This is by no means a scientific study, just some thoughts on what I have seen in my 22 years as a nurse and the loss of bedside nurses who hate it. I think the advent of nurses leaving the bedside will cause a greater crisis for the nursing profession.
I obtained my ADN in 1995 after having worked as a computer operator for 16 or so years in the defense industry. So, I was fairly high-tech as nursing was becoming higher tech.
I had no intention of continuing my education, as I was 46 at the time and wanted to do bedside nursing.
I recently did a minimum of research on the cost of obtaining a degree in nursing. And this varies greatly by which type of nurse one chooses to become.
The average LPN degree is around 12K, an ADN 14K or more, a BSN anywhere from 14K (state school) to 100K depending on which school you chose to go to. Once you have the BSN, there is a master’s degree to think about. And those program costs vary greatly up 200K again specialty counts towards the cost.
So if you want to be a nurse who provides anesthetics or an ARNP in a specialty like family medicine, that means more education and more money.
Is the cost of all this education worth it? Will you be able to find a job that will pay enough to cover the cost of your degrees and your student loans? What will happen to the bedside nurse? Will there be less of them to care for more and more critically ill patients?
In my 22 years as a bedside nurse, I have seen a sizable number of new nurses who tell me they hate working as a bedside nurse, and have either transitioned to another area of nursing or left the field.
In my last few years before my retirement, I have seen brand-new nurses with less than one year of bedside nursing experience who wanted to move in ARNP slots, and they return to school spend all that money and now cannot find a job in that area.
I fear that more and more new nurses without “hands-on” experience will take that route as well. In my opinion, this is not a good thing; they have not seen many things in the field.
Yet working in the medical/surgery/telemetry progressive care unit, an acute rehabilitation hospital, a psychiatric hospital including electroconvulsive therapy, as well as several skilled nursing facility settings that took very ill patients with major wounds, I learned how to get things done correctly and in a timely fashion; how to complete a head to toe assessment in just a few minutes. Was this due to my education? Most likely. Was it due to me keeping up with the latest procedures and sticking my nose in to help other nurses with complicated patients?
Yes, to all the above.
I find it scary to think that nurses — who loathe bedside care and can barely complete an assignment and won’t even enter the room of their patient with me to learn how to start an IV — are planning to advance; do they think they will have less patient interaction?
They don’t seem to understand they will have much more responsibility for the patient in question. (And if they’re covering for an MD, they may be responsible for several hundred patients on any given on-call weekend.) Believe me, I know it is not an easy job. I have seen them sweat over what could be wrong and how to fix it and what medications they should give. The wrong one, and you kill a patient.
Will they have the knowledge base to know just by look, sound, and the gut feeling that something major has occurred or is occurring with a patient?
If one cannot obtain a position to fit the newly acquired degree, will they be willing to work a lesser spot like staff nurse, without overstepping the legal boundaries of the position? In most states, one can work the lesser license if performing those tasks set out by the board. Until I obtained a job as an RN, I could and did continue to work as a CNA if I did not do the RN’s work.
Scary thoughts for sure.
Other things that go along with this is the staggering load of acutely ill patients that each staff nurse must care for each shift. Is management staffing to patient acuity or just to the matrix numbers? Are they supportive or just looking at the bottom line each day?
By supportive, I also mean are they giving the same seasoned nurses the hardest assignments every shift, which nurse is getting thrown under the bus newest nurses or the seasoned ones? Are they taking into consideration that not everyone wants to stay on one unit for years and years and might have taken the job to get experience as a stepping stone to a more acute level of care? Are they supportive of staff who have paid their dues moving on to other challenges or do they hold staff back?
Is the shift supervisor you work for supportive and helpful or a hindrance to you and your job performance? Do you hate going into work when you know certain staff members will be there?
Having worked for both type of supervisors, I can say the supportive, helpful ones were always the best to work with the other type make the unit dysfunctional. The old truism of a good manager versus a bad manager holds true for floor staff.
I understand the cost of medical care is high, and reimbursement is getting harder and harder to get, and all medical facilities have a bottom line to adhere to but at the expense of good nurses leaving the field. Not a good thing for sure.
I loved nursing. It scares me that if I become ill, I will have a nurse who doesn’t know anything or how to do basic nursing tasks taking care of me. I have a lot of knowledge stuck in my head, and many times I was the “go-to” person on the unit for things no one else had seen or done. If it was something I did not know, I never was afraid to admit it, then find a resource book or person who knew more than me.
I retired early because all the changes and lack of support just got to me. I needed to keep what little sanity I have left intact.
Ann M. Rogers is a nurse.
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