bring back diploma they can function on graduation

Waiting for Retirement · Oct 17, 2019

I don't believe anyone would argue that college-educated nurses have less clinical time under their belts prior to graduation than their diploma school peers. However much more is expected of today's RN, and that includes the level of education one receives in college: not just clinical duties, but a well-rounded education. Writing coherently in English is a good example of what is expected of a college graduate today.

While it's true that yesterday's diploma school grads could hit the ground running faster, if today's new graduate nurse require more orientation than their diploma-school predecessors, I'm ok with it, considering the rest that they bring to the table.

JadedCPN, BSN, RN · Oct 17, 2019

For what it is worth, I don't give a rat's a** as to whether a new grad nurse, of any degree background, can start an IV or not. You could teach any layperson how to do a task such as IV start or foley placement. When I was in nursing school (BSN) 17 years ago I didn't get to start a single IV during clinicals, yet I am now one of the best sticks around and have worked on pediatric IV teams.

I want my new grad to get the big picture, to understand the anatomy and physiology and pathophysiology and understand the disease process and all of that education being used as a foundation to get them to start critically thinking. The task-oriented type of skills will come with practice.

Cowboyardee · Oct 17, 2019

38 minutes ago, Waiting for Retirement said:
I don't believe anyone would argue that college-educated nurses have less clinical time under their belts prior to graduation than their diploma school peers.

Before diploma programs became so uncommon as to be mostly just outliers in nursing education, people used to say that all the time. Because data on the number of clinical hours in many nursing education programs is not available, its a pretty hard assertion to back up or refute, but that was at least a fairly common perception - that diploma programs offered more clinical hours and higher quality clinical rotations than bsn programs.

Realistically, I think it's readily obvious to any competent and experienced working nurses that the amount and quality of a student's clinical rotations has a major impact on how effective and safe they can be in the first months or even years of their professional practice. Of course, there's no law preventing bsn programs from offering very high quality clinical time amd lots of it - rather the pushback tends to come from a combination of cost-saving (clinical hours are expensive for nursing schools, which diploma programs partially circumvent via being more closely associated with the hospitals that run them) and also an emphasis on non-clinical evidence-free nursing theory (which is frankly an embarrasment to the profession) pushed by some nursing organizations, as the gen ed requirements in a bsn only make up part of the overall difference in credit hours.

For whatever its worth, its not by any means clear that diploma programs in this day and age actually have better clinical rotations than bsn programs. That would probably depend more on the individual programs being compared than an over-arching difference. And anyway, I can't find any large scale data to compare types of programs at large. On the other hand, there was never particularly any data demonstrating inferiority of diploma programs in the first place. I personally tend to think that gen ed bachelors classes help nurses as a profession more than as clinicians (which isnt a bad trade off), that more rigorous clinical education would of course help nurses as clinicians and improve patient outcomes, and that fluff classes in nursing theory and professional nursing help only those who make their living in education and writing fluff.

Cowboyardee · Oct 17, 2019

1 hour ago, JadedCPN said:
For what it is worth, I don't give a rat's a** as to whether a new grad nurse, of any degree background, can start an IV or not. You could teach any layperson how to do a task such as IV start or foley placement. When I was in nursing school (BSN) 17 years ago I didn't get to start a single IV during clinicals, yet I am now one of the best sticks around and have worked on pediatric IV teams.
I want my new grad to get the big picture, to understand the anatomy and physiology and pathophysiology and understand the disease process and all of that education being used as a foundation to get them to start critically thinking. The task-oriented type of skills will come with practice.

I know you didn't quite say this, but I'd like to point out that hands-on clinical experience is not counter-productive towards developing an understanding of patho, A&P, etc. For many or most students, the opposite appears to be true. Connecting nursing tasks to their rationales and the underlying medical knowledge seems to improve understanding and clinical knowledge by contextualizing it and allowing students to ask questions and check their knowledge and understanding against reality.

Of course, eventually there comes a point of diminishing returns for how much a student can improve their knowledge base by participating in clinical tasks. But in my experience, students don't even come close to that point in nursing school. And, as I mentioned in a separate reply, I dont mean to imply that diploma programs always have more or better clinical rotations than ban programs anyway.

Waiting for Retirement · Oct 17, 2019

2 hours ago, Cowboyardee said:
Before diploma programs became so uncommon as to be mostly just outliers in nursing education, people used to say that all the time. Because data on the number of clinical hours in many nursing education programs is not available, its a pretty hard assertion to back up or refute, but that was at least a fairly common perception - that diploma programs offered more clinical hours and higher quality clinical rotations than bsn programs.

Well...I have to disagree. I don't believe it's perception when the typical diploma program of yesteryear had students working daily in the hospital, including summers, doing clinical work for three years that today's BSN students do part-time (partial days or full days alternating with study days) during the week over the course of two years (excluding summers).

I have several relatives who experienced the diploma school process and naturally they shared with me their experiences while I made my journey through nursing school and clinical assignments via the college route. I have absolutely no doubt they spent MUCH more time in clinical rotations than I did. No question. As for "higher quality" of the clinical rotations, that's anyone's guess, as you've said. Quantity, no doubt. But quality..? Unsure. To hear my relatives discuss it one would think a new student was required to learn brain surgery before the weekend....but I digress ?

However, the rest of what you wrote I happen to agree with, for the most part. I prefer the well-rounded greater education of today's RNs who earned degrees to those with less overall education. Best of both would be to have a diploma school-educated RN who then returned to college for a degree. Bingo Winner! Fluff classes....we've all had them. But generally speaking having non-nursing classes taken in colleges that are not found in diploma schools---that's a good thing in my book.

Wuzzie · Oct 17, 2019

3 hours ago, JadedCPN said:
I want my new grad to get the big picture, to understand the anatomy and physiology and pathophysiology and understand the disease process and all of that education being used as a foundation to get them to start critically thinking. The task-oriented type of skills will come with practice.

You do realize that diploma education included this...in spades? I had 24 hours of clinical weekly and 25 hours of class. Yes, we were there for over 40 hrs a week. It was grueling.

winniewoman9060ret · Oct 17, 2019

Best of both worlds, would be a 5 year degree. Clinical experience with the class time. One nurse I worked years ago graduated from a university with such a program.

JadedCPN, BSN, RN · Oct 17, 2019

1 hour ago, Wuzzie said:
You do realize that diploma education included this...in spades? I had 24 hours of clinical weekly and 25 hours of class. Yes, we were there for over 40 hrs a week. It was grueling.

Oh yes I do! Sorry if it came across otherwise. My most memorable nurse mentors as a new grad we’re all diploma nurses and amazing. I was speaking more in general that regardless of degree I’m not worried about a new nurse not knowing how to start an IV, for example.

Wuzzie · Oct 18, 2019

Ohhhhh, got it and yes you’re right, the skills can be taught but it sure is nice not to have to start from scratch with new grads.

JKL33 · Oct 19, 2019

On 10/17/2019 at 4:42 PM, JadedCPN said:
I’m not worried about a new nurse not knowing how to start an IV, for example.

I kind of don't prefer it--for the new nurses themselves.

It is (appears to be) such a distractor to struggle with the task-y stuff after graduation. It just seems like it terrorizes people's confidence. And why wouldn't it? On the one hand, yes, in many cases it will be learned over time, but on the other hand how much of an expert does the patient think you are if you can't perform the part of the role that people are fond of calling "basic tasks that a monkey can learn to do"? And how good do nurses truly feel about themselves when they can't do these basic monkey tasks? My observation has been that this doesn't portend an easy road to feeling capable.

That's the funny thing about calling them monkey tasks; that in itself means that they are basic when you can do them, and they are inherently way more than that when you can't.

I don't expect people to come out being expert at these things, but I think it's inappropriate to get through school without a single attempt on a human being. They aren't that unimportant.

Cowboyardee · Oct 20, 2019

On 10/17/2019 at 3:04 PM, Waiting for Retirement said:
Well...I have to disagree. I don't believe it's perception when the typical diploma program of yesteryear had students working daily in the hospital, including summers, doing clinical work for three years that today's BSN students do part-time (partial days or full days alternating with study days) during the week over the course of two years (excluding summers).
I have several relatives who experienced the diploma school process and naturally they shared with me their experiences while I made my journey through nursing school and clinical assignments via the college route. I have absolutely no doubt they spent MUCH more time in clinical rotations than I did. No question. As for "higher quality" of the clinical rotations, that's anyone's guess, as you've said. Quantity, no doubt. But quality..? Unsure. To hear my relatives discuss it one would think a new student was required to learn brain surgery before the weekend....but I digress ?
However, the rest of what you wrote I happen to agree with, for the most part. I prefer the well-rounded greater education of today's RNs who earned degrees to those with less overall education. Best of both would be to have a diploma school-educated RN who then returned to college for a degree. Bingo Winner! Fluff classes....we've all had them. But generally speaking having non-nursing classes taken in colleges that are not found in diploma schools---that's a good thing in my book.

When I said that was the perception, I didn't mean to say that the perception was incorrect - just that I can't definitively prove it so (and also that the previous poster stating no one would make that argument is mistaken). I went to a diploma program myself. I try to be duly wary of my own biases, but it certainly appeared to me that my classmates and I hit the ground running more so than most ADN- and BSN-prepared new nurses I've seen.

For whatever its worth, many diploma nurses already also have bachelors degrees - just not in nursing. I do. If the point of pushing for BSNs were to get nurses more educated in general, I'll never understand why degrees in other subjects are given exactly zero weight on resumes or by HR departments. Sure, I understand why encouraging statistics and writing classes might be a good move. But employers completely ignoring advanced biology and chemistry courses while at the same time demanding nurse applicants take those ultra-rigorous nursing theory and professional nursing classes that fill up the BSN looks an awful lot like shenanigans to separate nurses from their money, prop up useless parts of our industry, and keep us hamsters spinning away at our wheels.