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Obviously if you came here, you are a nurse or a future patient of a nurse with concerns. I have only been a nurse for 10 years now. This came after many other types of jobs, across the board. There are a few things that I see being issues, with medical care and treatment. The medical malpractice insurance issue and the nursing shortage. Last is the the continuous changing rules by insurance companies and Medicare, regarding reimbursement. I refer to these changing reimbursement rules, as "games". Mostly because it's finicky irrelevant stuff, that is changed (in my opinion) to avoid reimbursement. Combined together, and healthcare is headed for a huge downward spiral. In the early 1980's there was a nursing shortage. Jobs as a nurse were easy to get. New grads at that time, found themselves working before they even passed their state boards. Why? Because they were in need of nurses, and would take whoever they could. They being hospitals and any other health care facilities. While this was publicized, the nursing schools were eventually flooded with potential new nurses. The late 80's and early 90's came. Potential new students found themselves on waiting lists, just to get into the nursing programs. As new grads completed training, and started their new careers the demand dropped. The economy, budgets and spending became an issue. Diploma programs (at least in our area) started closing down. Lack of enrollment, and the need for budgets to shift directions. The nursing field was back on it's feet. New grads no longer had jobs prior to State Board examinations. They were told to contact employers after they received their state license. Now 10 years later, the demand is back. The projections this time around are much worse. Projections into the future as far as 2020, show that we are headed for a major nursing shortage. Let's look at some of the reasons. 1) The elderly are living longer, and comprising more of the population. They are in need of the most medical care. 2) Currently, there are not enough nursing schools to handle the shortage as of right now. 3) The average age of the current nurse has increased. The average age of RNs in the United States has increased substantially from 37.4 years in 1983 to 41.9 years in 1996 and 44.5 years in 2000. The total US workforce has aged only two years during the same 17-year period. AORN Journal, Oct, 2003 by Susan Letvak While, not documented I believe on 2006 the average nurses age is about 49 years old now. Then you have to be aware of the fact nursing as a whole, do not get along well. Unlike physicians who have only one organization (The AMA), and one level of education. Nursing has multiple organizations, and multiple levels of education. There is bickering in between the organizations, levels of education, including discrimination based on education level. Yet from the BSN level down, pay, job responsibilities and scope of practice are all the same. Bottom line, it is all eventually going to nip us in the butt, if it is not addressed soon. Nursing Education: There are many venues in which to pursue a nursing career, all of which add to the instability of the nursing profession. 1) There is a diploma program. This is a 2 year program, usually sponsored by a hospital. The goal is to make RN's out of these individuals. 2) There is the ADN/ASN degree program. This is typically a program offered by a community college, and sometimes a State university. I am not sure about private colleges. This is configured to be completed in two years. However, most nurses I know have claimed it takes about 28 months. Once the program is completed, you have either an Applied Degree of Nursing or Applied Science of Nursing. 3) Then you have a BSN degree program. This is offered by a state or private college, and takes four years to complete. When they are finished with the program, they have a Bachelors Science in Nursing. 4) The last and obvious, are multiple other options as with any other higher degree programs. Such as doctorates in nursing, and multiple masters programs like Nurse Practitioner, CRNA, education, etc. etc. ***The differences in programs 1-3 are minimal. Although it's been debated, this was not meant to be a debate session. My perception on these differences are these things. Diploma, ADN, BSN are relatively all the same. The only difference being with the BSN, which covers statistics, and some administrative stuff. Pay scale there is no difference. The rates of pay do not vary whether you are a BSN or diploma nurse. Why go and get a BSN? My thoughts are if you plan on teaching nursing, or eventually plan on going into administration. Most administrative jobs prefer a BSN minimum. Most states require a BSN for part time clinical instructor, and MSN for full time nursing instructor. Most masters programs I have checked out, have a "RN to MSN" program. So apparently, there seems to be some disarray in the profession from the start. When I came into nursing in the mid 90's, the trend was primary nursing care. This meant, the nurse to patient ratio was much higher. I don't have exact numbers, but recall something like 4-7 patients to a nurse. The newer trend tends to be "Team Nursing". This where there is an RN, LPN and NA or nurse tech. How these concepts correlate to patient care. ***Primary Care concept= 30 patients/6 RN's mean each nurse essentially has 5 patients. Under this concept, the nurse knows the patients better. Including their history, medications, physician orders etc. Obviously a more cost consuming venture for te employer. ***Team Nursing concept= 30 Patients 2 RN's, 2 LPN's, 2 Nurse Aides. This concept means, the RN's are each now responsible for 15 patients. Each RN then works with an LPN and NA. The RN is responsible for knowing all 15 patients, history, meds and anything else. The downsides of the team concept are many. The NA cannot take orders from a physician. In some facilities the LPN cannot take orders from a physician. This means anytime a physician calls to give orders, the RN needs to break away from patient care. There is the issue of IV medications, that only the RN can do. Add the resposibility of filling out pre-surgery paperwork, knowing when patients go to what tests, among other things and one can be extremely overwhelmed and stressed. As I have said, it's not a who's important or who's necessary debate. I am an expert on scope of practices across the board. My point being, that overall care is sliding down the tubes. The last thing to remember is the RN is legally responsible for their patients, including anything that should/could or can occur under their watch. The LPN is also legally responsible for anything he/she does, during their time on watch. I am not sure about the legal ramifications with an NA? The difference here, is that if something goes drastically wrong it's not just oops. Physicians, Nurses, privately paid Paramedics and others in the medical field, have way more to worry about than an "accident" or "mistake. These people are the physicians eyes. I cannot tell you how many people go to nursing school and quit once they are in to it for a while. It's a lot of responsibility. Everybody has a job to do in this group. If something goes wrong there are legal ramifications. You may not only loose your job, but you may loose your license. If your not familiar with medical professional licensing, think of it this way. let's say your in your car, and you hit a pedestrian and kill them. Not only can you be sued by the pedestrians family, the state/munincipality will step in also. They will ticket you, and take you to court. You will probably loose your license to drive. Most likely not for life, but for a few years. In the medical professionals career, if you have no license, you have no job. No job, no income. Then how do you support yourself? So if you or someone you know have terrible care in a hospital, here are a few things to think about. 1) Did you write your senator or congressmen, to question staffing? In California a bill was passed, that requires minimal RN staffing. Clearly not the long term answer, but may help your area out. 2) How many people go into a different profession, where they don't have to work, evenings, nights, weekends, holidays? In addition they can make the same amount or more money in other fields, without all the legal liabilities? 3) Did you consider, or try convincing your children or grandchildren into nursing as a career? In the next 15-20 years, the current drought is going to worsen immensly. The people in their mid forties and youger, should be worried to death. When their time comes, there will be nobody left to take care of them. Here are some links related to these issues: http://www.aacn.nche.edu/Media/shortageresource.htm http://www.suntimes.com/output/news/cst-nws-nurse07.html http://www.nabeepchen.com/category/nursing-shortage http://www.voanews.com/english/archive/2006-01/2006-01-02-voa30.cfm?CFID=10641267&CFTOKEN=34750552 http://www.newsroom.msu.edu/site/indexer/2587/content.htm http://abcnews.go.com/WNT/Health/story?id=1529546&WNTad=true http://www2.mc.duke.edu/depts/hospital/9200bmt/shortage.htm http://www.usatoday.com/money/industries/health/2005-06-08-travel-nurse-usat_x.htm http://www.lopez1.com/lopez/nursing.shortages.short.staffing.htm http://www.y-axis.com/yaxisnewsroom/nursing.shtml http://www.findarticles.com/p/articles/mi_m0FSL/is_4_78/ai_108967612 These are just a few links. Go to any web search engine, yahoo, excite, google, etc. Type in nursing shortage. There are thousands of sites and info that will show up. This issue is in everybodys hands, not just those currently in healthcare. |