Where's the Love for the Bedside Nurse?

I’ve often been a proponent of good nursing education. I didn’t object when the bar was raised and the BSN became entry level in many nursing fields. More and more though, I am hearing a pretty strong push for RNs to pursue their Master's degree. And now, there is word that some nurse practitioner roles will require a PhD by 2015. This worries me.

Here’s why: We all agree that the BSN nurse has a greater expanse of knowledge at his/her disposal for bedside care. But if we push nurses to pursue a Master's, who is going to work at the bedside?

You certainly can’t expect a nurse to put all of that time, hard work, and money into pursuing a degree, but keep a position on the floor that will probably never provide much return on their investment. Or worse, we say that entry level for nursing should be the BSN, but once a nurse starts advancing their education, we replace them with a cheaper, less trained medical assistant.

Get more education, but do the same job? Go to school for your PhD? I understand the importance of advancing the nursing profession; I understand the place of the nurse practitioner, the nurse educator, the nurse manager. What I don’t understand is the place of the floor nurse in all of this high pressure for advancement. The floor nurse is the unsung hero.

It’s the bedside nursing judgment, discharge planning, and patient education that make an enormous difference in healthcare. Yet, we're pushing for them to be something more or different. Where’s the love for the bedside nurse?

In the hospital, most patients don’t know who the nurse practitioner is, but they know the nurse who checks on them, gives them their medication, and does the things they need. They know them by name.

In my view, being a skilled bedside nurse -- keeping your knowledge up to date and your skills top notch -- is just as important as pursuing another degree. I’d just like to hear more cheering for these nurses. You hear about the nursing shortage, and yet, the profession is pushing for nurses to shift away from the bedside.

Aren’t we contributing to the nursing shortage by pressuring nurses to get advanced degrees that lead to positions away from the hospital oncology units? I went back for my BSN, because despite my experience, I found that on paper I no longer qualified for my own job (a job that, incidentally, I was way better at than the recent BSN graduates). How long will it be before I don’t qualify again? And again?

A recent survey demonstrated that most nurses report being happy where they are. In fact, 76 percent of the nurses surveyed reported being either very satisfied or satisfied with their job, and 49 percent planned to keep their current job. Only 13 percent planned to seek a leadership role, 11 percent wanted to return to school, 10 percent wanted to teach, and 9 percent would like to become a nurse practitioner.

So, despite the push to go back for a Master’s degree, most nurses are happy where they are. Maybe the future of nursing isn’t so scary -- oh, wait a minute, 72 percent of the nurses surveyed reported fear for their jobs due to increased workloads, nursing shortages, risk of litigation, increased risk of medication errors, and the risk of being replaced by lower-paid medical personnel. Younger nurses were the least satisfied with their jobs.

Are we forcing nurses who are happy with their careers to change their path? How long before nursing becomes management top-heavy? Don’t get me wrong, the healthcare system needs advanced practice nurses, but we also need to place some value on the bedside nurse, who is, after all, the backbone of the hospital.