Anti-Intellectualism in Nursing

[fakenurse]

I went into nursing because I love science and medicine, and thought working with like-minded people to deliver high-quality care sounded like a great job. Since entering the profession, however, I've discovered that there is widespread mistrust and criticism of education and research in nursing. Nurses who are curious and love to ask questions are sneered at, and nurses who pursue further education are labeled "book smart" and lacking the prized "street smarts", which seems to equate to knowing how to start an IV. I've never heard of any other profession where furthering one's education is seen as a bad thing. I'm feeling so disappointed about this attitude, and really disenchanted with nursing. I loved school, I love learning, and I think more education is always, always, always a good thing. Will I always be an outcast in nursing because of this? If we want to be taken seriously as professionals, shouldn't we be embracing theory and knowledge and intellectual curiosity?

[ThePrincessBride, MSN, RN, NP]

Just slightly off topic.......I get a little irritated when I hear people, especially other nurses, imply (or directly talk about) the superiority of critical care nursing over med/surg. Granted, fact of the matter is that there are easier areas to work on than others, and easier facilities as well. For example, when I am sometimes floated to the rehab floor in my hospital, I find working there to be a walk in the park compared to my home GI surgical floor. Often boring, in fact. But to say med/surg nursing in general, and the nurses therein, are inferior to critical care nurses is ridiculous. You possess and hone different sets of skills depending on where you are, and each of these skills play an instrumental role in patient care. I've seen nurses that had worked in the ICU for years come to my floor and comment on how much more busy and challenging it was.

I'm not saying nurses from either area are better or worse, quite the opposite, I'm saying both areas can be challenging and require the same degree of knowledge and critical thinking.

In general, I've noticed that some nurses in higher acuity (ICU and even L/D) look down on other floors/specialties. However, when I worked in med-surg as a tech, the ICU nurses floated would even mention how hard it was to juggle five, six, (SEVEN) patients when they were used to having one....MAYBE two patients.

I do think that med/surg nursing is the foundation of all other nursing fields (many ICUs and specialties won't even look at a new grad without at least a year or two of med/surg under their belt), and having that experience opens up a lot of doors.

I've been told often that if one can make it through med/surg, he or she can make it through just about anything.

[Mr. Murse]

Inconceivable!!

[nurseprnRN, BSN, RN]

"I dunna think tha' word mean wha' you think it means."

(I love that movie!)

[lub dub]

Rising educational requirements for nursing have arrived due to several factors, none of which were formulated with the specific betterment of our profession in mind.

Requirements for increasingly higher nursing education have transpired in part because of economic forces and in part due to degree inflation, also known as credentialism. Partly due to the fallout of the economic meltdown of '08, multiple nursing employment markets across the US now contend with a glut of nurses and not enough nursing jobs. Hence, a minimum BSN degree requirement substantially lessens the number of applications through which recruiters and HR staff must pick.

If anyone's been paying attention over the past few years, the vast majority of hospitals didn't require BSNs when a true shortage of nurses actually transpired. Hence, higher degree requirements in nursing have turned into an effectual weed-out tool.

A BSN degree requirement also serves as a rudimentary screening tool for employers. Attainment of a baccalaureate degree signals to some hiring managers that the applicant has the ability to complete upper division college level coursework with a specific degree of difficulty. The baccalaureate degree also speaks to employers about a nurse's perseverance since he/she followed through on a mission that took four or more years of time from start to finish.

Moreover, I strongly suspect the BSN requirement is a nuanced class-based sorting tool since completion of a university education has traditionally been an unspoken marker of middle/upper class background in society. Even though this is the year 2014, only 30 percent of all adults in the US have earned a bachelor's degree of any kind. Some people remain blissfully oblivious, but prestige is a crucial facet of the American higher learning process.

Universities (read: entities where baccalaureate and graduate degrees are earned) tend to be situated toward the top of the prestige hierarchy based on perception of the general public, whereas community colleges, trade schools and technical colleges (read: entities where most associate degrees, certificates and nursing diplomas are conferred) are positioned toward the bottom end of the prestige pyramid because of open admissions and general lack of exclusivity.

Before anyone grows upset or ruffled over my post, I earned my ASN degree at a trade school in 2010 and also earned a practical nursing diploma at a trade school in 2005.

http://www.nursing.upenn.edu/media/Californialegislation/Documents/Linda%20Aiken%20in%20the%20News%20PDFs/BSNJAMA.pdf

[nurseprnRN, BSN, RN]

The classic paper. Unfortunately, many of the people who need to read it most are the ones least likely to understand it.

[Beautiful Mind RN]

"I dunna think tha' word mean wha' you think it means."

(I love that movie!)

Ah...that movie will always be near and dear to my heart.

My favorite line...

"Hello. My name is Inigo Montoya. You killed my father. Prepare to die."

Off subject, I know, but I could not help myself!

[withasmilelpn]

Essentially, a nurse should always be THINKING while they are doing their TASKS :-)

This from an insatiably curious LPN who initially went to College for English and Art, then had to drop out of my expensive out of state college due to my Dad losing his job. While taking courses at the local College supported myself working as a CNA, discovered that I enjoyed patient care. so I reversed course and went into an LPN program with the theory that I would go from there to a BSN - being an LPN would help pay for it. Life intervened, and years later still not an RN :-( (Did go back, money, family, need to work full time and unsupportive hubby short changed that. Green tea - I would've lept at your program.) I mention all of this because it lets me weigh in some on this subject of education.

As to whether BSN vs ADN prepares you to be a better nurse, I'm pretty positive my Elements of Shakespeare, Art History and Criminology class - the study of murder - has had no impact on me as a nurse (except make me a more interesting person perhaps? For others to say I guess, I did enjoy them though :-)) Now my Developmental Psych, and Sociology classes I can say were helpful. I wish going back to school was easier for all. In fact I wish there was much more on site education provided, with less inservices on rah rah teamwork, and more on say CHF...

I don't believe more education will lead to more respect from the public. Only nurses in the trenches ever really get what we do. I do think it may lead to more respect from other health disciplines such as OT and PT and SS as their fields require more education then ours currently does. Google "I hate nurses." It will be eye opening how some view us based on our education. I'm doubtful that it will lead to greater respect from doctors though, for a lot of reasons. I also don't believe it will lead to any great increase in pay, autonomy or power for that matter. Hospitals, etc have a vested interest in keeping our voices silenced - $$$$

Regardless of the credentials, or whether education will provide the respect nurses want, I fully believe that nurses should continue to educate themselves. So I do. I read constantly, subscribe to medical journals, haunt sites like these... Medicine changes constantly, knowing the latest evidence based practice, the how's and the whys is what your patients deserve. Rationalles really are important to know in order to be a really good, safe nurse.

However, I will say emphatically, patients also deserve the smiling, empathetic caring nurse as well. You may be the last person they ever see. And sometimes that's the only way to really get through to a difficult, non compliant patient. If you've developed a relationship with someone of trust and respect, you may have more leverage then if you don't take the time to fluff that pillow, etc

Nursing is a challenging balancing act, one of kindness, mixed with boundaries and education. I can often get people to do what's best for them with a whole lot of humor, encouragement and coaxing. But sometimes, despite your best efforts, you fail to reach people and it really stinks. You put out your best educational arguments to patients as to how things they don't want to do help them and they in turn think you're mean and not a good nurse. That's especially frustrating. It's also especially frustrating when its clear they respect the same exact words I've said from the doctor so much more.

[withasmilelpn]

There are studies that don't necessarily agree with the BSN argument by the way. The one above by Linda Aiken is from 2003 - this one is 2011 concludes experience does matter and BSN does not:

Transforming education

This journal article I found interesting because although it is does call for BSN prepared nurses, it states interestingly enough that there is no definitive research that proves BSN nurses care provides better outcomes (?!):

Transforming education

And I've found older ones that dispute BSN prepared nurses have better critical thinking skills than Nurses with their ADN - that critical thinking skills actually develop on the job and with experience. But because it's so old (1987) - thinking I won't include the link as perhaps it may not be relevant now.

This argument by the way goes back YEARS.

[lub dub]

There are studies that don't necessarily agree with the BSN argument by the way. The one above by Linda Aiken is from 2003 - this one is 2011 concludes experience does matter and BSN does not:

Transforming education

This journal article I found interesting because although it is does call for BSN prepared nurses, it states interestingly enough that there is no definitive research that proves BSN nurses care provides better outcomes (?!):

Transforming education

And I've found older ones that dispute BSN prepared nurses have better critical thinking skills than Nurses with their ADN - that critical thinking skills actually develop on the job and with experience. But because it's so old (1987) - thinking I won't include the link as perhaps it may not be relevant now.

This argument by the way goes back YEARS.

First of all, you have included two links in your post, but they are to the same article. And that is the article that, as you put it, "states interestingly enough that there is no definitive research that proves BSN nurses care provides better outcomes". Yes, that is what the author of the article said, but that statement is false. The study that I cited in my post (http://www.nursing.upenn.edu/media/C...Fs/BSNJAMA.pdf ) looked at over 200,000 patients in 168 hospitals over a period of one and a half years, and concluded that nurses with a BSN had better patient outcomes. That was a definitive study. Period. I say that because we work in a profession that is evidence-based. If you are going to disagree with the findings of a study like that, then please back it up with evidence, not just opinion.

[TiffyRN, BSN, PhD]

There are studies that don't necessarily agree with the BSN argument by the way. The one above by Linda Aiken is from 2003 - this one is 2011 concludes experience does matter and BSN does not:

Transforming education

This journal article I found interesting because although it is does call for BSN prepared nurses, it states interestingly enough that there is no definitive research that proves BSN nurses care provides better outcomes (?!):

Transforming education

And I've found older ones that dispute BSN prepared nurses have better critical thinking skills than Nurses with their ADN - that critical thinking skills actually develop on the job and with experience. But because it's so old (1987) - thinking I won't include the link as perhaps it may not be relevant now.

This argument by the way goes back YEARS.

Agreed that the debate goes back for years. Hopefully though, (to get back to the original topic), nursing is following an increasingly scientific approach to the practice. On the levels of evidence pyramid (Geriatric Nursing Resources for Care of Older Adults :: Evidence-Based Practice), cross-sectional studies such as the Aiken studies are certainly not at the top. I think we can all agree it would be difficult (though perhaps not impossible) to conduct a series of double-blinded RCTs and gather enough of these to conduct the meta-analysis that might more definitively scientifically answer the question. Cross-sectional studies can help us find and investigate relationships between variables though they are quite susceptible to the issue of "correlation does not equal causation".

For all the potential limitations of the cross-sectional study, it still outranks the level of evidence of the articles you posted, which is expert opinion. These are the most potentially biased and least (not un-) scientific of the possible research methods.

The preceding information was acquired thanks to one of those "useless" RN to BSN programs.

[lub dub]

The preceding information was acquired thanks to one of those "useless" RN to BSN programs.

Nice!

[withasmilelpn]

Sorry, I never said it was my opinion that the study was wrong. And no where did I state I was against BSN prepared nurses being better for patient care. I'd like to be one, I'm not, and given my age its less and less likely. My opinion is just exactly what I said there were studies that said differently. I'm not sure what happened when I copied and pasted - will see what happened to the link I meant to post instead. Certainly did not mean to post two of the same. So I apologize.

And I didn't say that - the article did -about definitive research - thus the ?! - because I'm curious why it didn't acknowledge the results obtained by Linda Aiken.

2001:

Nurse Experience and Education: Effect on Quality of Care : Journal of Nursing Administration