Professionalism and Credentials

  1. OK, just some thoughts here so early in the morning (after work...)

    I've been thinking on how we can improve the image of nursing and a couple of thoughts come to mind.

    First, what do people think about having a baccelaureate be the entry-level for nursing? (I ask this as an associate degree nurse, who's going to be going for my BSN, so bear with me.) I realize that this has been an ongoing debate for decades, but hear me out. Nurses are constantly looking to get paid more (as we should be), and demanding more respect (as we should be). However, I good-naturedly ask, why should we be expecting those things if the entry-level education requirement is the same as an auto mechanic or a dental hygenist? Granted, we hold people's health (and many times lives) in our hands -- but shouldn't that be even more reason to demand a higher base education? True, with the nursing shortage the way it is, it's not necessarily a practical idea; but perhaps there's a way to grandfather in the existing ADN and diploma nurses and make a transition to the BSN requirement over a few years?

    Second, it seems to me that many nurses (at least one's that I work with) are reluctant to get specialty certified in their fields (CCRN, CEN, etc.). Why? Sure, time is frequently a factor (especially if you have kids), but the reason I hear most is that there's no financial incentive from hospitals. So? What better way to reinforce that "a nurse is not a nurse" philosophy that to get specialty certified. Also what better way to impress upon patients, physicians, and the public that we're well educated and masters of our art than to get certification? Doctors love to get certified and credentialed because it increases patient confidence and garners collegue respect. Would it not do the same for nurses? The financial incentive (if you really need one), is that if the public see us as specialists, there will be more public support for paying us as specialists and professionals.

    Just my $00.02 worth. Now I'm going to bed...
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  2. 120 Comments

  3. by   fergus51
    I am now in Canada and the BSN has become the minimum for new nurses in BC, Ontario and PEI that I know of. I think a few more provinces will be or already have followed suit. I don't know if it makes better nurses or not, but I do think it increases our credibility when we demand more respect as professionals.

    As for the certification: My problem with it is the fact that we need to take extra courses to work in almost any specialty area. The L&D course is a minimum of 27 credit courses which included practicum (takes about a year and a bit part time). How am I supposed to pay for this and have time for it (especially a six week long practicum)? It's the reason a lot of Canadian new grads go to the US (because you're willing to do on the job training). I would think all of our continuing education courses would be enough to convince people that a nurse is not a nurse.
  4. by   pama
    Not again. Please check the statistics before posting. Statistics show the ADN graduate out scores the BSN on the NCLEX-RN graduate. Statistics also show hospitals would rather hire an ADN graduate over a BSN graduate due to the training and education.

    No one can make me believe a BSN is better than an ADN. Look at the curriculum. The major difference is the support courses. BSN programs require additional hours in humanities, not the nuts and bolts of the nursing curriculum. ADN programs are strong in sciences, nursing courses, and clinicals.

    The BSN as entry into practice comes about everytime BSN programs begin to experience low enrollments. Again, look at the statistics.

    Truthfully, I am tired of this being an issue!
  5. by   Julie, RN
    Just Brainstorming......
    How about BSN programs being a 5-yr curriculum with the last year strictly a residency? The BSN program could also be altered to include more core nursing. As far as a science back ground, I had 3 semesters of chemistry, 2 semesters of A&P, microbiology, pathophysiology, pharmacology, and basic biology. I think pre-science courses are required for nursing no matter what degree you get? As for NCLEX scores, they are like SAT's and GRE's and don't make a nurse a "better" nurse b/c of a particular score (some people are good test takers and some are not). I also like the canadian idea of requiring additional college classes to specialize.

    Last edit by Julie, RN on Nov 9, '01
  6. by   KRVRN
    I won't debate which is the better degree. But...

    "statistics show hospitals would rather hire ADN's than BSN's..." is rather a broad, weak statement. I can't imagine this quote being extrapolated to a very large population over the entire US. As we all know, it's all individual and a matter of opinion. My hospital would rather hire BSN's. That happens to be their preference. Were they included in the statistic?

    I also think you will get a fair amount of disagreement in saying that the only difference is the amount of humanities courses. If that were so, then why would hospitals want to hire ADN's instead of BSN's--why would it matter?

    If you hate the constant debate, pama, maybe you shouldn't start your post with "not again..." and end it with "...I'm tired of this being an issue." Mattcastens was asking a question, not starting a debate.

    I would like to read said statistics so I can be enlightened before I post again, please. Where can I access them?
  7. by   CareerRN
    I have to agree with the intention and the logic behind making a BSN a requirement, but I have to disagree based on reality.

    When and how is a liberal humanities class such as "Ancient Roman Architecture 101", and "Piano 101" actually going to uplift the nursing profession? Yes it might make for a better rounded education, but is taking a class to learn how to play a piano going to make anyone more of a professional?

    These are filler classes and ways for a college to derive more income, nothing more and nothing less. The fact of the matter is that most of the nursing programs require 2 years of prerequisites before you can start.

    Maybe the answer to this question is more focus on us. If we want to have more respect, better compensation, and better working conditions, then maybe we need to unite and demand it and accept nothing less. Maybe we should be focusing on all the individuals who hold us back by accepting what ever is thrown our way and will continue to allow it to continue. It seems like everyone wants someone else to step in and change things for us i.e. government, the public, administration, etc.. Is it not time for us to take the bull by the horns and change things ourselves. How long will it take for this to happen? How many more nurses do we have to loose before enough is enough. Efforts are being focused on replacing the nurses who have left and are leaving because they got tired of the conditions of nursing in general. So we just continue to try to replace the nurses who are everyday saying enough is enough and leave. Shouldn't the main focus be on stopping the mass exodus of experienced nurses who are leaving today and trying to get the one's who have left to come back? Now I wonder how this can be actually accomplished? Do you possibly think that maybe having nurses in charge and actually calling the shots as to how and under what conditions we will practice including appropriate compensation for our responsibilities might accomplish this? When I say nurses in charge and calling the shots, I am not referring to educators, nurse administrators, of politicians who have not been at the bedside in years. I am talking about the nurses who are actually there.
  8. by   nicola
    When I was deciding which track to take to become an RN, I polled many, many nurses. Their back grounds were varied - LPN's, RN's, dilpomas, ADN's and BSN's... To a person they told me to go for the BSN because it would make me more employable and would open more doors for me. I was reluctant because I ALREADY HAD a bachelor's degree and didn't particularly want to do 4 more years. Yet I don't regret my decision because all the jobs I've held as an RN have required the BSN. I've done home care and am now a supervisor.

    Now, what does "Footwear of Ancient Rome: an economic study" have to do with nursing? Nothing, really. I would argue that many of the non-nursing classes I took have helped me be a better nurse. My orig. degree is in Spanish and Sociology. I can communicate with twice as many people as my non-bilingual collegues. My background in soc. has made me more able to look at systems and see how the illness of one person affects the rest of the family. I took courses in logic and programming. Why? To clean up my thought processes. I had a penchant for sloppy thinking - not great for a nurse!

    I agree with the public perception of the BSN v. the ADN. I also agree that the BSN programs need to do more hands on before sending people out to work. Why not have a 5 year program ending in a year long preceptorship? I would have loved that and would have been a better nurse had I experienced that kind of thing.

    In the meantime, I think that we need to quit bickering amongst ourselves and start working together!
  9. by   BrandyBSN
    Matt wasnt starting a "who is better than who" debate. However, I find your comment about "hospitals prefering ADN nurses over BSN nurses" to be obsurd. I have seen many advertisments for RNs, with "BSN PREFERED", but I have yet to see one that says "ADN PREFRERD". If you find out of these, please post the address of the job listing page, so that I can be corrected.

    Neither makes you are better bedside nurse than the other. However, the compensation issue is valid. Compare nurses to teachers for a minute. A teacher with an Associates degree still has the certification to teach, they can teach all of the same courses as a teacher, and they might be as good as of a teacher (or better) than a teacher who has a bachelors degree. However similiar their skills are, the bachelor's degree teacher gets paid more. why? as a compensation for further education. Compensation for education occurs in almost every other profession, but not in nursing. That does not make sense to me.

    Some hospitals do compensate, and when I was job hunting, i looked for them. I have chosen a hospital that DOES pay for further education. Its not a great deal more, but atleast they acknowledge, and make a distinction.

    I think you are on the right track Matt. It might never be a reality, but atleast it can be the ideal.

    BrandyBSN
  10. by   canoehead
    Everything I've learned has been based on the diploma program, and I thought it was too short.

    I took the BSN after the diploma, it was a waste of time and money- not to mention my energy.

    I would prefer a 4 year program, with the diploma as the model, get people on the floors early and base the curriculum studies on the clinical experience. I would be for making the last year the specialty year with extra courses in whatever you choose to specialize in, or a basic med surg rotation system for those who don't want to limit themselves.

    I am available to teach for this type of program anytime.
  11. by   essarge
    Pama- you state:

    "Not again. Please check the statistics before posting. Statistics show the ADN graduate out scores the BSN on the NCLEX-RN graduate. Statistics also show hospitals would rather hire an ADN graduate over a BSN graduate due to the training and education"

    Please tell us where you got these statistics from.

    I am in a nursing program and would love to have the program extended one year to do a "residency". It would not only benefit me but also my future patients with the knowledge that I could amass from it.

    I agree with Brandy. When I am ready to look for a job, I will be looking for someplace that pays higher wages for higher education.

    No, maybe the literature course I have to take might not have anything to do with nursing per se but, all of the classes (including if I choose to take piano), will make me more rounded, able to discuss various subjects with a wide variety of people that I have contact with after I graduate. So yes, getting my bachelor's degree is well worth it (not to mention that I will have the ability to move up the ladder to areas that DO require a bachelor's degree).
  12. by   mattcastens
    Originally posted by CareerRN
    I have to agree with the intention and the logic behind making a BSN a requirement, but I have to disagree based on reality.

    When and how is a liberal humanities class such as "Ancient Roman Architecture 101", and "Piano 101" actually going to uplift the nursing profession? Yes it might make for a better rounded education, but is taking a class to learn how to play a piano going to make anyone more of a professional?

    These are filler classes and ways for a college to derive more income, nothing more and nothing less. The fact of the matter is that most of the nursing programs require 2 years of prerequisites before you can start.
    I think this is actually backwards thinking. As I wrote before, a two-year degree is what is needed to become an auto mechanic or a dental hygenist. If we start asking why and what the liberal arts and research classes have to do with bedside nursing we hurt our image. The public response might be, "Nothing ... after all, you're just glorified techncians." That is exactly the image we are trying to get away from. What if physicians only took the strict sciences and skills needed to become doctors?

    Do all of the "extra classes" make us better bedside nurses? YES! Because they help us understand the world, other cultures and each other. They teach us how to think in different ways and with differing points of view. They allow us to consiously work through problems.

    Can I, with an associate degree do these things? Of course! Am I a better nurse than some of my BSN collegues? I think so. However, my point is that public perception is very important. If we want to improve our image, maybe we should be demanding very much more from ourselves. Education is respected in our culture, let's start there. If we remain satisfied with the level of education required by dental hygenists, we will be percieved as "medical hygenists" and not the professionals that we truly are.
  13. by   fergus51
    Our BSN and diploma courses are exactly the same except that BSNs get another year of school where they do community/public health and more hospital hours. I never took piano or architecture, I had sciences as my electives, and the diploma students had to have electives too.

    Julie, I absolutely hate the fact that we need another bunch of courses to work in specialty areas because it takes my time and money. I don't see why a hospital that is short of nurses won't pay for us to take these courses (some are starting to but they're few and far between). To work in say L&D at my hospital means a minimum of 5 years of school! It's ridiculous.
  14. by   BrandyBSN
    I just got back from my American History class, and I was thinking a lot about the piano comment.

    I have a very strong background in Music. I have taken courses in african, jazz, classical, and wind, as well as competition on the district, and state levels on a variety of instruments. Actually, this DID help my nursing technique!

    When I percuss or ascultate a patient, to hear what structures are laying beneath the skin, the sounds are varied. Resonant, tympanic, flat, sharp, dull, brassy, and others. Each sound indicates a different underlying structure, or substance. If I would have never had a musical background, or had not received education in musical instrumentation theory, I wouldnt be as accurate in my patient assessments.

    Also, I can be more present with my patients who may have carpal tunnel syndrome(7 years of piano), stripped off fingerpads (I played bass guitar in jazz), Lip and gum problems (I also play trumpet), shoulder aches (I ALSO play flute), and back problems (yes, I also played tuba, which is huge and heavy, as well as tri-toms, orchestra bells). You are probably asking be now, what is my point. Well here it is...

    No matter whether a class I have taken as a separate nursing component, of is based solely on liberal arts and sciences principles, ANYTHING i have learned can be applied to my nursing practice in one aspect or another.

    Architecture 101? You bet that can be applied. You have a patient come in who has been hit with an I-beam. What would that mean to a nurse who had no idea what an I-Beam was?

    All the literature classes I have taken? You bet, those can be applied as well. By reading literature, I have learned about many different cultures, practices, and health beliefs.

    Exploring Religions class? Again, yes, it can be applied! What is acceptable interventions within a cultures religious beliefs.

    You see, you might argue that none of these have anything to do with nursing. But that is just not true. Every bit of knowledge and education that we have is fair game for use on assessments, interventions, and life process. These ALL add to my ability as a nurse. If you choose to look at them as if they have no value, that is fine, and I cant make you see them differently... however in the multi-faceted world of client care, education is the more the better. Less is not more.

    BrandyBSN

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Professionalism and Credentials