By Christine Moffa, MS, RN, AJN clinical editor
Head in the Sand, by jvh33, via Flickr
A few weeks ago I attended an orientation provided by the New York City Department of Health for a school-based H1N1 vaccination program. Years ago I worked as a school nurse here in New York and I thought participating in the program would be a great way to keep up some clinical skills and spend time with patients. A physician from the bureau of immunization gave an informative lecture reviewing the epidemiology, signs and symptoms, prevention, and treatment of influenza.
There were about 100 nurses in attendance, many of them new graduates who were unable to find full-time work. During a break one of the new grads said to me, “why do we have to sit through this irrelevant lecture?” I couldn’t believe it. If you’re administering a medication, I told her, of course you’d want to understand how it works and why you’re giving it. In addition you need to be able to explain it to the patient or their parent. She rolled her eyes and walked away. And I thought, once again: this is why nurses are not taken seriously as professionals.
Amazing…every comment above rang true with me in one way or another!
Is there a solution? Something that would encompass the issue from every angle? Probably not. I wish there was a simple “wave my wand” kind of fix, but I think it’s like I feel about being pro-life… hearts can really only be changed one at a time. It’s what we as seasoned nurses on the inside say and do that will make the ultimate difference for the new ones. Many of us became nurses because we wanted to “make a difference”…let’s widen that circle to include our colleagues. Take a new nurse under your wing and give a guiding hand….it’s really the only way, I think…one person, one heart at a time.
I see valid points in all of the blogs above, but the fact remains, you are not going to be able to separate those that truly have the innate desire to be a nurse from those that simply have become a nurse in order to fulfill a demand. The statistics continue to speak for themselves; 30 % of nurses rarely make the first year. Better retention practices are required and improvement in corporate structuring will need to be a priority. Most nurses leave due to burnout and poor management. Working on these issues may entice some nurses to come back. We need to embrace the new nurses by demonstrating empathy, both for the new nurse and the patient. We are the teacher and they are still the student. They will follow example, and hopefully grow to become excellent nurses like their preceptors. If not, they will fall by the wayside through omission by their peers, just as others have that can not endure this rewarding, dedicated, but demanding profession. Those of us that have prevailed over the years know that it takes a high level of commitment and a certain character to be there each and every day. Our hearts are in this 100%. for those that are not, they will tested and eventually discover that this is not the path for them.
One thing is certain, time and technology has changed the way that we deliver the care to our patients, but it has not changed “how” we care for our patients, and it never will. We must remember that there are always going to be people that enter nursing with the assumption of “how hard can it be” or for other reasons that we may not understand, but the real test is that of time. Time will tell.
Because of one ignorant new graduate nurse you make a broad generalization of ALL young nurses. I beg to differ that I know many young nurses who are as professional, if not more, than your average “seasoned” nurse. Classic “nurses eat their young” material!
This seems like another “us vs. them” story. Whether it be about new nurses vs. old nurses, one generation vs. another, physicians vs. nurses – or vice versa, day shift vs. night shift, or this color skin vs. that color skin it’s all the same argument and it’s as old as the hills. Because a young, new nurse rolled her eyes at something she probably should have considered important does not a stereotype make. The “we” people are always going to be better, brighter, smarter, and more diligent than the “other” people no matter who we, or they are. I’m sure there are more productive things to talk about than each other.
I find it interesting that this subject is being addressed as a current issue. Why would anyone be surprised that the nurses of today aren’t interested in ongoing education? Have you had your eyes closed for the past 10 years? All kinds of jobs are at a premium and people are being encouraged to “Become A Nurse”. People have been attending nursing school to “get the big bucks”, NOT for the right reasons.
Soo many new nurses, whom I’ve had the pleasure of encountering as a patient over the last 10 years, have no concept of pathophysiology, medications, proper nurse-patient interaction, nursing procedures, and least of all patient teaching. And there’s no reason to even mention critical thinking here because that is something that I’ve not experienced, even once, in all of the hospitalizations I’ve had in the last 10 years. I’m actually appalled and frightened at the actual errors in technique of this new breed of RN. But then what can be expected when we “educate” people to become professional nurses via the internet?
As a Masters prepared Clinical Nurse Specialist, from a traditional university program where I attended classes on campus and had the benefit of direct, immediate interaction with all the members of my class, as well as my professors in real-time, as well as having a clinical component to the program, I shudder at the thought of the new graduates who “learn to be a nurse” without the benefit of seeing or even touching a patient, or even the benefit of a nursing lab, not to mention NO MATH or SCIENCE requirements.
I’ve recently come across a very interesting advertisement in ADVANCE FOR NURSES, (PENNSYLVANIA EDITION OF OCT 26, 2009 page 16), entitled “On the pulse of Learning”. The offering is from the University of Dundee’s distance nursing (RN-BN) degree program. It states that it is the “FIRST BRITISH nursing educational degree to be awarded NLNAC accreditation in the USA!” There are “NO CLINICALS or EXAMS, NO CLASSES – study at home. NO MATH/NO SCIENCE. ALL RNs welcome.” These programs are “delivered entirely by distance education”. Has no one noticed that this is the manner in which we are now educating professional nurses? As a former nursing instructor at the “traditional” university level I would not, in good conscience, have been able to allow my nursing students to progress to the next level without a full knowledge and understanding of the math and science related to their current level of nursing. And how would they demonstrate their proficiency in that level of math and science? Certainly not by removing all math and science from the curriculum.
I have a friend who is “attending” an Internet Nursing School to obtain his RN at the entry level. He worked for over 20 years as a RRT before obtaining his Masters Degree as a biomedical engineer, and has his own Clinical Research Company where, over the last 15 years he has directed clinical research on every aspect of disease in humans. In his Internet Nursing Program he has never been exposed to the aspect of “Caring” in nursing. Of course how could he know of that? Caring cannot be taught through the internet. Caring is “modeled” by an actual nursing instructor, in person, at the patient’s bedside. My friend may, in the future, be able to pass the NCLEX but in no way will he be a safe, competent, caring nurse able to take on a patient load and meet their needs in even the most minimal way. Passing tests does not necessarily mean you are able to be a nurse. The “Art and Science of Nursing” needs to be learned AND assessed through a 3 way, face-to-face interaction of the nursing student, the patient, and the nursing instructor. All 3 need to be present. And a few weekend clinicals don’t adequately fulfill this requirement.
Since I’ve changed places over the past 10 years and been on the “other side of the bedrails” as the patient rather than the nurse I’ve been able to assess the status of our upcoming generation of professional nurses and I am scared! Give me enough time and space and I’ll tell you of the many experiences I’ve had that will concern you to a much greater degree than that of our new grads not being interested in “continuing education”.
A message to those of you who are in a position where you are able to make a change in the Future of Nursing: OPEN YOUR EYES !!! Take off the blinders. Stop arguing about “entry level into nursing” or the new Nursing Doctorate Degree and take a cold hard look at what you are promoting as “professional nurses”. If things don’t change the “profession” of nursing that I am most passionate about will be a JOKE!
Frankly, it is my belief that students and new nurses alike have learned this culture of apathy and disengagement from practicing nurses. These behaviors, in my estimation, are symptoms of a much more malignant problem and that is burnout. Research supports that burnout is contagious (Bakker et al., 2005) and unless we advocate for reform in the nursing practice environment, the professionalism in nursing practice will continue to suffer. Many of you know new and old nurses alike who also roll their eyes at many of the innovative quality initiatives being pushed out in mass quantities by IHI, TJC, NDNQI, and CMS. What they represent for RNs is yet another unfunded mandate that nurses will have to fulfill during the course of an already jam-packed shift and the folks who end up suffering are our patients. We barely have time to fill out all the documentation required, much less place our stethoscope on our patient’s chest. I have seen such a paucity in nursing assessment within hospitals that I often wonder what exactly our nursing interventions are based upon anymore. After clinicals, I often feel like post-conference is managed like an incident debriefing where we discuss things we’ve witnessed that are not representative of safe nursing care. I have had students ask me why nurses never use their stethoscopes! If we’d like understand why nursing students act the way they do, we might be wise to look in the mirror. We are their mentors and we are passing on this legacy of apathy to new nurses before they have cut their first tooth. They are looking to us for examples of how nurses are supposed to act and practice. Please, professional nurses, use care with the image you convey.
As a nurse educator, I would never tolerate apathy and unprofessionalism out of a nursing student. There is no greater responsibility than that which we are given as nurses and any measure of apathy is unacceptable and even dangerous. We will have to work as a nursing community to advocate for a work environment which is manageable and conducive to safe patient care. The only problem is that old habits die hard and even safe nurse-to-patient ratios are no panacea. Once nurse-to-patient ratios are safe, we will need to creatively address the fall-out resulting from burnout within our profession.
Just my $ 0.02.
Bakker, AB, Le Blanc, PM and Schaufeli, WB. Burnout Contagion Among Intensive Care Nurses. 3, 2005, J Adv Nurs, Vol. 51, pp. 276-287.
I am a wannabe nurse. I spent 3 years as a Hospital Corpsman in the USN. We were trained at Great Lakes, ILL to do our job. Any time any of us missed or did a mistake we were booted out of the Corps. When I had my 1st baby, I told the nurse during my labor/delivery that I worked in an ob/gyn clinic. She aked “what is that”?
One thing I say is, always stay humble, then you will learn. I have found nurses have too big of an ego to learn more….
My daughter is now an BSNRN and graduated from a Midwest University. She compares nurses who come from other schools than what she attended. It is interesting to hear what her fellow nurses are lacking. Maybe, the profession should work hard at making sure there is consistancy in the program it offers, nationwide.
Nursing has pretty much dummied down. Nurses, new grad nurses aren’t the same. They are more selfish, as unwilling participants in the profession. Mr. President said I should become a nurse so I did. I guess filling their head with the idea that they are qualified to lead, is more important than the nursing process, critical thinking, knowledge of medications, basic pathophysiology, or compassion. We now train them as managers or higher since the degree and license automatically qualifies them to manage the outcome of care, or worse offer advance degrees before they even graduate their first nursing class. Qualifications of the candidates for nursing is lacking. school isn’t as hard, and the State Boards (75 questions and your in test) all go to discredit the profession. Hearing a new nurse explain a drug or a procedure to a family member is enough to make you ask when did they start teaching bad information in nursing school. Pathophysiology has been replaced with “leadership” training. So go figure why our new nurse are no more knowledgeable about nursing and the human condition than a PCA. At least in my beginning days the Orderlies and Aides now called PCA where the aspiring nurses and doctors that really knew the seriousness of the undertaking and that lives where at stake, and bad decisions could kill someone. Even they understood enough to ask why something was being done, it was called learning for future need. That’s why in the near future nursing is a program that will run on a computer with prompts for the technician (RN) to follow, no critical thinking, just do what the computer suggests and we won’t get sued. Thanks Corporate America for ruining two noble professions.
Maybe the student felt it was irrelevant because it was something they already learned in school? I obviously can’t speak for them but if the lecture is about influenza, it is taught in nursing school curriculum, and being new graduates the information should be quite fresh in the mind. Ignorance doesn’t seem to be the biggest issue with that individual but, more so a poor attitude. One could only imagine how she would interact with patients if that is how she dealt with you, her colleague. If an educator wants to instill critical thinking, professionalism, and self responsibility in students then have those qualities in the curriculum and make it quantifiable. When a syllabus says your grade is determined by 4 exams then that is where the focus will be for the students because if you do not get the grade you will not pass the class to get the chance to take the NCLEX to become a nurse. If I fail a class by 1 point and go to the director of my nursing program demonstrating my professionalism, critical thinking, and self responsibility i would get a pat on the back and a registrar’s form in the hopes that I could repeat the class if there are enough seats. My 3.8 GPA allowed me gain admission into my nursing program not my professionalism, critical thinking, and self-responsibility even though those are key qualities for a good nurse.
Your post resonates with me. I am a faculty member in an undergraduate BSN program at a university in the midwest. I have become increasingly discouraged in my job as an educator. The focus of students is very short-sighted: typically on points and grades. As hard as I try to instill professionalism, critical thinking, and self-responsibility for one’s own learning, I frequently come away profoundly discouraged. What that new nurse said to you typlifies the midset of at least half of my students. I have not been successful in coming up with ways to solve this troubling trend.