Yes in the US, we are established as generalists. Our programs are designed to provide holistic care to our populations, providing our licensure to be of a generalist nature-our licensure exam-the NCLEX-provides questions that cover subjects such as Peds, Mental Health, OB, etc., however the key of becoming a licensed entry level nurse are four components: Safe, effective care; Health Promotion; Physiological Integrity; and Psychosocial Integrity. These components are transferable, regardless of specialty. For example, if a OB patient has kidney stones, depending on the trimester that the patient is in, will be on Med-Surg, but her status will be taken under consideration, same for Peds and Mental Health patients...there status doesn't change. That's where the "holistic" thinking comes in.
Upon going into a specialty area, there is on the job training and educational support for that specialty. There are hospital and health systems that design programs for the employees so that the fundamentals of what we are taught in school are built upon on the job. RNs can be specialized and become certified in a specialty after a period of time working in a specialty, so there is ample opportunity to be "specialized". Certified in a specialty constitutes a proficient, competent level in that specialty.
I highlighted your questions and decided to specifically answer them:
[*]How do you overcome the obstacles noted by the committee (quoted above)?
I don't see the "obstacles" as the committee stated as obstacles. Having a generalist training has allowed me to be able to effective care for a pt with a mental health diagnosis, a person with a intellectual disability effectively in a medical-surgical environment, and tailor teaching and interventions specifically for the individual.
[*]In your preregistration training, do you get instruction and clinical training in all the above disciplines of nursing?
Yes. We are required to have extensive hours in theory and practicum rotation in all disciplines. Students are also encouraged to seek additional exposure to specific specialties by interviewing for "nurse extern" positions. Some programs have programs specifically for student to have extra semesters totaling an additional year of clinical experience in a specialty setting. These programs either have a relationship with area programs or can be open to all. They are very competitive to get in. Not getting into one does not make or break a nurse who wants to specialize. There are opportunities to make such moves whether newly licensed or licensed over 5, 10-plus years, etc.
[*]How do you manage to go from learning how to manage a pregnancy and deliver a baby (not 100% sure if US nurses/midwives do this going by One Born Every Minute USA?) to promoting independence in a young person with a severe intellectual disability to working in a mental health special care unit? Does it even work like this? Or are these things learned at postregistration level?
Depending on the structure of the program, rotations are arranged in theory in what would be close in theory. In my program, health assessment and Maternity were in the same semester, because of the advanced assessment in maternity, it was a great transition. Some are structure with Maternity and Pediatrics in the same semester.
I had assessment and Maternity in the same semester. I assisted in giving birth with 3 mothers, 1 C-Section, had two post partum patients, and their children per clinical day, rotated in the special care (NICU) nursery and the newborn nursery. It wasn't daunting at all. The setup of Maternity was taking care of the mother and the child.
Either way, adequate theory and practicum is established. As far as intellectual disabled individuals, those factors are considered in all aspects...there is no separation of specifics...those 4 factors I spoke about in terms of licensure come up...Health Promotion is a factor to ALL, regardless of disability. It is probably due to our factor in how "health" can be determined as broad in terms of function in our society, and in theory, every individual has the chance to maximize their well being is optimal in terms of health promotion in our country.
[*]Do you think you'd be better prepared to work with specialist populations if your preregistration training was specialised or would giving up the mobility associated with generic training be a non runner for you?
For me, I do not see the chance of nursing school to be specialized, because that would drop the holistic nature in nursing, in my opinion. We encounter people with various backgrounds, cultures, abilities, etc, and for that, we tailor out interventions based on individuals. Again, no one loses their specific health issue whether I am treating them in the community or in the hospital or in a facility. The generalist role allows for that, and there are many opportunities to specialize post licensure. There are plenty of associations that assist with continuing education and support to become specialized.