I'm just curious...

[MattiesMama]

I've been following the ADN vs. BSN/RN vs. LPN discussions on here for quite some time. I think it's pretty apparent that some type of final decision needs to be made regarding where nursing is going as a profession. What strikes me is that rather than creative, pragmatic solutions being offered, I keep seeing parroting of the same idea (or a version of it) that the only way to "solve" the problems our profession is facing is to (a) get rid of LPN's and/or (b) get rid of ADN's and diploma nurses, and make a BSN the standard point of entry to the profession. So, I have a few questions for those of you who hold these views:

1. What exactly are you proposing we do about the millions of LPN's in this country, as well as the thousands currently going through LPN programs right now? Do you strip us of our licensure? Demote us to being CNA's or techs?

2. Same question, applied to the ADN's-what do you propose be done with them?

3. What do you percieve are the potential ramifications of making a BSN the entry point in terms of bedside nursing. Have there been any studies done to determine how many BSN students would be content working at the bedside for their whole career? And what about in the nursing homes and LTC, which is where the projected need will be the greatest? I'm just curious, because I've read so many posts from RN's (ADN's and BSN's alike) who are bemoaning the fact that they have to "settle" for nursing home work in this economy, and have no desire to make that their career. If we phase out LPN's, and especially if we make BSN the standard point of entry, is it really realistic to think that there will be enough bedside nurses in LTC to care for our aging population?

4. How is this push towards a higher educational standard going to effect the role of nursing? Because we all know that facilities will not be able to afford to hire all of these BSN's without "outsourcing" many tasks that have traditionally been part of the nurses role to UAP's. If we have UAP's providing bedside care, doing things like med administration, trach suctioning, etc. (which is already happening of course) then what, exactly, is a nurse? Are we just the "managers" who oversee care?

These are just a few of the questions I have. Because the way I see it, what is being lost in this whole debate is the fact that when we throw around ideas like "lets just get rid of the LPN's/ADN's" you are not speaking in hypothetical terms, you are talking about a large group of professionals-good, hardworking people who have worked hard and sacrificed to gain that title that you seem so flippant about doing away with.

Is this ok with you? And if not, what exactly do you propose we do about it? Is a compromise even on the table anymore?

[MattiesMama]

I can't go into all the technicalities mentioned, but in my country there has been a move to phase out Enrolled Nurse (LPN eq) training; now they are putting an end to bridging training as well. The effect this will have on patient care makes my hair stand on end.

We have already seen the negative effects on patient care of making students college or university based as opposed to hospital based. Now they are proposing to remove the mainstays of bedside care as well, totally ignoring the fact that about 90% of nursing care is basic care, requiring intermediate skills levels. Sometimes I think that nursing in my country is destroying itself from within.

Christine just curious, what country do you live in?

[nursel56]

Thanks, and this is exactly why I'm asking these questions. I've sat on the sidelines on a lot of these debates. I get frustrated...I don't really care about "patient studies". Anyone who's taken statistics knows that you can twist them to suit any argument you want to make. What I do know for sure is that while this squabbling is going on, the very facets of our profession are being sliced, diced, and auctioned off to the highest bidder. .

I agree 100%. The phrase "while Rome burns" comes to mind. My thoughts come from a perspective of having been to school a loooooong time ago, worked for 10 years, left to be a SAHM for a while and returned, which maybe made this stand out in sharp relief to me. I don't hear too much complaining about it from other nurses who started when I did. I respect the activist ANA agenda nurses here, but I can't help but wonder how things would've been different if the massive amount of time and energy spent in ultimately ineffective strategies to make nursing on par with medicine had been spent at uniting us and created enough bargaining power to head some of this off at the pass. Didn't happen. I can assure you that it would've been a very rare event prior to the late 80s that a nurse would have been fired for not delivering "service with a smile" to a manipulative patient who siphoned the time from a nurse with sicker patients with childish demands and threats of complaint to the whatever they call the customer service person at the facility. Sigh.

[roser13, ASN, RN]

"And I think deep down, the aversion towards working in SNF has less to do with unsafe patient loads than it does with the fact that many nurses simply don't want to work with the elderly. Because it's depressing, maybe a little boring, and a constant daily reminder of your own mortality. Whatever the reasons are, it's just not all that popular. There is simply no way that we will recruit enough BSN's to work in that setting to meet the needs of the aging population, period. "

You know, I have often wondered about this issue. I love the geriatric population and would have loved to have gone there in my career. However, I have never once given a second thought to working in an LTC. The reason? I learned early on (in my first clinical, as a matter of fact) that as the RN, I would never really interact with or care for the residents. I would be busy with paperwork, documenting this, charting that, talking to the docs, etc. The actual patient care would always be relegated to LPN's and aides. That has no appeal to me.

Perhaps a total change in care delivery toward valuing the nursing role in the aging population.....haha:lol2: what was I thinking:smokin:

[OttawaRPN]

Really interesting to read the responses here...

I always like to look at what other countries are doing...I think Canada, for example, has a pretty good approach. Their LPN's now have 2 years of education and graduate with an associated degree. To become an RN you need to go for 2 more years of college, and graduate with a BSN. So while all of their RN's have 4 year degrees, it's not the "entry point" per se. I would love to hear from someone who nurses in Canada to get a perspective on how that is working.

I think something like that, along with reforming nursing education just might work...

Actually, it's not quite that way yet. Currently, there is no standardization of PN programs across the provinces, some provinces are one-year and others a two-year diploma. The RN program is now a 4-year BScN for all provinces except Quebec. The bridging from PN to RN is approximately 3 years full time, again with no consistency. Although all PNs and RNs write the same national licensing exam, each province has their own regulatory/licensing body overseeing nursing practice in their respective province and licenses are not transferable between provinces. It's a bit of a crap shoot with 2 points of entry for nursing, similar to America's 3 points of entry.

However, in 2006 the Canadian Nursing Association put out a document called "Toward 2020 - A Vision for Nursing" which is a lengthy research paper outlining, among other things, various anticipated events to have been completed by the year 2020 - everything from health care reform (public vs private) to future nursing trends to streamlining nursing education.

As far as the latter goes, the projection is this....

There would be ONE point of entry based on core competencies allowing nurses to exit and re-enter education w/o having to repeat courses. Nurses would be educated in up to 4 modular spheres making movement through the different spheres easier with common readily transferable skills/knowledge enabling them to practice in any area of the country. Building blocks, if you will. The first block being a 2-year diploma in practical nursing, add another 2 years for BScN, then another 2 years for MScN and finally a doctoral degree (either an additional 2 years for nursing science/practice) or 4 years for PhD. Since most nurses would be educated in the first 2 blocks (PN and BsCN) upon graduation they would be considered "generalists" with the option to certify in various clinical specialties. The MScN and doctoral levels broken down even more (professional or academic stream.) It also attempts to do away with an official licensing exam, if you graduate with a diploma or degree, you've achieved the competencies required to practice as an LPN or RN in any province across the country. Hence, streamlined.

In theory, it sounds great. But whether Canada will see this in my lifetime is yet another crap shoot.

[somedaypeds]

This kind of change was done to the accountants back in the 90's. My husband was in an associates program for accounting. While he was enrolled, they changed the guidelines for taking the CPA examination - now you had to have your bachelors degree. Since he was already in the program, he was and is still grandfathered in - he can take the CPA exam with only his associates because the ruling came while he was in an associates program.

I imagine this will be the same if they change the NCLEX so that one must have a bachelors degree. Anyone in a program will be grandfathered in.

So what happened to the associates in accounting program at the community college? It is still there. True, you can't sit for the board exam after completing, but you are still 2 years farther into a bachelors program with less cost than completing all four at a major university.

[GHGoonette, BSN, RN]

Christine just curious, what country do you live in?

Hi, saw your post on my mobile this am, but only just got home.

I live in South Africa; reading these posts, I see that the same "rumours" regarding your LPNs and our ENs originated at round about the same time, the early to mid eighties. Up till now the "authorities" have not succeeded in doing away with the course, but as I understand it, the intake is becoming less and less. Most "new" ENs are those who have bridged from Enrolled Nursing Assistants, which appear to be on a level with your CNAs.

The EN course consisted of 2 years training, mostly hands-on, with 4 months at nursing college each year; these were split into two "blocks" of two months each. At the end of the 2 years they wrote an exam set by the South African Nursing Council, and if they passed were entered on the Roll.

Those who wished could later apply to bridge; this involved a further 2 years study, again split between hospital and college, at the end of which they wrote a final exam. If they passed they became Registered Nurses.

There were practical components as well, of course, which I believe you refer to as "clinicals".

When I did my training, there were (if I remember rightly) 3 intakes a year, with thousands of school leavers (as well as older trainees) entering the health care system as student and pupil nurses. We applied to the hospital we wished to train at, were appointed by the hospitals and were sent from the hospitals to college-not the other way around. The pupil nurses were the 2 year trainees, while we students did a three year course, with 5 months of college each year. We were the future Nursing Sisters, or RNs. At that time, the only degreed nursing courses were (here I'm really dredging my memory!) a 4 year Bsc course for those student nurses who wanted a university education, and advanced post-basic training courses in admin and education. In the mid eighties, a 54-month course was introduced; unlike the previous training system, this was "college based", taking the student nurses away from the bedside. It was supposed to "raise the standard of training to degree level", but overlooked the lack of real on-the-job experience that we had. Besides that, it drastically reduced the numbers of nurses actually doing the work in our academic hospitals, with a predictable effect on basic patient care.

Where we have really shot ourselves in the foot, however, is in the closure of most of our nursing colleges. All over the country, the trend has been to shift training from the old colleges to Universities, resulting in staff shortages at crisis proportions in the major hospitals-which serve the poorest in our communities! In Cape Town alone, there were 3 nursing colleges; there is now only one. (Speaking under correction there-I think one of the hospitals managed to hang on to theirs-so we possibly still have two). The others were closed in the late 90s/early 2000s, and this was a country-wide trend, all in the intersts of "rationalization".

Although student nurses were taken away from the hospital setting, this was not so as regards the pupil nurses. They continued with a predominantly hospital-oriented training, which provided at least some relief from the staff shortages, but with such a drastically reduced intake could never fill even a fraction of the holes...

Now they are denying them the right to bridge as well, and you can imagine what that will do to future intakes.

[GHGoonette, BSN, RN]

Thanks, and this is exactly why I'm asking these questions. I've sat on the sidelines on a lot of these debates. I get frustrated...I don't really care about "patient studies". Anyone who's taken statistics knows that you can twist them to suit any argument you want to make. What I do know for sure is that while this squabbling is going on, the very facets of our profession are being sliced, diced, and auctioned off to the highest bidder. It makes me sad to think that 20 years ago (maybe less?) you didn't have "med aides" and "dietary technicians". I've also seen people argue that these tech's make life "easier" for the nurse...and I just have to shake my head. It only makes things "easier" because you have an unsafe patient load, and it takes some of the burden off of your shoulders to delegate a task to someone else. And you only have an unsafe patient load because your employer realized it was more cost-effective to hire 1 nurse and 10 techs than it would be to hire 5 nurses. They aren't doing you a favor

And I think deep down, the aversion towards working in SNF has less to do with unsafe patient loads than it does with the fact that many nurses simply don't want to work with the elderly. Because it's depressing, maybe a little boring, and a constant daily reminder of your own mortality. Whatever the reasons are, it's just not all that popular. There is simply no way that we will recruit enough BSN's to work in that setting to meet the needs of the aging population, period.

Btw, there is one question I have regarding the numerous "techs" which I repeatedly hear of on AN. Respiratory techs, Scrub techs, Med aides and now Dietary techs-are they classified as "paramedics? What kind of training do these various disciplines go through?

Most importantly, do they have professional bodies that represent them and protect both their interests and those of their clients? We as nurses have our own governing bodies which determine our training requirements, oversee training facilities, set standards and enforce disciplinary and ethical regulations; do they?

[nursel56]

Btw, there is one question I have regarding the numerous "techs" which I repeatedly hear of on AN. Respiratory techs, Scrub techs, Med aides and now Dietary techs-are they classified as "paramedics? What kind of training do these various disciplines go through?

Most importantly, do they have professional bodies that represent them and protect both their interests and those of their clients? We as nurses have our own governing bodies which determine our training requirements, oversee training facilities, set standards and enforce disciplinary and ethical regulations; do they?

No, unlicensed healthcare workers are called a variety of things, depending on the state they work in and even the facility they work in. When I worked at a peds hospital they didn't have CNAs but something called a "ped tech" who did basically what a CNA would do in the adult setting. Paramedics have their own initials very specific to what they do that I'm not completely familiar with.

Usually "techs" go through a specific vocational program from a few months to a couple of years in length for some specialties. They usually get a certificate or a diploma. Sometimes a medication aide is a CNA first, but not always! I'm not sure about a Dietary tech, though. Anyway, I wanted to give you a general answer, those more familiar with that career hopefully will fill in the details.

[MissJulie]

"Usually "techs" go through a specific vocational program from a few months to a couple of years in length for some specialties. They usually get a certificate or a diploma. Sometimes a medication aide is a CNA first, but not always! I'm not sure about a Dietary tech, though. Anyway, I wanted to give you a general answer, those more familiar with that career hopefully will fill in the details."

As a CNA, maybe I can shine a little light on this subject... Here in Kentucky, I don't know if it would be the same everywhere, because you never know, but we don't really refer to people as "techs," which can lead to some confusion for myself here on AN. "Techs" are instead referred to as their actual title, CNA, MA, etc. (Most hospitals in my area also don't hire UAPs- Unlicensed Assistive Personel- as the burden of responsibility would mainly lie on the nurse, and the nurses, RNs and LPNs, have enough going on without watching over someone else's shoulder.)

To get my CNA, I had to complete a certificate program (one semester) at the college I attend. (Our school requires the aid course to be taken before application to the nursing program, either LPN or RN.) I then had to sit for a state exam. I am proud of my degree and certification, it's something that I had to work hard for, and although I am seen as assitive personel, there are things that we do that nurses can't get into their schedule due to med administration, dressing changes, etc. that they have to do. Also, CNAs are employed in LTC, acute care, and ambulatory care settings.

MAs have a certificate program, and set for an exam. Generally, MAs are only hired by doctor's offices, to do injections, etc., and not by LTC or acute care.

We also don't have Respiratory "Techs," but have Respiratory Therapists. The RTs have an associates degree and complete the same amount of clinical hours as we do. The specialized degree is important, and although the duties can be done by nurses, it assists the nurse to have someone else to do this, as the CNAs can take care of code browns, bed baths, etc.

The college I attend also has a surgical tech program, that is an associates degree with clinical time equivalent to ours, however, this program is not heavily enrolled in as the job market is pretty low. And, as far as dietary techs, I'm not sure about what training they have.

BTW: To a previous poster, paramedics aren't techs, they have a specific program that they complete and are required to sit for an exam as well. Actually, there is a college in my area that has LPN to ADN, and also has Paramedic to ADN...

Just my opinion... :)

[nursel56]

Thanks, Miss Julie - and I'm one who does like to do the things CNAs do as part of "total care". I worked at a hospital where we had primary nurses. Sounds like Kentucky has really thorough and consistent policies for healthcare workers!

[GHGoonette, BSN, RN]

Thanks to both of you! I also had some excellent feedback in another thread regarding some of the training that Respiratory Therapists go through.

Most of the duties which you describe are performed by nurses in South Africa, we don't have much in the way of "assistive services" here; there are dieticians who set menus and plan meals for patients with specific dietary requirements, and "hostesses" who help with the serving of food.

Scrub Techs we don't have at all-registered nurses who wish to work in Theater may do a post-basic course in Theater Technique. However, there are company reps who may be requested to assist a surgeon when a new product is being used; most of them have medical or nursing background.