Generic nursing license out-of-date?

[jjjoy, LPN]

With the diversity and specialization of different nursing specialties, maybe the traditional nursing education system where there's one license for all types of entry-level nursing is out-dated.

People who want to teach can't just go to "Teaching school" and get a generic "teaching license" and then be qualified to teach any subject to any age group. Elementary teachers need to earn an elementary teaching credential. Middle school and high school subject teachers need to be credentialed in their subject area. Pre-school teachers have their own certifications that must be earned. Unfortunately, some teaching positions don't require any formal training in teaching such as college professors, but that's another issue for another day and a different discussion forum!

For many nursing jobs, the only legal, minimum requirement is a nursing license. Experience or certification may be preferred but in a pinch, anyone with a license will do. Whether it's NICU, a dialysis clinic, the OR, an oncology unit, pediatrics, L&D. Nurses are NOT identical, replaceable cogs. ICU is very different from med-surg is very different from L&D. Yet the entry-level requirements and training is exactly the same for all.

Most nurses enjoy the fact that they don't have to go back to school to switch nursing specialities. Some facilities offer strong on-the-job support, but others it's "sink-or-swim." Do we really want a "sink-or-swim" mentality when it comes to health personnel learning their job? Of course, formal training doesn't guarantee a good practitioner. And there are many good practitioners who have taught themselves. But as an educational and professional regulatory *system* and I sometimes think that nursing education & licensure ought to be more specialized depending upon the kind of nursing one wants to work in.

Why try to cover it all in one nursing educational program? Is that not like arguing for teaching credentials to cover pre-school through college education in all subjects (math, literature, music, etc)? There are only so many curriculum hours and the trade off for greater bredth is less depth.

Food for thought!

[RNMariposa]

Maybe if we had an extra year of training for whatever specialty we wanted that would help us all be prepared for the job once we graduated.

[dria]

thanks for a very thought-provoking post. i get where you are coming from, but i can say (in my case at least) that the flexibility to switch to different areas of specialty is one of the factors that drew me to nursing in the first place (whoops, just looked back, you did address that. i blame the cold meds!)

anyway, i'm not saying it's not a bad idea (and actually quite good) but how do you propose that this be accomplished considering the present nursing faculty shortage? would a better solution be to standardize the orientation programs across hospitals and specialties? (hey, if we're dreaming, let's dream big!)

[billythekid]

Maybe if we had an extra year of training for whatever specialty we wanted that would help us all be prepared for the job once we graduated.

This is a great thread which highlights the importance of the fact that nurses are not interchangeable across all specialties. I work in a cardiac icu, and would have a terrible time adjusting to the workload of 6-8 patients even on a regular cardiac floor. Not that it isn't possible, but a different approach is needed to handle the needs of 2 pts versus 6.

In choosing where to work, I chose a hosp that had an intensive orientation program ("fellowship") which has turned out wonderfully for me. As Mariposa suggests, a one year training, or fellowship, or residency (or whatever you want to call it) is the safest and most efficient way to acclimate to the environment in which you'll be working. I'm not sure that every specialty would necessarily require the same length of training period, but education and competence is an important factor in nurse satisfaction and retention.

[Rhone]

I think it would make sense to have short-term classes for "certifications" to prepare nurses for specific specialty areas.

But a whole other year of school to limit yourself to a specialty? I think that's not only a problem for nurses (who often enjoy the flexibility of being able to switch to different areas mid-career), but for the health care system as a whole ("Oh crap, ICU was the big fad for nursing students last year... now we have a ton of unemployed ICU nurses who can't find jobs, and a ton of open positions in other areas that we can't fill!").

[BrnEyedGirl, BSN, MSN, RN, APRN]

When I was new grad, the hospital had a program for new grads that did specialize in the area you would work in. I started on a cardiac unit, I spent 4 months working with a preceptor, taking EKG classes, a pharm class, I spent 2 weeks in the cath lab, I took a class on lab values, I shadowed our secretary our pharmacists, our dietary staff, our cardiac rehab staff and our pt educator. It was a great program,....that no longer exists! I am fortunate in that the ER I work in has an internship and our "baby nurses" have an in depth 18 week orientation, longer if they need it.

Just becoming a safe, competent nurse before trying to specialize is important. I honestly believe that I learned more in my orientation than I did in school, but I needed that basic education in order to advance my learning. As someone else mentioned, the fact that I can change "specialties" is one of the reasons I love nursing. If I couldn't change without going back to school I would be upset. I think that's where specialized certifications come in, and the hands on learning to me is a much better way to learn.

[P_RN, ADN, RN]

When I graduated I just "knew" I wanted to be an OR nurse, I HATED IT. Then I thought peds-same thing, then since I like older people I tried med/oncology-thought I'd cry myself to death. Then I found ortho....loved it....still do. That is one benefit of on the job training. If I'd spent another year in each field I tried before I found ortho, I don't think I'd ever continued Nursing. Different strokes for different folks. Your point is well made though. We really don't ever start learning til after we graduate.

[SummerGarden, BSN, MSN, RN]

as everyone else has said, you make good points. however, i disagree that most areas require specialty. people with bs/ba degrees in soc, psych, business, finance, accounting, education, engineering, etc. are required to take classes in everything in the field though there are specialties within the career... and yes you can get a license in something related to any of these degrees in most states or through the feds. in some cases the requirement is years of work experience not just the education... thus, nursing is not worse off for graduating nurses with basic knowledge in all areas and no work experience since the requirement is that he/she must obtain a license after passing a basic competency exam (the nclex).

besides, school is a poor place to make a career choice no matter what an academic career counselor says! if i left school wanting to be an er nurse, for example, and could not get a job in the er (which is true), then where would i be today?? unemployed and having to go back to school for a different specialty then required to take an additional exam and get another license??? not even soc, psych, it, computer sciennce, chemistry, biology, business, finance, etc. grads have it that bad! similar to those degrees, the lack of opportunities in my region for a particular specialty would not prevent me from being considered qualified to work and train as a novice in another area of interest because my degree in nurising is general rather then specific. just some thoughts...