A nurse is a nurse is a nurse... not!

  1. Nurses hold many different roles. Saying you're a nurse is like saying you're teacher. Is that a pre-school teacher? A college professor? A senior center arts instructor? Do you teach ESL or advanced physics? There is no one certification that qualifies a "teacher" unlike the "RN" licensure.

    So maybe the different kinds of nursing ought to have their own separate training programs. Maybe they train together the first term or take some classes together, but otherwise they are separate degrees. The different areas of nursing would then have to more clearly define themselves publicly and within itself as a profession. Acute care nursing education would include most bedside hospital nursing. This nursing involves fairly quick patient turnover and immediate physiologic monitoring and intervention. Long term care nursing education could include training for nursing homes, long term inpatient rehab, etc. They'd learn to deal with a larger patient load and the type of charting for this type of environment. More emphasis would be placed on preventing patient deterioration. Community health nursing education then would focus on public health and perhaps generic school health. If a nurse wanted to change fields, they could take a shorter course to qualify for a different field of nursing.

    Home health needs would dictate what type of nurse was called for... short term home chemo or a complicated home hospice patient might call for an acute care nurse whereas a more stable or less acute home patient might call for a LTC nurse.

    If a school had particularly complex patients, they might need to hire an LTC nurse familiar with chronic child health conditions in addition to a community health nurse who would cover the healthy child population.

    There are lots unique areas of nursing that this doesn't cover and I'm sure there are tons of flaws in my quick sketch but what do you think of the general concept?
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  2. 19 Comments

  3. by   Tweety
    I think a generalized nursing education that teaches assessment skills, and has clinicals in a wide variety of areas.........followed by on the job training is a bit more practical that what you're talking about. There's a shortage of instructors as it is, imagine the nightmare of having to find instructors and setting up so many programs.
  4. by   sirI
    Nursing education and NCLEX is the minimum standard as outlined by the BON. True, some nursing programs offer added "extras", but for the most part, only prepare the individual for NCLEX with minimal preparation. There must be some type of standardized training or we'd be all over the place with post-education licensure and as Tweety pointed out, a nightmare.

    Once, there were individual state board exams that everyone had to pass in order to become licensed. This was replaced by a national standardized NCLEX. Now, across the nation, the nurse passes the exact same standardized test according to their education.

    After the individual is trained and licensed, on-the-job training is necessary to "specialize" in any given area. This may take years to become proficient enough to be considered so and often takes years to be considered an "expert".

    The individual may obtain certification in their specialty area to prove added knowledge/expertise in any given specialty. MANY from which to choose.

    The title 'nurse' is that the individual met the educative requirements and holds a license from their state BON. It's a legally protected title. Teacher is not and the word, 'teacher' can be used by anyone.
  5. by   emsboss
    I agree with Tweety...We all start with the same knowlege BASE and expand from there...I, for example, am an ICU/ER nurse...I would be lost on OB or Oncology. We all must find our niche. BTW...To the Hospice Nurses out there...My hat is off to you for filling that much needed niche!
  6. by   TazziRN
    Not to mention the difficulties in transferring to another area of nursing.....if you needed another degree for each specialty there would be no such thing as a wide pool of opportunities.
  7. by   llg
    I agree with the other responses that point out that entry-level nursing education is just that --- ENTRY-LEVEL. It introduces the student to the basics that allow them to begin a career safely. Further education and experience are both necessary to produce an expert in any specific specialty.

    The mistake people make is in assuming that their entry-level degree is sufficient (or should be sufficient) to "take them anywhere" in nursing without additional education and experience.

    I don't think we should make it harder to deliver that basic entry-level education that gets people started. We should promote the continued education of the graduates -- and not settle for less because it is convenient. Settling for less gives people the idea that further education and experience is not needed for career advancement, takes away their incentive to invest in it, and inhibits the development of good programs to help people get it.
  8. by   fgoff
    I agree Entry Level (novice) is not Competent Level (Expert).

    Have a great weekend!
  9. by   nursesaideBen
    I have to agree with the previous posters. A lot of students aren't sure where they want to specialize in after graduation. I couldn't imagine having to decide what type of specialty I would be going into while in school. That's what is so interesting about nursing, we are trained to do a little bit of everything in almost every type of enviroment.
  10. by   jjjoy
    How about post-graduate certification, then? After working, say, six months in a certain area, you become certified in that area. Then you are a formally recognized "med-surg nurse", "critical care nurse" etc. This is how it works informally, so I'm just thinking of some kind of formal differentiation so that it's not so tempting to lump all nurses together. It could certainly discourage the unsafe practice of floating unprepared to nurses to specialty floors that they're not familiar with. People looking into a nursing education would also more easily prepare for the fact that their education is still just beginning when they graduate. They would have their nursing license but wouldn't be a "med-surg nurse" or "LTC nurse" or whatever until they earned their certificate.
    Last edit by jjjoy on Jan 19, '07
  11. by   nursesaideBen
    Quote from jjjoy
    How about post-graduate certification, then? After working, say, six months in a certain area, you become certified in that area. Then you are a formally recognized "med-surg nurse", "critical care nurse" etc. This is how it works informally, so I'm just thinking of some kind of formal differentiation so that it's not so tempting to lump all nurses together. It could certainly discourage the unsafe practice of floating unprepared to nurses to specialty floors that they're not familiar with. People looking into a nursing education would also more easily prepare for the fact that their education is still just beginning when they graduate. They would have their nursing license but wouldn't be a "med-surg nurse" or "LTC nurse" or whatever until they earned their certificate.
    Certifications already exist for nurses who have chosen a selected specialty. Although I believe that in order for the nurse to be eligible she/he must have several years of experience in that field and take a state test in order to be certified. I don't think it's really appropriate for someone with 6months of experience to certified as a specialty nurse. There is so much to learn especially in those first couple years after graduation that I just think seeking specialty certifications 6 months post graduation would be putting the cart before the horse.
  12. by   jjjoy
    The current certifications are generally reflect more of an expert level in that area than basic competency. I'm talking about something between the general 'get you in the door' nursing license that works for the wide variety of nursing areas out there versus something that indicates a basic, functional competency in a general area of nursing. Kinda like a residency for physicians. They may be a doctor at graduation from med school but they know it doesn't mean much clinically or professionally until they complete their residency.
    Last edit by jjjoy on Jan 19, '07
  13. by   TazziRN
    Why do we need more certs than we already have?
  14. by   jjjoy
    Nursing, like medicine in general, has gotten more complex. There's more to learn and the patients are more acutely ill (as they are sent home as soon as they don't need specialized care). It would make sense for nursing education to include more specialized training at an entry-level instead of forcing employers to train the new grads for up to 6 months at their own expense.

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