BSN minimum requirement

Charles S. Smith, RN, MS · Mar 17, 2001

Originally posted by MollyJ:
I am intrigued. What would a re-shaping of the role look like? My presence in a public high school has shown me that one of the blessings and dilemmas of nursing is that our role is somewhat analagous to the teacher. I takes a lot of teachers to do the job. It probably takes a certain level of education to do the job well. Delegating the actual day to day task of educating to paras would surely, I believe, reduce the quality of the end product. I believe similar analogies occur in nursing. And yet the sheer numbers of us needed by the public and health care industry mean that we have unique problems. I think because there are so many of us, we will never aspire to having the status in the world that you have when your skills are relatively rare and indemand. We only need one CEO, a few brain surgeons, one DON and those "rare, highly prized" roles get more status. So how do we re-shape this role? What would that look like? Are we talking the designation of the technical vs the professional nurse? Give me more.

Thanks for the discussion.

Molly, thanx. I will try to be succinct here, but that may be a bit difficult. The predominant role enacted by nurses in most (not all) settings is task driven and task oriented. The sense of worth we seem to hold on to is based on accomplishing tasks. Many posts on this thread speak to tasks, competence, getting things done efficiently, etc. Many performance evaluations also reflect how well someone does specific tasks. I learned tasks well, too, as a student, as a nursing assistant and as an RN. We tend to compare one another based on how well we start IVs, put in foleys, change dressings, keep patient care units clean and orderly, draw labs, etc..the list is endless. Should tasks be the benchmark for who is a "good nurse"? I say absolutely not. The critical emphasis should be on how well a nurse puts the whole patient picture together...integration.

Let me elaborate. I am working on a practical theory for nursing work/practice based on the concept of "integration". This is far different than the care/cure models taught in nursing and medical schools. My philosophy of nursing has changed over the years to reflect the nursing process more fully, but to extend it further. I believe that the central role of nursing is based on integration and not care. To care is not the sole domain of nursing. Caring occurs in all disciplines. Integration only occurs in nursing. We are the single discipline that actively interacts on an ongoing basis with all other health care disciplines and are the only discipline that has 24 hour vigil for our patients. We shoulder the responsibility for putting all the pieces together in one coherent plan to facilitate the health, well-being and/or transition (death) of our patients. We inform the rest of the healthcare team either actively or passively. Thus, we integrate (or should) all the pieces into a unified whole that is meaningful for both the patient and the team. This is true cognitive (thinking), problem-solving (critical thinking), creative and purposeful work. It has meaning for the patient, patients' families and for our profession.

I am no longer concerned with how well a novice nurse comes out of school knowing tasks. Tasks can be learned. I am more concerned with nurses coming out of school who can not think independently or critically. No amount of clinical hours in nursing school doing specific tasks in a specific regimented fashion can replace the ability to think. We seem to be diluting our ranks with individuals who can take instruction well and are efficient at "doing" (all necessary right now, but why do we need to hold onto this model for the future?). We seem to be reducing nursing to a level of mediocrity based on tasks rather than elevating the profession based on purpose and meaning. As long as we are task driven, we are interchangeable with other groups of care-givers who are equally capable of performing tasks. In reality, nurses have absorbed tasks over the years because MDs and other groups have no longer wanted to perform them. Nurses have even passed on certain tasks to others when we have no longer felt the pressing need to "do" them ourselves. So, what do we hold on to? We have the nursing process and we have integration as a basis for reshaping our roles for the future. From an economic standpoint, holding onto a task driven care model does not make us unique. If we are not unique, we have no niche market, nor do we have any basis for creating our own unique economic worth. Cranking out task masters over and over only serves to equilibrate supply with demand for task doers and serves a short term need only. When we create our own demand for unique services (by limiting the supply), we create economic incentives to use our real skills for improvements in healthcare and thus, create reimbursement commensurate with that performance.

You mention the professional vs. technical dichotomy that has been previously discussed. No, i do not envision professional and technical nurses. I envision one Professional nurse group (educated at the baccalaureate level at the very least) that is prepared well enough to perform the function of integration in the healthcare arena. This Nurse group will know the medical model, will know the technical care models of nursing, but will be responsible and accountable for outcomes of patient care, inpatient, outpatient, whatever setting through the process of integration. The actual tasks that we know of today in nursing will also be taught, but do not have to be done by nurses. We must be responsible and accountable for the outcomes, putting the pieces together for the benefit of all. I truly believe that nurses ought to be the gatekeepers to healthcare. I realize this is a huge stretch for many and I am leaving out many of the blanks. I hope, nonetheless, that you get the general idea. I do not base my performance on a set of tasks, although i am skilled and accomplished having given many years to learning them. What I do in my nursing role, better than any other discipline, is to cognitively process all aspects of the patient situation to enact a meaningful difference for the patient.

Well, I will reread this in a bit after I have fully awakened..I may make some revisions once i have had my second cup of coffee... thanx again, Molly

regards

chas

Charles S. Smith, RN, MS · Mar 17, 2001

Originally posted by MollyJ:
I am intrigued. What would a re-shaping of the role look like? My presence in a public high school has shown me that one of the blessings and dilemmas of nursing is that our role is somewhat analagous to the teacher. I takes a lot of teachers to do the job. It probably takes a certain level of education to do the job well. Delegating the actual day to day task of educating to paras would surely, I believe, reduce the quality of the end product. I believe similar analogies occur in nursing. And yet the sheer numbers of us needed by the public and health care industry mean that we have unique problems. I think because there are so many of us, we will never aspire to having the status in the world that you have when your skills are relatively rare and indemand. We only need one CEO, a few brain surgeons, one DON and those "rare, highly prized" roles get more status. So how do we re-shape this role? What would that look like? Are we talking the designation of the technical vs the professional nurse? Give me more.

Thanks for the discussion.

Molly, thanx. I will try to be succinct here, but that may be a bit difficult. The predominant role enacted by nurses in most (not all) settings is task driven and task oriented. The sense of worth we seem to hold on to is based on accomplishing tasks. Many posts on this thread speak to tasks, competence, getting things done efficiently, etc. Many performance evaluations also reflect how well someone does specific tasks. I learned tasks well, too, as a student, as a nursing assistant and as an RN. We tend to compare one another based on how well we start IVs, put in foleys, change dressings, keep patient care units clean and orderly, draw labs, etc..the list is endless. Should tasks be the benchmark for who is a "good nurse"? I say absolutely not. The critical emphasis should be on how well a nurse puts the whole patient picture together...integration.

Let me elaborate. I am working on a practical theory for nursing work/practice based on the concept of "integration". This is far different than the care/cure models taught in nursing and medical schools. My philosophy of nursing has changed over the years to reflect the nursing process more fully, but to extend it further. I believe that the central role of nursing is based on integration and not care. To care is not the sole domain of nursing. Caring occurs in all disciplines. Integration only occurs in nursing. We are the single discipline that actively interacts on an ongoing basis with all other health care disciplines and are the only discipline that has 24 hour vigil for our patients. We shoulder the responsibility for putting all the pieces together in one coherent plan to facilitate the health, well-being and/or transition (death) of our patients. We inform the rest of the healthcare team either actively or passively. Thus, we integrate (or should) all the pieces into a unified whole that is meaningful for both the patient and the team. This is true cognitive (thinking), problem-solving (critical thinking), creative and purposeful work. It has meaning for the patient, patients' families and for our profession.

I am no longer concerned with how well a novice nurse comes out of school knowing tasks. Tasks can be learned. I am more concerned with nurses coming out of school who can not think independently or critically. No amount of clinical hours in nursing school doing specific tasks in a specific regimented fashion can replace the ability to think. We seem to be diluting our ranks with individuals who can take instruction well and are efficient at "doing" (all necessary right now, but why do we need to hold onto this model for the future?). We seem to be reducing nursing to a level of mediocrity based on tasks rather than elevating the profession based on purpose and meaning. As long as we are task driven, we are interchangeable with other groups of care-givers who are equally capable of performing tasks. In reality, nurses have absorbed tasks over the years because MDs and other groups have no longer wanted to perform them. Nurses have even passed on certain tasks to others when we have no longer felt the pressing need to "do" them ourselves. So, what do we hold on to? We have the nursing process and we have integration as a basis for reshaping our roles for the future. From an economic standpoint, holding onto a task driven care model does not make us unique. If we are not unique, we have no niche market, nor do we have any basis for creating our own unique economic worth. Cranking out task masters over and over only serves to equilibrate supply with demand for task doers and serves a short term need only. When we create our own demand for unique services (by limiting the supply), we create economic incentives to use our real skills for improvements in healthcare and thus, create reimbursement commensurate with that performance.

You mention the professional vs. technical dichotomy that has been previously discussed. No, i do not envision professional and technical nurses. I envision one Professional nurse group (educated at the baccalaureate level at the very least) that is prepared well enough to perform the function of integration in the healthcare arena. This Nurse group will know the medical model, will know the technical care models of nursing, but will be responsible and accountable for outcomes of patient care, inpatient, outpatient, whatever setting through the process of integration. The actual tasks that we know of today in nursing will also be taught, but do not have to be done by nurses. We must be responsible and accountable for the outcomes, putting the pieces together for the benefit of all. I truly believe that nurses ought to be the gatekeepers to healthcare. I realize this is a huge stretch for many and I am leaving out many of the blanks. I hope, nonetheless, that you get the general idea. I do not base my performance on a set of tasks, although i am skilled and accomplished having given many years to learning them. What I do in my nursing role, better than any other discipline, is to cognitively process all aspects of the patient situation to enact a meaningful difference for the patient.

Well, I will reread this in a bit after I have fully awakened..I may make some revisions once i have had my second cup of coffee... thanx again, Molly

regards

chas

Sandy McLellan · Mar 17, 2001

I graduated from a diploma program in a teaching hospital in 1966 and have never regreted my educational choice. Over the years I have watched, trained and mentored many a two or four year grad who was not prepared for the reality of practice. I believe that neither the two or four year programs contain enough clinical experience.

I worked all three shifts,and weekends, and knew the flow of 24/7 care when I graduated. I can honestly say there were no surprises, I didn't feel cheated or deceived. Now,as a VP of Nursing, I admit to a prejudical deference to a diploma grad. Sure, I am delighted when they added to their basic education and got an advanced degree, as I did. But, I will hire a diploma grad over any other given the opportunity.My choice is for a diploma grad at the bedside taking care of me.My dream is to be able to bring someone to their senses that nursing academia has cut off it's nose to spite it's face, and has eliminated the most effective method of training nurses that we ever developed. Every one of my classmates, (126) are still nursing and loving it! Sandy

Sandy McLellan · Mar 17, 2001

I graduated from a diploma program in a teaching hospital in 1966 and have never regreted my educational choice. Over the years I have watched, trained and mentored many a two or four year grad who was not prepared for the reality of practice. I believe that neither the two or four year programs contain enough clinical experience.

I worked all three shifts,and weekends, and knew the flow of 24/7 care when I graduated. I can honestly say there were no surprises, I didn't feel cheated or deceived. Now,as a VP of Nursing, I admit to a prejudical deference to a diploma grad. Sure, I am delighted when they added to their basic education and got an advanced degree, as I did. But, I will hire a diploma grad over any other given the opportunity.My choice is for a diploma grad at the bedside taking care of me.My dream is to be able to bring someone to their senses that nursing academia has cut off it's nose to spite it's face, and has eliminated the most effective method of training nurses that we ever developed. Every one of my classmates, (126) are still nursing and loving it! Sandy

OneWngedDove · Mar 17, 2001

Originally posted by Lburns:
It is my firm belief that the minimum requirement for nursing should be a BSN. We want to be accepted as a profession, yet we allow 2 year programs to dominate the field. Now I went to a 2 year program and will be finishing my BSN this semester. My school did a great job preparing me for "tasks" of nursing, but oh, it is so much more than that. Many other countries have moved or are moving towards 4yr degree minimums and the US needs to stay atop in this competative field. The nursing shortage will not always be here and it is to your advantage to get your degree now. The 2 yr programs will make a great footstep in the years to come, but the 4yr degree will become the RNs of the future. As nurses move into the 21st century we need to pull together to demonstrate our power as a profession, the only way to do this is to have strong, educated nurses in not just bedside tasks but critically thinking, politics, research and community health. Think about it, comments welcome.

I'm gonna go out on a limb here and say that the minimum nursing requirement should be someone committed and dedicated to giving quality, competent, and holistic care. Building on that quality is what will make all nurses, any nurse a GREAT and faithful servant to her number one priority--NURSING!!

The title of "nurse" conjures up images for each of us. We have all been tended to by the medical profession at some time in our lives. So it must be true somewhere within each of us is an idea in our mind of what we believed a "good" nurse was and what we believed a "bad" nurse was. And when we made that decision on the consumer side of nursing (who treated us as what we considered a "good nurse" or a "bad nurse") I seriously doubt that we ever asked either kind of nurse if the were a bsn, or adn or diploma or whatever we only were aware of whether our needs had been met effectively and caringly or not.

That being said, it is the same for those who consume OUR services. Our patients are not aware of anything more than if we deliver quality, and compassionate care. That is where our dedication and goals need to be focused. How did our patients feel when we finished their care? What impression did we leave them with? That cannot be taught in a book, can't be manifested magically by a degree either (ANY degree).

Let's all be dedicated to healthCARE. Holistic healthcare at that! It is the area that we have ALL been trained to address as nurses and What "sets us apart" from the rest more than what degree is after our RN on our name badges!

We all do a service that should make us proud and no matter how we got to where we are education wise we need to hold fast to our number one goal....touching our patients lives with kindness, compassion, empathy and care that they will get NOWHERE else if we do not walk the extra mile and give it from our hearts. And while we're at it let's see if there is some left over to give to each other too!!

Just my take on things,

Dove

OneWngedDove · Mar 17, 2001

Originally posted by Lburns:
It is my firm belief that the minimum requirement for nursing should be a BSN. We want to be accepted as a profession, yet we allow 2 year programs to dominate the field. Now I went to a 2 year program and will be finishing my BSN this semester. My school did a great job preparing me for "tasks" of nursing, but oh, it is so much more than that. Many other countries have moved or are moving towards 4yr degree minimums and the US needs to stay atop in this competative field. The nursing shortage will not always be here and it is to your advantage to get your degree now. The 2 yr programs will make a great footstep in the years to come, but the 4yr degree will become the RNs of the future. As nurses move into the 21st century we need to pull together to demonstrate our power as a profession, the only way to do this is to have strong, educated nurses in not just bedside tasks but critically thinking, politics, research and community health. Think about it, comments welcome.

I'm gonna go out on a limb here and say that the minimum nursing requirement should be someone committed and dedicated to giving quality, competent, and holistic care. Building on that quality is what will make all nurses, any nurse a GREAT and faithful servant to her number one priority--NURSING!!

The title of "nurse" conjures up images for each of us. We have all been tended to by the medical profession at some time in our lives. So it must be true somewhere within each of us is an idea in our mind of what we believed a "good" nurse was and what we believed a "bad" nurse was. And when we made that decision on the consumer side of nursing (who treated us as what we considered a "good nurse" or a "bad nurse") I seriously doubt that we ever asked either kind of nurse if the were a bsn, or adn or diploma or whatever we only were aware of whether our needs had been met effectively and caringly or not.

That being said, it is the same for those who consume OUR services. Our patients are not aware of anything more than if we deliver quality, and compassionate care. That is where our dedication and goals need to be focused. How did our patients feel when we finished their care? What impression did we leave them with? That cannot be taught in a book, can't be manifested magically by a degree either (ANY degree).

Let's all be dedicated to healthCARE. Holistic healthcare at that! It is the area that we have ALL been trained to address as nurses and What "sets us apart" from the rest more than what degree is after our RN on our name badges!

We all do a service that should make us proud and no matter how we got to where we are education wise we need to hold fast to our number one goal....touching our patients lives with kindness, compassion, empathy and care that they will get NOWHERE else if we do not walk the extra mile and give it from our hearts. And while we're at it let's see if there is some left over to give to each other too!!

Just my take on things,

Dove

angieselby · Mar 17, 2001

I have read every message on this subject in one sitting...whew! let me start by saying I am an LPN, little pathetic nurse as one poster put it. Of course I know it was directed to one specific person, but I am sure I am not the only LPN who read that and cringed. I wonder if the writer thought that one up all alone on the spur of the moment or had heard that somewhere before. But that is not why I am writing. I am continuing my education simply because I feel limited in my current position. Not limited by myself, but limited by the law, as it should be. I am trying not to comment on any specific post, with the exception of the LPN thing. I simply would like for all nurses, no matter the initials behind your name, to remember why we became nurses in the first place. In my case, I had never thought about becoming a nurse even though my mom is one, until I had negative experiences with nurses during my pregnancy and childbirth. Maybe I am arrogant, and thought I could do a better job, or maybe it was then that I understoond what nursing should be. We have tasks to do yes, but I am more concerned about the manners in which we carry them out. I was 19(and married) when my daughter was born, and after a fast and furious labor and natural(no drugs) childbirth my nurse said to me something like-- you were a great patient come back anytime, but wait until you are older. Too judgemental. That is just an example, and I dont want to stray far from the topic at hand. No matter what the minimum education requirements for RNs are to become, we must remember that no university can teach understanding, acceptance, empathy, respect, and kindness. One of the things I love most about nursing is the abundance of oppurtunities for learning, even an ADN RN can work in different units of the same hospital and learn new things. To say that not pursuing a BSN degree is complacency is not accurate. I believe that every nurse learns something every day and that is what life is about

angieselby · Mar 17, 2001

I have read every message on this subject in one sitting...whew! let me start by saying I am an LPN, little pathetic nurse as one poster put it. Of course I know it was directed to one specific person, but I am sure I am not the only LPN who read that and cringed. I wonder if the writer thought that one up all alone on the spur of the moment or had heard that somewhere before. But that is not why I am writing. I am continuing my education simply because I feel limited in my current position. Not limited by myself, but limited by the law, as it should be. I am trying not to comment on any specific post, with the exception of the LPN thing. I simply would like for all nurses, no matter the initials behind your name, to remember why we became nurses in the first place. In my case, I had never thought about becoming a nurse even though my mom is one, until I had negative experiences with nurses during my pregnancy and childbirth. Maybe I am arrogant, and thought I could do a better job, or maybe it was then that I understoond what nursing should be. We have tasks to do yes, but I am more concerned about the manners in which we carry them out. I was 19(and married) when my daughter was born, and after a fast and furious labor and natural(no drugs) childbirth my nurse said to me something like-- you were a great patient come back anytime, but wait until you are older. Too judgemental. That is just an example, and I dont want to stray far from the topic at hand. No matter what the minimum education requirements for RNs are to become, we must remember that no university can teach understanding, acceptance, empathy, respect, and kindness. One of the things I love most about nursing is the abundance of oppurtunities for learning, even an ADN RN can work in different units of the same hospital and learn new things. To say that not pursuing a BSN degree is complacency is not accurate. I believe that every nurse learns something every day and that is what life is about

Kaliko69 · Mar 18, 2001

I'm gonna go out on a limb here and say that the minimum nursing requirement should be someone committed and dedicated to giving quality, competent, and holistic care. Building on that quality is what will make all nurses, any nurse a GREAT and faithful servant to her number one priority--NURSING!!

Dove

That was nice. Thanks for reminding me of why I am in nursing school and giving me HOPE of working with some people who may think exactly like you do.

Kaliko

Kaliko69 · Mar 18, 2001

I'm gonna go out on a limb here and say that the minimum nursing requirement should be someone committed and dedicated to giving quality, competent, and holistic care. Building on that quality is what will make all nurses, any nurse a GREAT and faithful servant to her number one priority--NURSING!!

Dove

That was nice. Thanks for reminding me of why I am in nursing school and giving me HOPE of working with some people who may think exactly like you do.

Kaliko

HazeK · Mar 18, 2001

Professionally speaking: BSN should be entry-level requirement (no other "profession" does NOT require this)

Realistically speaking: we need nurses! So I'm grateful for them however they get their RN! I certainly do NOT want someone to not be a nurse just because they don't want to go for their BSN!

Locally speaking: it takes sooooo long to get into our local comunity college nursing program that our AD grads take almost the same number of college hours as our BSN grads! So, why not go for the BSN??

Besides, if you later decide to go into management, it is a pain in the gluteus maximus to have to go back for the BSN later!

Happiness!

Haze :-)

PS to those that are UNprofessionally verbal about this discussion...grow up! Dividing nurses against nurses is unprofessional & helps no one!

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HazeK · Mar 18, 2001

Professionally speaking: BSN should be entry-level requirement (no other "profession" does NOT require this)

Realistically speaking: we need nurses! So I'm grateful for them however they get their RN! I certainly do NOT want someone to not be a nurse just because they don't want to go for their BSN!

Locally speaking: it takes sooooo long to get into our local comunity college nursing program that our AD grads take almost the same number of college hours as our BSN grads! So, why not go for the BSN??

Besides, if you later decide to go into management, it is a pain in the gluteus maximus to have to go back for the BSN later!

Happiness!

Haze :-)

PS to those that are UNprofessionally verbal about this discussion...grow up! Dividing nurses against nurses is unprofessional & helps no one!

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