nurse diploma

sparrow · Jul 15, 1999

I'm a diploma nurse and proud of it. Unlike many of the nurses I have worked with over the past 20 years from both AD and BS programs, I was able to walk on to any unit and actually work with very little orientation or additional teaching! I was able to do this from the time of graduation. I have worked in several different hospitals and was always the "official preceptor" for any new nurse coming into the facility - in all cases (regardless of education) they spent at least 3 months with me (some took as long as 6 before being turned loose upon the patient population). During that time I saw lots of new nurses and was constantly amazed at how little they actually knew, regardless of the type of program they came from - I saw BSN's and AD's who could not take a temperature or give and enema or any of a number of things a 3 month diploma student would have already done 100's of times! In addition, most of them have terrible organizational skills because they have never had to take care of an entire ward themselves and can't care for more than 1-3 patients at a time! And with some of them, this did not improve with time!! I do everything any other nurse does and a lot more. I am one of the highest paid nurses in my hospital and even though I am only a "diploma grad" I am certified in infection control and am the Director of the IC department. I am a "regular" nurse and hospitals still like to hire diploma grads over AD's and BSN's because we are experienced and they don't need to invest a small fortune in us to see a return! And if "dooor opening" is all that is interesting some nurses, then I say they are in the wrong profession - they are here to care for patients and if they want to make big money, then perhaps they should get a degree in computers!

Ahn · Jul 16, 1999

This is addressed to a personal e-mail I recieved from: C. Visconte.

I was unable to send my reply due to a flaw of some kind with the e-mail address you sent.

I hope this is the BB that inspired your comment. Please write me back via the personal message center on this BB, and I will forward my response.

In the meantime, check out; www.nurseweek.com

they have an article about the VA and nursing degrees. Hope this helps!

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Keeping the Faith

wildcat · Jul 25, 1999

ok everyone, let's get the facts straight. The difference betwen an ADN and a BSN is the amount of education. A BSN has two years of liberal arts education consisteing of prepratory courses (anatomy, physiology, cellular biology, microbiology, general and organic chemistry, statistics, algebra,communications, nutrition, psychology, child psychology, sociology, to name a few) in addition to 2 years of nursing school including all of the clinical hours that an ADN has in conjunction with nursing theory courses, nursing research course, and a professional preceptorship. So anyone who says that a BSN is not as well trained as an diploma nurse is obviously has not done their research. NOT THAT THERE IS ANYTHING WRONG WITH BEING A DIPLOMA NURSE.

sparrow · Jul 26, 1999

BSN are certainly well educated, but are usually somewhat lacking in clinical experience. I've precepted BSN's who had never put in a foley or given an enema. One did not know how to take a temperature with a mercury thermometer (and this is when that is all that was used! Still haven't understood how she got though 4 years and still didn't know that!)! Education is great, but if you can't apply the knowledge of what real use is it? And it's not just a problem with BSN's but grads of the ADN programs have the same problem. I've seen some take as long as 3-6 months before they can actually function and then, after I've TAUGHT them what their nursing programs should have done, they go someplace else! Usually then they go into the city for the big bucks (and this little hospital pays very well for our area) and I get to start all over with an whole new crop! Very depressing. The reason that the city place will not hire them in the first place is because they want EXPERIENCED nurses and will not invest the time and effort into seeing that they get that experience, but will take the nurse I've worked with, invested time and effort into.

CardiacRN · Jul 29, 1999

Clearly this has become a heated discussion, and people are becoming defensive........The path you take to become an RN all depends upon what you value and want from your education. I did a BSN program, despite others 'reminding' me I could get the same RN status in less than 4 years, and I certainly do not regret it in any way(it was worth every penny). I wanted a BS, and as I look around today, a BS is what society's employers are looking for.

I would not dispute the fact that BSN graduates MAY not get the same number of clinical hours as diploma/AD grads, but I ask you, is it really that big of a deal? (I may have opened a can of worms here I say this only because I maintain that technical skills(nursing aside) can be achieved by anyone. I can change the oil in my car after being shown, but I certainly could not tell you how the pistons and engineering component tie into the scheme of things. We are all capable of learning technical skills, but we all don't know or understand the process and dynamics behind the system. Sure, I wasn't the best at putting in foley caths upon graduation, but I could certainly explain to a patient and family the anatomy and physiology behind cardiomyopathy, the drug regime to improve the ejection fraction, etc......That is my point. I am not implying that RNs who are diploma/AD don't have this knowledge base, I am simply saying that BSN programs stress the importance of knowing the 'how' and 'why'of our actions.

sparrow · Jul 29, 1999

When you explain cardiomyopathy and the accompaning drugs tot the patient, how much do they actually understand? I work in an area of the US that is considered medically underserved, where I encounter people on a daily basis who are considered functionally illiterate, some who are incapable of telling time. I've sat next to many a patient reading the discharge instructions to them, saying: "Do you understand? Is there anything you want me to repeat or explain again?" They always nod their heads in understanding, dening their need for more information, but I can tell by the look in their eyes they haven't the faintest ides what I've said. And, trust me, all that fancy lingo you learned in school, well, use that and they think you are a "furnner"! I remember trying to teach a 30 yo new diabetic how to inject her insulin and recognize impending coma/shock. And all she could focus on was "I don't know how I got this, I don't eat no sugar". I simply could not get it through to her how this had occured. Another time, I had a lady repeatedly admitted for hypertensive crises, she simply could not take her medication properly. I worked with her for hours, then found she could not read. So I worked at color coding her meds, made a clock face and color coded it when she was supposed to take a particular drug. After all this she confessed she could not tell time! I asked her how she knew when to start dinner. Reply: "When Oprah comes on TV". Ever teach some one to take their meds using the TV guide? Of course, I should have known, the sattlite dish is the state flower!!!! All the fancy, medical talk is simply of no use when you really need to communicate!

CardiacRN · Jul 29, 1999

Thank-you mable.......We have now launched onto a new topic of patient literacy/learning needs and deficits, etc.....I was not implying that it is wise to through around the medical jargon with patients because 9 times out of 10, they really have no idea, even though they nod their heads. So no, I don't say "you're ejection fraction is 27%, and the captopril your doctor put you on works on ca channels, blah, blah...." Clearly, this is not appropriate if I wish to have my patient understand. Again, this is a totally different topic which has been presented, and the topic here is about the difference in all levels of nursing, and how to accurately portray what is the education on all levels.

So again, my point is that BSN programs dwell upon the 'how' and 'why' of anatomy and physiology interacting with pharmacology and the ongoing advancement in medical technology. A foley cath? I am confidant that I could teach my mother the technique behind the "skill".

mable · Jul 30, 1999

Well done, CardiacRN! I could not have said it better myself! It is so very important to understand the "why" in this profession, and a BSN offers the very best preparation for that knowledge.

sparrow · Jul 30, 1999

Well, you want to get back to prepared and educated? Well, I just found out that all 5 of the new BSN grads we hired and orientated failed boards! Prepared? They took these right after getting out of school. What happened? The BSN program is not a new one and had a fair pass rate (I attended a hospital based nursing school that had never had a fail, had been turning out nurses for over 30 years, and 3/4 of all the grads had made "nationals" on exams - for those of you "kids" it means you score over 500 at a time when 250 was passing). What is wrong with this picture??? What is happening?

wildcat · Jul 31, 1999

ok sparrow, I looked up the only hospital in your area and it has less than a 100 beds. Hmmm hiring the cream of the crop are we? The facts need to be faced. Diploma nurses are better nurses right after they are licensed. The reason they are better is due to the fact that 95 percent of them work for the hospital at which they were trained. Diploma nurses do not have to get past the same obsticals that another new RN coming from a different program would have to face. OK, now to account for your proof that BSN's are not prepaired. Just as many diploma nurses failed boards during the same testing period as your new nurses. Point being. We as health care providers should want the best for people in our care. And as the comercials on T.V. say "the more you know." I happen to agree that the more educated a person is the better.

sparrow · Aug 9, 1999

The hospital size does not matter. We are one of the better staffed and higher paid in the area. We stay competive! Also, aside from this batch - we tend to retain staff BETTER than the other hospitals in our area (I think it has a great deal to do with the fact that we treat people like people and not warm bodies!). So before you slam the hospital, learn a little about it! Small hosptials (and I know, I've worked in the big places and also in the ones in this area) give BETTER care! I've seen and personally experienced some of the nursing care in places like Hopkins, and GW and it leave just a little to be desired! And this hospital is not the only one in the area - two others are 250 and 300 beds and the only time we see these people as students is during their very first clinical. The school is college based with both ADN and BSN programs of long standing. As far as diploma nurses staying in the hospital where they graduate - I didn't and neither did any in my class! Nor did any in the previous two classes! I never worked in my school's hospital as an RN. As far as hiring the cream of the crop - we turn people down because we don't have enough positions. However, we are not responsible for their schooling or for allowing them to graduate if they prove incapable of learning! We are not the ones to "pass them on". All we know about them at the time of hire is that the are board elegible and have graduated - we do not get the grades they graduated with! So, now what? The failed diploma nurses you speak of: Are they Associate Degree Diploma or Hospital Based 3 year Diploma Nurses? My school was in operation for over 30 years and had a 100% board pass rate! Over 75% of us made Nationals, myself included (remember back when you got an actual grade and anyone making a score of over 500 in each section was considered in the upper 10%, and state boards were a 3 day, all day long affair and and each area of study was tested individually?) Instead, today who really knows how well a grad is prepared - they don't really test them! I am not familar with these failed diploma nurses you speak of! I've never seen one!!!!

MollyJ · Aug 10, 1999

People, look closely at this discourse. Look at all of this ENERGY that is being poured in to this defending of basic nursing programs. This is complete evidence of how divisive this argument is and how COSTLY it is to our profession and it is the BEST argument for a single entry level in to nursing. Gee, if we didn't argue about this, do you think we would be a stronger, more unified voice for what's happening at the bedside? Do you think we could do a better job of promoting nursing if we weren't engaged in "pissing contests"? Do you think more men and women would be attracted to nursing if they saw a future beyond the challenging but gruelling role of bedside nursing? (There is one; I have seen it and touched it but only after completing my BSN and MSN!) Could we deal better with our concerns about nursing education if we weren't always dancing, grappling, or fighting with the entry in to level issue? Employers in industry and other fields say: Give me employees that have a work ethic and some basic skills and I can shape them in to an employee for my business. I frankly think this sets the bar too low for a group that purports to call itself A PROFESSION. I have to tell you that I am sometimes appalled by who gets in and through nursing programs and my colleagues in the hospital echo this. PLEASE do not think I am dissing every new grad; I am proud to call MANY if not most of you colleague, but I still strongly believe that the holy role of ANY nursing program is GATEKEEPER to the profession and I think sometimes the programs snooze on the job. What if we all took ALL of this energy to the NLN/our local colleges and universities and helped create BSN programs that better balanced clinical and didactic information (keeping in mind the mission of the BSN program to prepare nurses for broader roles). Probably when I got out of school 75 to 95% of nursing took place IN THE HOSPITAL. That is not how it is anymore (some say the percentages are reversing; 25% in the hospital; 75% out) and education misses it's mark when nursing students ARE only prepared for a hospital care role.

If nursing is to be future oriented, do we want to keep focussing our energy on this tired old discussion?