Oh PLEASE don't let this degenerate into another nurse vs. doctor thread. It will attract every troll on SDN and will fester into a massive weeping boil on the forum. We've been lucky that we haven't had one and they tend to metastasize to the general forum and others.
Agree x 3
Let's just stick to that there is a critical nursing shortage and it's affecting all of us.
So let's try to address the "shortage". I would argue that the lack of good ED nurses is not necessarily a lack of bodies w/licenses. It is a lack of folks who are willing/able to do the job.
{**Boring story alert**}
On my last travel gig I stayed around for over a year. It was a great place w/good rapport and a manager who would hop into the trench to help out occasionally when her salary shift was over (rare as a dodo) . For all the goodness in the place it still had a massive able-bodied deficit. That's why they paid me a decent wage to hang out for so long as an independent agent. I was paid out of department funds and operated outside the realm of the hospital hierarchy. (I had no problem being her lap dog as she was a cool master who gave me a very pretty collar.)
At her suggestion we concocted a fairly kooky new-grad boot camp. Willing volunteers received a fat incentive including CC differential and weekend pay etc. We interviewed a crapload of new AD RNs. We needed nine and took twelve with a three month orientation. The interview included a good bit of basic knowledge around rhythm strips and case presentations. More importantly it sought to define the candidate's philosophy regarding what is important in the care of the ED pt. The gold ring was given to those kidz that in some form described rapidly completing the plan of care as directed by the EDP. There was a lot of tooth pulling to get that out.
The three month "internship" had an extremely steep learning curve. Precepted shifts were only part of the package. There was a good bit of reading assigned (TNCC, ATLS, Cards chapters etc.)
This'll get even more boring if I detail the whole program, but at the end we had 8 keepers. These folks still had a lot of "judgement seasoning" to develop, but they were stinkin' gurus at moving the meat. Why? Sure they were good nurses who knew how to take care of folks. But, more to the focus of the ED, it was b/c they were decently trained at learning what really counts in a dept. That is, seeing an order-doing the order-communicating to the doc. That's it.
Med-surg, ICU, step-down, OB etc. all have a very different auto-pilot set by orders practice. The ED, by contrast, requires immediate performance and communication. This is not taught in nursing school. As nurses today are taught, the physician's "collaboration" in care is tolerated. That doesn't work in this specialty.
EM is one of the very few places where nurses and docs work together in real time. It's why I became an ED nurse and why I am hoping to have a spot in an EM residency here in 7 months.
To the issue at hand-How to correct the lack of good, homegrown ED nurses-
I believe that we as present and hopeful future EMPs play a role. I know very few nurse-nasty EM docs. They get selected out pretty quick. It's not our attitude. It is a lack of adminstrative oversight.
Out of ~11 facilities I worked at only two where the physician group's judgement had any bearing on who was going to be joining the team. Why?
1. Docs are not paid to vet nurses. Without some incentive, they feel no obligation to raise a voice.
2. It's messy. As medicine has moved to the rearmost breast, we have disengaged from the seething hill of hospital hierarchy. Yes, there is no pain involved in walking past the door behind which is the dreaded management meeting. But, that pain is just shifted to waiting 2 hours for an IV start or a blood draw.
3. We don't demand it.
#3 is directed at docB. I am a newbie to doctorland. From lurking for years on this board it seems to me like you have significant insight into how group-hospital dynamics function. Is it complete fantasy for a group to have a rider placed on contracts in which certain members of the group can be assigned some say in what nurses get kept after their trial periods? couldn't these same docs encourage carrots for those RNs they regard as doing the job well? Is it out of the question for groups to have some incentive reward for those nurses who make the most difference in a department?
Perhaps if these ideas were not simply fantasy, but a way for EMPs to regain some say in departments, we could discuss more citizens SOCMOBing and get on to the shaggy dog thread.
Or, we could just keep griping and poking at that boil.
