Nursing’s Mean Girls

If you are a nurse in the United States you probably have heard about the “mean girls”. They are a group of good old girl nurses that have reigned terror over the profession for many years. They are the ones that so narrowly defined nursing theory as to make it somewhat useless in our interdisciplinary healthcare world. They are the ones that narrowly defined admissions in a way that has forced many universities to go to blinded holistic admissions to avoid all manner of bias. They are the ones that have controlled our professional organizations in a way that doesn’t allow dissenting views or any views not consistent with the good old girls’ perspective even when the evidence is against them. And, they are the ones that control our journals and seem to think that protecting nursing is more important than integrity and evidence. In short, they are bullies.

We will not be able to remain the most trusted profession if we don’t clean up our own house. We need to take a thorough look at our educational standards. It is time for nursing to have its own Flexner report and it should not be managed by our professional organizations who have consistently shown they are unwilling to make difficult decisions or stand up to for-profit universities that are widely known to be diploma mills. Sadly, to compete many nursing programs have lowered standards to compete. Let me give a few examples.

  • DNP Scholarly Projects started out as rigorous work. Many were well-designed quality assurance projects, some were qualitative research, and others were small quantitative research projects. Now, much of what is produced is less than the Master’s Thesis that used to be required.
  • RN-BSN programs are often not equivalent to BSN programs at the same university. The best programs are still excellent, but many have turned into diploma mills. We all know it, but we keep silent.
  • Simulation was supposed to be based on a well-designed and rigorous study that showed how it can be equally effective to clinical experience. Yet, we went from rigorous simulation to universities using online modules and calling it simulation. When students do not do well the solution doesn’t seem to be to change the didactic content but to change the simulation to something less complicated.
  • Online courses when well done are useful to some students, but many are poorly done with no significant didactic content and excessive discussion boards that are barely reviewed.
  • Clinicals are getting harder and harder to find. This isn’t the fault of the education system, but rather the hospitals that not only limit access but limit what students can do and then wonder why they can’t manage a full load of patients on day one.
  • How we count clinical hours is not standardized. A credit hour of clinical range from 30-75 hours. Clinical can be hands-on with patients, shadowing a nurse, simulation either high or low fidelity, online simulation, or even writing a paper about clinical or another topic.
  • Ped, OB, and psych are now optional or electives at some schools with zero clinical in those areas.
  • Medication calculations are now considered a high-stakes test by some and there have been some who have proposed to much emphasis is placed on it. Yet we just saw a nurse convicted for a medication error. The FDA gets over 100,000 reports of medication errors a year. The right dose, at the right time, to the right patient is as basic as it gets.

Maybe the Carnegie Foundation will be willing to fund nursing to do a similar process and if they will not then we need to establish a coalition of the willing.


Rejoice: COVID-19 vaccinations begin

The third Sunday of Advent is a day to Rejoice. This year it feels especially true as I cried watching the first trucks loaded with COIVID-19 vaccines pull away from the facility headed toward you. I was grateful for the scientist who used their intelligence to imagine new vaccines that can be produced quickly and safely. I was grateful for the FDA that insisted on following the safety procedures even in a crisis so we could all have faith the vaccines are safe. I was grateful to FedEx, UPS, and Boyles that are doing the deliveries, and for the U.S. Marshalls that are escorting them. I was grateful for all of those that have served on the committees that planned how to distribute the vaccine when it arrives in communities all across the country. And I am grateful for all of those that are working in their communities to be advocates for vaccinations.

Two days this week I am volunteering to administer COVID-19 vaccinations. It will be the first time since March that I have been inside in a room with a large group of people I don’t know except to go to the grocery store. While I have concerns about doing indoor vaccination I think it is worth the risk to keep hospitals and communities from using nurses that are caring for patients. I also believe it is a small way to give back to all of the frontline personnel that did so much for all of us during this pandemic. When this over we owe them so very much more.

The first day I’m eligible I plan to show up, roll up my sleeve, and get vaccinated. It is important for everyone to get vaccinated. We need to reach a minimum of 70% of the population vaccinated to achieve herd immunity and that means the majority of us have to play our role as good citizens. It is what Americans do. We show up when we are needed and we come together. We see the whole as more important than any one individual. And we enter each crisis as a community. I don’t want this crisis to be any different.

To me it is simple:

  • Love yourself enough to stay healthy by being vaccinated.
  • Love your community enough to reduce risk and be able to fully participate.
  • Love your country enough to help end this pandemic, end the isolation, and make it possible for everyone to get back to work, school, and church.

I miss seeing my friends and my students. I miss taking the time to talk to the people in the grocery store. I miss restaurants, concerts, plays, and travel. Most importantly, I miss a time when the daily news didn’t involve numbers of the dead, ICU availability, and new positive tests. I hope each of you will do your part and get vaccinated.

I know that many fear vaccinations and there have been things in our past that add to that fear. There are others that believe conspiracy theories, it will most likely be impossible to change their views. By their nature, conspiracy theorists are not rational. They can no more control their irrationality than a person who is afraid can control their fear. The difference is the person who is afraid may recognize the fear as not in their best interest, but the person that believes conspiracy theories will not. Therefore, it is important to walk with the people that are afraid and be their strength and comfort. We should not equate people who are afraid with those who buy into conspiracies. I hope that each of my friends who has influence and trust in their community will take the time and effort to walk with those that are afraid or lack trust. Lend them your compassion and your strength.

The light at the end of the tunnel may just be UPS and FedEx headlights. Give them a warm welcome and for the next few months pull to the side and let them through traffic.


Standing on Holy Ground: Nurses, Suffering, and Values

Teaching students is always a pleasure and a privilege. Yet, sometimes the stories that have been the most powerful for me seem to have no impact on them. Today I read them an excerpt from Mary Elizabeth O’Brien’s book, Spirituality in Nursing. Sr. Macrina advised,

“if you should ever hear God speaking to you from a burning bush, and it happens more often than most of us realize, take off your shoes for the ground on which you stand is holy”. How appropriate, it seems to envision practicing nurses, who must come together with their patients in caring and compassion, as standing on holy ground. God frequently speaks to us from a burning bush, in the fretful whimper of a feverish child, in the anxious questions of a preoperative surgical patient, and in the frail moans of a fragile elder. If we take off our shoes, we will be able to realize that the place where we stand is holy ground; we will respond to our patients as we would wish to respond to God in the burning bush.”

Book_of_Exodus_Chapter_4-5_(Bible_Illustrations_by_Sweet_Media) (1)I believe we should all take off our shoes and experience what is holy in our professions and our human relationships. What are we called to do and what is preventing us from doing it? We should take off our shoes of bias, our shoes of fear, and our shoes of judgment and help alleviate unnecessary suffering. Only then will we be able to feel what is holy and just. Only then can we answer the questions that examine our values:
Who am I? Who am I to become? How do I get there?

Adult Health: Nursing Ethical and Legal Issues

Art by: “Book of Exodus Chapter 4-5 (Bible Illustrations by Sweet Media)” by Distant Shores Media/Sweet Publishing


Access to Cost-Effective Care is Limited by Turf Battles

Have you ever wondered why healthcare is so much more expensive in the United States than other similar countries?  Let me propose that it is partially the fault of Congress, physicians, and other health care providers that are more interested in protecting turf than caring for patients.  In the 1960’s Dr. Loretta Ford and Dr. Henry Silver developed the first Nurse Practitioner (NP) program at the University of Colorado, now referred to as Advanced Practice Registered Nurses.  The purpose was to expand healthcare to those in under served areas and fill gaps.  Nurse Practitioners do this by combining some practice aspects of medicine and some of nursing.  This holistic approach to patient care has been adopted in other countries and has greatly expanded access to care.

What has been shown in repeated studies is that Nurse Practitioners provide high quality and cost-effective care.   There are over 100,000 nurse practitioners in the U.S. and the number is growing.  The problem is that some states significantly limit their practice and require collaborative agreements with physicians.  The impact of this is that it increases cost and decreases the number of nurse practitioners.

There is currently a petition on the White House We the People website that request the barriers to advanced practice registered nurses be removed.   There are only a few days left to sign the petition.  If you care about access to affordable health care then this is important to sign the petition.

https://petitions.whitehouse.gov/petition/remove-barriers-prevent-advanced-practice-registered-nurses-practicing-their-full-scope/WJSdg1P3

We petition the Obama administration to:

Remove barriers that prevent advanced practice registered nurses from practicing to their full scope.

Advanced practice registered nurses (APRNs) have provided safe and effective care in the United States for over four decades. When the Affordable Care ACT (ACA) is fully implemented in 2014 over 30 million Americans will gain coverage under the law. APRNs currently have barriers to practice which include requirements for being supervised by or having a collaborative agreement with a physician, inability to admit patients into hospice or home health and restrictions on prescription of controlled drugs.There is currently a shortage of primary care physicians and the restriction to APRN practice limits patients access to care. Advanced practice registered nurses should be allowed to practice to their full scope of education and training.