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As my career in nursing has progressed, I have enjoyed
the exploration of historical nursing. I have been enlightened
by reading about nursing in its beginnings and throughout
the 20th century. This has become a hobby of mine. My
mom, who earned her BSN from the University of Colorado
in 1949, as well as other friends and colleagues, have
helped me amass boxes of nursing memorabilia that I
would like to direct to a "National Museum of Nursing"
(as soon as one exists).
Through the years, it has been interesting to look
at all the changes that have confronted health care.
Yet nursing has continued to hold on to some things
that do not necessarily serve us well. I look at how
we practice and manage nursing today and realize that
some aspects about nursing are long overdue for the
discard box.
For example, can we please ditch the old 7 a.m., 3
p.m. and 11 p.m. shift divisions? Even when we started
with 12-hour shifts, we just fit them into the existing
scheduling pattern beginning at 7 a.m. As the issues
of an aging nursing workforce are acknowledged, I have
been giving this considerable thought. What if we moved
the "day" shift to 6 a.m., then scheduled
four-hour blocks around the clock? Nurses could work
variable shifts from four to 12 hours in length. Staffing
levels could be adjusted more frequently to respond
to patient scheduling of surgery and procedures.
Computers could coordinate the meshing of 8s and 12s
easily, and nurses could more easily blend their work
schedules with parenting and the demands of life. Shift
differentials could be attached to the four-hour blocks
based on demand. If you want to work between 10 a.m.
and 2 p.m., fine, we'd love to have you. If you want
to work 2 to 6 a.m., we will make it worth your while.
The bottom line is that it seems to make more sense
and be more responsive to the needs of nurses today.
Here's another one: We could make a lot more room for
students in our clinical settings if we did not structure
student rotations in such a rigid manner. Patients theoretically
are available to students 24 hours a day, seven days
a week. Yes, even Mondays during faculty meetings. Perhaps
a week or two of continuous clinicals makes more sense
than one or two four- to six-hour clinical visits a
week in the span of five to eight weeks. We need to
find ways for students to taste real nursing long before
they don a cap and gown.
OK, now this may get a few people's dander up, but
how about you and 20 or 30 other nurses forming a professional
corporation to create your own profit-sharing plan and
a customized benefit and retirement plan? Create a compensation
program for you and your partners, then find the best
hospital at which you would like to work. Negotiate
yourselves a great deal with financial incentives for
quality and service. This means you cut out the middle
person (union or registry) and simply make your own
deal. While perhaps this idea is not for every nurse,
I can think of more than a few who would relish the
opportunity.
Even though you may think I have lost my mind, my point
here is that there is an urgent need for us to look
at our options differently and create our own future.
Do not let our old habits and rituals keep us from exploring
the future. Do not be one who says, "Oh, we couldn't
do that" or "That wouldn't work."
The real question is, why not?
Discuss this and other topics with your colleagues
at www.nurseweek.com/rnvillage.
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