKeepDriving · Dec 3, 2016

You know, If I could have gone to school to "just be a nurse" that would have been awesome. I enjoyed taking care of patients, talking to them, learning about medications and treatments as well as working with tons of different disciplines. Prior to going to nursing school I worked a lot of odd jobs - food, bars, grocery, manual labor ect. None of those jobs were amazing but I made decent enough money and was treated pretty okay. I got dual degrees in psych and nursing because I wanted to help people, get an education, have more respect, and better career prospects.

Except I didn't become "Just a nurse".

According to some of the hospital's where I've worked - I also am suppose to be providing patient's with "The Disney Experience"... So I'm a Disney Land Character with a Specialty Skill. However that specialty skill seems to get in the way of getting high patient satisfaction scores (Like NPO-ing someone's kid before surgery damnit) and I should be able to fix that complaint according to one of the hospitals I worked at. Just try harder! Be Sweeter! Smile More! It's your fault that they complained!!! So Although I'd like to think I'm Bell... well read, empathetic to the best of my abilities while remaining assertive, My hospital has this belief That I'm Nurse Gaston apparently... withholding food and not smiling enough to get good scores.

Others have decided I also double as Marvel's Comic book character "Quicksilver" because I should be able to handle 6 patients, some with requiring total care, while providing transport, doing rounds, running groups, passing meds, performing admits, charting, discharges and somehow able to squeeze in a lunch and 15 min break... or float right in the middle of my shift to pick up another 6 patients. I mean what it comes down to is using our unpaid breaks to chart because good lord if you stay over 15 min to finish your charting you can expect a screamer from the Administration about your "Bad time management". Never mind that we've told them that running the unit on a bare bones crew without CNA's or Techs literally makes it impossible to take breaks and that we need more help. It's however never the system's fault... it's our fault for not managing time better and if we don't like it "We can quit".

Somehow I've also manage to get a decent education in being a human punching bag along the way too. I've been hit, kicked, spit on, cursed out, had patient's threaten to rape me, had patient's try and spray me with HIV-HEPC infected spit balls, watched staff members get brain damaged by patients and one unlucky soul strangled to unconsciousness. But it's never the patient's fault because "They're sick" and pressing charges is highly discouraged. Oh and the patient's behavior - according to some managers - is your fault because you should have been more therapeutic, you shouldn't have enacted this restriction or set that limit. God forbid you ever defend yourself or one of your fellow staff members - we had one guy that lost his job and was turned into the BON because a patient started strangling a nurse from behind until she lost consciousness and no one could get the dude off of her - that is until that staff member finally decked him in the face. Well, sorry - that's patient abuse.

That's not even bring up all the non-nursing stuff I also apparently got educated in - Omnicell/Pyxis Trouble shooting, Novel-Length Progress note writing, when I worked in the OR there was also surgeon mind reading with equipment set up that they decide they "Just have to have" at the last minute, patient room cleaning with laundry service, phone answering and turkey sandwich/opiate administration, and so much more!

Oh, and don't ever get sick on the job because you'll never be allowed to get off early - According to one manager breath mints not only cure bad breath from vomiting but are good enough to power you through mandatory overtime!

No. I didn't become a nurse. I became the hospital scapegoat, patient punching bag, overworked, chronically stressed customer service representative that just happens to have specialty nursing knowledge - but damnit it better not get in the way of those satisfaction scores!

BeenThere2012, ASN, RN · Dec 3, 2016

I personally know many nurses who are in grad school, applying, or want to apply in the near future. Out of dozens, I only know two who don't want to work directly with patients. Why is it not "caring for people" when you're an NP? Believe it or not, you are still physically touching your patients, looking into their eyes, hearing their stories, becoming part of their lives -- maybe for decades and across generations in primary care.
It's not a zero-sum game. We have way too many nurses entering the workforce now, thanks to shortsighted decisions made years ago, and that will continue for a while. And we need more primary care providers in the US, which is what most NPs become. We will need more nurse midwives and CRNAs as well. The nursing profession can afford to send nurses to grad school.
When I hear this complaint -- which is often -- I wonder if the complainer is really upset because she feels that the value of her own career and raison d'Ãªtre is being called into question. Like that, if other nurses want a different job, that must mean she's a fool for sticking around -- or somehow the work is less meaningful because other people don't want to do it. I have two answers to that.
1. Your work will always be meaningful. We need you. The world needs you. Every kind of nurse matters, from school nurses to floor nurses to flight nurses to APRNs. Patients can't survive without you, and you've personally saved lives doing what you do. You know this.
2. The other side of the coin is that nowadays floor nursing is really difficult and unpleasant for a lot of people, in a lot of places -- not because of the nature of the work, but for all the reasons that it's difficult and unpleasant for you too sometimes. Poor nurse staffing, EHR demands, administrators, etc. I don't need to elaborate. If some people want to leave, it's not necessarily because they don't like nursing, or caring for people; most of the time, it's because they hate all the BS.
So don't make other nurses the bad guy. We need to work together to make every part of nursing better for nurses, which means recognizing the value in each others' work.

I agree with most of your points. Another one that can be pointed out is that many more nurses entering the profession, are leaving the bedside and moving on more quickly because of the reasons you stated and for others, I'm sure. What this means is that there are fewer experienced, expert nurses on the floors than before. The care patients are receiving is not always as good as it once was in certain aspects, as in many units (and growing), the majority of the staff are relatively inexperienced.

This also means newer nurses don't have the mentorship that used to be part of your growth as a nurse. In one position I had relatively recently, there were very few nurses with the experience I had. The newer/younger nurses never heard of some of the technigues, interventions, etc I sometimes wanted to use and just didn't understand alternative ways of achieving some things when the one and only way they knew about couldn't be done. It was frustrsting for me as the vetting of the alternative technigues often did not come until much later by someone else when it was too late. When I started out, I had a lot of respect for the more senior nurses I worked with. That is not to say you follow blindly, but using critical thinking, and when something made sense, you tried something new and learned a lot that way. When I did some travel nursing, I learned different ways to do certain things that were more of a regional norm based upon the major universities teaching in those areas.

The broad based knowledge that "expert" nurses have, is falling by the wayside as fewer nurses stay at the bedside for the long haul. Don't get me wrong, I fully support advanced degrees, further "professionalizing" nursing, and so on. Just saying that it seems to me that more and more the skill mix in med-surg units and even critical care is narrowing as time goes on.