By Donna Cardillo, RN, MA, CSP, FAAN
Things sure have changed in nursing and health care since I graduated from nursing school 30-plus years ago. And just as equipment, treatments, and procedures have changed, so too has the way we educate students, how we recruit and retain nurses, and how we support and manage nursing staff. And yet, I still hear colleagues yearning for the way things used to be, wondering why decades-old strategies aren’t working anymore, and refusing to recognize the sweeping changes before their eyes. As TV’s Dr. Phil would say, “Let’s get real.” Let’s reminisce for a moment and then take a hard look at the realities of the nursing profession and the changing face of the RN.
The workplace
Nostalgia: People used to stay in the hospital for days at a time. General post-op patients didn’t get out of bed for three days — and only then to dangle their feet and sit in chairs! Nurses had time to give back rubs, chat with patients and families, and generally do what needed to get done.
Reality check: Only the sickest patients are hospitalized today. On average, they’re older and have more multiple-system problems than before. Length of stay is minimal no matter what the diagnosis, resources are fewer, patient-to-nurse ratios are up, and regulatory requirements are at an all-time high. There’s more technology to manage and an abundance of paperwork. This environment challenges the most experienced nurses.
New graduates can’t quickly and easily assimilate as in days of yore, no matter how well-prepared they are. Comprehensive, extended graduate orientation programs, mentors, preceptors, and internships are required to support and nurture the new nurse in today’s fast-paced, high-volume, high-acuity settings. Managers and administrators who don’t recognize and address this will experience higher-than-average turnover and attrition rates.
The workforce
Nostalgia: Most newly licensed nurses were young and naive. Physicians and senior nursing staff could easily intimidate them. They had to “pay their dues” by dedicating themselves to their jobs — sometimes at the expense of family time, health, and sanity.
Reality check: New nurses range in age from 20 to 70. They’re better educated, more experienced, and interested in living a balanced life. Sure, they have plenty to learn about nursing, but they may know more than their supervisors do about technology, finances, management, customer service, and team building. If old-school RNs try to impose their values on them or manage by bullying, many new nurses will leave.
Today’s newest members of the profession have a much broader view of nursing than their predecessors. They don’t feel compelled to stay on staffs that don’t recognize their prior work experience and education, respect them as a people with outside commitments, or address their need for ongoing education, advancement opportunities, and cooperative, participatory workplaces. You can accept that this is the new face of nursing, or you can continue bad-mouthing them — and watch them walk out the door.
The need for education
Nostalgia: Most nurses attended hospital-based diploma programs that were light on college credits and heavy on clinical time. When these students graduated, they were ready to manage entire floors — at least under the watchful eye of their instructors. And while some nurses did go on to further their education, there was no strong need or encouragement to do so.
Reality check: While it’s easy to blame schools for not doing their job, students more than ever must learn in the same amount of time as (or less than) students in the past. Because so much care is delivered outside the hospital today, students need to have practical experience in alternative treatment settings, as well as in hospitals. Because of advances in nursing and medical science, there is much more to learn about treatments, procedures, drugs, and therapies, including complementary and alternative methodologies. Because of an increasingly competitive job market and a need for nurses to be on a par with other licensed health care professionals educationally, more college-credit courses are required in all programs, and the pressure is on to get advanced degrees.
It’s time to wake up and smell the Betadine. You can stay stuck in the past and whine and complain about the good old days, or you can recognize the changes, find ways to adapt, and move forward. Change is never easy, but without it, there is no progress.
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