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Leanne Grace

Student Registered Nurse,

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What is the Public perception on the role of the modern nurse?

Nurses roles and our scope of practice has been dramatically changing in terms of modern nursing. We have many different registration levels and standards. We as the nurse have an idea of how we think our patients perceive us, but is this actually the way people feel about the care they have received? Especially to those of an older generation, have you seen a change in the care provided by nursing staff in your lifetime? And what role do you think the nurse plays within the health care team? Where do you think the nurses job ends and where for example the doctors job begins. Now I don't want to give away too much information because I wish to know what your personal perceptions are!

I am from Australia so my understandings are based on our system of care and on how things work here. But I am also very interested to here any experiences about care in other countries. Similar changes have been experienced in most developed areas in relation to nursing.

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  • Aug 3 2013: I have had been unfortunate enough to require hospitalisation a few times in the last few years through unrelated instances. I have been fortunate enough to be cared for by the most diligent, mindful, empathetic and reassuring medical staff, but equally I have had experience of those for whom it seems they are not aware of the importance of basic care or empathy with regards to patients.

    The cause of this can be due to a whole number of different influences and combinations there of. The level at which an individual takes their role on, be it environmental (I am X because I need to be for a job/income) or all the way through to identity (I do X because it is an honest expression of my truest self) can potentially be a dramatic influence on the level of diligence given to the role.

    The level to which the ethos at the heart of any organisation is a true representation of the culture ie the values which those predominately that form that culture, are reflected in the ethos whole heartily. There is also a requirement that this ethos is clearly seen in the most simple of tasks. As soon as a level of task, which is in actuality contributing to the implementation of the ethos, is not seen as having a level of complexity as to be indicative of the higher value elements of the ethos, people can be dismissive of those tasks and what should be the foundation of a culture to achieve the ethos, can be view as not having relevance. It is the responsibility of everyone, especially those specifically charged with implementing the strategic level so fth ethos, to recognise the value of all tasks in their contribution.


    With Genuine Interest

    Paul
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    Aug 5 2013: Great question. I remember this article from 2002 http://www.wilkesbeacon.com/opinion/the-changing-role-of-the-modern-nurse-1.1153866. It seems that they were spot on with the modern nurse.
  • Aug 3 2013: Hi Leanne,
    Maybe this is not the answer you're looking for, but I thought I'd still comment. Im a doctor in India. The topic rings bells for me because I've been thinking around the same lines. This is not about perception, but rather what I think the role of nurses should be in modern healthcare.

    We have this typical hierarchy in hospitals you would have noticed which goes like: HOD>Senior doctor>junior doctor>Head nurse>nurse>paramedical staff. This is a really archaic system in my mind. there is a spectrum in all of these going from Good to Bad. The patients(and a lot of staff) generally have a view as : doctor - decision maker, Nurse - the caretaker. you may also notice that mostly duties are are divided that way.

    how i think it should be(for nurses) : if a nurse has been trained and is aware of the correct procedures, their complications and how to manage those, they should be allowed to do those procedures(under observation at first) simply because that would increase the efficiency of the whole team. In emergencies, in case of unavailability of a doctor the nurse should have enough training and expertise to be able to handle it precisely. As a team the doctor and the nurse should be able to double check any parameters that the other checks for better quality control. switching a nurse from a more passive role in the treatment to a more active one, where he/she is able to manage most of the common and simple diseases. the hierarchy should remain because its based on knowledge and experience of a person, however the roles in all of those should overlap considerably.

    there are legal issues of course, and each country has its own guidelines on what should and shouldnt be done by a nurse, so these may vary. but everybody personalises :) so it depends on you and your doctor to figure it out.
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    Jul 31 2013: I am not clear on the roles of people other than the doctor on the health care team. There are nurses that seem to do what nurses have always done, except that they also input data into the computer. Some units in addition have nurse practitioners while others have Physician assistants. I do not know the distinction between these categories.

    The PAs are equipped to handle very routine complaints, but one would go to a doctor for something that demanded real diagnostic skill.

    I don't know what sort of credential the people have who give shots, take blood, remove stitches, and so forth.
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      Aug 1 2013: In Australia it is not uncommon for vaccinations to be given by nurses who have been trained, also taking blood is a post grad course and removing stitches is something we learn in our practical classes at uni.

      Nurse practitioners have more prescribing power then a Registered nurse and can essentially initiate more medications and treatments without a doctors order.

      Physician assistant is not a term I have heard used where I have been, so I'm not sure what the distinction is but I imagine they work underneath the guidance of a medical doctor.

      As for the differences in nursing, we are now far more educated and able to undertake more complex procedures, catheter insertion, blood drawing, Removal of drains and that kind of thin that previously would have been done by the doctor. Mostly more of a critical thinking profession rather then a yes doctor ill look after your patient and make sure they get to the toilet. Of course we do all that and more now!
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        Aug 1 2013: Here you don't need to be either a nurse or doctor to give vaccines. Medical assistants, who do administrative and clinical tasks for a health team, are the ones perhaps most likely to give shots and draw blood where I live. I have noticed recently that some doctors are fine with people's removing their own stitches.

        You are right that a physicians assistant is formally speaking under the supervision of a doctor, but they do simple procedures without the doctor in the room, diagnose simple things without consultation, and so forth.
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    Jul 31 2013: Oh, I wanted to also share this talk with you.
    It's by a doctor, and, I think you will enjoy it very much.

    http://www.ted.com/talks/abraham_verghese_a_doctor_s_touch.html
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    Jul 31 2013: Hi Leanne, this is a very nice topic of conversation.

    I think that people have changed, and that is affecting all professions.

    What I have seen locally is a lot of nurses being recruited from Asia to come and live and work here.
    There is a huge shortage.

    Sometimes, there is a language barrier.
    I have also noticed lack of training....especially people skills.
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      Aug 1 2013: You will find the language barrier is pretty common everywhere, and the universities do actually make an effort to help these students out (at least the on I attend does!) and if they cannot communicate effectively then this is something they can be stopped progressing through their degree for. Nurses who immigrate to Australia have to pass certain tests and have their qualifications recognised.

      The problem with nursing is some people become very task orientated, the person becomes not so much a person but a series of tasks they have to complete, Someone who is delivering holistic care will realise that half the care of the patient is keeping them calm and finding out what they actually need/want.

      Have you had some less then ideal experiences in communicating?

      Thank you for the link, I will be sure to watch it!
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        Aug 1 2013: You have to bring in nurses from overseas as well?
        Wow, I just thought it was the US that had this problem of nursing shortage.

        And, I think that the point you make of being task oriented is right on the money.
        But, again, it is not mutually exclusive to the nursing profession.

        I often visit hospitals because of elderly family members, and also lots of elderly in our congregation.
        So I will find myself translating a lot of times for another patient, or for the person I am visiting.

        It is kind of scary to me....I think, wow, what if I wasn't here?
        But I'm sure I'm overreacting, or at least I hope so.

        And I think you will enjoy the talk. Especially with what you have just shared with me.

        I wish I had a friend that was a nurse, so that I could call her up and have her join this conversation.
        But I don't :(

        You take care Leanne.
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          Aug 1 2013: Well Australia is currently not only faced with a shortage of nurses but a shortage of funding for nursing posistions with many people having jobs cut over the last 12 months. As a nursing student that will graduate mid next year it is a concern that finding a job would be tough. On entrance to this degree we were all told due to the shortage we would walk into posistions.

          In Australia if we have a person whose first language is something other then English they will be appointed a translator that will come in and help with ensuring proper patient understanding and that we ensure informed consent.

          There are many ways to communicate and it is more then just what we say. So long as enough understanding is gathered to be safe.

          I did enjoy the talk, I watched it this morning and I couldn't agree more. The concept of touch is something that isnt lost on nurses. We afterall touch our patients every few hours at least to do their routine observations, assist them in their daily activities, as well as thorough nursing assessment. I have seen this used in practice and it is all about being appropreate and providing comfort and assurance to our patients.

          It is primarly the experience of the patients that I am curious about, or perhaps that of the nurse that was educated in the hospital setting observing modern nurses. It is interesting how being unwell also experiences the perception of people. Inadequate pain management causes people to be cranky and intolerant. And if you manage that persons pain then they become alot easier to communicate with and provide their other needs. Though sometimes the difficulty is determining that the patient has pain, some of the older generation don't ike to be a bother so you really have to have a good patient nurse relationship to meet their needs and find out their true pain level. The nurse is the flag raiser for further treatment, the better our relation the better treatment options we can provide.
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        Aug 1 2013: Your last paragraph shows that you have much insight, especially into geriatric care.

        People in pain are a challenge, it takes a lot of understanding and patience, along with humor.

        In June I had to visit the ER due to a fall. Next to me there was an elderly woman who had fallen and broken her ankle in three places. The nurse who put her in a cast was so funny, and he managed that woman's complaints in such a way that I was left with a deep sense of admiration for his skills..............it's a lot like being a mom, and a teacher..........you must use a bit of psychology, and like I said, humor doesn't hurt either.

        How could there be a shortage of funding for nursing staff?

        Are the hospitals in financial trouble? And if so, why?
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          Aug 1 2013: I don't really want to turn this into a political conversation; but thats what it is! Politicians here have cut health care funding and as a result have also cut nursing jobs. its Mind boggeling. We had a Shortage before this happened, and now its getting worse. The real problem of it is we have an aging population so our clinically skilled nurses are retiring and more will soon and new graduates need time to get ready for those roles and experience. A new graduate can't just fill the role of a nurse that has been working for 20+ years in her speciality. There has been alot more then what this news article presents but itl give you a pertty good picture of what is going on...

          http://www.couriermail.com.au/news/queensland/campbell-newmans-target-of-14000-jobs-does-not-include-health-workers-hit-by-commonwealth-funding-cuts/story-e6freoof-1226561233085

          Because its expensive. Health is always a big election issue and we are due to go to a federal election soon. The cost of keeping one patient in a bed is staggering its more then 1000 for a single day. Its pretty complicated. Some have suggested that privitisation of the system would help, but I think that would just make it less accessable. I think the private system might be a bit better at budgeting but ultimately health care shouldn't be about finances. Because without proper healthcare you have so many other issues that arsie as a result.
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        Aug 1 2013: Oh boy Leanne, are you sure you are in Australia, and not the US?

        It sounds like the politicians over there are doing the same thing as the ones over here.

        It seems everywhere in the world there are just too many elderly ones, and the systems that are in place are about to burst......

        But I am certain that in the long run you will be ok, and that you will find a position in a health care facility. Keep a positive attitude. :)

        I will read the article you provided. Thank you.

        In the meantime, did you see the TED talk yesterday about people "volunteering" to drive motorcycle ambulances around cities to save lives and help bridge the time that passes between an emergency call going out, and an ambulance arriving? It was quite a presentation.

        I'm signing off now....it is a bit late.