My best friend Reid made an interesting point the other day. “I have,” she said, “an alphabet soup of certifications. I have ACLS. I have BCLS. I have TNCC. I have ENPC. I have pieces of paper that tell me I can run traumas and defibrillate people. I have critical care courses up the wazoo. Some of these things I paid for on my own, because I wanted to improve my practice and give better patient care. So,” she concluded,”why the hell am I being paid the same as the med-surg nurse upstairs who has none of these?”
Good question. In Ontario, at least, the nurses union — ONA — has decreed that all nurses are equally qualified to work in every setting, and are interchangeable in terms of duty and practice. It’s a very pretty idea, but theoretically and practically speaking, it’s rubbish. Floating a med-surg nurse to the ED is a College of Nurses complaint waiting to happen. It’s dangerous for both patients and for nurses. Even ICU nurses have trouble coping in the ED setting (but for some reason, in my experience, the reverse isn’t as nearly as true.) The difference, I would argue, is not in the provision of basic nursing care or even the intent to provide good patient care but in skill sets, critical thinking and training. Emergency nursing, like any other high-acuity nursing speciality, requires considerable initial and ongoing education, but also, it’s important to remember, has a much higher standard of practice and responsibilities.
Further the lack of any differential in pay according to training/certifications acts as a disincentive for nurses to continue their ongoing education. For example, the fee for the Trauma Nursing Core Course (TNCC) is sometimes, but not always, paid for by hospitals, but in any case, there is no real recognition of nurses completing the certification. So apart from professional pride, why do it? Appeals to professionalism are a bit naïve and idealistic, and only go so far. If you can encourage any nurse to upgrade their skills and education by offering pay differentials, I would be for it. Better educated nurses with better skills and better critical thinking skills means better patient care, better outcomes and ultimately, higher nursing morale. The myth that all nurses are created — and remain — equal has to go.