May 4, 2006, 5:25 pm

Anyway You Want ‘Em, That’s the Way You Need ‘Em!


I don’t remember doing this in anatomy and physiology!

Then again, it’s been so long I barely remember anatomy and physiology.

What if the “canvas” had a hairy chest?

What if the “canvas” was a woman?

It almost looks like he’s drawing Dilbert. Or Dogbert.

Hmmm….perhaps I should retake the class in the interest of nursing science.

Nah, forget it.

With my luck I’d get someone who looks like Woody Allen.

Not that there’s anything wrong with Woody Allen….

I’m just sayin’……

Many of the nurses I know, both in the world of bloggers and in my day-to-day work life either have or are pursuing advanced degrees in nursing, be it a BSN or an MSN.Some are actually entering the nursing field via a Master’s Degree (MSN).I say bring ’em on!We need nurses.

But exactly what type of nurses do we need?

Right now, at this moment, we need nurses who are:

  • Bedside nurses. Nurses who actually perform and work at the bedside with patients in hospitals.
    • This is most acute as the only reason one would need to stay in the hospital would be for nursing care. Nurses do the medication administration, the monitoring, the assistance with the activities of daily living.
    • Beside nurses are the eyes and ears of the doctors, who cannot be everywhere at once.
      • Trust me, if your heart goes haywire, it won’t be the doctor who does that first defibrillation that shocks you back into life.
      • Unless you’re in the ER, and then the doc watches the nurse do it.
    • With all due respect to my colleagues in the laboratory and radiology services, if you dropped every other service in a hospital, with the exception of doctors, the hospital could still function. Drop nursing and you have no hospital.
  • Younger nurses. Now lest I be accused of age discrimination, the fact is that according to a survey requested by the California Board of Registered Nursing in 2004, the median age of an RN in California was 47.7, with the median age of new graduates being 28.1 years. The nursing profession in this state was described as a “middle-aged, aging” workforce.
    • We baby boomers are booming right up the age charts and when we are elderly and too old or too disabled to keep nursing, who will take care of us?
    • We’re all going to be retiring around the same time frame. Who will replace us when we do?
  • Community health nurses.
    • For health maintainence via clinics and health programs
    • For health care
    • To advocate for the patients in the community for access to equipment and medications
    • To make sure those of us who are less able to access health care don’t “fall through the cracks”.
  • Nursing instructors.
    • We have more applicants for nursing in this state than we can handle because we don’t have the space for them in nursing schools. Some students are actually chosen by lottery. Lottery. Why?
      • Not enough nursing professors. Why?
      • Because the pay is horrible compared to hospital nursing.
        • These are the men and women with the MSNs and the PhDs who should be compensated for their education and experience.
        • Because educating the next generation of nursing professionals is hard work and it should be rewarded as such.
        • Think about it. Does the medical doctor teaching med students make less than those students will as interns?

So what do we do, as nurses, to encourage people to go into the profession?

  • Quit bitching!
    • Pardon my language.
    • Yes, the work is hard, sometimes back-breaking, emotionally draining and relentless. Paramedics, cops and doctors face the same issues and they deal with it, just like we nurses do.
    • Talk to potential students about the realities of the profession but don’t sit there and tell them all the reasons why they wouldn’t even remotely want to consider entering it.
  • This was a recommendation from a reader in one of my comments sections: encourage anyone who is interested in nursing as a profession (assuming they have no hospital background already) to shadow a nurse for a full eight hours and watch what they do, what they have to handle.
  • Make nursing attractive to young people as a viable profession.
    • Salary – raising the salary might help, but if you are not meant for nursing no amount of money will get you into it and no amount of money will make you successfull at it. If you are meant to do it, no amount of money will keep you out of it.
    • Decrease the workload – we now have mandated ratios in the state of California. When we can’t admit upstairs, we add staff to the ER to handle the overloaded department. The days of one nurse to a ward of 20 are long gone, my friend.
    • Keep the entrance requirements high and tough – get the best and the brightest.
  • Do not, DO NOT drop the Associate Degree as an entry level option for nurses.
    • The focus of their program is the basic bedside nursing that we need so badly.
    • You can obtain your ADN and work your way through to your BSN or MSN as you are actually gaining work experience.

Frankly, if I were to choose to get my BSN now, I would appreciate it much more than if I had gone directly into a BSN program.

I know so much more about nursing, meaning patient care.

I learned it through hands on experience, so my advanced classes would have more meaning. They would be reinforced by my nursing experience.

I’ve said before that I am an associate degree nurse (ADN) and proud of it.

My junior college was one of the first ADN programs to be accredited by the National Leauge for Nursing and maintains that accreditation today.

I work beside BSN and MSN nurses who are fantastic and I even have my colleague-who-is-PhD-candidate! I love ’em and I learn from them every day. But when push comes to shove, we all do the very same patient care. Some have more knowledge than I do in leadership and nursing models. Some have more knowledge in nursing diagnoses and have the gift of teaching in addition to nursing.

But I once figured out that if I worked full-time night shift (which would never happen in a million years, trust me), given my years of experience and where I’m at on the pay scale, I’d make well over six figures (before the decimal point!).

Not bad for a two-year degree, eh?


  • Janet

    May 4, 2006 at 7:00 pm

    Tell it, Kim!! We need more nurses at the bedside and we need to do whatever it takes to get them there. BSN’s and MSN’s and PhD’s are fine but it all begins at the bedside. Some of the best nurses I have ever known have been ADN’s.

  • Pk

    May 4, 2006 at 7:40 pm

    I’ve been a patient for quite a while now. So I’ve gotten to know many nurses, from LPN’s to MSN’s.

    I think the one I had the hardest time with was in caring for my mother when she had her knee replaced in October. He was in the rehab hospital. He was an MSN, and an instructor at a 4 year, private university’s nursing school. Therefore, he knew everything there was to know about nursing. And health.

    Except, he didn’t. I feel awfully sorry for the nurses who come out of his classes, not to mention those who have to put up with his care.

    After telling my mom that the doctor’s weren’t taking care of her correctly, and that there was no reason why she shouldn’t be given the pain medicine that was ordered (that my sister and I had told him had been dc’d that morning because of hallucinations) he went ahead and gave it to her, even with her insisting it was the wrong drug and her doctor said no. He told her she was a ‘silly old woman’ (that’s what her roomate told us)

    When taking a medical history, she told him that her daughter (me) had mysthenia gravis. When I came in, he informed me that I must have been severely mis diagnosed because that had been cured and prevented with a vaccine for 20 years.

    Uh ..go back to your books. Oh, and talk to the rehab neuro on staff …he’s MY neuro.
    (yes, I did tell my neuro of the treatment we were recieving from this nurse and what he said about MG, I just couldn’t resist, even though the neuro was not seeing my mom, he was checking on her out of curtesy to me, he’s been my doctor for 14 years)

    That had to have gone down as my WORST experience with nursing care ever.

    I couldn’t explain it …burn out? Too much information in his brain and it all got mixed up? Know it all syndrome? Who knows.

    Thankfully, WE knew enough to know how to handle the situation appropriately.

  • marj

    May 4, 2006 at 8:31 pm

    you are so right, kim! you know that the nursing faculty shortage is bad when your professor asks you when you’re going to come back and teach… and i JUST GRADUATED!!!

  • Judy

    May 4, 2006 at 9:56 pm

    Another thing that would make the nursing programs more attractive would be to reduce the waiting periods.

    The ADN program in my local Community Collage can take you 4-6 years to complete. Starting from scratch you have 1-2 years of academic classes to complete, application to the ADN program, THEN waiting 18-30 months to get into the program. Once you actually get into the program another 18 months to complete.

    Grapevine says that the University BSN program has the same or greater waiting time.

    I think we loss a lot of potential nurses, because thay can’t afford the wait. Life just moves on and people need jobs to meet today’s need, not a job 5 years down the road.

  • Chele

    May 5, 2006 at 5:15 am

    If only people knew there were so many areas of nursing. Floor nursing wasn’t for me (though I did it for 5 yrs) I’ve been in the ER for 5 yrs now and I love it. There’s SANE, research nursing, community health, home health, hospice…you name it, its out there. It isn’t just emptying bedpans. My in-laws tried to discourage me when I went into my ADN program by asking me…why do you want to empty bedpans? They don’t know the autonomy we have. They don’t realize, as you put it, that the hospital would shut down without us! Now 10 yrs later the family has come to me and asked me to try and talk a young cousin out of going into nursing!!! Yes I do believe they are insane!

  • pixelRN

    May 5, 2006 at 5:51 am

    As always, well said, Kim. When I was getting my BSN I noticed many people like myself, in possesion of a liberal arts degree with no marketable job skills. Hopefully we can continue to divert some of these people into nursing. I was ‘diverted’ and now I find myself in this wonderful career. As for the instructor shortage – when I was vacationing in St. Kitts a few months ago I came across a brand spanking new college of nursing. I was told that this was built as a direct response to our shortage of nursing programs in the US. Wish I had gone there… maybe I will go back there to teach when I have more experience!

  • TC

    May 5, 2006 at 5:54 am

    Yeah!!!!! Three cheers for Kim! Very well said, as usual and thanks for the props to ADN’s. My ADN program was very good and I had learned and experienced a lot more than BSN grads by the time I graduated. I don’t think a lot of people realize that BSN and ADN’s have the same amount of clinical-4 semesters(at least where I live). BSN programs offer more theory, community and public health nursing courses.

  • Soar Loosers

    May 5, 2006 at 8:22 am

    Nurses are heroes. Over worked and under paid, nurses takes abuses from every end including doctors, patients, patients’ family and administrators. It is appalling, the pay discrepancy between a doctor and a nurse, even skilled ones with years of experience! This coming from a physican’s perspective.

    Part of the problem stems from the traditional practice and fact that nurses are not independent contractors like doctors. Being an employee of the hospitals really limit the nurses’ capability for earning what they truly deserve. Just look at the salary that hospitals are willing to pay travel nurses. Still though, nurses deserve much more. Nurses should be able to independently bill for their services just like physicians do. NURSES OF THE WORLD, UNITE!!!

  • Jodi

    May 5, 2006 at 10:50 am

    Texas Tech University in Lubbock TX is now offering an RN to MSN program…..regardless of whether it’s a BSN or an ADN. You can do it online too! I don’t think there’s any other field that will allow you to skip the BSN. I’m sure the driving force is to get more instructors into the world. (Note….they won’t accept you unless you’ve had a certain amount of bedside experience behind you)

    My ADN took me 3.5 years to complete. Nurses from my Community college program passed the NCLEX the first time at 97% last year. The BIG Gigantic RN program from the major TX university only turned out about 80%.

    There’s something to be said about close-nit programs who focus on training their nurses to be at the bedside….and not working behind a desk.

    It’s appalling to me that there are still organizations out there that want to do away with the ADN.

  • Karen

    May 5, 2006 at 2:56 pm

    A great post, Kim! ::: applause ::: I don’t think I could have said it any better.

    When I first started considering nursing school, my family tried to talk me out of it and told me what a big mistake I was making. Thankfully I didn’t listen to them – I love being a nursing student and I am so proud to be a future nurse.

    If only we could accomodate future nurses in the CC programs … I went the direct-entry MSN route because there was no waitlist.

  • Dr John Crippen

    May 5, 2006 at 5:02 pm

    Hi Kim

    You say:

    “With all due respect to my colleagues in the laboratory and radiology services, if you dropped every other service in a hospital, with the exception of doctors, the hospital could still function. Drop nursing and you have no hospital.”


    That should be embossed in gold and pinned up on the door of every hospital administrato in the UK.

    The biggest problem in the NHS in the UK is lack of bedside nursing. In the UK, nurses are leaving the bedside to take more technocratic roles. Leaving aside the argument about how well they manage in those roles, they are sorely missed at the bedside.


  • ThirdDegreeNurse

    May 5, 2006 at 5:38 pm

    As always, Kim, you are Ms. Right On.

    With 19 community colleges in our little state of Kansas, I thought it would be easy to get into an ADN program when I 3 prereqs before I could even be considered. I did the prereqs and decided to just take all the ones I needed for the BSN and go that route. I am lucky to be at a hospital-affiliated college instead of a university so I’m being taught by practicing nurses who are all about bedside nursing.

    Still, I’m with you. ADNs give so much emphasis on clinical experience. It’s the waiting time that deters a lot of people…back to the catch-22 of not having enough faculty.

  • Teresa

    May 5, 2006 at 6:35 pm

    People are hospitalizd because they need nursing care. If they could care for themselves, they’d stay home.

    Great post.

  • Flea

    May 6, 2006 at 5:23 am


    Check out the logo of Children’s Hospital, Boston. An early attending of mine pointed this out to me when I was in residency, as a way of pointing to the foundation on which that institution rests.



  • Janet

    May 7, 2006 at 11:23 am

    This is in response to TC’s comment about ADN’s and BSN’s having the same amount of clinical, 4 semesters.
    Ack! No wonder there is such a need for internships and further education after graduation.

    Back in the dark ages when I went to a diploma program we had 6 weeks of classes and then we were in the hospital doing clinical rotations for the next three years straight with classes after our clinical time. Yes, the patient acuity was lower then and care was not so high-tech but we were well-grounded in the basics of nursing care. No matter how many bells and whistles we have now, the basics haven’t changed in 30 years.

  • Jen, (almost!)RN

    May 10, 2006 at 9:24 am

    Heh, I did that in anatomy.

    Regarding not knowing what nurses do: hell, I didn’t know what nurses did! I wrote a paper my first semester that said something to the effect of “Nurses in x country do many of the same activities as we do here: give medications, perform procedures, and follow doctor’s orders,” completely leaving out the assessing and critical thinking part. I went into this to “care for people” (insert smoochy voice)–thank god I love what it turned out to be in addition to the caring!

  • Alisha

    May 15, 2006 at 9:40 am

    I am a registered health information technician which is like the paper side of healthcare. Iam also a certified nurse asiistant, phlebotomist, etc. I would love to get into the clinical side of nursing and become a rn at least at an associates level. The problem is that I am a coder. So not only are there no evening programs for nursing in my area, if I take off two years from working as a coder it will be to hard for me to get back into the job market because coding is everchanging. Do you have any suggestions?

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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