Reclaiming our 'nursing fundamentals'.

A t a 50th wedding anniversary celebration for my former nursing instructor, other faculty members told me their horror stories of recent hospitalizations. Oral care wasn't offered, they weren't turned and repositioned, and nobody checked to ensure their nutritional needs were met after procedures. I was dismayed. After 25 years of hands-on nursing , I had earned my master's degree in nursing education in order to emulate these role models. I assured them that I still teach the basics—bed baths, oral care, back rubs, positioning, and range-of-motion exercises—and we mourned the lack of such fundamentals in many nursing curricula. I've taught entry-level nursing in baccalaureate and associate's degree programs and sensed that some faculty see fundamentals as glorified training for certified nursing assistants (CNAs). I've felt their disrespect, as if they think that teaching fundamentals is less complex, and therefore less important, than medical–surgical courses. But I think we lack a clear vision of what nursing fundamentals should be. As nursing curricula expand, many have deemphasized procedures focusing on patients' comfort. Rather, they stress physical assessment, the nursing process, and nursing diagnosis. Textbooks now emphasize critical thinking, developmental stages, and cultural competency, as well as technical skills such as care of ivs and chest tubes, which nursing faculty prefer to teach, thinking it helps students to feel " like nurses. " In reading these textbooks , you wouldn't know that nursing was once synonymous with performing basic tasks of hygiene and personal care for hospitalized patients. Meanwhile, in the name of efficiency, we sacrifice our ability to keep patients clean, comfortable , fed, hydrated, warm, and pain free. Many programs have limited nursing skills laboratory time. Some might eliminate lessons in bed bath and bed making: my graduate students have said that many hospitals cut back by providing premoistened bath packages and not changing linens daily. CNAs who perform fundamental tasks are valuable assets, but RNs must train and supervise them. How can we ensure that excellent care is given if we don't learn and practice these skills ourselves? I recently taught CNAs in an associate's degree nursing program; they took a patient's blood pressure in six different ways. Bedside technology can enhance patients' comfort, but I wonder whether tending to the machines adds to nurses' and We lack a clear vision of what nursing fundamentals should be. patients' stress level. And doesn't relying only on technology limit us? Many …