Here’s how I see nursing in the future: Instead of working for hospitals, nurses will work for organizations similar to travel nursing companies, or perhaps nursing professional bodies. Nurses are commissioned by hospitals (not doctors…as that would make doctors our direct bosses…there’s enough issues there already without making it worse) to care for patients. The nurses would be paid PER patient, not per hour, with every additional patient costing the hospital more So, for example, I would be paid $100 per day for one patient, $210 for two patients, $330 for three patients, $460 for four patients. Each additional patient would be $200…so a six patient load would cost the hospital $860 per day. In this sense, I could choose to carry any sized patient load I desire. If I only want one patient, sure! If I want six, sure! I get a lot more money for extra patients due to the increased stress it causes. Plus, since each extra patient costs the hospital more and more, it would create desperation for them to keep patient loads to a minimum.

To carry this further, I think there should be a primary nurse philosophy around these patients. What I mean is that the Registered Nurse is there from Mon-Fri days and works in more of an organizational capacity; coordinating care, teaching, assessing, etc. Much of the hands-on work is performed by students, NAs, and LPNs (who’s scope of practice would be advanced further in order to accomodate the RN’s new job description).

A day would look like this:

07:00 - Review patient’s current blood work, care incidents from evening/nights, examining vital signs, assessments, charting from last 24 hours. Preparing a tentative plan of action for the day.

07:30 - Rounds! Visit each patient, spending as much time as possible with each (meaning hours if necessary!). A full head-to-toe assessment, assist with hands on tasks if necessary (usually in the capacity of teaching staff/students/patients), psychosocial analysis, discharge planning, emergent care needs, family discussion.

09:30 - Meet with doctors (or review their charting), respiratory therapy, physiotherapy, social work etc. etc. etc. regarding patients. From these meetings, care needs are further developed.

12:00 - Lunch

13:00 - Meet briefly with LPNs/NAs/students to discuss emergent care needs, and any changes to care plans as per meetings with patients and interdisciplanary team.

14:00 - Using a formal system, communicate a detailed plan of action for patients that focuses on rehabilitation and works toward progressing the patient to discharge.

15:00 - We can go home, but we each have offices (cubicles?) onsite or offsite that we can go to if we need to do research, have meetings, etc. etc. There are secretaries that keep track of our patient loads and bill the hospitals for us. We can also take this opportunity to follow up on patients who have gone home, answer voice mails/emails etc.

Learning is very much encouraged in these offices. Perhaps we have a weekly patient presentation where everyone presents their patients to the group and ideas are passed around and formed. Perhaps someone just conducted research or read an article that would benefit your patient.

During the day, we are available at all times to teach students/LPNs/NAs/patients procedures. We are available at all times to see our patients regarding psychosocial needs. We are available at all times for emergencies.

In addition, there are RNs that are specialists in being charge nurses. They work days/evenings/nights in a charge capacity. Much as they do now, they are the traffic controllers of the unit. In the evening/night, they are similarly available for ermergencies/psychosocial issues/teaching. They also act as a resource and specialist in the practical aspects of nursing and can offer advice. Some units may need two charge nurses at a time. They are paid a VERY nice salary (i.e. $200,000 per year or more). They are the cream of the crop and have experience up the wazoo! Perhaps they have taken a certification course to become a charge nurse…it would be a specialty. Nurses would strive toward being a charge nurse as it is the most revered, and highest position they can hold.

Our days are very flexible and do not necessarily have to go as mentioned above. If you are unavailable to see your patients until afternoon due to meetings or conferences, that’s OK! The charge nurse is there in case of emergencies. Our days flow as needed, and as per our necessary schedule. We are professionals, and we are given the freedom to work as though we were!

Our days are a bit longer, but they are more flexible, they are more professional, we’re better paid, we’re treated with respect, we keep regular office hours, we work TO OUR FULL SCOPE OF PRACTICE!