Am I Crazy? Revaming the RN/NP school curriculum...

[greygooseuria]

This summer, I am taking Bio I and II together along with calculus, both for personal enrichment and because I plan to get a science PhD after my MSN or go on to med school once I have my loans paid off/finish the prerequisites. Anyhow, I am finding molecular/cellular biology to be INCREDIBLY useful to my current nursing practice and to my practice in NP school (I have one year left to go) and I'm only in the second week of classes! I am finding the material to be applicable to many things, and feel I almost missed out on something by not having this included in nursing school/NP school. I've also been reading some chemistry textbooks and physics textbooks and these also are giving me a much deeper understanding of pharmacology and how what I prescribe for patients or interventions that I perform as an RN "work" and I appreciate my practice that much more.

Am I crazy for thinking nursing and NP school, much like med school/physical therapy school, should include these as courses required in the curriculum? A year of physics, biology, chemistry and organic chemistry I feel would not only give greater knowledge to our graduates and a deeper understanding of the physical world, but also give greater creedence to our profession, ie: we have the science AND the heart! I am finding what I am learning to be SO much more applicable to my learning than theory, research, communication, and policy ever were, and that's comparing classes I've had for a whole semester versus ones I've been in for only 2 weeks so far. I can only imagine how useful biophysics will be when I get to it.

I subscribe to the "don't be a douchebag to your patients and listen to what they're saying" philosophy and did so LONG before nursing school so maybe that's why I find most of the current curriculum useless. lol

[nstudent16]

I agree,

The model for PA's is based on medicine, while the role of an NP's is based on the nursing model. PA's are only allowed to work under a licensed Doc, whereas NP's are allowed, in some states, to open their own practice. The anonymity of an NP is much greater than a PA in many states...perhaps because it is recognized that an NP will consider the whole patient, whereas PA's are trained to diagnose and prescribe.

Good point.

[greygooseuria]

Well, I know a lot of people who have taken a lot of science class and are horrible scientists too And ultimately, I agree with you. If/when I have to take "don't be a douchebag to your patients and listen to what they're saying" classes, I'm sure I'll feel the same as you.

Ultimately I think the quality of the program makes more of a difference than the classes when it comes to what meta-skills you get out of it. I think I got most of my good science thinking skills from working in research but feel pretty good about my undergrad degree also being some useful preparation. The pre-reqs I'm taking now I'm highly critical of and was very unhappy with the level of memorization vs understanding. The difference isn't just the courses-- it's the philosophy of teaching.

And from what I've seen so far, I agree that revamping would be wonderful.

I try to keep in mind that nursing is actually a pretty young profession and as more demarcations happen e.g. CNA vs LPN vs RN vs BSN vs NP vs PA vs MD work I think a lot of the revamping is growing pains. Personally, I would be in favor of an MCAT style pre-nursing school exam rather than GPA based competition, especially for 2nd degree programs. Personally, I think Univ of Washington's work experience/job shadow requirement is awesome (I use them as an example as they are often ranked #1 in the nation).

I'm glad you had a good experience with an MD preceptor and it sounds like you will do great in research if you choose to go that way.

Do you have any thoughts on how students could get more out of nursing school to better prepare them, as you see it?

I think students would get more out of it if nursing school looked something like this:

Freshman Year (Fall/Spring)

BIO I/BIO II

Chem I/Chem II

Freshman English/Freshman English

Elective/Elective

Sophomore Year (Fall/Spring)

A+P I/A+P II

OChem I/OChem II OR Biochem

Health Assessment/Pathophysiology

Nursing Fundamentals/Elective

Junior Year (Fall/Spring)

Pharmacology/Human Growth+Development

Med-Surg I+Clinical/Med Surg II + Clinical

Calculus I/Calculus II OR Stats

Elective/Elective

Senior Year (Fall/Spring)

Psych Nursing + Clinical/Practicum in specialty of choice

Peds Nursing + Clinical/OB Nursing + Clinical

Physics I/Physics II

Elective/Elective

Electives would fulfill gen eds, so could include psych/sociology etc. Research would be another one and could probably be combined with community health. Require a community health project during the summer between junior/senior year to fulfill that requirement. Include nutrition info in chem/bio/A+P to fulfill that. While this looks like a pre-med student schedule, it also incorporates nursing and the background in bio and chem/ochem would make pharmacology come alive MUCH more and the professor could go much more in-depth with how drugs work. I think these same requirements should be required for NP school too, so graduating RN students would be prepared to apply to NP school if they so desired.

[tigerlogic]

But there are no classes to tell you about how you shouldn't call your patients "grandma" and "hey sweetie."

Such a pet peeve....

I'm not sold on having physics or calculus in there but generally think that you can't do the really interesting biology (molecular biology, cell biology, microbiology, genetics, physiology) until you've had a year of chemistry, and would love to see that ante upped. Personally, I would have loved a more 'hard science' basis in Nutrition rather than the lame class I took that talked about how vegetarianism wasn't a religion and why whole milk was evil because that's what the FDA says. sigh. So, having that integrated could be good.

I also think people should get their CNAs early on and should start working with patients sooner. Knowing if you have the stomach for the bodily fluids as well as the endemic short staffing, being constantly interrupted and working with your body would be better to know sooner rather than later.

[greygooseuria]

I agree. Physics is useful for knowing pharmacokinetics/dynamics though, and physics explains the natural universe and why atoms behave as they do.

Nursing as a whole seems to want to ignore the fact that gravity exists and that humans are composed of atoms and molecules which comprise their cells.

[elkpark]

I dunno -- my hospital-based diploma program in the early '80s included a full year of organic chemistry and A&P plus micro (that one was only a semester :)), the same courses that the chemistry, biology and pre-med majors at the college at which the courses were taught took. I can't imagine having been a nurse all these years without having the hard science background I got in my original nursing program. My experience in teaching in BSN and ADN programs in more recent years has been that nursing education has been seriously watered down over the years.

However, I know from my experience teaching that there is a big difference between "nice to know" and "need to know" (that's the eternal debate in every curriculum committee meeting I've ever sat through). How much longer and more expensive would nursing programs be if they were providing "optimal" education for nurses? How much more should nurses get paid for having that additional education? Do you think most employers give a rat's behind about their nurses' grasp of O chem and biophysics? How would that "optimal" education change what most RNs do all day every day? We barely get any credit or compensation for what we know as things are now.

[greygooseuria]

elkpark, I agree to an extent but I think market economics would eventually take over. For example, with all that coursework being required nationally (rather than by different schools), it'd basically guarantee a BSN as the minimum degree, which would contract the RN workforce. By doing so, there would be a higher demand and less supply, meaning RNs would then have greater bargaining in negotiations regarding salary and benefits; I only see this advancing the nursing profession rather than holding it back.

[hoosier guy]

limiting the supply of nurses in order to raise salaries is a horrible idea. the only thing that will do is cause med asst. to expand their role and do it for less money than a rn. look at what happened when there was a doctor shortage, we got nps and pas. if there is the type of nursing shortage that is being predicting for 2020, we will get something else to do the nurses job.

[greygooseuria]

Maybe in outpatient med offices, but in a hospital? I think the ANA is a powerful enough lobby to stop that. Plus, I doubt the American public would want someone with a certificate giving them IV medications.

[That Guy, BSN, RN, EMT-B]

A lot more things need to change in nursing school before adding more/different classes.

[greygooseuria]

I agree with you there. I personally found nursing school to be very very easy...but maybe that's because I can learn things once and have it memorized. I also find nursing practice to not be terribly hard either, but find NP work to be challenging (I'm sure I'd find ICU or ED nursing challenging, but med/surg and rehab where I've worked are so task-focused it's mind-numbing).

Let's focus solely on NP education here, since RN education seems to be detracting: do people think these hard sciences would really not radically change practice?

[scabby21]

I am a RN who graduated in Dec 2010 and we had to have Bio, Chem, and Organic Chemistry before entering the nursing program. Of course Bio has a lot to do with nursing, however I cant really say that Chem or Organic Chem really helped with my nursing course work or my life as a nurse. I think that it would be rediculous to add physics and calculus to the nursing curriculum.

[elkpark]

I think the ANA is a powerful enough lobby to stop that. Plus, I doubt the American public would want someone with a certificate giving them IV medications.

You must be fairly new to nursing ... :) Name me one thing the ANA has lobbied for that it has ever gotten implemented. They've been pushing the BSN-as-entry-level proposal for nearly 40 years (or has it been 40 years now? Wasn't the original "white paper" published in 1965?), and that's no closer to happening than it was when it was first proposed. The ANA is one of the weakest professional organizations out there (at least partly because of how few American RNs belong), and no one in Federal or state government really cares what the ANA thinks or wants (unfortunately). Nurse practice acts and other legislation/rules/regs controlling nursing education and practice are developed by state legislatures with input from all stakeholders, including physicians, hospital administrators, insurers, and the general public. None of those groups have any interest whatsoever in RNs costing more to educate or employ.

And there have been any number of efforts over just the 25+ years I've been in practice to develop other, non-licensed roles to serve as less expensive providers of what is now considered RN practice. Shoot, that's how LPNs first came to be. My father was an RN in the 1930s, and I remember him talking about driving to the state capital with other RNs to lobby the state legislature against the creation of LPNs because RNs then considered that a direct threat to their practice. LPNs now can do a whole lot more than they used to be able to do just back when I entered nursing, all of which is practice that used to be considered exclusive to RN practice. There was a big hubbub in the 1980s when the AMA proposed creating a new role, the "UAP" (for Unlicensed Assistive Personnel, as I recall, who would be trained and controlled by physicians, not by nurses) to take over part of RN practice. Lots of states now have "medication aides" or some such relatively new role. The stated rationale for these proposals is always to "help" RNs and free up our time for more important duties, but the bottom line is always to have someone who costs less doing the work.

RNs are constantly walking an extremely fine line. If we push too hard for more education or more pay, we risk getting further marginalized than we already are. I'm not at all an apologist for this point of view, and am as big a proponent of comprehensive and high quality education for nurses as anyone, but this is the reality of the interesting predicament we are always in. (I am constantly reminded, in nursing, of the old Chinese curse, "May you live in interesting times" -- the times are always "interesting" in nursing ...)