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Meeting the Challenges of a Changing Profession To stimulate interest in the 2002 TNA Annual Convention, we recently emailed the following request to all TNA members with email addresses on file: “Have you ever promised yourself that one of these days you would write an article for the Tennessee Nurse? Well, here’s your chance. “TNA’s 2002 Convention theme is Meeting the Challenges of a Changing Profession. We believe many TNA members have strong convictions about what will be required of the profession in order to meet head-on the challenges of change. Whether it is relative to education, practice, professionalism, ethics, organizational structure, public policy, regulation, or financing, everyone has an opinion–and we want to hear yours. We will print as many short, succinct editorial opinions about the changing profession as space permits. Just think of it as a stump speech addressing the TNA 2002 Convention theme. “We can’t promise we’ll print every one we receive, but we’ll do our best to get yours in. You may think of ways to address the theme we have not mentioned, so don’t rule anything out. Sometimes the best pieces are the most spontaneous.” Several of you did respond and here are your thoughts about nursing’s future–both varied and thought provoking. We appreciate all opinions submitted and regret that not all were published due to space limitations. Don’t Be Shy Karen Lusky, MSN, RN To meet the challenges facing the profession in this millennium, nurses will have to get their message to policymakers and the public through media of every type. For example, a recent study published in The New England Journal of Medicine, confirming that nurses make a dramatic difference in how hospitalized patients fare, did a great job of advancing the profession’s call for higher nurse staffing ratios. Why? Because every major newspaper in the nation picked up the story. The net result: a better-educated public that may start “voting with its feet” by choosing hospitals that do what it takes to get and keep qualified RNs on board. Of course, the majority of nurses and other health professionals don’t perform studies that end up splashed across the New York Times. Yet, nurses have an excellent opportunity to be quoted and even featured by newspapers, magazines, online publications and the trade press. Nurses are, by nature, great communicators. And, by virtue of the work we do, nurses are storehouses of anecdotal accounts that stir others to compassion or action. So if you have an expertise or story to share, watch for articles on that subject in local and national newspapers. Do online searches looking for publications that have recently published articles on the topic. Then call the publications or reporters and tell them you’d like to be interviewed for the next story. Even reporters at The Wall Street Journal or Washington Post are always looking for new sources with a fresh slant on a subject from various parts of the country. And the more you are quoted on a subject, the more other reporters will see your name and contact you. Call your organization’s media department and volunteer to serve as a source on a particular subject, or suggest a good story that presents nurses and the organization in a favorable light. The media department can then pitch the idea to the press. When you do talk to a reporter, go for the bold. Do your homework so you can cite statistics and leading-edge thinking to make a point. Use colorful “sound bytes” and don’t be afraid to share your unique opinions or ideas on how to address a health care dilemma. If you’re worried about being misquoted, ask the reporter up front for permission to review the comments or run them by your media department. To some extent, however, agreeing to be interviewed by a reporter requires a leap of faith in that you can’t control the spin of a story or the context in which your quotes appear. Yet, it’s a chance worth taking to get nurses and the work we do in the public eye. Nurses can also take advantage of op-ed pages in local and even national newspapers or magazines to share our personal opinions and policy suggestions on any health topic, from the advisability of granny cams to the nursing shortage. Whatever the opinion expressed, the larger “meta message” is that the author is a nurse who is obviously vested in the well-being of patients. You never know when your persuasive editorial will catch the attention of people in a position to influence health policy and reimbursement. ______________________________ Architects of the Future Gary D. Crotty, MSN, RN, APRN, BC The elimination of contradictions is, in my opinion, the most important challenge and burden nursing must face in the future. Registered Nurses (RNs) are told they are valuable. However, salary compression, low pay (except in time of extreme shortage), undue influence of medicine in advanced practice nursing, poor benefits for educators and under representation in top administrative (academic, insurance boards, health industries) and governmental positions persist. Extensive downsizing has eliminated the “loyalty factor,” which was alive and well in most institutions in the past. Some RNs left positions to work for “nursing agencies” for higher salaries. Unfortunately, most “nursing agencies” are not owned by nurses. Owners, however, receive a considerable fee for brokering nursing services. Nursing entrepreneurship has been slowly evolving over the past 20 years. When large numbers of Registered Nurses come together, incorporate and contract services to hospitals and primary care settings, a fundamental shift in power occurs. True nursing agencies evolve and corporations owned by RNs become employers. Employment by traditional employers is reduced or eliminated. The corporation negotiates fee schedules with contractors and creates benefit packages for employees. Such a corporation, for example, might contract to provide 24-hour nursing services on oncology units in three different hospitals. This could easily become an employment option with larger benefit packages in the future. Given the outsourcing by many academic institutions for educational and consulting services, the viability of a similar model might also be examined for educators. Medicine typically tries to control advanced practice nurses (APNs) through legislation under the guise of “protecting the public.” Yet research consistently shows APNs provide safe and effective care. The primary purpose of such initiatives is to control competition and limit access – not improve quality of care. The efforts of organized nursing should continue to strive for increased autonomy through legislation. All Registered Nurses (APNs or not) should band together to pass legislation that ensures freedom of choice regarding selection of a health care provider. I envision the RN of the future as highly visible, in great demand and not dependent upon traditional employers. Through political activism and entrepreneurship, we will be architects of a future perhaps not possible before. ________________________________ Strive for Excellence in Practice Peggy Strong, MSN, RN, CNA Many changes in nursing practice are necessary in order to meet the challenges we now face. In the hospital setting, technology must continue to improve–especially paperless medical records. However, in order to create a meaningful medical record, current processes will have to be assessed and changed. No healthcare provider can continue to document the same information in two to three different places because that is “how we have always done it.” Nursing administrators must step forward and educate hospital administrators and boards of directors regarding ANA’s Nursing-Sensitive Quality Indicators and ANA’s Safety & Quality Initiative. Nursing administrators must also educate hospital administrators, boards of directors and nurses about the Magnet Recognition Program, and we must work toward meeting the criteria for achieving Magnet status. Perhaps the most important practice that must change is the model for delivering patient care. Hospitals must work in interdisciplinary teams with the RN coordinating the care of the patient. This means that we, as nurses, must learn how other disciplines function and take advantage of their expertise to improve patient care. We must learn to supervise and delegate more efficiently and to hold each other accountable for actions taken in order to demonstrate that our first priority is high quality patient care. This will require all nurses at all educational levels to further develop critical thinking and assessment skills and to strive to achieve proactive leadership skills. In order to accomplish change and meet the challenges it brings, nurses must become more active within our professional association and be more aware of what is happening in public policy development. Nurses need to become involved and not wait for someone else to “take care of us.” This is a critical time for everyone, and we must all be ready to step up to the plate and make the changes necessary for moving nursing forward. ____________________________ One Nurse at a Time Delaine Inman, MS, RNC, HNC Columbia, TN Why do we so often long for the “good old days of nursing?” Were they really that good? When I was in nursing school and for many years later, things were not that great when it came to respect in our profession. We wore white uniforms with uncomfortable caps pinned to our heads. We kept a fresh pot of coffee going all the time and fetched it for the doctors on demand. We gave our chair to the doctors when they walked into the nursing station. We grabbed a stack of charts and carried them in our arms as we made rounds with the doctors. We were expected to share information only if asked, and we were not to question or disagree with the doctors. The doctors could and often did disagree with us and told us so in front of the patient and our coworkers. It was an everyday event to be verbally abused. Sometimes we were in danger of physical abuse from flying objects thrown by an irate doctor. To top that off, our nursing supervisors and nurses with more seniority were also allowed to verbally abuse and embarrass us, and if we said anything back, we could be reprimanded for insubordination. So why in the world would we want to go back to those days? Believe me, we don’t. My generation is a generation of nurses who were shaped by the 60s. We learned how to assert ourselves, and we wanted to change the world. Many of us feel we failed because health care isn’t the way we want it to be now. Maybe we have made more progress than we give ourselves credit for. In the big picture, maybe we made more of a difference than we realize. Maybe we didn’t fail after all. Maybe we forged a path for the next generation to continue to want to assert themselves and change things for the better. Maybe it isn’t so odd that my daughter chose nursing as a profession. Maybe things aren’t perfect, but that doesn’t mean our hard work and good intentions haven’t mattered. How can we continue to make a difference, meet the challenges of the future and change healthcare for the better? Making a difference and changing the world occur the way they have always occurred, one nurse at a time. United as a group and as individuals, one patient at a time, one voice a time, one vote at a time, one letter at a time to our politicians, and one “whatever it takes to get it done attitude,” we can continue to change healthcare and nursing. Florence Nightingale’s legacy lights the path for every generation of nurses to work for change and the light must never be extinguished. If we value what we do and who we are as individuals and a group, I believe we will always be instruments of change and we will always be able to make a difference and overcome every challenge. We are victims and powerless as individuals–and as a group only when we believe we are. We are in charge of our choices to take action in each and every moment we live. __________________________ Nursing Education Sharon J. Markham BSN, RN The nursing profession faces many challenges in the ever-changing healthcare industry. In order to augment the professional status of nursing, we must be proactive about developing a standardized nursing education. The perfect opportunity to advance the public perception of nursing and attract new health care professionals is at hand with the current nursing shortage. The current shortage is due, in part, to the aging of the nursing workforce and inability to adequately recruit younger nurses. The public perception of nursing must reflect professionalism. I believe by changing perceptions we can attract many more individuals into this rewarding career. Nursing has struggled with attaining true professional status and is often referred to as a technical field. For nursing to garner the respect and autonomy of a profession, the baseline educational requirements must be raised. Within all professions, there is a standard educational baseline for entry. The baccalaureate degree is the educational entry point in most professions. Nursing licensure has alternate educational routes including a diploma, an associate degree, and a baccalaureate degree. There is no distinction given to higher education in the workplace. This is problematic in changing the public perception of nursing. In the layperson’s opinion, what exactly constitutes a nurse? For professional advancements to occur, changes must be made. It is paramount that the educational requirements be raised and standardized to a level equivalent with other professions. If we in the nursing community do not value education, how can we expect others to value our profession? If we wish to have autonomy in practice, we must first have autonomy in education. The baccalaureate degree should be the minimum educational standard for professional practice, and as such, nursing professionals should rally in its favor for licensure. ________________________________ Our Variance Is Our Strength Katherine Horn Robertson, RN, FNP Clinician, Metropolitan Health Department There will always be nursing regardless of the number of individuals entering the profession because the essence of nursing is delivery of appropriate care to others. Nursing is caring and tending based upon thoughtful observation, and its practice is crucial for the survival of a population. To fear that nursing could ever cease to exist is folly. We get in our own way attempting to regulate and categorize a profession of such vast scope. Reading about nursing and the shortage and discussing with other nurses their experiences lead me to believe that individual nurses are left blind to their impact, which is huge. Stress and dissatisfaction are likely the results of being unable to fully appreciate the often subtle effects of their work. An article appearing in the Atlantic Monthly recently about the cleanup of the World Trade Center site spoke to an issue also pertinent to nursing. The author noted the falling away of hierarchy and bureaucracy in the aftermath of disaster and the subsequent empowering of the individual to make decisions and act. This seems to me democracy, and its lesson must be learned by nursing. Our talents and experiences are widely divergent, and our avenues of endeavor are not uniform. This variance is our strength, and we need only to realize this truth. Let us simply cease the bickering within our profession over which degrees were earned and how and when. Many fresh new graduates of prestigious nursing schools honed their skills and instincts by following the guidance of nursing technicians trained quickly and in time of dire need. May we always tip our caps to the knowledge gained by experience and without manuals. Years ago, many of the certified nursing technicians who had helped to give me my foothold were unceremoniously “let go” to allow for primary nursing. Primary nursing, once the gold standard, would leave countless numbers in 2002 unattended. As this century opens, let nurses see each other and ourselves as solid columns separate and similar and distinct and upholding humanity. ________________________________ We Must Change With the Times Robert W. Koch, DNS, RN Assistant Professor Loewenberg School of Nursing When I think about the changing times in our profession, so many challenges come to my mind. With 25 years in practice, and seeing several cycles of nursing crises, I believe that many answers to looming questions have yet to be discovered as the saga of our professional journey continues decade after decade. What critical changes must we address? One key issue is the fact that we, as nurses and a population, are getting older. More and more of us are living longer and want a better quality of life. The baby boomers are better educated as a group than our predecessors and have greater consumer demands. The image of the “senior” is rapidly changing from dependent, frail, sick persons with dementia, to healthy, vibrant involved individuals who seek better health and question current health care system options. More prevalent are boomers who pursue health information via Internet sources and opt for more “natural” approaches to health. They want a good product for a fair price–even in health care. Nursing practice, education, and research are challenged to meet the needs of these consumers–the customers–and respond sensitively to secure a professional role in health promotion and disease prevention for this growing group. Another concern is the ability of professional nursing organizations to increase in numbers and creativeness through acceptance of what defines an “active member.” Nurses often work full time, care for a family, and attend to other daily responsibilities. Could an “active member” be defined as a nurse who pays dues and reads professional publications, yet cannot attend meetings that conflict with work and childcare? Can we encourage membership with flexible contribution of time and energy? It excites me to see TNA offering online resources to nurses. Let’s welcome everyone regardless of their level of “active member” contribution. In short, so many of our problems are the same as in the past, but have new and stark implications for our professional viability. We must not grow tired before solutions are discovered. Nursing’s potential contributions are too important to the health and well being of our society to be lost to the sedation of “that’s how we’ve always done it.” ________________________________ A 20th Century Nurse’s View of 21st Century Nursing Victoria A. Whitehead, MSN, RN I was educated in the Twentieth Century. I was giving IV medications using gravity or IV push before technology took over, and we had to become pump and computer literate. Sometimes all I did was share a word with a patient or family member about the weather and the door to more therapeutic communication opened wide. There were failures to communicate, but just a few. I tend to wax poetic when I remember nursing school: what I learned, what I didn’t learn, and how absolutely naïve I was. As the years have passed, I am more afraid than I was then. We have moved toward what I call “assembly line nursing” – put a tube in, pop a pill down, move on. That may sound trite, but the view I have of nursing now saddens me. We manage care. That means some patients are pushed into rehab before they have had time to gain enough strength to tolerate it. And, if they don’t improve within so many days, they are discharged with little chance they will be re-evaluated after they have improved. Medical science is debunking the idea that “you can’t teach an old dog new tricks.” Brains can be retrained, hearts can continue to beat after heart attacks, and heart attacks can be prevented. Of course, everything we do has limits dictated by our genetic make up, but even some of those limits are giving way to science. But, for some people there is little benefit from science. My feeling is that if science cannot help them, we could at least be nice to them, and I am not sure we always are. In this age of cell phones, instant messaging and unmanned probes to Mars and beyond, just simple courtesy in speech and simple pleasantries seem obsolete. We want instant results in everything we do, and the human body and psyche do not always work instantly. We have become an impatient society saying in subtle – and not so subtle – ways that some humans are simply expendable. We talk about quality of life as opposed to sanctity of life. We treat symptoms and numb pain without knowing the cause. We try to convince ourselves if we train more technicians and pay them minimum wage, long term and even acute care can be managed in cost-effective ways. I don’t think giving people a different title is going to solve the real problem. One day some one is going to admit taking care of people is hard work. It is hard work both physically and emotionally. There are rewards and disappointments. There are nurses who know how to comfort, teach, and care and make it look easy. They only work part of the day and week. What about the rest of the time when neither the patient nor the family sees a nurse at all? What about the missed opportunities to learn something from or teach something to a family? Caring for people is not the same as engineering or plumbing. Trying to cost out care based on how many steps were taken or how many minutes it takes to start an IV or take a temperature has always seemed extreme to me. How do you account for the unexpected – the sudden seizure or hemorrhage? We need to project what the future really holds. Short term fixes, turf wars and being short sighted have left us vulnerable to assault by those who now consider nurses a luxury that can gradually be phased out with a little planning. The general thought is to find someone to hand the patient a pill, give a bath, change a bed or dressing and keep quiet. Nursing was never about just doing something to people. It was about doing something for people. There is a difference. Being able to express that difference is what is needed and quickly. I thought the nurse was the one person who could help someone bridge the gap between the now and what comes next. What comes next for nursing? ____________________________ A Unified Effort John C. Preston, DNSc, RN, CRNA Where do we go? How do we get there? What will we need to know to be successful? How do we pay for it? Such lofty questions, each of which I have heard uttered by a nursing colleague at sometime over the last several years, are being spoken with ever increasing frequency and the stidor of desperation. Fellow nursing educators and practitioners who search for answers as they pontificate about the future of our profession are echoing these comments as well. Each of these questions, in reality, are ingrained in the nursing culture, for they have always been with us and most probably will always remain in our hearts, if not on our lips. I believe we can all agree that the inability to answer these questions creates a queasy feeling emanating from the pit of our stomachs having been germinated by the uncertainty of these postulates. Is this state of affairs really anything new? I dare say not. My personal feelings lead me to believe that we are merely focusing on the fact that no matter how we might try, no matter how many advances we have made in science, specifically in healthcare, the future remains out of our explicit control. This zone of “lack of control” is an uncomfortable place to exist for the members of a profession possessed by a need to be in control. So how, then, do we meet these and other challenges of an ever-changing profession? A question that is so simple to speak and yet, at the same time, so elusive to yield an answer. My answer is unification. All of nursing needs to unify, form a strong coalition, and maintain a collective front. We need to do so by pulling together politically and professionally. We must support our professional organizations, devote manpower, and contribute funds to lobbying and strategizing efforts. We need to clearly identify our place within the 21st century health care system, lay claim to our practices, and back up these claims with words and deeds. We need to stop criticizing our fellow professionals and refuse to participate in the “bashing” of other health care colleagues. We need to stop trying to predict the future and focus upon creating our own destiny. Only then will the elusive answers to these questions begin to have concrete realism. Only then will nursing really be able to meet the challenges of the future. _______________________________ Reclaiming the Pride of Nurses Kay Bone, MSN, RN, ANP, GNP Kingsport, Tennessee I recently watched a segment of CBS’s “60 Minutes” featuring a story about South African nurses who made around $5,000 yearly and were being recruited to work in the United States due to our nursing shortage. An articulate nursing professor from the University of Pennsylvania stated she thought this was appalling, as it was leaving South Africa with a worsening nursing shortage of its own. I had to agree with her, yet could not blame the South African nurses, who were promised $25,000 salaries plus housing. It also occurred to me that these nurses had been working under almost impossible staffing ratios, and one particular nurse had been at her position for over 20 years. The staffing in the United States will seem like heaven to them. We also are all aware of this very process happening in our own country, with nurses taking leaves from their current jobs to travel with an agency for six months or so. This process, at best, is simply a shifting of the resources, and at worst, a contributing to the rise of medical costs. This vicious cycle of rising medical costs and, in turn, lay-offs and worsening patient-to-nurse ratios will continue until we find another solution to the nursing shortage. Students in my Senior Nursing Issues class at Milligan College in Northeast Tennessee recounted stories of being ignored by staff nurses during their clinical training and told by others to reconsider their choices of career and even to “get out while they could.” We must reclaim our pride in nursing. We must tell our stories, mentor our peers, and take credit for all we do. We must be willing to go to high schools to recruit young, eager students and shine a positive light on our profession. We can tell these young people that a nursing degree will provide the opportunity for many diverse pathways within one career. We can form “Sharing Stories” groups–meet at lunch and share our stories among ourselves. We can work at health fairs, write articles for local newspapers, or just tell our neighbors what we do. We can choose to never say “I’m just a nurse,” but to tell others how our work is what keeps patients alive. Better yet, we can tell how our work is what brings families together, helps others be creative in resource utilization, helps our patients examine their spiritual meanings in life, helps empower patients to take charge of their own health, and yes, even helps our patients heal into the dying process. We can begin by simply journaling our stories to ourselves to validate our day’s work and to reminisce with awe about the importance of what we do. We must believe in ourselves, and take pride in ourselves, and this positive attitude will carry over to those around us. _________________________ Keep the “Care” in Care Plans Crista L. Briggs, MSN, RN, Instructor In the early days of nursing school, faculty begin teaching the ABC’s of sustaining life: Airway, Breathing and Circulation. Instructors repeat over and over again, “If they aren’t breathing, nothing else matters.” In addition to teaching this basic truth about prioritizing nursing interventions, it is equally as important for educators to ingrain another basic truth into their students in order to meet the challenges of a changing profession. From day one of nursing school, caring should be presented as an essential component of nursing. Parallel to each lecture and alongside each clinical experience, this theme must be relayed through discussion and role modeling. I often find myself using the phrases, “If you don’t care, nothing else matters” and “Remember the ABC’s: Always Be Caring.” In this time of nursing shortage, healthcare agencies are appealing to students by offering sign-on bonuses and flexible schedules. Schools are working diligently to recruit men and women into their programs. The media relays stories of hospitals that are understaffed and desperate for nurses. We see advertisements for the nursing profession on television daily and the newspapers are filled with available positions. With all of these incentives, it is likely that many young men and women are coming our way who are choosing nursing as a career for the wrong reasons. They may be applying to nursing programs out of a sense of obligation to fulfill the needs of society, or they may be responding to a parent’s dream instead of their own. Students may be recruited for positions in local hospitals simply for the financial reward. In order to maintain a future of excellence in nursing, educators must strive to maintain high standards for individuals seeking to enter the profession. During admission interviews, personalities will always differ; previous experiences and GPA’s will vary. But let us look deeper into the person and accept nothing less than those who exhibit a caring spirit. While in school, caring can be enhanced through classes, clinical experiences, patients and fellow students. Let us not get caught in the mold of looking at grades as the only criterion for evaluating students. Schools of nursing should never graduate nurses in quantity at the cost of lowering quality because of the nursing shortage. As educators, we have the responsibility to admit caring students, then foster and enhance this quality throughout the program so patients in this generation will be “cared for” with the excellence for which nursing has always been known. May we all stand for the highest standards in nursing education and hold our students and ourselves responsible for the essential “caring” element of nursing. |
To promote and protect the Registered Nurse and advance the practice of nursing in order to assure a healthier Tennessee.