A nursing professor colleague and I recently had a conversation about the challenges of identifying viable clinical rotation sites for students. This professor is finding that many sites are limiting the amount of care the students are able to provide, primarily because of patient privacy laws and the risk for medication errors. The students are just not getting the volume of hands-on care opportunities as in the past which is limiting experience while in school.

We both recalled the days when student clinical rotations included acute care, home care, possibly employee health outpatient care, nursing homes, and if one was available, psychiatric inpatient care. The specialty rotations always included labor and delivery, postpartum care, and the well-baby nursery. The pediatric rotation was a bit more challenging because no student was ever permitted to provide medication to a pediatric patient – at least when I was attending school – so this rotation was really providing private-duty babysitting to the pediatric patient.

These options are becoming more limited today. Some health care organizations are not permitting students onto acute care units but rather to long-term skilled inpatient care areas. Maternity stays are shorter so the students are not really able to provide postpartum care to the mother or the infant as was the option years ago. Many hospitals have closed inpatient psychiatric care areas and pediatric care areas are few and far between.

Besides these basic issues the nursing professor explained that many students want experiences that are not “typical.” When this professor asked the exiting class what types of clinical experiences would have enhanced their nursing education, the responses were interesting and included:

• Forensics/crime scenes
• Correctional facilities
• Emergency medicine organizations

By this time both of our heads were spinning – imagining what type of mayhem would ensue if any of these locations had groups of nursing students completing clinical rotations! However I raised another area that might be of interest to nursing professors in the future – rock medicine.

No, this is not archeological medicine but rather emergency medicine organizations that staff medical emergency tents during rock and roll concerts and provide health care to the participants as needed. Actually an organization in California has been providing medical support to concert-goers since 1973 and just celebrated 40 years of caregiving.

Back in 1973 a promoter for a rock group approached a medical clinic in San Francisco to provide emergency medical care during a Grateful Dead and Led Zeppelin concert. From there the group has grown to over 1100 physicians, nurses, paramedics, and emergency medical technicians who volunteer to provide medical care for football games, concerts, fairs, and other events throughout California. This particular organization – Rock Medicine – provides care free of charge so health care professionals are volunteers and they accept nursing students.

Since my nursing professor colleague is not located in California and the volume of rock and roll concerts that occur in her vicinity are slim, this option was not embraced however it did help us both start thinking outside of the box for student clinical rotations.

Health care is being provided in locations that were not even imagined a few decades ago. Who would have thought that peritoneal and hemodialysis could be provided in the home? What about the elderly patient who has a computer transmitter on the kitchen table that transmits morning weight and vital signs to the health care provider so heart failure medication can be titrated according to the current health status? And home care nurses are using smartphones to send photos of wounds to health care providers so dressing treatment can be prescribed in real-time.

The nursing student and nurse of the future will have many more opportunities, options, and avenues to provide health care to patients. So even though many cities might not have a Rock Medicine organization to use as a clinical rotation for students, it serves as an example of what settings can be used for learning in the future.

These are exciting times for the profession of nursing. The barriers and restrictions for clinical rotations might still exist but nurses, with their collective infinite creativity, will find ways to obtain the learning experiences that are needed and desired to meet the needs of the ever-evolving population.

In the meantime, rock on!

Until next week….

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Burnout is a term used to define exhaustion with little interest in work or other activities. Other characteristics of burnout include:

• Lack of energy
• Irritable with others
• Being cynical or critical
• Lack of motivation at work
• Change in appetite and sleep habits
• No satisfaction with work production
• Disillusioned with place of employment
• Use of food, drugs, or alcohol to improve mood
• Physical ailments such as headaches and backaches

From a discussion with other nurses through social media I learned that burnout is still occurring, particularly with staff nurses. It is also being blamed for lack of productivity for those at the nurse management level.

I wanted to know what these nurses perceived as the cause of their burnout. The responses ranged from:

• Unclear expectations
• Extreme physical expectations
• No control over assignment or workload
• Bullying by other staff and nurse manager
• Expectations to work overtime with little time for family

The nurses participating in this discussion where extremely vocal about what burnout has done to their health and personal lives. One nurse is blaming burnout for a significant weight gain and a new diagnosis of type 2 diabetes. Another nurse is actively seeking another profession since she believes burnout is ruining her marriage and personal relationships with other family members. The group all chimed in to say that burnout is contributing to an increase in attendance at “happy hours” after work and the weekends.

I found these comments interesting since research has shown that burnout can lead to:

• Obesity
• Type 2 diabetes
• Alcohol or substance abuse
• Negative influence on home life and relationships

Not all nurses participating in the discussion were following personal-destructive habits. Several nurses claimed that they used to experience feelings of burnout but have learned to channel these feelings into more productive actions such as working out at the gym, gardening, participating in other sports, and making a change in future life-plans.

One nurse participating in the discussion explained that she used to use the term “burnout” as an excuse for not being happy at work. This nurse first confronted her feelings and then spent some time figuring out what changes needed to be made to feel more productive and happy with work. As this nurse continued, it took several months but ultimately the nurse decided to leave hospital nursing and move into home care. Since becoming a home care nurse the feelings of burnout have disappeared since the nurse now has more control over work expectations. And work-life balance has improved.

Burnout has plagued the nursing profession for decades. It has been blamed for everything from emotional outbursts to medication errors. And research has shown that burnout is a real phenomenon that can lead to significant health problems.

Every nurse is not able to join a gym or participate in sports but taking a walk during lunch or at home with the family pet can work wonders. As the industry continues to change and expectations rise, the threat of burnout is real. But nurses are in the unique position to practice what we teach to our patients and do something physical to release the stress.

Burnout will most likely never disappear as a symptom of imbalance in the life of a nurse. In the meantime though, someone might prefer to bounce a ball, instead of their head, against a wall to relieve stress.

Until next week…

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Reflecting back on this television series I recall there being three nurses – one was a nurse manager and two were staff nurses. This series was intriguing to me since I was starting out in the nursing career, employed in a teaching hospital and found the setting very similar to what I was experiencing at the time.

But what was lacking in this series was the interaction of the nurse with the patient and the physician. The “stars” of the series were the physicians. Yes, there was a nurse manager in the list of leading actors/actresses however the part played and the role within patient care was not highlighted.

As I continued in the profession through the years my interest in watching “anything medical” on television declined. I can name a few shows that having anything to do with medicine or nursing. I recall some discussion between nurse colleagues about “Gray’s Anatomy” and “ER” and the most recent “Nurse Jackie” series but I have never watched any of these episodes.

My main reason for a dislike of television shows that focus on medicine or nursing is that they are not realistic. The main character is a physician and there is always a nurse or two hovering around, trying to get the physician’s attention – for something not necessarily patient-care related. This is not the reason why I became a nurse.

Nursing has been combating the image of “physician handmaiden” since the Middle Ages and even now in the 21st century television portrayal of nurses has not changed. There might be a scene or two where a nurse saves a patient’s life or calls a physician on an issue but those are few and far between.

My feelings are actually backed up by the Center for Nursing Advocacy – an organization who observes and reports the portrayal of nurses in the media. This agency reported that nurses outnumber physicians in health care settings by a ratio of 4 to 1 yet physicians receive much more federal and private funding for education and research than nursing.

The executive director for the Center for Nursing Advocacy explains that the reason for the poor funding is because of the way the role of nursing is minimized in the media. Nurses are portrayed as standing in the background while physicians discuss, plan, and provide all of the patient care. As the director states and I agree -this couldn’t be further from the truth.

Another problem with the way nurses are highlighted in the media ties into how the general public views and expects nurses to function with patient care. The general public is being lead to believe that the physician is the “boss” in all things related to nursing. The public is not exposed to nursing leadership, problem-solving, and critical thinking skills that are the cornerstone of the profession.

Over the last several years many schools of nursing and other organizations have begun focusing on the role of the nurse through short television commercials. The goal of these advertisements is either to gain student enrollment or encourage someone to buy a particular product. These attempts at improving the image of the profession to the general public are weak.

One would think that with all of the nurses throughout the country there would have been at least one television series that resembles the reality of the profession of nursing today. However, would anyone want to watch the series?

How many people want to see a nurse struggle with a confused patient? Or sweat over trying to save an intravenous access site in a patient who is barely surviving and needs chemotherapy medication? What about the situation where the nurse is caring for the child whose mother just learned that the child is terminal? Or the times when an elderly patient in a nursing home sits at the front door, waiting for the arrival of family members on a holiday, but the family never arrives?

These situations are too raw for general television viewership. These situations are too real and ratings might fall. Yes, these situations are the reality of the profession and not intended for entertainment.

Since the chances that any television series will ever portray the true essence of nursing are slim, I will continue to avoid watching “anything medical.” I will encourage the Center for Nursing Advocacy to police the cable networks for adverse nursing situations and support this advocacy group any way that I can.

Until next week…

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Fast forwarding to this last month, I realized that anytime a group of nurses get together to socialize, conversation inevitably ends up on something related to the profession. Recently after planning to meet a group of nurse colleagues for lunch I made a conscious decision to try and steer conversation away from nursing. I was not very successful…

After getting through answering the typical “how have you been?” and “what’s new in your life?” questions one of our lunch companions began a soliloquy on the “latest and greatest” happenings in her aspect of the profession. Those in attendance sat up in attention, listened, and offered the applicable “oh my” and “wow” as responses where appropriate. I sat back and studied the menu. I was consciously trying to avoid participating in “shop-talk.”

Soon afterwards another nurse companion began to chime in and discuss issues and concerns that are plaguing her place of employment. By this time the table server had taken our drink orders and I was slowly memorizing the appetizer list. Thankfully no one had yet asked me for my opinion on the topics being discussed…

I permitted this to go on for a few more minutes then decided to try to break the tone of the conversation by asking everyone what they were planning to order and if we needed to ask for separate checks. At this time I was finally asked why I was being “so quiet” and if something “was wrong.”

I explained how medically-oriented family members were unable to have conversations that didn’t focus on “all things medical” and that I was consciously trying to avoid that negative cycle. My lunch companions stared at me with jaws dropped. They could not believe that I would purposely avoid talking about issues, activities, and concerns within the profession.

One colleague suggested that I was suffering from burn-out and should take a vacation. Another stated that I must need to find a new job if I’m finding it hard to discuss the profession during a casual lunch.

I tried to explain that we are much more than our profession. I emphasized that we have lives, families, interests, and goals that go beyond being a nurse. At this point it was strongly suggested that I relax and just participate in the conversation without trying to change behavior that was not going to be changed.

This is when I had the “ah-ha moment” that many read about but seldom experience. My colleagues found joy in talking about the profession, whether it is in a positive or negative way. These nurses whom I have known for years look forward to meeting with other nurses to complain about employers, argue new policies, discuss the future of health care, and whatever else happens to influence the profession of nursing on any particular day.

I also then realized that like my nurse colleagues, I too find joy in meeting with others in the profession to talk, rehash, and discuss issues. I thought if I changed my behavior and not participate that others would follow and conversation would steer clear of all things nursing. I was wrong.

So even though my experiment to avoid “shop-talk” failed, I realized that every person cannot be a nurse. But we cannot take the nurse out of the person. It does not matter how many years or decades a person has been a nurse, we have a common bond. We are nurses and that is something that no one can ever change or take away.

So instead of trying to avoid discussing things that matter to nurses I am once again embracing the times when I can meet up with nurse colleagues. Avoiding shop-talk might be appropriate while grocery shopping or attending civic activities, but never again will I side-step opportunities to share and learn from nurse colleagues.

Until next week…

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An older guest who is a stroke survivor was attending this social gathering and began making a loud noise while engaging in a conversation. Most of those present just assumed that this person was having a particularly boisterous verbal response. However one person – who happens to be a nurse – quickly walked over to the older guest and determined that her airway was occluded. The loud noise actually was a bark being made in an attempt to cough and clear the airway.

Within seconds the nurse performed the Heimlich maneuver and quickly pivoted the victim to sit on a nearby chair. Another guest who is oxygen dependent gave the nurse a spare nasal cannula who applied it to the victim. By this time an ambulance was en route and arrived in 2 minutes. Oxygen was made available to the victim and the other guest was able to resume oxygenation without harm.

Throughout all of this drama – which lasted no more than 5 minutes – two other guests were standing off to the side observing. These guests are physicians. Yes, we were all pleased that the victim was cared for and the situation had a good outcome but why were the physicians “letting” the nurse handle the issue?

This is not the first time that I’ve been in attendance at an event where a medical emergency has occurred and there are physicians available to intervene. I’ve also overheard physicians say that “it appears that everything is being handled” and just walk away. This behavior annoys me.

I understand the need to protect a license and the fear of being sued for inappropriate care but consciously not helping another person or even offering to help when the education and experience is well documented is just unacceptable to me.

Like most nurses, I personally know a fair amount of physicians. I’ve worked with many of them as well as having used their services. The one behavior that I’ve observed on more than one occasion is when someone asks the physician a question the response begins with “is this one of my patients?” If not, the response may continue with something like “well tell them to make an appointment” or “tell them to go to the emergency room.” Medical advice is not readily provided.

On the other hand, nurses are usually the first to jump to the aid of someone in distress. I’ve done it and I’ve seen other nurses do it too. Why do we do this?

I believe it is because of our education – and the role we play in health care. Nurses do not ask for proof of health insurance or name and location of a pharmacy prior to providing care. Nurses do not collect co-pays after providing medication or treatments. And nurses do not have to obtain authorization from a health insurance company before assisting another person in need.

As I reflect on the situations where a physician could have assisted with an emergency situation but didn’t I silently thank all of the brave men and women who chose to become nurses. Although many believe that the health care industry would collapse without an adequate number of physicians I feel that they are wrong.

Nurses are the backbone of the industry. Nurses step up to the plate, without thoughts of personal harm, and help those unable to help themselves. Nurses don’t stop to think what impact the action might have on personal finances or paper work. Nurses just do, what they do best – care for other people.

So as the situation was coming to a close during the social gathering I overheard the emergency medical personnel and the rescuing nurse encourage the older guest to “be sure to see your doctor as soon as possible.” I thought it was funny that throughout all of this drama medical support personnel and the nurse supported the role of the physician in health care. Too bad physicians do not always offer the same support to us.

Until next week…

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The actual “pledge” was not written by Florence Nightingale but rather by a committee at the Farrand Training School for Nurses in Detroit Michigan in 1893. The committee named it the Florence Nightingale Pledge to honor Nightingale as the founder of nursing.

The pledge is as follows:

“I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.”

Many participating in the discussion about the pledge could not recall ever reciting it during nursing school graduation – or pinning. Others have evidence that the pledge was printed in the graduation ceremony booklet but was not recited by the new nurses.

Personally I recall the Dean of the School of Nursing standing before my graduating class and leading us all in the recitation of the pledge. I also recall at that time it was something that we all had to do – but never really spent much time thinking about what the pledge meant.

The discussion about the pledge started because the word “God” is in the opening sentence. Some nurses believe that it should be changed to “Divine Power” so as not to alienate or offend some who might have different spiritual beliefs.

This quickly moved to the next area of concern of “passing my life in purity.” Quite a few nurses believe that this statement is a direct link to women in religious orders who happened to practice nursing as part of their calling.

Some nurses also believe that “abstaining from whatever is deleterious and mischievous” is too broad and really has no place in current society. The definitions of “deleterious and mischievous” could refer to a large number of things which may or may not be applicable when practicing nursing. However, nearly all of the nurses participating in the discussion agreed that the statement about “not taking or knowingly administering harmful drugs” is important and practiced daily.

There was additional discussion about the statement about doing “all in my power to maintain and elevate the standard” of the profession. Some nurses believe they are powerless within the profession whereas a few stated that the feeling of powerlessness is a reason for the discord and conflict that results in bullying and other intimidating behavior that causes many nurses to leave nursing.

The group nearly unanimously agreed that the next statement of holding “in confidence” all personal matters and family affairs was in line with HIPAA regulations and extremely important when practicing in today’s society.

There was additional discussion about the phrase “in my calling.” Few, if any of those participating in the discussion stated that they were “called” to be a nurse. Reasons for becoming a nurse ranged from steady employment to being told by parents that this was the best choice of employment for women.

The first part of the final sentence of the pledge – to aid the physician in his work – brought additional discussion. Many argued that physicians are not all men in today’s society and there are other health care professionals – such as nurse practitioners and physician’s assistants – whom the nurse supports. However the final statement of “devoting to the welfare of those committed to my care” was found to be highly applicable today.

Even with these minor issues and discussion I believe that the committee who wrote the pledge was very astute and forward thinking. In today’s language the pledge highlights:

• Providing self-care
• Doing no harm to others
• Supporting the profession
• Maintaining confidentiality
• Working in collaboration with other health care professionals
• Being loyal to the patient

Besides a few terms that might be viewed as “dated,” I believe the Florence Nightingale Pledge captures many of the behaviors of the modern nurse. As National Nurses Week in 2013 has recently ended maybe all nurses can take a few minutes to reflect on the pledge and the influence it has had on their practice of nursing.

Until next week…

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The thought of a day to honor nurses actually started in 1953 when a staff member within the US Department of Health, Education, and Welfare wrote to President Eisenhower asking for a specific day for nurses. In 1954 National Nurses Week occurred from October 11 through 16 which corresponded with the 100th anniversary of Florence Nightingale’s mission during the Crimean War.

There is not much written about a National Nurse’s Week between the years of 1954 until 1974.
However in the early 1970s a New Jersey businessman began promoting the idea of a Nurses Day because of the excellent care provided by nurses at a local hospital. Then in 1974, President Nixon declared the first-ever National Nurse Week to be held in February.

New Jersey became the first state to officially recognize May 6 as Nurses Day in 1978. And in 1981, nurses in New Mexico worked to have May 6th declared “National Recognition Day for Nurses.” The American Nurses Association stepped up in 1982 and in the same year President Ronald Reagan signed a proclamation officially declaring May 6, “National Recognition Day for Nurses.” The ANA changed the event to a week-long celebration, beginning May 6th and ending on the 12th which is Florence Nightingale’s birthday.

The week of May 6 through 12 is also when National Student Nurses Day is celebrated, specifically on May 8th, and International Nurses Day is celebrated throughout the world on May 12th.

I find the history of National Nurses Day fascinating. It literally took an act of Congress to make this a special day for those in the profession. I have to ask why?

Every person, family, and neighborhood has nurses. We are everywhere! We shop, we take children to school, we participate in parents, civic, and religious organizations. We use the public library and local banks. Often times we are stopped on the street to discuss health problems and telephoned in the middle of the night to discuss the new onset of symptoms. Yet, few, if any, recognize the value of nurses or the knowledge we possess.

Personally I can divide my friends and acquaintances into two groups – those who keep in touch “just because” and those who keep in touch when a health problem arises. I have been texted, emailed, and telephoned from emergency rooms, labor suites, and intensive care areas by acquaintances that are in the midst of a health crisis. These individuals need someone to “translate” what is going on and what they should do. So they contact me.

But as soon as the latest health crisis is managed and life goes on, the urgent messages stop. Like a bad B novel cliff hanger – I have no idea how the story ends! I then find myself searching for these same people who harangued me for hours and days to just find out their health outcome. Many of these individuals just laugh and say “everything worked out” but never provide much more feedback.

I know that I am not alone with these types of experiences. Nurses everywhere are contacted for help, encouragement, support, and teaching. But once the acute situation concludes, we are quickly forgotten until the next major event.

This probably should not bother me, but it does. Nurses are much more than walking-talking textbooks. We are real people, with real lives, who might actually be experiencing a health problem at the same time as being expected to care for others. These nurses most likely won’t even share their own personal health concerns since there is no real need to ‘bother’ anyone.

No profession is perfect. No job is perfect, and no life is perfect. But what the profession of nursing has that many do not is a group of consistent, sharing, compassionate, and empathetic people who just want to make people a little more healthy and hopefully a little more happy during their journey on Earth.

So, from one nurse to another, happy Nurses’ Day! I’m not sure how you will celebrate this special day just for you. Maybe your employer will buy you lunch or dinner or provide you with a gift card or some other token of appreciation. Maybe some of you won’t even be recognized. It really doesn’t matter. As nurses we know our value and our worth. And, that’s why in our hearts – every day is Nurses’ Day!

Enjoy!

Until next week…

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My personal experience caring for newborns and children has been limited to assisting family and friends with these “little people” who bravely permit me to touch their children and are usually well or have minor illnesses. But I marvel at those nurses who are able to provide care to children who are acutely or chronically ill.

At the beginning of life and through the formative years to young adulthood children are constantly changing and developing. Nurses who care for these young patients understand these developmental stages. Adjustments are made like flashes of lightening to meet their care needs.

Although many would like to believe that neonatal and pediatric nurses primarily care for children with acute health problems, this is not always the case. Many nurses have chosen to provide care to children with chronic and terminal illnesses. These nurses are angels on earth to the children and their families.

These nurses face death every day. They have put aside their own fears and feelings about the end of life and do their best to make the time they spend with a terminally ill child as pleasant and meaningful as possible.

Nurses who choose to care for the terminally ill child must also care for the child’s family. As many nurses know the family’s care can be more complex and demanding that the care of the patient. A special salute and thank you is given for all that you do to support the family during the days when the child is teetering between life and death.

Recently I met up with a neonatal intensive care nurse who is a personal friend. She has been caring for ill newborns for decades and still looks forward to going to work every day. As she explains, caring for these children provides her with the motivation to make each and every day as special as possible. This nurse has devoted her entire life to caring for premature and ill neonates and finds the work satisfying and her “life’s purpose.”

This friend wanted to make sure that I understood something though. She stated that nurses who work with ill neonates and children often experience the stages of death and dying on a daily basis. The nurses are not immune to dire situations and often find themselves crying along with the families while providing care.

When I step back and analyze all of the different opportunities within the profession of nursing I am taken aback by so many nurses who choose to work in difficult situations. Many nurses kick and scream, cry and complain, and take fits about various issues and concerns within the profession however at the end of the day; these nurses would not want to do anything else with their lives.

Nurses who commit to caring for ill neonates and children do so for the love of nursing. They make a decision to provide this level of care and they rarely leave. Maybe this is why specialty care units such as neonatal intensive care areas have the lowest levels of nursing staff turnover in health care organizations.

So as National Nurses Week approaches I want to thank the nurses who have that special amount of compassion and skill to care for the smallest and most vulnerable among us – the children.

Until next week…

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I have had only one experience caring for a patient who was identified as being a prisoner from a local jail. This patient had an acute onset of an illness for which the correctional facility was unable to treat so he was transferred to an acute care hospital.

This patient was not physically restrained however a guard was sitting at the bedside during the entire course of the hospitalization. The patient was very pleasant despite being acutely ill and caused no issues with the nursing staff during the hospital stay.

As this patient’s nurse, I found that the crime the patient committed was of no concern to me. I approached the care as I did with every other patient assigned. Reflecting back on that time I realize that I practiced nursing using the utmost of nonjudgmental behavior.

But, what if the patient in the bed is known to have committed heinous crimes? I wonder if I would be able to approach the care of the patient with the same level of nonjudgmental behavior as I have used in the past.

I applaud nurses who care for patients with known criminal records or who are in the process of being tried for crimes. I marvel at their ability to focus only on the patient’s acute care needs and disregard the reasons that might have caused the injuries. These nurses are truly unique individuals.

Then there is an entire genre of nurses who provide care to people who are currently incarcerated. These nurses are categorized as being correctional nurses and they provide care to over 2.3 million adult inmates in state and federal prisons and local jails. While at work these nurses are subjected to the same limits on personal freedoms as the patients to which they provide care. I am not sure that I could work behind locked doors with security guards in attendance.

These nurses deserve a great deal of respect. The environment is potentially threatening to physical harm yet these nurses provide care and extend concern without passing judgment on the reason why the prisoner is in the facility in the first place.

The roles and responsibilities for correctional nurses might not appear different from other nurses in acute care or ambulatory care settings however the expectations may vary. Nurses who work in corrections can belong to the American Correctional Healthcare Association and become certified as corrections nurses.

Whenever there is a situation that affects the community with harm, the first responders are identified as being angels in disguise. I believe that the nurses who care for the victims and those who commit the crimes in acute care facilities deserve recognition as well. Very little light is shed on the expectations for these nurses who are caring for those who have life-threatening and life-changing injuries. And less attention is given to the nurses who care for the people who caused the injuries in the first place.

Even though National Nurses Day is a few weeks away I would like to thank these special nurses now for their fortitude and commitment to the profession; for their ability to provide care in a nonjudgmental manner, and for being bright shining stars in hospitals throughout the country.

Until next week….

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Magnet status is an American Nurses Credentialing Center Recognition Program for hospitals. This program has five Model Components as the primary basis that is used for achieving Magnet recognition, and 14 Forces of Magnetism that make up the foundation of the program.

Two of the Model Components focus on Structural Empowerment and Exemplary Professional Practice. Depending upon the healthcare organization, implementation plans might include having nursing staff achieve specific levels of educational preparation.

This nurse explained that with the plan to achieve Magnet status all nurses who do not have a bachelor’s degree in nursing can lose their jobs. This colleague was not aware of the number of nurses this would impact but stated that nearly half of the nurses who work on her care area could be affected.

I think it would be fair to say that this colleague received her basic diploma in nursing education in a Pennsylvania school of nursing and relocated to Florida for better weather. This colleague did not pursue any additional formal nursing education and believed that the diploma program was sufficient for the staff nurse role.

Our conversation this morning was interesting because this colleague does not want to “have” to return to school to keep a position. I wanted to know why she is so averse to continuing her education and asked her to explain her decision.

This nurse has a negative opinion towards institutions of higher education. She claims that whatever is taught in a school of nursing cannot match what has been learned after working 20 years as a staff nurse. She continued by stating that teachers in schools of nursing today have minimal bedside experience and could not possibly have a clue how to plan and provide patient care.

I found these beliefs and opinions quite strong but continued the conversation – taking the risk that she might hang up on me. I asked if she had considered a bridge program where an RN could achieve a BSN or further education. Many of these programs are available online and could be completed over a course of several years. The structure is more flexible to support the currently employed nurse.

This was not well-received so I thought of another approach. I asked her what she would do if she lost her position. After a few seconds of silence the response was one of resignation – “I don’t know.”

I found this response interesting because if this nurse would have attended additional formal education in nursing she would be able to make a plan. There is a myriad of opportunities for nurses today – many more than existed two decades ago. This nurse thinks that the only skill she has is to provide patient care.

We spent a few additional minutes discussing her experiences with patient care, her skills, and as the conversation ended, she had a rough plan outlined that could be implemented in the event her position is eliminated.

This conversation and others that I’ve had in the recent past has made me realize how many of my colleagues do not take the time to keep up with current events within the healthcare industry. Most everyone has a computer, or access to one through a library, and it is quite easy to find sites where current issues in nursing and healthcare are discussed. Many of these sites have list servers or blogs where other like-minded nurses can discuss issues that are affecting them in their careers.

I also felt quite sad knowing that many experienced nurses might be losing their positions because of a lack of formal education. The nursing profession has not been able to make a firm stand regarding entry into practice and now is at risk of losing a vast amount of knowledge and experience.

Even though there are many positions statements and standards of practice written for nurses, few take the time to study them. And even fewer attempt to practice them. Only time will tell what happens to my colleague in Florida.

Hopefully one day the profession of nursing will make decisions that move the profession forward. It would be so much better if the profession of nursing stepped up as the leader and implemented the changes that are needed within the profession instead of resisting the changes that are being imposed upon us by others.

Until next week…

(MCN Learning has a website where nurses can obtain continuing education hours. Access the website through this link: https://healthcareeducation.mcnlearning.com/. )

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