San Antonio Military Medical C
Research Nurse Coordinator
In general, I support a four-year nursing degree, with caveats. 1) As others have mentioned, there must be enough trained, experiences and skilled instructors for this process to work. With out the proper cadre, the product will NOT meet the practice standards of modern nursing in any environment. 2) My strong belief: all nurse need the formal "book learning" and skills training to meet the needs and expectations of our patients. As I have said many times: "Nurse" is both a verb and a noun. Without hands-on training and practice, the nurse becomes a figurehead. What about the adage of :1) see one; 2) do one and then 3) teach one.? We have ALL got to support high-level superior nursing care where ever we have our practice. This is not a dance: One step forward and two steps back. That sort of education and training will never last and WILL ultimately fail.
Joseph B. Warren RN BSN CWON LTC (retired) Army Nurse Corps
The more hands-on teaching and quality education we get, the better nurses we will become.
JB Warren RN BSN CWON, LTC (retired) US Army
As I watch the Nursing "situation" in the UK, I would like to share one view from "across the pond".
In a November 2016 news article, Elizabeth Whitman, a quality and safety reporter for Modern Healthcare (http://www.modernhealthcare.com/article/20161115/NEWS/161119949) posed the question : ” Could replacing nurses with nursing assistants pose risks to patients?”
Whitman stated: “While swapping professional nurses for nursing assistants might seem less expensive for hospitals in the short term, new research suggests it's associated with lower quality of care, increased patient risk and thus higher costs in the long run.”
The study, published on-line in November 2016 issue of BMJ Quality and Safety (http://qualitysafety.bmj.com/content/26/7/559) examined data from hospitals, patients and nurses in Europe. The richer the skill mix of nursing staff, the lower the mortality rates and odds of poor patient ratings or quality reports, it found, although it did not establish a causal relationship or identify specific mechanisms by which outcomes worsened. Aiken LH, et al. BMJ Qual Saf 2017;26:559–568. doi:10.1136/bmjqs-2016-005567
Perhaps this is the notorious "N=1" research report, but the study examines data from 13,077 nurses in 243 hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland, and 18,828 patients in these hospitals. There were two major conclusions from the results: 1) A bedside care workforce with a greater proportion of professional nurses is associated with better outcomes for patients and nurses. 2) Reducing nursing skill mix by adding nursing associates and other categories of assistive nursing personnel without professional nurse qualifications may contribute to preventable deaths, erode quality and safety of hospital care and contribute to hospital nurse shortages.
Pretty bold stuff, eh?!
Joseph B. Warren RN BSN, Division of Neurology, San Antonio Military Medical Canter, Texas
You are "spot on" in your assessment of the situation. For leaders in the UK, let me remind you of the old American expression: "You get what you pay for!" Highly trained compassionate experienced nurses do not come cheaply, and experience comes only with "time on the job" in tough clinical situations. Find the funding for better salaries, I say. The next patient may be one of your loved ones! JB Warren RN BSN LTC Army Nurse Corps (retired) and research nurse coordinator, Brooke Army Medical Center.
You are "Spot On!" The value of a nurse becomes evident when there is a medical or surgical crisis, when there is healing or comforting to be done. Otherwise we are forgotten. Remember the poem "Tommy? Kipling articulates the forgotten soldier theme when he wrote: "While it's Tommy this, an' Tommy that, an ``Tommy, fall be'ind,''
But it's ``Please to walk in front, sir,'' when there's trouble in the wind." Can we as nurses fall behind? I don't think so: It is not in our nature to be timid when there are lives to save and suffering to be tended to!. When I hear nurses being blasted by politicians and administrators who have forgotten how to lead or care, I am very angry. I see what they're doing, but I don't get it. I have been a nurse for 40 years, including several deployments in the US Army. And I get like Tommy, and recall the famous closing to Kipling's poem: Yes it's Tommy this, an' Tommy that, an' anything you please;
But Tommy ain't a bloomin' fool--you bet that Tommy sees! If I can see the mess in the UK nursing situation from Brooke Army Medical Center, Texas, why can't those leaders right there see the problem? Perplexing, isn't it!? JB Warren LTC (retired) US Army Nurse Corps