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.

Another fan of less fluff!

Specializes in School Nurse, Maternal Newborn.
because i love the profession I have chosen, so just because I think it could do with some improvements doesn't mean I dislike what I do. Why do I have to be a doctor just to be more knowledgeable?

Who says that you have to? Don't you do more on the side when it comes to learning? I always have my nose in a medical book, online nursing sites, nursing journals, etc. I didn't expect to have it all spoon fed to me by an instructor.

Specializes in School Nurse, Maternal Newborn.

a little learning is a dang'rous thing;

drink deep, or taste not the pierian spring:

there shallow draughts intoxicate the brain,

and drinking largely sobers us again." .... pope

*◦.✰ proud member of the crusty old bat

some people just gargle from the spring, lol! :-)

Specializes in Homecare, Public Health.
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.

Ditto!

As an LPN I also have continued my education on my own and by taking classes! I make darn sure I understand my patients diagnosis, meds, labs and possible problems and outcomes. I continue to learn everyday! I ask questions and don't stop until I have my answers. I will be an RN within the year and be considered a new nurse also and I'll keep on learning.

No LPN & ADN programs should not be eliminated they are great stepping stones to furthering your education or to find out if nursing is for you. I'd hate to spend 4

Specializes in ICU, LTACH, Internal Medicine.

Hospitals with residency training programs receive roughly $200000 per head, per year, from generous Medicare. After paying their residents abot $50000/year and still charging them for parking and cafeteria meals, they're pretty much free to pocket the difference.

If you'd like to see how much doctors of different specialties "respect" each other, spend some time in place where specialists have to interact with each other and make joint decisions. Preop is especially good place for seeing battles royal between anesthesia and everybody else.

And I'm absolutely agree with all said above. Nobody can prohibit me from studying all things I want to know, and I'm pretty sure that there's no such thing as "useless medical knowledge". I read all books I find interesting, whether they're recommended for course or not; and I just made a rule for myself that there must be nothing "i-have-no-idea" about every patient I'm assigned to, be it diagnosis, test, diet or patient's culture. It takes a bit of sleeping time, but it works.

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.

LOL, with what time? Every time I try to do just that, the charge nurse comes around the corner with another medic slip, or tells me to go get someone from the lobby. If I have time to be reading anything, then I have too much time on my hands.

As far as seminars and courses, there are *very few* in my area. Our unit educator provides little to no education; she functions mostly as a manager. One thing I would love to have the opportunity to learn more about is pediatric trauma, since we do receive those patients every once in a while. Yep, I could buy a book with my own money and spend my own personal time reading it, which I actually do since my workplace is so lacking in educational opportunities, but philosophically, I do have an issue with this.

I feel that if my workplace really expects to have a competent, trained and knowledgeable staff, and has the resources to put into advertising such, maybe, just maybe, they ought to think about things like staff satisfaction, staff retention, etc., which are directly related to educational opportunities, instead of working us like mules, not filling vacancies, working us short, and yet still expecting the same performance.

As far as the OP, I think there are some very good points. In discussion with non-nursing friends, I've learned that it's just assumed that nurses know what they're doing. It's just assumed that nurses have a broad knowledge base and know all kinds of complicated medical stuff. It's just assumed that we're as educated as the doctors. What's not assumed is whether we are going to be "nice" and smile, fluff pillows, bring blankets, etc. Because the general public views nurses as primarily givers of comfort, and that is the role that they really expect us to perform. All of the knowledge stuff, all the higher level skills, while they're valued, are just taken for granted.

It can be frustrating when you're trying to multitask, prioritizing your interventions so that you're doing the most critical tasks first, yet the patient wants you to do the least critical things first, because those directly relate to their comfort level.

An example; I was drawing up Zofran to give to a nauseated patient. The grand daughter at the bedside, knowing I was drawing up the med and watching me do it, asked me for a cold washcloth to place on the patient's forehead. Now, granted, it only takes a second to stop drawing up the med and grab a cloth, but still....

I think paying one's dues at the bedside is critical for any nurse, especially if you plan on going into advanced practice. But, I am seeing the appeal of doing some non-bedside, more intellectual nursing, such as case management or care planning. Yet I couldn't be effective in those areas without bedside experience, IMHO.

Specializes in School Nurse, Maternal Newborn.

SORRY, NO CIGAR. If you are expecting your facility to be the ones putting all the effort into your learning process, you are sadly barking up the wrong tree. I DO MINE AT HOME. I don't have any more time available to me than anyone else. I think of it as investing in myself. I have paid for MANY seminars myself, to go out of town for, with NO reimbursement. I just get the satisfaction of learning new skills, even if they will bring me ONLY that satisfaction, and no money.

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.

I agree that education is lacking. Instead of the time wasters like nursing theories I wish we spent more time in school going over common diseases and what to do/look for. As a new grad, I think sometimes you don't even know what to look for. You have to read up on illnesses and nursing a lot on your own while writing 50 page papers on bs theories of care and other garbage. It is embarassing. Instead of70K the residents where I work cap out at 56K and that is for 6 or 7th year. keep in mind the 80 hour work weeks, where the hour limit is probably not being enforced from what I have overheard. Unlike new grads residents do not routinely switch around hospitals or jump ship. From my experience in going to school/working in a teaching hospital many of the residents are proactive at teaching nursing staff stuff(which might prevent some useless paging on my part)!. Ex. In my ob rotation the dr in the room went over stuff like reading fetal heart monitor while the nurse I was supposed to follow sat at the desk eating donuts( true story) the entire time.

Still reading the first page. My issue is not passing meds or bed baths, I rather do that than ever be a dr. My issue is nurses not being taught in school what labs, vitals, trends should be reported immediately, what actions to take. etc. I find these items lacking in many nurses my self obviously included...............No reason there should be endless training on making beds or baths.

The most offensive by far is the attitude of " you want to know more be a doctor or pa or np ."

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.

from wikipedia:

nursing is a [color=#0645ad]healthcare [color=#0645ad]profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal [color=#0645ad]health and [color=#0645ad]quality of life from conception to death.

medicine is the [color=#0645ad]science and [color=#0645ad]art of [color=#0645ad]healing. it encompasses a variety of [color=#0645ad]health care practices evolved to maintain and restore [color=#0645ad]health by the [color=#0645ad]prevention and [color=#0645ad]treatment of [color=#0645ad]illness in [color=#0645ad]human beings.

regardless if one agrees or not with the above it is quite clear that medicine and nursing are two very different academic disciplines and thus have vastly different education.

most pre and or entry requirements for nursing programs do not even begin to reach the level of study in the sciences and other core subjects to prepare one for the same level of study in pathology as medical students. the science courses generally required of nursing students again most often in no way compares to med students. one can use all the coldspa you want, but medical and nursing diagnosis are not the same and thus require different educational approaches.

regarding the balance of the op, med surg i, nursing fundamentals, or whatever any program calls their intro/first nursing class for incoming students has always been about laying down the foundations of nursing arts as t hey are now called. learning how to ambulate, toilet, bathe, take vital signs,make beds and so forth may not be exciting and even considered "aide work", but guess what? most every state practice act requires either directly or not that rns have those skills.

for one thing while one may go months, days or even years in one's career and never touch a bedpan or have to make a bed i shouldn't bet the farm you'll escape from such tasks totally. long as one works bedside, and am including the units here as well there is a good chance sooner or later ....

the other reason is that professional nursing staff are expected to train uaps in those skills. this could range from corpsmen in the military to volunteers after a disaster and all in between. if you shipped out to haiti after the earthquake or a similar event do you actually think you're going to find ready trained nursing assistants? nurses will have to do the work themselves (stretching an usually short supply quite thin) or find local talent that can be taught and trusted to do the jobs.

make nursing education longer and more indepth? are you kidding? are you trying to give tons of pre and current nursing students a coronary event? *lol*

current nursing students would likely tell you their plates are full enough as it is thank you very much and wouldn't welcome additional helpings.

med passing is one thing that cannot be skimped upon and indeed is an area where "21st century nursing" is going backwards it seems in terms of education. there was an article just last week in the nyt citing a medicare/medicaid study that errors are not only increasing but many times those making mistakes don't even know they did so. despite all the pre-hiring testing and so forth there are still way to many meds errors made by nurses often with adverse to severe consequences.

there is considerable opinion that what is wrong with "modern nursing" is that it is trying too hard to become quasi-physican centered, and along the way dropping much of what is or what used to be central to the profession.

yes, there are well seasoned/experienced nurses who can go toe to toe with doctors. but if you examine their careers closely you'll see they got that way by putting their time in on the floors/units, asking lots of questions and never closed themselves off from learning.

SORRY, NO CIGAR. If you are expecting your facility to be the ones putting all the effort into your learning process, you are sadly barking up the wrong tree. I DO MINE AT HOME. I don't have any more time available to me than anyone else. I think of it as investing in myself. I have paid for MANY seminars myself, to go out of town for, with NO reimbursement. I just get the satisfaction of learning new skills, even if they will bring me ONLY that satisfaction, and no money.

Actually, according to our union contract, the facility I work at is obligated to facilitate our required certifications and unit based competencies, thankyouverymuch.

Specializes in School Nurse, Maternal Newborn.

Enjoy your cigar,BUT- to be obligated to facilitate REQUIRED certifications and competencies is NOT the same as what the OP was lamenting that she was not getting! What is REQUIRED is usually pretty mundane and minimal. Expecting that they provide ALL the knowledge that she was lamenting not getting is NOT the responsibility of the facility. I stand by my statement. If she wants to "know more, as nurses do not know enough", she may just have to take some initiative herself.

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