NURSES’ NOTES

A Sentence of aving finally accessed IMAGE’S H pages, printwise, this writer is be-

hooved to prioritize her objectives so that the conceptualizations contained herein will be translucently articulated and the parameters of the discourse strictly delimited in order to maximally impact the perusers.

And if you lasted all the way through that sentence, you are to be com- mended, congratulation-wise, for your patience and fortitude. If you saw noth- ing wrong with it and had no trouble understanding it, I worry about you.

Actually, my only conceptualization is to say, “Isn’t that an awful way to write!” And my only objective is to plead with you, in the name of all edi- tors and readers, (‘Please don’t write like that.” My parameters are pretty narrow too; IMAGE’S editor didn’t ask me to write an essay, much less a ser- mon. All she wanted were a few words (my definition of “few” has always been flexible) to serve as a sort of intro- duction to the sentences below, which I culled from many years of manuscript

DIALOGUE

Sentences reading.

So you’ve had the introduction; now here are the sentences. I didn’t make any of them up, honest. Nurses really wrote them and submitted them for oth- er nurses to read. None of them was ever printed in its original form, save for a few over which I had no control, but I preserved them in my little cham- ber of horrors. In the meantime I’m waiting in the bar for those faculty members who, o n e a u t h o r wrote, “made their decisions in all sobriety.”

From the patient’s point of view and per- spective, input over theyears has been consis- tently of a positivistic nature.

The patient’s elimination is a major nurs- ing responsibility.

A course in ethics confronts the problematic situation of optimal curriculum placement for muximization of importance.

The recommendations fell on ears that were disinclined to implement them.

Having decided upon the underlying themes ofthe conceptual framework, the cum;- ulum revision was approaching completion and operationalization.

To the Editor: I was strangely uncomfortable after reading ‘‘Nursing shortage

in transition” (Prescott, Dennis, Creasia, & Bowen, IMAGE, 17,4, 1985). Temporary nursing shortages are important problems in the delivery of hospital care. Some of the categories of shortage overlapped, but that wasn’t the source of the discomfort. The pri- mary failure of the piece is not having delivered what was prom- ised: “how hospitals and nurses can deal with the problem.”

The discussion in the last part of the paper is based on the “devil theory” of management. It is not quite clear whether the hospital itself or the hospital administrator or fiscal officer is the devil. Whoever it is, it is this devil that is responsible for the “pre- dominant approach to have existing staff nurses work harder. ” The author notes that “typically administrators and fiscal officers not involved in patient care make decisions about cost-saving mea- sures, with consequences for nursing practice.” So the final rec- ommendation is: “the inclusion of nurses in major decisions about where and how to achieve cost savings would help to iden- tify the probable impact of proposed budget cuts on clinical service delivery. It would also help to minimize situations in which nurses work short.”

The basic question here is control of professional resources. The

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Any living person, whaicver thkr age, must present a tickct to ria’e the bus.

The most important criteria for admission is the student’s high school record.

It must be kept in mind that the needs of clients, in terms of the latter’s verbalization of their goals, are of the utmost importance for the nurse to consider in the detennination of t h plan of care.

The nurse introduced the patient to the sy- ringe and insulin.

Regrdfully, puzv~yors of health care only rarely emit positive, meanin$ul, informative and insightful feedback to populations of a subdominant culture.

There are various kinds of learning experi- ences which have been designed, curric- ulumwise, to fmilitate the achievement of the behavioral objectives of the course.

A manuscript should have some reason given for being @ected,

Edith P. Lewis, R.N., M.N. Editorialmriting Consultant

Southbury, Connecticut

PAT LEWIS has probably reviewed more manuscripts than any other living nurse as editor of Nursing Research, American Journal of Nursing and Nursing Outlook, and as reviewer for, among others, IMAGE.

policy position of the American Nurses Association is not cited. The ANA testimony before the Institute of Medicines’ National Committee for the Study of Nursing and Nursing Education addressed this lack of control by saying that the ability of nurses to have an impact on the health care system is inextricably bound to securing third-party reimbursement for their services. Three changes were recommended: (a) fee-for-service payment for nurs- ing services, (b) reimbursement from government and private third-party payers for nursing care, and (c) the costing out of nurs- ing services and subsequent reallocation of all revenues for nursing services. If one really wants to deal with the issue of control over professional resources, the only way is to wrest control of the money generated by those resources.

Decisions on staffing levels are then in the hands of nursing administrators who are spending what they are earning rather than negotiating for a piece of a total budget that they can never control.

John D. Thompson, R.N., M.S. Professor of Public Health and Nursing Administration Yale University

IMAGE: JoumaZ of Nursing &hoZarxh$