nurse diploma

sparrow · Aug 10, 1999

MollyJ: You have hit the nail right on the head - the nursing schools ARE the gatekeepers of the profession! Some where, some how, the current programs are simply not fulfilling their rolls. This is why I'm so strongly defending the hospital based schools - they had it down pat. People who couldn't make the grade were deftly weeded out and not simply passed on to graduation. The current programs are simply not doing that. I don't know - are their expectations too low? I know we were required to take NLN exams all through school and woe be to the student who failed one! Our grade average had to be at least a 4.0 to maintain. we worked in the hospital 5 days a week from 7 am to 1:30 pm and attended classes from 2p to 6pm with some classes in the evening and weekends. Very long days! Then many of us worked on the weekends. Generally the hospital staff on 3-11 and 11-7 Fri, Sat and Sun was composed of 2nd and 3rd year students with an RN supervisor and one RN in OB! We also took many of our courses at the college (Psychology, Sociology, A&P, Chemistry, Nutrition, English, Literature, History, etc.). Believe me, this sort of intensive training weeded the serious students from the playtime nurses! And this was all crammed into 3 years! (We went 11 months out of the year, none of this summers off!) As I said in my previous posting - How are these people sliding through school - regardless of WHAT kind of program it is????

wildcat · Aug 11, 1999

You know I remember the guy from Saturday Night Live, John Lovetts. I also remember a character of his that always told outlandish stories. He used to say "yeah thats the ticket." "Yeah, we all had 4.0's out of a 4.0 scale, Yeah that's the ticket." "Yeah, 100% graduation rate, Yeah thats the ticket." "Yeah, I'm so beyond belief."

Perfection is a hard thing to obtain. I for one have not reached this mark. But to say that BSN students are "passed on to graduation" is beyond reproach.

sparrow · Aug 11, 1999

Well Wildcat: I've checked with a friend of mine who is a clinical instructor at that school (she is ADN, BSN, MSN!) and asked what the board fail rate was. I was told that 45% of the ADN class failed, and 48% of the BSN class have failed. (This is of those who have taken the test so far!) I asked what she thought the problem was and she replied, "They were a WEAK class". My question: Why were they allowed to continue? She, unfortunately, is not tho one to make that decision. So, Wildcat, why? Previous pass rates from this program have been between 75-100% pass. If they were a "weak" class, perhaps they should have been removed??? It's hard to hire the cream of the crop when the school is taking the dregs of the barrel!!!!

sparrow · Aug 11, 1999

By the way, I never claimed perfection - you made that statement. I simply said that hospital-based diploma nursing programs held their students to a much higher standard. We had our fair share of washouts, and that is my point - they did not graduate! Those that did WERE the cream of the crop!!!!!

ltm · Aug 11, 1999

Reading this topic is very interesting. I am a 4th year student in a BSN program that is hospital-based. Our NCLEX pass rate is currently 96%. We are in clinicals 3 days a week from 7am to 3pm. I also work in the hospital on the weekends. We are required to take NLN achievement tests all through school and if we do poorly on them, we are then required to take a supplemental class. People who cannot make the grade do not survive in our program. So basically my comment is that there are still schools with intensive training programs that produce very competent nurses. I must agree with Wildcat, saying that BSN students are being passed on to graduate is beyond reproach. The BSN program that I am in has high expectations.

ltm

ckipp · Aug 12, 1999

From a different perspective: I am a nursing director and have worked the management side of nursing since the mid-80s. I was originally a diploma graduate who attained her BSN and MBA. The educational path determines your long term marketability. Bottom line is an AD or Diploma limit your options. The nursing product from any program is determined by the strength of the program and the strength of the person completing the program. I have seen clueless experienced MSNs and expert level AD grads. When all preparation levels graduate they are not a finished product. You must go on to combine your education with a dose of real world experience and lifelong continuing education.

What I have noticed at an ever increasing pace, nurses who graduate with insufficient knowledge, attitude and skill to be safely functional after a reasonable precepted orientation. I believe this is related to two issues: poor development of a work ethic and schools who do not prepare the students for reality. I recently had an interaction with a BSN, 6 months out of school who is having tremendous problems. She had never heard of "Reality Shock" or the Benner Novice to Expert concepts. She thought her education was done at graduation. Combine this with a willingness to call out sick whenever the workplace and social life conflict; just about daily tardiness; unwillingness to work off shift, weekends or holidays; resigning jobs with no notice; using the workplace PC to job search and shop on the internet; multiple personal phone calls at all hours; job hopping based on "how much are you going to pay me?" and a complete lack of understanding of what "customer service" is.....I could go on and on.

ltm · Aug 12, 1999

sparrow-I can definitely see your point though. There is an ADN school in my area that is not hospital-based and working with some of their students at our hospital can be a challenge. Some of them do not even know how to take blood pressure manually, let alone interact with the patients. The strange thing is that they go to school the same amount of time as we do (4 years), get an ADN, then they come to our school to get their BSN (which takes about a year or more). My point is that it should be mandated by the NLN (or someone) equal requirements to obtain an RN license. By equal requirements I mean, clinical hours, didactic hours, and a certain amount of clinical experience should be required before a student can apply for boards. Maybe that is unrealistic, but I think that it would help to unify and strengthen our profession.

sparrow · Aug 13, 1999

Ckipp - what you are describing is what we are seeing also - graduates ill prepared to work: one new BSN grad who left after only working one week in orientation, told us she was going some place where she didn't have to work so hard because she didn't ever plan to touch a bedpan again! Every thing you cited, I've dealt with during my years as preceptor, not just once but many times over. I agree that ADN and diploma limit career choices and advancement (of course, hard as it is to believe, there are those of us who do not hunger for advancement or to be the boss, like taking care of the patient and are quite happy at the bedside, and always remember, without us to do that, every one who wanted advancement would most probably be doing bedside nursing. You know the saying about too many Chiefs and not enough Indians? Good heavens, we can't all work in Administration - some one needs to care for the patient! And most hosptials can ill afford to pay BSN, and MSN to do it!).

ltm: You are very lucky in you choice of a nursing program - I wish they were all like that. But, you see, the operative word in you statement about your school is that it is HOSPITAL-BASED!!!! Now there is a BSN program worth going into! Yes, you are getting the kind of intensive training you are going to need. But you must understand, many of the BSN and ADN programs are not hospital-based, but originate in colleges. These programs usually provide for no more than 2 clinical days in a week, with the student coming on at 7 AM and leaving a 11 AM and being assigned to 1 patient! Nothing intensive there! And they attend a regular Sept-June school year, with all the required breaks. I've had many new grads tell me that during 4 years of these two day/week clinicals they have never put in a catheter or changed a colostomy bag! It happens. If their one patient doesn't happen to have it, they don't do it! They also have problems with setting priorities, because when you only take care of between 1-3 patients at a time, knowing what to do first for 20 is mindbending! I've worked with some that even after several years of experience have great difficulty with that. Organization is another lack - you don't need much if all you have is one patient, but you need plenty when you are responsible for 20 or more! And those of us who have been working for years are TIRED. We work very hard to help new grad, make the experience positive, but the work still must be done. And we all know it takes twice as long to show some one how to do something than it does to do it yourself! WE old timers should not need to show nurses something their school should have prepared them to do. This is not an internship, if it is where are the clinical instructors?

sparrow · Aug 13, 1999

Agreed. Programs should be regulated. All should be required to offer the same number of clinical hours and class room hours. I think that way back in Middle Ages, shortly before I graduated from my hospital diploma program, when BSN, and ADN programs were still working hard to become established, the original theory for both of these programs was to require graduates to stay at a hospital affiliated with the school and work an internship period of a year. During this time they would be paid but also supervised by clinical instructors specifically placed in the hospital by the school for that purpose. Somehow that got thrown to the wind and new grads were thrust upon us without proper preparation. We were then doing what their instructors should have done - Teaching students! Very frustrating when you have a wing of 30 sick patients and have to stand and precept a new grad who has never inserted a foley cath!

jbw · Aug 13, 1999

Well, ok sparrow..you are right...we should ban all BSN and ADN programs and go back to having hospital-based diploma schools...of course this is based on your opinions which are based on your narrow world experiences...so we will take your agruments and generalize them to all other programs..God, no wonder we are still struggling with nurse/physician collaboration when we have groups of nurses who still think with mindsets based on educational experiences from the 1960's. As you can see I am angry and frustrated by the amount of energy devoted to advancing one point of view...so fine I give up and also grow way too bored and weary with the limitaions I see in the thinking to continue with this particular dialogue. ADIOS

Joe,RN · Aug 13, 1999

I am so sick and tired of you Diploma RN's ramming your superior preparedness down my throat. I have been a nurse for a long long time, first as an LPN, then ADN, then BSN and finally MSN. I have had the opportunity, over the years to precept nurses from all areas including Diploma graduates. There was very little difference in skills, from any of the "new" nurses from any educational level. IT WAS THE INDIVIDUAL INVOLVED AND THEIR ATTITUDE AND ADAPTABILITY!

BSKamel · Aug 13, 1999

As an RN trained in the "Middle Ages," I have spent more years as a nurse than I can sometimes believe. I am a Diploma RN and I have gone back to school more than once in the past. I am now in school again. One should never stop learning. If you are in nursing, you can't afford to risk your patient by failing to continue learning. I have had the priviledge of doing ICU, CCU, Cardiac Rehab, Oncology, Med-Surg and for the past 15 years, Psych Nursing. I value my education and I respect the nurses I have had the opportunity to work with. It is shameful that we strive to teach our younger nurses to be respectful of our patients and coworkers, but then we openly criticize them on an issue that it is time we dismissed. In order to mentor, we must first respect ourselves and our peers. Without respect, our profession looses sight of it's goals. Let us look at what we can do for and with one another to improve and encourage the Professional development of many and more Nurses.