Is it moral for nursing schools to keep taking tuition if they can't place their - page 3

The question was from The Ethicist column in this Sunday's New York Times (found at . As you will see in the column (below), the question addressed law school, however, it is an equally valid... Read More

  1. by   elkpark
    Schools provide education, not jobs. It is up to the prospective student to research job prospects for different fields and academic disciplines, and make the best choice for her/himself. If schools had to shut down departments that couldn't place all their graduates in jobs, there wouldn't be a single college/university left in the US that had a fine arts department -- and we would all be worse off for that. As already noted, a big piece of this is the (unfortunate) shift by many from looking at education as education to looking at education as the ticket to a particular job/career.
  2. by   ProfRN4
    Unless the school has a direct link to an institution that provides employment (I'm thinking of the hospital-based school of nursing, which are few and far between nowadays), I think it's absurd for someone to believe that a school will guarantee a job. It's like going to a doctor with a fatal illness, and then saying to the doctor "but you promised me I would not die". Its a very juvenile way of thinking. Life stinks, promises sometimes need to be broken. My ex and I promised to love each other, foresaking all others. That didn't happen .

    I walked into nursing school during a shortage. 2 years later, the powers that be had this brilliant idea to beef-up the role of the CNA, so they could do more RN duties. What did this mean for graduate nurses? Less jobs (we don't need you, the UAP can do half of your job). I graduated from a hospital based school, and this is where the majority of my class ended up working,

    You can't create jobs out of thin air. The for-profit nursing schools pride themselves on job placement (it's some sort of mandate, by whom, I'm not really sure). Look at Amy commercial for a trade/tech school: "job placement is available". I think it gives them extra federal funding or something. They try VERY HARD (most of them), as they have to justify that they are following through on their word. they follow every lead they get. they are relentless. But you can't get blood from a stone. And in the case of nursing, if its an ADN program,you can't make someone hire an AD nurse when they require a BS.
  3. by   KelRN215
    The product that a school is "selling" to the student is not a job, it's an education. No school promises that a degree will get you a job. Graduating from high school (even a private high school that you pay tuition at) doesn't guarantee that a student will get into college. Graduating from college doesn't guarantee you a job or admission into graduate school. And it's not unethical or immoral for a school to educate students without being able to guarantee these things. There are no guarantees in life. Now, when I graduated from college in 2007, the Nursing school was the only school in the University that had 100% of its students employed within 6 months. These numbers were published by the school/the student newspaper but I still never thought it was the school's job to secure my employment. They had resources (a Career Center to help with resumes and cover letters) to help and that I utilized but I always knew finding a job was my responsibility and mine alone.
  4. by   KelRN215
    And on that note, I wonder if the person who wrote in to the NYT to ask this question thinks it's unethical for liberal arts schools to offer Undergraduate programs in things like History or Philosophy... which almost never earn the student a job.
  5. by   HouTx
    Quote from ixchel
    I know a guy who will cry to you all of the woes of possessing a 4 year degree and being jobless. He's 30-something, living with parents, and can't get anything better than minimum wage stuff. "College is a scam!" he'll cry. "We were told we'd have jobs when we graduate!" Boy is he all about the occupy protests, posting stuff on Facebook about how victimized he is.

    Did I mention his bachelor's degree was in philosophy?
    I am So shocked! Do you mean to tell me that the philosophy companies are not hiring?
  6. by   RNmyFriend
    What I think is unethical is when people are told by Nursing Schools, Colleges and Universities that there is a year to year and a half waiting list to get into a particular nursing program and that the student should take all the non nursing classes while they are waiting to get into the nursing program. The student spends big tuition dollars and all these classes relating to nursing in eager anticipation of nursing school. After a year and a half of spending money on tuition, fees, books, gas, and all other college related expenses the student starts the nursing program only to be dropped in a semester or two by arrogant. egotistical teachers that prejudge students and pick out favorites and find ways to boot the students they don't like out of the program. This almost happened to me. I was getting all A's and doing fine first semester when I ran into some of these "instructors". I dropped out of that school and attended another school within the same community college program in another city. I ended up graduating with honors and went to another school to finish my AS in nursing. I got a job in a hospital and have been working as a RN. I feel sorry for all the students that did not fight for their nursing degree and spent all that tuition money on classes they will never need not to mention the year and a half of their lives waiting for something that never happened. I know that nursing is a tough profession and that not everyone is cut out to be a nurse, but I think that far too many people who would make good nurses are not given the chance because these "instructors" let ego, pride and arrogance get in the way.
  7. by   marcos9999
    Nursing education/training is very peculiar. We all know that clinicals will not train you and they are at best a "get you feet wet" kind of training. The real training is done by the hospital which is the "unspoken rule" of the system in the nursing's training hence the new grad programs however they are not coordinated with schools whatsoever. Hospitals will only train nurses as they see a need for it always reflecting their needs and financial interests. For about 5 years now hospital have only trained about 50% of the new graduate nurses. This makes total financial sense from business point of view. However hospitals "forget" that they were awarded by the federal government a non profit status (tax shelter) means they must provide and protect health care and the community. While they profit heavily from the great recession making nurses overwork and hire less and train less they create a void in the supply of new nurses entering the profession. All is safe if the economy never recover but we know that will change. The next nursing shortage is brewing as you read this.
  8. by   netglow
    RNmyFriend, sadly this recently happened to someone in my extended family. She was a 4.0 BSN student until her last year of her BSN, one teacher dropped her down drastically in their point system after a semester of walking on eggshells with crazy, to where she would not pass. She responded by seeing the treachery in nursing, and changed majors. I have a relative that was a nurse and has been retired for a decade or so, and she, learning of how things are now from me, as well as from this young one, just shakes her head in embarrassment saying that things never used to be this way, and that if faced with this new nursing norm, she'd never work as a nurse. She feels responsible in a way because she had encouraged us both - based on what nursing used to be.
  9. by   elkpark
    Quote from marcos9999
    Nursing education/training is very peculiar. We all know that clinicals will not train you and they are at best a "get you feet wet" kind of training. The real training is done by the hospital which is the "unspoken rule" of the system in the nursing's training hence the new grad programs however they are not coordinated with schools whatsoever.
    Keep in mind that what "we all know" is a comparatively recent phenomenon -- until relatively recently, nursing schools did prepare their graduates to function effectively as entry level nurses with relatively little orientation (certainly nothing like the current extended internships and other training programs for new grads). If anyone had suggested to hospitals (or nursing schools) 20 years ago that new graduates would need three to six months of extended orientation/handholding/additional training, and hospitals should foot the bill for this, everyone would have had a good laugh and wonder what planet you had fallen off of.

    Hospitals are not happy about the current state of affairs, have not been happy about it for some time, and, even before the economy tanked, were starting to "vote with their feet" by balking at hiring new grads. I don't expect that to change just because the economy improves eventually.
  10. by   marcos9999
    Quote from elkpark

    Hospitals are not happy about the current state of affairs, have not been happy about it for some time, and, even before the economy tanked, were starting to "vote with their feet" by balking at hiring new grads. I don't expect that to change just because the economy improves eventually.
    Yes. When hospitals used to be hospitals and not wall street outlets they behaved more like teaching/public service providers facilities. That all changed in the 70's when they became a feast for hungry lawyers who could find plenty of cases to go after. Now students can't even touch a patient. In the end the market will rule all. When the supply of experienced nurses drop to low levels and the census rise things will move rather quickly.
  11. by   samadams8
    Quote from DoGoodThenGo
    If every college, university, professional school and so forth shut down everytime there was downturn in graduates finding employment there wouldn't be many left.

    Nursing went through a major purge from the 1970's through 1980's when scores of programs both diploma and college (ADN, BSN) shut down due to lack of interest in the profession. Then when everyone was wailing about the coming "nursing shortage" there weren't enough programs/slots and or professors and clinical instructors.

    It is rather easy to shut down nursing programs, starting them up is another matter. Staff especially the good ones aren't going to hang around on tenter hooks, but move on to other gigs. Indeed one of the problems nursing schools are having now finding qualified instructors and professors is that many of the older guard either retired or has passed on. Those with potential to become nurse educators make far more with often less hassle working at the bedside or anywhere else but in teaching.

    The best any nursing program can offer is excellent traning and education in preparation for taking (and passing) the NCLEX and laying the foundations for a career in nursing. Everything else is up to the individual.

    Regarding law schools, the problem there is for years persons have believed having a law degree was the ticket to wealth, power and status. Ever since shows like "LA Law" and "Boston Legal", and even "Will & Grace", people seem to think all lawyers are goodlooking, wealthy, connected, and so forth. The reality is quite different however.

    Just landing a spot as a junior associate at a top legal firm took some doing. Once there yes often one could earn >$85K to >$100K off the bat, but you worked your *** off to get it. Putting in literally almost 24 hour days where a car would drive you home long enough to bathe and maybe grab an hour of sleep then take you back to work. Oh and count on working weekends as well.

    Like nursing the problem with the legal profession is the practice is changing with the pace quickened by the recent fiscal/economic crisis.

    Being as all this may just as with nursing if persons would do their homework before going to law school they'd pretty much know what chances they had of finding work post graduate.

    There are only ten or perhaps under twenty law schools worth attending in the United States. We all know their names because some of hte most powerful and sucessful lawyers attended including Obama and most POTUS. Harvard, Yale, Princeton, Georgetown, Columbia and about handful of others make up the top ticket.

    Law education in the United States has a dirty little secret that was exposed during the fiscal crisis. By and large obtaining a JD or law degree does *not* teach one how to practice law. That is where being a junior associate (and all those aforementioned long hours) comes in. Many fresh law school grads do not know how to draw up vaild contracts, start legal proceedings, and so forth. All that comes from the period spent post grad doing associate work. However during the economic crisis clients began taking a closer look at their legal bills and began refusing to pay thousands if not hundreds of thousands for billable hours done by associates. They found it cheaper to either to have the work done in house, outsource it, or simply demand as part of keeping them as clients the law firms absorb such costs themselves. This as one may imagine caused firms to scale back if not cease hiring new grad associates.

    I was fortunate enough to have a good attorney, who is quite the mensch by the way, clue me in to it. I was never as interested in the core of it--knowing the kinds of things you end up doing most of the time--as opposed to any of the more glamourous things. People don't get that the entertainment business is not going to show the many, many tedious things involved in the core work of a particular profession. When, for example, they show the thrill of being a teacher, they show Michelle Pfeiffer in the more exciting roll in Dangerous Minds. They DON"T show all the work that a teacher has to take home--all the papers or quizes or tests or reports they have to plow through at home or after classes. They don't show the tons of prep time involved in doing the lesson work.

    For physicians, they don't show all the paperwork they must get boggled down into or the fact that they often have to struggle with getting decent compensation from insurance companies--even if they have managers that are supposed to help them. They don't see all the government required hoops that have to be jumped through after office hours. Nor do they see all the years of actual rote learning that people have to totally cram into their heads in the first two or so years of medical school, often, even before they go near a patient. They certainly don't show the enormous amount of debt for student loans that physicians mostly have take on--$200,000 or the 8 plus years post undergrad that they have to go through before they can even try to make a decent dollar.

    In most fields, people don't do enough research to know the hard, core details of what is involved on a day-to-day and year-to-year basis. Without adequate research, you can't make an intelligent decision about, well, counting the cost/s.

    I think you have to become as acquainted with a particular area as much as possible. What most people end up doing is focusing on getting into the schools or particular areas--rather than say, taking courses that are general education, while they more fully investigate or put in the necessary shadowing hours for a particular field.

    Every field will have some large core area of things that are not that attractive. But you have to investigate the field fully enough so that you can weigh your interest and enthusiasm and commitment to the field, and then see if it will be worth it when you add in the bulk of ALL the other stuff that isn't so fun or great.

    What I think community colleges should do is stop with the ADN programs that can lead to sitting before the NCLEX. What they should do is work to help people bridge INTO nursing--preparing them for when their base education will be bachelor's in science by offering strong, transferrable general education courses, and then helping students by getting them into shadowing programs, where students can really get much more of a taste for what nursing is all about. Those shadowing "courses" or units could meet some kind of credit requirement that is transferrable. Now, if the student/s find out that it isn't their deal, they lose nothing but the shadowing time, b/c the GE are transferrable to other areas of study.

    In medicine, for example, they want people to have shadowing and exposure to medicine. They look at such hours upon application to a medical school program. They want to know if people have some kind of idea about what they are getting into.

    So for nursing, the more shadowing experiences into various areas, the more points toward acceptance into a nursing program. Make these programs tougher to get into--in terms of academics as well as extra curricular/shadowing experiences. They are often just too easy for many people to get into.

    And it can't just be about being academically competitive. You would need to show commitment and experience/exposure to the field. You would also need to show the current market realities for nurses.

    Example. If you go to another nursing website, at least for the job opportunities that they are posting, you will see that positions across the country for medical-surgical floor nurses are > 10x's what they are for say, NICU positions or PICU positions. IOWs, you can see what areas the bulk of the nursing positions are. You can then estimate a probability for landing into this area as compared with the other areas of specialty--pretty low comparatively. (YES, there are always exceptions. Everyone wants to be the exception. But you can't make your decision based primarily on the outliers.) At the very least, you work in med-surg for a while, and the chances for opportunity in other areas of specialization will present themselves--especially if you have the core insights of basic medical-surgical care of clients and the how they function.

    Anyway, I think that would be a good place for nursing as a profession and nursing education to start.

    At the end of the day, it's on the prospective student and the current student to get a clue about what they are pursuing.

    As a nursing program administrator, I would push for requiring a certain number of shadowing hours and a review of the current market power, as well as volunteer, extra curricular work, along with academic excellence and high test scores for entrance. And it shouldn't stop someone that doesn't have these things in line. They can just do the work in school, get their grades up, prepare properly for standardized tests, get shadowing experience, and participate in volunteer work in order to obtain the best points for acceptance into a program.
    Last edit by samadams8 on Dec 4, '12
  12. by   samadams8
    Quote from marcos9999
    Yes. When hospitals used to be hospitals and not wall street outlets they behaved more like teaching/public service providers facilities. That all changed in the 70's when they became a feast for hungry lawyers who could find plenty of cases to go after. Now students can't even touch a patient. In the end the market will rule all. When the supply of experienced nurses drop to low levels and the census rise things will move rather quickly.
    True. But people have to look at nursing along with the bigger picture of healthcare--what it is today. It's changed enormously since the 70's. What will not change is the fact that in order to reduce costs, a huge bulk of care, diagnostics, and treatment functions have moved OUT OF THE HOSPITAL.

    Stays have also decreased dramatically as per insurance reimbursement requirements. A whole huge amount of healthcare is now OUTPATIENT. All the trends indicate that more will continue to move out of the hospital, until only the most sick will be in them.

    So now you have only so many positions in hospital left for nurses to fill. Nurses must look to outpatient settings in order to find work. The nursing shortage will probably never be what it once was, b/c the need for the higher numbers in staff has been cut d/t moving services out of the hospitals.

    Things like homecare, hospice, rehab, and long-term care are areas for which nurses will have better chances in terms of job procurement. Now nurses and nursing students will need to face this reality. Nurses no longer have pick of the litter for various areas of specialization. That's part of why the specialized areas are so catty. People want to work in these areas, b/c of interest, but there is a lot of climbing and clawing within them. I know. I have seen it for years, and I see it on a regular basis, and it has only gotten much, much worse.

    Things have changed even with open heart surgery. The move to minimally invasive procedures, for example, has reduced stay times as well. When stay times are reduced, the number of nurses need to care for these patients is reduced.

    All these nursing students and newer nurses are looking for their dream jobs in areas where there is limited need, due to a changing world of healthcare. These positions no longer exist in the numbers that they once did.

    Will there always be a need for nurses? Sure, in some capacity. The thing is, in terms of probability for gaining positions, they positions available will be in the things I mentioned, like homecare, hospice, rehab, LTC. Shoot, insurers have even severely cut the time for in-hospital stay for those with drug, ETOH, and mental health issues. They move them quickly into outpatient settings.
    The other area for nurses may be the office setting; but in general, you aren’t talking about the same amount of financial compensation. Pay rates for nurses drop significantly, most of the time, when they work in medical offices. Furthermore, the patients in the office are mostly stable, so the ability to learn the mix or nursing and medicine, as nurses once did, is much less as well. Honestly, I can now see why people go through a 6 month program to become medical assistants. The cost: benefit ratio is better if you want a job in this area.

    Nurses cannot work the numbers as they previously could. So when these students think in their minds, "Hey nursing gives job security," they need to understand in what area their (at least hopefully) job security will be. It is not like it once was, and it will never be as it once was.

    Yes, people will retire from nursing, and enrollments into nursing programs may drop as well. But the number of in-hospital positions will still be comparatively limited.

    If nursing students don't accept the realities early on, they are foolish for not doing their homework. So they must understand that when they get through school, the areas for landing positions will be medical-surgical floor nursing positions, and all those other areas I've mentioned--and even a good number of reputable HH agencies and hospices require at least a good year of acute or critical care nursing experience.

    The other issue is Obamacare. No one really understands how this will affect the hospital's budgetary bottom line. Until they figure it out, they will continue to be reticent about taking on full-time nurses, even where they can use them.

    So, if you want to work LTC or rehab, then nursing may be a good career choice for you. If you want to work, say, acute care or specialized critical, outside of Med-Surg., no, not so much. You will have a hard time finding a job.

    You may find adult ICU positions--predominately on nights, but these positions and ED positions want that core MS experience. It NO LONGER matters that other nurses in the past landed specialized areas right out of school--out of NMger's needs to staff d/t desperation. That's NO LONGER RELEVANT.
    No one has the budget for the training of inexperienced nurses in these areas.

    Furthermore, it's a buyer's market, so they can and will be picky.

    Now, you can look for hospitals that have nursing residency programs for areas of specialization, but the seats are VERY limited.

    Thus, you need to make sure your GPA is closer to 4.0, that you are very mature and seem "pliable," meaning you are willing to take a lot of guff, work a lot of off-shift, holidays, and weekends, and that you have great references from teachers and others in healthcare. Even then, there are only so many seats for such internship programs. So besides the other things, you would need to apply when such programs are opened up again, very early, and you should be able to communicate and interview very well.
    They are going to choose those that meet these requirements to the highest letter, right off the top. If your stats look good, but you submitted your application later, you will probably be out of luck. Once they fill, they fill, period. And there aren't really a lot of good programs like this around.

    Now, relocating may be helpful, but also be prepared to be paid less after relocation. And don't expect relocation bonuses to be great, if present at all.

    Reality can suck. So “Caveat Emptor?” is a wise position to take prior to going for a nursing education.
    Last edit by samadams8 on Dec 4, '12
  13. by   nurseprnRN
    Quote from Meriwhen
    IMO, if a school promised you in writing that they WILL place you after graduation...then yes, it's unethical for them to take tuition if they renege on their end of the bargain.

    In reality, almost no school will promise to get you a job after graduation: it's too much of a liability for them. Even the local hospital diploma programs will tell applications that while they do prefer to hire their own grads, that job placement is in no way guaranteed.

    Now, if they promised to HELP to place you...there is no ethics violation. They only promised assistance with finding a job, not the job itself. Ultimately, landing the job is your responsibility.

    Moral of the story: do your homework before applying to any nursing program...and don't blame the school if you don't.
    See, this is why I don't understand why somebody said part of your due diligence was to ask your prospective school how many of their grads were employed. How the heck would they know? It's not their job to know that, and they don't know that. It's not like the new grads-- or the old ones-- check in every year and tell them. They don't.