Thursday 12 November 2009

You will Need a Degree to become a Nurse

We just had a death in the family of the canine type, I have been reading BBC have your say, and I am in a real bad mood.

Here is the BBC article you have all probably read. I have been in mourning so I am behind with all this.

Here are the fucktwits on have your say.

I am in two minds about nurses being required to have a degree to qualify.

Let's talk about the pros first.

First of all a hell of a lot of research has shown that the patients of well educated bedside nurses have higher survival rates. Anyone who qualifies as a nurse will be thrown into a situation where he is own his own dealing with complex stuff, making life and death decisions and having to think fast on his feet with no second chances almost immediately upon qualifying. He will have to handle all this whilst getting interrupted on every 30 seconds or so throughout a 12 hour shift. Support? What a fucking joke. He will be the lone RN for a large number of patients with only untrained care assistants to help. This is how it's been for years. The matrons sure as hell won't come any where near the wards and it will be rare for our newly qualified hero to be on duty sharing a patient load with another qualified nurse to guide him. This is how it has been for years and it is getting worse.

Why are people in this country so silly? Why do they seem to have a death wish? If you don't think that your RN needs to be well educated as well as have a manageable number of patients you must have a death wish. You must want to die. You certainly don't really understand what a nurse actually is.

When I was overseas many patients would throw their registered nurse out of the room if she didn't prove on the spot that she had a university education. "Are you a BSN" "No sir I trained under the old diploma program" "Then get the fuck out of my room lady". Sad but true. Our older nurses are some of the best simply because they have decades of experience behind then and have proven that they have the tenacity to hang on in this hell profession. But people over there seem more switched on and seemed to have more of an understanding of what a nurse actually is. People in the UK do not understand what a nurse is.....

The old ways of training turned out good nurses for their time. The nurses that trained that way who are still practicing are excellent. They have decades of experience behind them and have grown with the changes. If you tried to train today's nurses like that however you would increase hospital mortality rates. The old training would not suffice now. As someone who has a strong desire to live and who will be a patient some day I have thought about this a lot.

I would thr0w a caring and empathetic nurse who couldn't get through pharma maths at Uni out of my hospital room . I don't give a goddamn about how caring or empathetic you are. I want to stay alive. If you are a caring and empathetic but not that bright I have less chance of surviving my hospital stay. I hope you are caring but first and foremost I want you to be on the ball because I know how much information you will be analyzing and how fast you will be moving and it is scary. I say this as someone who has been a nurse for well over a decade. I say this as someone who has seen patients die because their caring nurse was off helping hand out commodes. I say this as someone who wants to live.

Let me link to it again in case ignorant sickos like Jeremy "But what about the caring"Vine happen to be reading. It's all in the link...just scroll down. Or google nurse education and mortality rates.

Research has shown over and over and over again that hospitals that have a higher proportion of well educated nurses on staff providing direct patient care have higher survival rates.

If I had a registered nurse caring for me who didn't catch onto the fact that I was going into renal failure or was pre -arrest because she was lovingly off somewhere else bathing and making cups of tea for her other patients I would get her sacked and get her license revoked. I would also have a strong desire to beat her to death with a hammer.

Actually I suppose my next of kin would be handling that because I would be either in ITU as a result of failure to rescue before the problem got to big...or I would be in the morgue. If my nice caring but not so bright nurse doesn't catch onto my deterioration in condition who will? Anyone who is an RN will find himself alone with a large group of patients and no back up other than untrained carers. The carers won't catch onto my change in condition unless it is blatantly obvious. When it is blatantly obvious it is too late. This is why the nurses need to stay on task with assessments, labs etc. The docs are NOT around to do it, they won't do it and the nurse will take the heat over any failure to rescue screw ups. This is real life not television where the docs are always around the patients and the nurse is just their assisting. That is not real life.

I swear to god that if I , as a patient, caught my RN making tea and making beds rather than dealing with the things that the carers cannot help her with I would be on her ass like flies to shit. I want to live. So should you. The older trained nurses we have now have been around the block about a 1000 time and done a lot of continuing education. They certainly know what they are doing. Don't worry about them. What I am afraid of is a 19 year old here in 2009 who wants to be a nurse getting trained like they did in 1972 and then getting thrown onto the wards in the current situation.

Now that I said all that about dying and needing intelligent nurses let me explain why I think that the all degree qualification for nurses rule is stupid and pointless.

Management does not actually want to staff the wards with trained nurses. On any given shift the majority of staff are untrained carers who do not understand your diagnosis, history, complications, the way your symptoms present and your drugs. The knowledge of all these things is extremely important to nurse a patient properly.

Currently, most of our actual nurses are NOT degree trained. There are 3 kinds of nurses. There are the ones that trained long ago under the old system (most of our current nurses fit into this group), there are nurses who trained in 3 years at uni and obtained a diploma, and there are nurses who trained in 3 years and got a degree (the latter is the smallest group).

I have a degree, my ward sister has a diploma. We are both RN's. We will rarely ever work together because of management. They are dicks. When I am on duty I have a large number of patients with only carers to help and when she is on duty she is also in that situation. They won't ever pay for any more than one RN to be on duty for the same large number of patients whether that RN is old fashioned trained or university trained. Management only wants to hire untrained carers and they want to have as few actual nurses as they can get away with.

This is why nursing care is so bad and a degree won't mean much if they are going to continue to staff the wards in this manner. I want my nurse to be smart, but if she is on her own with 15 patients we are both fucked.

It wasn't too posh to wash registered nurses who wanted these untrained carers brought in to the hospitals. Registered nurses are left with no choice but to delegate all basic care to untrained people. We hate this. It screws things up for me. It screws things up for the patients.

Hope that your nurse is smart enough to get a degree, and hope that she has a manageable number of patients so that she can stay on top of basic care as well as everything else. This is what the nurses want. It is all linked. When this becomes the norm staffing wise, nursing care in our hospitals will improve. Until then, no expensive quick fix band aid will succeed.


Nurse Anne said...
This comment has been removed by the author.
Nurse Anne said...

Just wanted to add that this is NOT a dig at nurses who do not have degrees. First of all I was a diploma first. Second of all most of the nurses that work on my ward trained before I was out of nappies and can run circles around me knowledge wise. They are smarter too.

This is about the now and the future. Kids today are dumb. If they want to become nurses I want to see them get the degree and go through the toughest educational program.

If they can't hack it, they can become an HCA. They'll have a much easier time getting a job caring for patients on a hospital ward as an HCA than they would as any kind of an RN

Puzzled? said...

Which one is a Nurse? Does it matter?

"I will notice how you are breathing while bathing you. An HCA will not or may not connect the dots. I will notice if you are showing signs of internal bleeding, shock, neurological changes, drug reactions, dehydration, pneumonia, hypoxia, infection etc etc etc ad nauseum. I will catch these problems and sort them. An HCA will bath you and go onto the next patient because she doesn't know any better".

You will Need a Degree to become a Nurse.

"If I had a registered nurse who didn't catch on that I was going into renal failure or was pre-
arrest because SHE WAS LOVINGLY OFF SOMEWHERE ELSE BATHING and making cups of tea for her other patients, I would get her sacked and get her license revoked. I would also have a strong desire to beat her to death with a hammer".

Perhaps this imaginary nurse was bathing her patient to pick up the signs and symptoms you quoted as she knew a HCA would not and was looking after her patients best interests?

Nurse Anne said...

You missed the point ENTIRELY.

Nurses need to be doing basic care.


If she has a large number of patients (as is the norm now) then it would be very very dangerous to be doing basic care rather than leaving it to the HCA's. With a large number of patients you will never catch up to the point where you can mop brows and make beds without missing the boat on something major.

IF the nurse has a small number of patients say 5 then she can knock out the assessments, drugs, etc in the first hours of her shift and then spend time on basic care.

If a nurse has 20 patients she will never ever ever get through all the drugs, assessments etc etc. 2 hours after her shift ended she will still be catching up on things that only a nurse can do.

I am assuming that the RN caring for me will have 30 other patients as THIS IS REALITY. And as her patient I would like to know how the hell a nurse to 30 patients can take the time to bed bath when she has enough IV meds to give that it takes up 58 minutes out of every hour.

With 4 or 5 patients the serious implentation of treatments will take less time out of every hour thus freeing up the nurse to do basic care.

This is why we need safe staffing ratios (1 registered nurse to 5 or 6 patients) to ensure that nurses are doing basic care.

With 20 patients I cannot do basic care without putting someone in danger.

With 5 patients (assuming that the acuity level is the same) I CAN do basic care.

Give the registered nurses safe ratios and they will be able to do basic care. And the patients will be better off.

If I have 5 patients I would be able to do basic care unless they were all critically ill. If I have 30 patients (REALITY) then I would be struck off for doing basic care considering I will have to leave serious stuff to do it and someone will get hurt.

does that explain it?

This is why registered nurses in our hospitals are not doing much in the way of basic care. It's not a choice they get to make.

Nurse Anne said...
This comment has been removed by the author.
Nurse Anne said...

Say I have 20 patients on IV antibiotics and multiple IV meds. It could take more than 45 minutes out of every hour just to prepare, gather supplies, mix them and give them. If a dose gets missed because I am bed bathing and the patient goes septic or has a seizure I am in deep fucking shit.

Once I had only 5 patients with 3 on IV meds but I was able to get every thing ready, up and given in much less time, thus freeing up time to do some basic nursing care. That was good.

IV meds is just one example of something only a nurse can do that can take 45+ minutes out of every hour. Sometimes if I start preparing all the IV's due for noon at 11:30, I won't get to the last one until 3PM. The next lot are due at 4 PM. That is how long it can take. That means that people miss doses and don't get drugs at the time they are due. This is a serious error.

If I stopped to hand out bedpans to help out the care assistants then It would take until 7Pm to get all the noon IV's out. It's not like the care assistants could carry on with the IV's. The patients just wouldn't get them on time and then they get real sick.

That is how it is with large patient loads. We need safe ratios so that nurses can do basic care without hurting someone. None of this would be an issue with a manageable patient load for the RN.

Valda Redfern said...

I entirely agree that if as a patient I have to choose between smart and caring then I should choose smart. My self interest dictates that I should prefer intelligent, well-trained nurses to compassionate nincompoops, and if university education is what ensures competence in nurses then I'm all for their having degrees. My best bet, though, is to do everything I can to stay out of NHS hospitals.

Anonymous said...

Hi, Nurse Anne
It's me, "Anonymous", again. I truly hope the people in your country are reading your blog. You are brave to come out with all this information. The public in the U.S. do not really have a clue either. I think as nurses, we have dropped the ball on educating the public as to why we are so important to them. Our educators have certainly dropped the ball in convincing the public of our necessity. Have you seen Johnson & Johnson's nurse recruitment PR ads? I've tried to watch them without puking. We HAVE to move away from the virtue language that plagues our profession and start emphasizing the strong science, mathematics, and verbal skills base required of nurses. We have to start emphasizing why we need smart people in the profession. Our patients will not survive if we are sweet, virtuous numbskulls who cannot anticipate a potential crisis situation. We also have to be allowed to speak in medical language. Who died and willed diagnostic power to the doctors anyway? I know we don't diagnose, but we do anyway when we infer someone has lost too much blood after a major surgery and we have a Hgb/Hct drawn if their blood pressure and urinary output is too low. That's working toward a medical dx! Or when we call to ask for IV lasix for someone SOB with rales in the lungs and obvious edema! We just inferred they are in CHF! The public needs to be educated on how nurses save lives every day, just by paying attention. I've almost decided our profession needs to hire a REAL PR firm to set the record straight on us. But your blog is a start. BTW, I'm following you on Twitter. Sorry I rambled. If you haven't yet, read Nursing Against the Odds by Suzanne Gordon. She is truly a great investigative journalist and one of our loudest advocates. Keep writing hard, Anne!
Casey in the USA

Nurse Anne said...

Thanks guys.

I blame television. That is where people get their views about what a nurse is. Television always shows doctors at the patients bedside all day long, with a pretty nurse there to hand them stuff.

My acute hospital patients can go two days without seeing a doc.

It's my job to figure it out if that shortness of breath is a sign of ccf and it's my job to let the doctor know so he can diagnose, order lasix and it's my job to give the lasix safely and monitor the patient for any changes or further deterioration etc.

It's my job to make sure that their blood is drawn to ensure that their potassium is okay once they had all that lasix. If the ball gets dropped on any of that it's my ass in a sling, not the doctors. It's not like the doctors are going to bother to write their own lab orders without us requesting them to do it. Still they often can't get over to do it and we have to write them.

The ball gets dropped, the nurse gets blamed. I have seen it one too many times. I was going to blog about all the doc errors I have seen nurses get the blame for but it got too long.

We had a doc prescribe a med for a patient. He prescribed it on the drug chart. It is a new drug, not supposed to be given with something that the patient was already on. But he never crossed off/ discontinued the other drug.

He wrote orders for the new drug friday night and the new drug was to be given saturday AM along with 13 other meds including this one that he should have discontinued. No pharmacy AT THAT TIME.

Nurse gave the new drug as well as all the other drugs prescribed to be given at that time. Including the previous drug that wasn't crossed off. I wouldn't have known either that they are dangerous together. Plus she was doing a drug round for 15 people with all of them shouting her as she was stood there with the drug trolley. It's no wonder we can't concentrate.

The patient was okay but it was a considered a serious and THE NURSE LOST HER JOB FOR NOT PICKING UP THE DOC'S ERROR. The doc: nothing.

Pissed me off.

Anonymous said...

It happens in the USA, too, Anne. The public isn't any more aware over here either. They just don't seem so out to get nurses like the people in your country. We catch drug contraindications here, too. I have actually heard of hospitals instituting protected med passes. In other words, the nurse is NOT to be interrupted during his or her drug round until he or she is DONE. The only exception for interrupting is an emergency (as in a code). Tragic mistakes happen when nurses are unable to pass meds without interruption. We have a program called Cliniguide on our computer. We can look up any drug we are unfamiliar with and get the information we need about it. That helps, too. Hospitals should have the latest drug books on ward nurses' med carts. I guess I got off-subject, but protected drug rounds needs to be the rule in every hospital. But I guess nurses across the world are doing well to convince the public they need support to further their education. Shame on people who don't think nurses should be life-long learners! I want a SMART nurse to take care of me. Doesn't necessarily have to have a "degree", but I want that nurse to have taken the time to enhance his or her knowledge base since graduation from school.
Casey in the USA

Unknown said...

In my country, people who want to become a nurse need to get an authorization of the health authorities, similar that for getting Generic Viagra, and the only possibility of obtaining it is through a degree.

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Miami Office Space said...

you know that Just over a quarter of the 315,000 nurses in England currently have a degree.

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