A Nursing Dilemma

When I was a student Nurse in the late ’50s, the educators in nursing started the movement to upgrade nursing from Florence Nightingale’s vocation ( “a calling”) to professional status. They diligently and systematically phased out the diploma programs and moved nursing into the college setting.


  • Specializes in Operating Room. Has 50 years experience.

We were very proud of their success. However, they made a major mistake by keeping the clinical experience out of the college curricula. New nursing graduates no longer were or are capable of giving basic nursing care when they receive their nursing degree. The pendulum has swung almost completely to the academic.

I was in a diploma program and was based at a hospital for three years. We lived in dormitories next to the hospital. We had two weeks off a year. We were not allowed to get married or pregnant. If we did, we were told to pack our bags and go home. Our nursing career was over. They didn't change those rules until the middle 1960s.

Our instructors and head nurses had served in the military during WWII. They had the almost impossible job of taking high school children and making responsible women out of us in a matter of two months. The discipline was high and intense.

We went into a school in September and were caring for patients by November. In June, the nurses would take a leave of absence until their children went back to school in the fall. In my second year (eighteen years old) I was charge nurse of a post-op floor.

The clinical education outweighed the academic, but that education gave me an intensive study of Anatomy, Physiology, Pharmacy, and Chemistry. It also included professional ethics and History of Nursing 101. We spent many hours on ward duty. We worked in every department of the hospital, even the diet kitchen. When we graduated, we could work proficiently, were able to give comprehensive nursing care.

The educators have to bring the pendulum back to the middle for balance. The introduction of co-op programs in the colleges is imperative. Intensive clinical experiences in the academic setting would have many advantages.

New nurses graduating with basic nursing care skills would result in less stress in the workplace for everyone. Under an educator's supervision (co-op program), student nurses would be trained in basic nursing care that is relevant to all area's including the specialties, Emergency Room, ICU, CCU, OR, NICU, etc.

At present, graduate nurses come out of school with very little knowledge of clinical nursing. This puts tremendous pressure on the new graduate as well as the nurses who they work with. They not only have a heavy workload but now have to assume an educators role as well. That extra cap the experienced nurse now wears could be eliminated by a large degree. Student nurses should graduate with a working knowledge of basic nursing care. Nursing orientation could be drastically shortened.

Many hospitals require at least two years of medical nursing before he or she is allowed to specialize. With a co-op program that time could be reduced by half.

The trend in nursing is going back to the bedside nursing with a huge nursing deficit coming when the "baby boomers" retire in a few years. The population projection then is 80,000,000 people. Out of that number how many nurses? Men and women who have chosen nursing as a second profession, will not provide replacements. They too will retire shortly after the " boomers".

The future of nursing has to improve if we are to maintain excellence. At present, there are not enough nursing educators. Many have been lost to attrition and low salaries. Educators must be paid more to equal or surpass the nurses working in the field.

Recruitment at the junior and high school levels must be continued.

Magnet status in hospitals is tantamount to retaining good nurses and improving the quality of a nurse's life.

We need to utilize the knowledge of older nurses who are not working. Give us clinical instructor status to take the burden off the staff nurse.

I do not have a college degree, but I have 50 years of experience in my field.

I am of great value teaching in the clinical setting.

There are many of us who would and could be of assistance in the educator's world.

I strongly suggest you use us to pass this legacy on to the future nurses of America.

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28 Posts

In New Zealand we have clinical practice and theory during nursing education. Since I graduated the clinical practice has been updated. I would like to see the third year of nursing be all clinical placements. I felt the theory in nursing was very strong but the clinical somewhat lacking. We have pre-ceptorship programs where nurse have a pre-ceptor for 12months. At this stage they are registered and get paid.

Chaya, ASN, RN

932 Posts

Specializes in Rehab, Med Surg, Home Care. Has 15 years experience.

Such a simple concept , but how timely. I definitely felt clinically unprepared to be on the floor as a new nurse despite all the academic content. It just never occured to me that it could be otherwise!

Specializes in Med/Surg,.

Most academic programs include clinicals, perhaps not continous clinical experience like recieved in diploma programs, but it is still there. I also was a nurse's aid for three years and a food server/transporter for a year before I became a nurse, and it did nothing to help me with stress levels what-so-ever other than I am efficent at it. I am stretched so thin on the floor anymore it's impossible to perform basic nursing duties and professional nursing duties to the extent patient's need.

I have no doubt you would make an excellent clinical instructor with you vast nursing expierence. I think the problem needs to be addressed with the 500,000 liscened RNs who do NOT work in nursing.


196 Posts

Specializes in GERIATRICS, DEMENTIA CARE, MED-SURG. Has 10 years experience.

Nursing programs are searching for people like you!!!!!! The pay is terrible so not many people apply............at least in Washington State. They almost had to cancel the 2000-2002 program for lack of an instructor.....................

I am so glad that i am not along A Nursing Dilema is a very good articule i share you same feelings you are a good NUrse i salute you keep the good work and tank you Californiagirl33:heartbeat

allnurses Guide

llg, PhD, RN

13,469 Posts

Specializes in Nursing Professional Development. Has 46 years experience.

How many of today's students would be willing to make the level of committment required to put in that much clinical time? How many would be willing to pay the cost of the additional faculty salaries that would be required? Very few, I suspect.

While I agree with the basic underlying idea of strengthening the clinical component of nursing curricula, I also see the problems in trying to implement it.

kda340, RN

1 Article; 3 Posts

Specializes in Operating Room. Has 50 years experience.

llg, I am not asking for additional time, I want it incorporated into the present curriculm time frame. North Eastern University does it, why not all???

Thank you all for reading and commenting.


4 Posts

I graduated in 1974 and I recall my instructors telling the students that we were not having clinicals in some areas because the hospital will train us when we get a job. The first year of school we had one day per week clinical and the second year we had 2 days per week.

In view of all this, I agree that more clinical in ALL areas of the hospital needs to be included in nurse curricula.

Some may feel that this would cut down on the academics but let's face it, if you go for your BSN, [which I am doing right now] there are many classes you have to take over anyways. And many more that you have to take because when you got your RN degree those particular classes were not required. Not only that but there are several required classes that are not really needed to be a good nurse, you might use one objective of a particular subject in nursing but you have to take the entire semester class.:typing

well, off to study


4 Posts

Reply to Brklynborn

I wonder if they did not have instructors because of the degree they require an instructor to have. I don't know what it is in Washington but here, even in a community college you have to have a masters degree[or at least working on the masters while teaching]. Not all that many nurses have masters. Many cannot even squeeze out the time and finances for an RN to BSN. In my opinion, the rule makers definately make it difficult to achieve nursing goals.

kda340, RN

1 Article; 3 Posts

Specializes in Operating Room. Has 50 years experience.

Thank you all for your input. I really appreciate all your comments. Maybe someday graduating nurses will have the best of both sides of our profession.


1 Article; 266 Posts

Specializes in Making the Pt laugh..

kda340 I have to thank you for the great article. I am newly graduated from a three year degree and have been quite vocal about the lack of clinical training. I had an interesting discussion with a senior lecturer at our University and we both agreed that a halfway meeting between the "old" training and the "new" academia is what is required to strengthen the nursing profession. The problem that we could forsee is that of the word "profession", there are many who think that you can't be in a profession without a degree and you can't get a degree without a strong academic record. Skills based training is considered vocational not higher education therefore not a profession, (I dont know the terminology in the US....sorry)

As for the older nurses instructing the baby nurses, I have to say that I can think of nothing better. I will never forget the little lessons that come from the "olden days" (where there was no airconditioning so pillows had their opening away from the doors to prevent micro-organisms infecting them.) I think as well as (the important) skills there are standards and traditions that could easily passed on to the new generations to continue the core values that it sometimes apears that nursing is starting to lose