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From: "Howard McCollister" <>
Subject: Re: RN, LPN, NP, et al
Date: 22 Sep 2003 16:13:05 -0500
Message-ID: <3f6f652e$0$48250$>

"Candide" <> wrote in message
> X-No-archive: yes
> "Earle Horton" <> wrote in
> message news:bknbha$3m9jj$
> > "Howard McCollister" <> wrote in message
> > news:3f6f0bbc$0$42168$
> > --snip--
> > >
> > > I swear, the Nursing profession has to be the most mis-managed,
> > > poorly organized, lack-of-foresight profession in this country.
> > >
> > ;o)
> >
> > Earle
> Hmm, will have to take exception to some of those statements Earle.
> "Mis-managed" by whom? Nurses or the institutions that employ them? Much
> of what effects nursing is totally out of their hands. From being billed
> as a "service" just like housekeeping to the scope of their practice.
> "Poorly organized"? Perhaps? But again by which standards? Nursing by
> nature has not been and organized "union" type profession. Indeed
> neither was teaching (the other traditionally female profession ghetto)
> , until municipal teachers started organizing. Lay teachers in religious
> schools have only recently started organising as they now make up the
> large majority of staff, replacing religious.
> "Lack of foresight"? Well it is hard to plan when the floor keeps
> getting pulled out from beneath you. A dwindling young population, a
> dwindling number of young women (sorry Earle the profession is still
> about 90% women) entering the profession  and again much what effects
> nursing happens "TO" it.
> During the 80's and 90's when managed care was sweeping the country and
> hospitals were chucking out experienced RN's faster than you could say
> "Florence Nightingale", alarms did sound in some quarters, but by and
> large nobody listened. Now we are paying for that mistake as an entire
> generation of good nurses, who with their experience by the way would
> have made excellent instructors, are gone.
> The thing is nothing ever really changes; so what,a good many nurses
> wonder is the point of it all?

No, I'm not talking about unions. Nursing is mismanaged by the organizations
that control nursing education and distribution in the US ie: the AACN, the
ANA, the AACN, the AORN, the AAOHN...virtually all of the nursing
organizations that are supposed to be lobbying on behalf of nursing
education and occupational responsibility, that are supposed to be lobbying
the various states and providing input into their licensing laws, that
literally determine what their job responsibilities will be in the various
health institution venues where they are employed. "Out of their hands"?
Yes, but only because the people who are supposed to be leading the way for
nursing have no imagination. Yes they have been getting chucked out right
and left, because these organizations didn't have the balls or the foresight
or the imagination to secure a more valuable role in health care for them.
I'm not talking about the power of collective bargaining, I'm talking about
the power that comes from being a crucial, irreplaceable part of the health
care decision-making process.

The entire concept of Physician Assistant came about because these various
nursing organizations determined that they didn't want Registered Nurses in
such a critical decision-making role. They would rather that RNs be
handmaidens instead of physician extenders. When they finally woke up and
changed their minds, they found their newly created Nurse Practicioner
program vastly overrun by the Physician's Assistant programs.

So here we are now, with BSN Registered Nurses little more than hand-maidens
to the doctors. Intelligent men and women who get little job satisfaction,
make little input into patient care decision-making and still have to make
beds and empty bed-pans in many institutions. Job satisfaction is at an
all-time low, and it's reflected by the plummetting numbers of available
nurses. And it's because of the lack of imagination of these  nursing organi
zations that they couldn't or wouldn't approach state licensing boards about
expanded roles for nurses, nor nursing educational institutions about
expanding their educational opportunities in preparation for an expanded
role as a member of the health care team.

Of all of the nursing specialty organizations, only the AANA (American
Association of Nurse Anesthetists) has any balls. They have stood toe-to-toe
against the American Society of Anesthesiology and the American Medical
Association and withstood their best shots. They are an admirably formidable
force that has made very effective input into CRNA training, and used that
curriculum to lobby state legislatures and licensing boards into broad
licensing priveleges that makes them effective practicioners. You won't ever
see a CRNA emptying a bed pan. If all of those other organizations took a
lesson, Registered Nurses would be a far more effective part of the health
care team.


From: (Steve Harris
Subject: Re: Death by Medicine
Date: 11 Oct 2004 12:42:31 -0700
Message-ID: <> (DRCEEPHD) wrote in message

> >Subject: Re: Death by Medicine
> >From: Aristotle
> >Date: 10/9/04 5:38 PM Pacific Daylight Time
> >Message-id: <>
> Your comment about nurses is way off the mark.
> If a nurse dares to try and think, if the nurse dares to question the
> doctor or his orders, the nurse can be and often is fired by the holy
> high priest of medicine, the doctor.
> The fault is with the docs and not the nurses.
> DrC PhD.


Nurses work for hospitals and hospital management corporations.
Hospital nurses do not, in general, work for doctors. And certainly
not for the attending physicians in hospitals (who may or may not work
for the same corporation the nurses do). Nurses have a pretty strong
union, and it's pretty difficult to get one fired. Not that doctors
usually are interested in getting nurses fired. You need to understand
that just about any initiative or thinking a nurse does when it comes
to patient care in a hospital helps or takes some load off the doctor.
Or decreases some doctors legal exposure. Doctors are almost
universally glad to see nurses observe and think. Don't imagine
otherwise. Cee, Ph.D., you haven't BEEN there.

The point about many nurses not having the skills to do good patient
assementment is valid as far as it goes. The problem is that patient
assessment is one of the hardest jobs in medicine, and doctors fail at
it all the time, too. Shift-work nurses miss some of the continuity of
care that the attending usually has. Also, it's hardly reasonable to
expect nurses to have great clinical diagnostic skills. I'm happy if
nurses can be taught to report when patients quit eating or drinking,
have a big change in mental status or mobility, start having odd vital
signs, and just plain look bad. You'd be surprised how often they
can't. Doctors themselves miss these simple things often enough,
especially when they don't know the patient's various "baseline"
states well. Whether or not this can be counted as "iatrogenesis"
depends on your standards. My feeling is that the medical care system
isn't really willing to pay the amount of money it would take for a
Marcus Welby to attend each and every patient 24/7.

Finally, I need to reemphasize the fact that these studies of numbers
of patients supposedly killed by medical mistakes, are simply guesses.
They come from taking the death rate in ill patient populations which
have suffered medical mistakes, and assuming that 100% of the deaths
are due to the mistakes. Which is equivalent to assuming that when
mistakes aren't made, ill hospital patients are immortal. We lack a
control group, and until we get one, we can't tell what % of deaths to
attribute to mistakes.

Finally, there's another important control we need, and that's a
non-treatment control. Some treatment situations are so complicated
that it may impossible to avoid mistakes. In that case the question we
need to ask is: which is more dangerous-- treating with mistakes we
know we're going to make, or not treating at all? For example, we know
chemotherapy and surgery kill some fraction of people who have it, but
we continue to use both because the results where we do nothing, are


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