What's Wrong With 21st Century Nursing

Nurses General Nursing

Published

I love being a nurse and all that this profession was, is, and will be, but there is still something that deeply troubles me about this profession as a whole.

Working in a fast paced environment and a haven of knowledge I often find myself wondering what we could do better as a profession to keep up with the cutting edge.

My issue: nurses don't know enough.

From nursing school up to staff nurse, nurses just aren't taught enough.

I often find myself admiring just how much effort goes into a physician's education.

I love how doctors respect one anothers expertise and how their is a culture of teaching and learning in medicine. The chief teaches the resident or medical student, wealth is shared and the medical profession as a whole in turn reaps the benefits of shared knowledge.

Don't get me wrong we nurses can learn so much from each other, but are we? Do we share?

Sometimes I wish nursing school was longer and was less about the fluff and more about real time situations. Too much goes into learning how to pass meds and cleaning patients. Too little goes into how to monitor your patients, what signs to look for and basic bedside skills.

I was miffed when in my first semester of clinical we were sent to a nursing home to basically learn how to give bed baths and pass medications, as if that was all a nurse did. The next semesters were not much different at all, again learning how to pass meds, and look in charts.

I was also irritated on how little we actually learned about certain diseases, what to look for and tying that into the clinical aspect! (in regards to how lab data, patient presentation, medications, all rope together to help you think critically)

Sure nothing prepares you for the real world, but shouldn't you atleast be as prepared as you can be?

I'd love to be able to read CT scans/x-rays. I hate answering questions of worried patients/family member without knowing the entire picture. I hate saying ''oh the doctor has to tell you more about that'' because I lack the basic foundation doctors are drilled to have. Why should I be a bedside nurse for 10 years to know the things that a second year resident knows?

What bothers me also is how much more valued physicians are! Even physicians in training! Any given hospital has no issue paying a resident up to $70k/yr, a resident or intern who most likely won't stay at that hospital he or she trained in after they become an attending. But to train a new grad nurse or pay for continuing education for nursing staff is always a budget issue.

I love hospitals that value nurses enough to have something called a ''clinical ladder'' were a nurse is trained and prepared for a role of greater responsibility.

I love when a hospital puts time and money into training new hires, especially new graduates. I cannot tell you how enraged I was when I found out a prospective employer would only give a new grad nurse 2 weeks of bedside training for the ER of all places? With a crappy 4 weeks of classroom training to learn about paperwork!

I find myself wanting more. No, med school is no longer my dream. There is something special and unique about nursing, but I'm tired of nursing schools training students just to pass NCLEX, train us on how to be NURSES! I envision a nursing where nurses receive high quality education and training and in turn have a greater say in each and every single patients' care.

But until we value each other, our own profession, and our own value as professionals, nothing will change.

when i finished my mn i (and many other mns) were working bedside. if you want to compare medical education with nursing education (which is sorta silly, but for sake of argument), i had my six years. people who want more education can always get it.

i see ny state has a bill before the legislature that would mandate every rn to have a bsn within 10 years (ten years!) of graduation from a lesser level. you think?

Specializes in Trauma, ER, ICU, CCU, PACU, GI, Cardiology, OR.

unquestionably, there are many colleagues of mine that feel the same way about this issue. however, we nurses (not all nurses) don't have the camaraderie that doctors have among each other. therefore, some nurses are to preoccupied with how much load of work they received, while someone else got the easier load. undoubtedly, all you remember your preceptors, some of them are great. however, some are undeserving of the tittle, and most new grads don't complain for fear to get a bad reputation. regarding the non-sufficient knowledge, i must say nursing is a never ending school, after one graduates one must continue to keep themselves up to date specially on the department for whom your working for. i'm appalled regarding the treatment among us nurses, in answer to getting rid-off lpn's & adn's i must say i have four lpn's and 8 adn's under my supervision; and i wouldn't exchange them for any new resident or new bsn.in addition, every single member of my team is valuable, one can't exist without the other. moreover, several of my colleagues including myself can read a ct-scan & x-rays, because we took charge, and cross-trained; you don't have to have a phd. to interpret them to your pt. following this further, there are so many seminars that are available to us nurses, all you have to do is reach out to your manager and follow through. remember, nothing that is worth knowing can be taught. lastly, nursing has so many branches to offer, there's no need to be just an" rn "as many here have said. although, all i ever wanted in life was to become a nurse. i totally agree with esme12. when she stated and i quote " we shared in our knowledge and supported each other and shared our knowledge. somewhere along the line we have decided to degrade the value of our fellow nurses and have therefore become hoarders of "individual" knowledge terrified if we share what we know we are no longer worthy somehow." in conclusion, the pursuit of knowledge should be a persons goal, without excuses or excluding other valuable members of a team. the limitations in nursing are place by individuals, not by our profession.

"No offense, but if you feel this way, why didn't you just go to medical school."

No offense, but this is exactly what is wrong with the nursing field...if you're reasonably intelligent and you want to know more, do more and/or be more involved in medicine then become a doctor...not become an advanced care nurse practitioner or work with your nursing associations to encourage greater nursing education and involvement...nope, go be a doctor.

I don't understand why you haven't taken the bull by the horns. Nothing is stopping you from learning. Don't except to be spoon fed! Jump in with both feet! Buy textbooks, go to seminars, take every inservice offered by your hospital. Subscribe to nursing journals. Take ACLS, PALS, or other certifications. Even if it is not required for your job. Don't worry about passing or getting a high grade. Just learn to improve yourself. Talk to your coworkers. AND this is critical....LISTEN. Your patients and families will tell you more than you have ever imagined

Specializes in Critical Care.

Sounds like you should go on to be an NP, then you will have more knowlege, on par with a primary MD. Regardless, you can learn on your own if you want. You can read books on internal medicine, case study, differential diagnose handbooks, to learn more and gain confidence.

I've been a nurse for many years and I've learned so much over the years on the job and thru reading and studying on my own. There is so much free info out there between the internet and the library, of course if you want credit for it than you have to go back to school. If medical school isn't your thing, maybe you should consider NP school if you can afford it. Again regardless of what you do or where you go to work or study, it is what you make it. The more extra effort you put in the more you will get out of it in the end!

I know a lot, but I don't know everything and when people think I do I let them know there is always more to know. One person cannot know everything, even doctors, one doctor cannot know it all, that's why they have specialties. Doctors are not in competition with each other, but share their knowledge among each other as friends and associates. Nursing should be more like this, but I think that's not always the case, due to rivalries, competition, etc. An ICU nurse is going to have different knowledge than a chemo or med-surg nurse; but the ICU nurse is not better just has a different skill set and we should share our knowledge, rather than one-up each other.

When someone makes a comment how smart I am, I remind them I've been a nurse a long time and learned a lot over the years. I try to share my experience so the newer nurses have an easier time of it and less trial by fire.

I agree with any of the posters here. Schooling has changed. The amount of knowledge is climbing at an alarming rate. Nurses are pressed into service as long, hard, and as often as possible by the health care system gone wild. And how do nurses respond? Well, I can't answer that question for you but I see the outcome of the answers.

The art of nursing is getting lost in the shuffle. The science is there. The technical aspects of giving medications safely is there. The human caring while doing the task is gone or at least on its way out.

The OP thinks you can learn enough to achieve mastery of nursing. I doubt it is possible. You can master techniques, learn labor saving ways, find shortcuts. You can even gain expert knowledge of all the diseases you see. You will be out dated almost immediately. Nursing today is like swimming in the ocean. If you allow the current to take you then the best parts of nursing will be lost. Compassion does not outdate. Being considerate is not something extra. It is what made a nurse the most trusted person. He/She was not out to take advantage. It was a given.

Challenge yourself to learn more. Seek out experiences that you don't get in your normal day to day work. If you work with adults learn about dealing with newborns. If you work NICU then seek some ortho challenges in your cont. ed. If you want to be a well rounded nurse don't box yourself in. If you do it right you will learn to find your own compassion for an area you might have never had the opportunity to delve into. it does not mean you have to change jobs. It might mean that there is less back biting amongst all the nurses. Comradeship can help nurses to work together for a change.

I think what the OP wants is not just to know more, but to be more to the patients than the person who shoves pills, regulates IVs, reports significant labs, etc. At least I hope that is one of the things being looked for. To lose the art of nursing would be more than a loss to us as a profession. For many of us it would mean the loss of who we are. To be knowledgeable is good. To be a nurse in all the many forms it takes, that is great.

Specializes in LTC, assisted living, med-surg, psych.

Book smarts are one thing. Life experience is quite another. The best nurses, IMHO, have a combination of both. It's good to have the solid clinical knowledge, the scientific principles, the internal encyclopedia of diseases and medications that doctors and advanced-practice nurses do. But all the "book-larnin'" in the world can't take the place of years spent at the bedside, seeing the same things over and over again and dealing with people in all their infinite wit and wisdom (or the lack thereof).

I love it that I can perform a hundred different assessments merely by looking at a person and talking with him/her for ten minutes. I love it that I can listen to a pair of lungs and sneak a peek at the ankles to figure out whether I'm going to call the doctor for some Lasix or a course of prednisone. And I relish the detective work that goes into diagnosing and treating complex medical issues.

None of this was learned in a classroom, although nursing school certainly gave me my start. I learned it from the ground up, from wiping butts to surfing the Internet into the wee hours investigating treatments for Postural Orthostatic Tachycardia Syndrome (which was something I'd never even heard of until a month ago). I read, watch a lot of Discovery Health, research topics of interest online, and listen between the lines when people describe their symptoms to me. And while I realize the limits of my formal education, I don't consider myself beneath those who have more years of academics under their belts than I do.......not even doctors. ;)

:cough: go to med school :cough:

Nice responses. LOL yes I am working on my continuing education-go to conferences, CEN here I come! I also utilize the nurse educator for not only my department but for the ICU's. I love to learn and know one should not have to ''go be a doctor'' in order to learn more. It's my opinion that to be a good nurse you have to have a wealth of knowledge and yes that includes being in the process of learning too! hey I'm just a fairly new nurse myself lol.

I have been thinking about NP, but to be honest I want atleast 5 years of bedside experience (ER-ICU-Med-surg) before I even think to dive into that.

I haven't found my niche, I literally just want to try everything, NICU-ICU-Trauma-Med-surg-endoscopy-cath lab-teaching!

And yes it is very irritating how devalued lpns and adns are. At my current job most of the senior nurses think I'm a new nurse, which is true in some regards, but I tell them that I've actually been a nurse for 6 years, because I was a LPN for some years before I got my RN license, so this once nurse told me ''oh that doesn't count'' you're still a brand new nurse.

Specializes in Oncology/Haemetology/HIV.
I love being a nurse and all that this profession was, is, and will be, but there is still something that deeply troubles me about this profession as a whole.

Working in a fast paced environment and a haven of knowledge I often find myself wondering what we could do better as a profession to keep up with the cutting edge.

My issue: nurses don't know enough.

From nursing school up to staff nurse, nurses just aren't taught enough.

Don't get me wrong we nurses can learn so much from each other, but are we? Do we share?

I was also irritated on how little we actually learned about certain diseases, what to look for and tying that into the clinical aspect! (in regards to how lab data, patient presentation, medications, all rope together to help you think critically)

I'd love to be able to read CT scans/x-rays. I hate answering questions of worried patients/family member without knowing the entire picture. I hate saying ''oh the doctor has to tell you more about that'' because I lack the basic foundation doctors are drilled to have. Why should I be a bedside nurse for 10 years to know the things that a second year resident knows?

What bothers me also is how much more valued physicians are! Even physicians in training! Any given hospital has no issue paying a resident up to $70k/yr, a resident or intern who most likely won't stay at that hospital he or she trained in after they become an attending. But to train a new grad nurse or pay for continuing education for nursing staff is always a budget issue.

I love when a hospital puts time and money into training new hires, especially new graduates. I cannot tell you how enraged I was when I found out a prospective employer would only give a new grad nurse 2 weeks of bedside training for the ER of all places? With a crappy 4 weeks of classroom training to learn about paperwork!

But until we value each other, our own profession, and our own value as professionals, nothing will change.

Wow.

Where do I start?

Why aren't you learning? It is easy. Read up on the conditions that your pt has, read the chart, question the MD and your resources.

After one graduates, one takes the burden of education upon themselves. they seek out opportunities. There are courses and CEUs all over the place.

No has to "teach" a determined person. If one can read and is determined, SEEK IT OUT!

!!!

I come from the sticks/boonies, from a nondescript ADN program. I currently work at a very wellknown, internationally famous highly rated teaching hospital. Did I get there by waiting for someone to teach me? No!!!!!! I did it by working and learning my tuchis off.

I hate to tell you, but when med students graduate, many express the same issues with not knowing enough. They require of themselves to do massive amount of studying outside of the required 80 hrs of work a week. The attending teaches some, but they are expected to research the issues on their pts before and after rounds.

How many nurses do you see doing the same? No one is stopping them from doing the same thing. Many of my coworkers, are PICC nurses. they are required to be able read xrays - they can read them quite well.

And I do not know where you work, but I know of few to no residents getting the pay you describe in my facility, and most nurses with substantial experience are getting paid quite a bit more than the residents. But it is really moot. For the pay of a resident, the facility is getting basically an indentured servant, that will be expected to spend several yrs there (barring major issues), work 80 hrs or more per week, plus do outside research. They will be having to work holidays, weekends, 24-30 hr shifts. Paying a nurse, they can jump ship easily and take all their knowledge and CEUs elsewhere.

And residents are expected to hop from one area to another with little training whatsoever.

In respecting others, one first needs to respect oneself. And perhaps one needs to look at onself to start, learning and doing, to gain that respect.

Specializes in Cardiac Care.

I am a LPN... but I can chime in here.

I can hold my own with more than a few physicians and NPs. I can even answer many questions people have about their DX. Why? Because I took it upon myself to take classes like, ACLS, PALS, NRP, Interpreting Lab Values, Interpreting Arrthymias, IV Certification, Ventilator Management, Pathophysisology, and 12 Lead EKG Interpreting. I have also learned a lot about medications for certain disease processes,their side effects, and alternate uses, just because of passing a ton of them all shift.

I have taken all of these things not because they were required, but because my philisophy is "I am the keeper of my potential" if I want more education than it is up to me to go and get it! It's also nice to be told by an NP that she likes talking to me, because she can rely on my judgement, because I can look at the big picture.

Is a new grad BSN better prepared for bedside nursing care than I am? Maybe, maybe not, but when I have that RN next to my name soon, it won't be based on only the stuff I had to learn in school to pass the tests.

And yeah it does kinda suck knowing that when I get my RN, I will be considered a "new" nurse again. My critical thinking skills have not reset themselves, I can tell you that.

Specializes in critical care.

I think you'd be better off as a PA, no offense.

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