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

[jjjoy]

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?

[jjjoy, LPN]

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.

[mvanz9999, RN]

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.

I don't agree. I would argue that employers should be forced to train new grads for 6 months and longer, thereby increasing their motivation to RETAIN those nurses. If you've shelled out money to train a new employee for 6 months or a year, you're more likely to want to keep them employed at your facility. Otherwise, you're just going to have to pay more to retrain someone else.

[WinksRN]

I agree llg, continue education is important but only so much can be obtained unless you plan on crossing the path to becoming a doctor. furthering your degree should not , however, be as expensive as it is. If I were a RN with 15 years experience and settled in my life, no way I would want to go back to college and acrue more debt for a BSN, just to study what I have been practicing for years, Nursing is stills a profession of practice and not necessarily of gaining as many degrees as possible to gain some sort of further respect from the medical community. I think jjjoy has a good idea goin when a nurse shortage is a thing of the past.

[jjjoy, LPN]

I don't agree. I would argue that employers should be forced to train new grads for 6 months and longer, thereby increasing their motivation to RETAIN those nurses. If you've shelled out money to train a new employee for 6 months or a year, you're more likely to want to keep them employed at your facility. Otherwise, you're just going to have to pay more to retrain someone else.

That makes sense if employers were mandated to provide 6 months of training (meaning the new grad doesn't count as full-time staff in unit staffing and their preceptor isn't given a full load to juggle while trying to train someone). As it is, it's amazing how many facilities will push a new grad (or even an experienced nurse) beyond their limits and let them go instead of working with them to improve the situation.

You bring up an interesting point in regard to the responsibility of employers to contribute so substantially to the training of qualified manpower.

Oh yeah, if there were some set amount of time that a new grad couldn't count as full-time staff then facilities wouldn't be tempted to push them to be on their own in order to alleviate staffing issues. You hear about new grad with less than 2 weeks orientation to LTC and 8 weeks is considered a generous new grad program in some hospitals.

[nurse4theplanet, RN]

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?

I am not following your motivation here. IMO, nursing as a profession is suffering because we are not unified in our ideas about such matters as educational requirements and minimum degree needed to enter into practice (evidenced by the age old debates that reoccur LPN vs. RN, ADN vs. BSN, etc.). Implementing your theories would increase the stratification.

I do understand your concern for identifying your specific competencies and specialty areas, but this is being done through certifications and with lots of experience. That has already been addressed by others. I just want to make one more point. One of many reasons people choose nursing as a career is for the diversity and opportunities to change direction. I didn't know what areas of nursing I would perform best in or be happy with until I had a basic dose of each different specialty. If you required nurses to pick a specialty beforehand, I think it would increase the amount of nurses who leave the feild.

We need to unify our profession, not further divide it. We need to celebrate our diversity and freedom to move from one area to another, not limit ourselves.

[nurse4theplanet, RN]

Another point to ponder, if you specialized to the degree that you are implying...it would further strain the availability of healthcare to the patient. The more limited a nurse is in her practice, the smaller patient population she will be able to serve, and the more costly her services will be to the patient. For example, I will use the medical profession. If you go to your PCP for a certain complaint, he may not be specialized to treat it and have to refer you to a specialist. This means another appointment, another copay, another insurance claim, and more costly procedures/diagnostic tests. The same would happen in nursing.

As it is now, general nursing knowledge allows you to take care of a very diverse patient population and meet a variety of needs. If you wish to expand upon that, then you seek out higher degrees and advanced practice. This takes nothing from your general knowledge and does not restrict the patient population you are able to serve, yet gives you new skills of focus and a larger scope of practice. In this respect, nursing is far more advanced than medicine, IMO.

[SCRN1]

I like the idea of being able to go from one area to another area of nursing. If I'd had to have a specialized degree for each, I would have never been able to work in the areas I have.

[jjjoy, LPN]

I like the idea of being able to switch around, too. Within acute care, I can see changing specialties to not be a problem. Or for someone from acute care to transfer to a position that draws on that experience such as legal nurse consultant.

But switching from school health to acute care rarely happens. Even switching from LTC to a hospital can be very difficult. They are different kinds of nursing and if you go down a non-acute nursing path, you are more or less limiting your self. Meanwhile, nursing school doesn't turn out students ready to deal with the reality of acute care nursing and so many of the new grads we're churning out are quickly leaving acute care.

I'm just tossing ideas around is all.