Lowering the Bar?

mark_LD_RN · Jul 7, 2002

i totally agree that there should be one entry level ,and that being the BSN. I don't think being made to become an lpn first would have made be a better nurse. it is not so much the program that makes the nurse as it is the person that makes the nurse. I attended a very diffucult BSN program, which required more clinical time than any of the local ,lpn or adn programs, it was expensive and hard but worth it. But still no matter what program you go through you will still need experience. I do not see eliminating the lpn first requirement as lowering the bar. as long as there is an adequate clincal component.

I worked as a nurse tech for a while before graduateing out of money needs. One of the local adn programs has instituted a cna prerequist to the rn program it has failed miserably. if i wanted to be a cna i would have worked as one.

nothing against cna's or lpn's but i did not want to be either of them. I have many friends who are and they are very good at it,it just is not for me.

Dayray, RN · Jul 7, 2002

Thank you all for your responses. Allot of different view points lol.

I think one thing we can all agree on is that nursing programs and the various roles LPN's RN's and BSN's very greatly from area to area.

I also agree that nursing needs to change some things in order to viewed as a profession. I think before we start saying that a person should be a BSN to work as a nurse we first should make some sort of standard for BSN. In my part of the country ADN's and BSN's receive the exact same amount of nursing credits the only difference being that BSN's have to get a year or so more credits in things like music 101, history 101 and stat's.

Perhaps in other areas there are classes that some how encourage more critical thinking at the BSN level but not here. I don't really think you can teach someone to think critically. You can give them the basic information they need to draw conclusions (i.e. the heart pumps blood, therefore a critical thinker relizes that if it stops beating the blood stops moveing) but how do you teach someone to think?

I keep hearing people referring to LPN as a unique role but as I have said before in my area LPN's function very similarly to RN's.

I also think it would be great if we could educate the public on what a nurse actually is. People seem a little confused I've heard so many strange things from non-medical people. Some think we are doctors with a little less school, others think we are waiters and waitresses and others seem to think we walked in off the street and got hired without any training at all.

I am glad I made this post but I think what we can learn form this is that there is no way we can answer this question. Look at all the different types of programs mentioned in this thread. I don't think its fair to compare anyone to another. From state to state laws and curriculums very so much, not to mention differences in quality of instructors or the varying roles of nursing.

Thank you all for your input. I'm going to start a new thread lets talk about what "The nursing program" should be like.

mark_LD_RN · Jul 7, 2002

first and foremost there is more to getting a bsn than music 101, religon , etc as you mentioned. there is more clinical time, chemistry, critcal care and other nursing courses. along with a couple of basic management courses. BSN programs also spend a lot of time teaching pathophysiology and disease processes, so we know why we do something and not just how. it also prepares you for the next levels of education, ie. masters,NP, and/or phd.

second it is proven you can teach a person critical thinking skills admittedly it is easier for some to grasp than others.

SmilingBluEyes · Jul 7, 2002

Really, it depends on the program Mark. My ADN degree had all the courses that the BSN 100 miles away did.....just lacking two essentials (nursing-related) I could find: nursing research and stats. THAT IS IT....I , too , had chem, microbio, pathophys. algebra, dev. psych, and and such pre-req's BSN's have to have. **all that.** really. And we spend hour-for-hour just as much time in clinical as the BSN students up the road did, lacking one Fulltime semester, I believe. We even went thru the summer, classes and clinicals with only 3 weeks off, then back to school!

This is why I express such frustration. My program, tweaked a bit, could/should have BEEN a BSN program. I put in the time in the class and in clinicals.......and to get an RN-BSN is aggravating cause they want one to do over some of the things already done in ADN school (example: physical examination ad nauseum. WE DID THIS ALREADY!) It's a money-making thing, the way I see it. And I am stuck if I want to obtain a BSN. There are other examples, too, but I won't get into it all here.

I still say, Access is key....to ensuring all RN's are BSN-prepared in the US, period.

Dayray, RN · Jul 9, 2002

I agree with Smiling here.

With all due respect Mark I have to ask if you have actually looked at the curriculum for most ADN programs. I also took patho and micro in fact we had to take twice the amounts of credits in Bio prerequisites that our local BSN program does. Most AND programs include considerably more clinical time then BSN programs (in my case ADN clinical time is about 160% that of BSN clinical time) If I could start over again I would probably go to the BSN program. Not because the BSN program better prepares nurses but because by the time I am done with my ADN I will have 126 credits and the BSN program requires 128.

The 5 BSN programs in my area require 3 nursing classes the ADN program doesn't they are management, research and public health. They also require 1 chemistry class ADN's don't have to take.

I don't want to sound harsh or start an ADN vs. BSN debate but I find that allot of BSN's are told in school that they are somehow superior to ADN's in education. Maybe you attended an exceptional program but for the most part BSN's are less clinically prepared then ADN's pathopysiology, disease process and critical thinking are about equal.

The good things about BSN programs are that they better prepare you for management and I do think that they give the nursing profession a better appearance to the public (makes us look more educated when we really aren't).

I respect your opinion and have both enjoyed and agreed with most of your posts and like your personality but I have to tell you I'm a little offended by your comment about BSN's actually knowing why they do something and just not how to do it. ADN's also know why they do something and insinuating that they do not diminishes them as well as the entire nursing profession.

Don't want to start a fight but felt that needed to be said

mark_LD_RN · Jul 9, 2002

well dayray Yes I have looked in to the adn and bsn curriculum at the local colleges. and here the bsn hours are far more.. just one example, preceptorship requirement adn programs 40 hours the other is 60 hours. bsn programs one 160 hours mine 200 hours. our clinical days were 12 hours a day and the adn program has 4 to 8 hours a day.yes i did have to take a management course and a research course. but i also had to take extra critical care courses. we had rotations in er,cath lab, nicu, sicu,neuro icu, 10 weeks each peds,L&D.postpartum,psy, and new born nursery.

i was never told bsn's were superior to adns nor do i believe that. both the bsn prgrams here require much more clinical time than any of the three adn programs i find it hard to believe that it differs that much from one area of the country to the other.

as far as the truth goes i have never been told we are superior but one local adn program openly fills its students heads with falicies, like more clinical time, (which i already covered), they tell students it is a 2 yr program in actuality it is 3 and often a little more. around here letting one know you have a bsn is like painting a bulls eye on your back, they live for the moment to shoot you down.

as far as being insulted it was not meant that way, i just meant we also get more theory and patho than the local programs. it is sometimes hard to get across what exactly is meant by communicating in this manner.

the adn and bsn debate will go on for ever as long as people promote the different fallicies out there. Any bsn program that openly tells it students they are superior is wrong just as is any adn program making that statement and the others i mentioned,.

I know everone likes to think their program is the best for what ever reason and that is fine. but the facts should always be considered and before judging a program besure to check the info for your self.

one local adn program boasts a 100% pass rate on boards for last 3 yrs which is false . it is a matter of public record that they are below 73% and on probation for low scores. This is just example of one program don't anyone think it is aimed at them or all adn programs. just trying to show how schools will fib in order to recruit students.

I was not trying to start a adn or bsn debate or insult anyone. anyone that knows me would know that. beside why would i knock adn programs when i am an adjunct instructor at one of the local adn programs? i have also taught clinicals at my alma mter, which requires a bsn to teach clinicals and at least a masters to teach classroom segments. I was just stating facts as they are .and NO I don't teach at the one that is on probation. I am currently working on my masters and CNM. so i can teach at the college i graduated from. I also plan on pursing my NP degree.

one other point ray, you say that you will have 126 credit hours and the bsn program requires 128 credit hours. if this is so why would a person choose the adn program if the bsn was avaiable to them. we have the same problem here the adn programs are trying to ad more curriculum to the program to compete with the bsn programs here. it is getting to the point were it does not make sense to get the adn degree. like i said it takes 3 + years to get adn degree here and it takes 3 yrs to get BSN at one local university with an accelerated program( 10 week semesters,with longer classroom hours and longer clinical days, the credit hours are the same, and the clinical contact hours are the same.) the other BSN prgram takes 4 yrs or little less.

the clinical time issue often comes up,but the truth of the matter is, any acredited program must meet the criteria of so many clinical hours for every classroom hour if they are to maintain their accreditation. well enough of this already, i have wasted way to much time on a debate that will undoubtedly go on for ever,:)

just as you said day ray, I am not trying to start a debate just saying what had to be said

everyone have a nice day,:)

**SKM-NURSIEPOOH, BSN, RN** · Jul 9, 2002

originally posted by dayray
the school i'm going to has always used a 1+1 curriculum this means that to become an rn you have to first go threw an lpn program and get your lpn license. altogether you have to take 40 credits of perquisites (a&p, patho, micro, math for meds, psyche, and social science) and about 60 credits of nursing classes to become an adn. altogether it takes about 4 years to finish the program 2 years of nursing classes and 1 1/2 - 2 years for prerequisites or about 1 semester less then it would to become a bsn. i like most of my classmates choose the a.d.n. route because it has allot more clinical time then the bsn program in our area.

they have decided to scrap the 1 + 1 curriculum and go to a strait curriculum. a.d.n. students will no longer need to become licensed as lpn's or complete any prerequisites they will instead go threw a 6 week orientation (meant to replace the 40 credits of prerequisites) and then go right into the a.d.n program with no prerequisites and be done with the program in a year and a half. they are also planning to cut about half of the clinical time they currently have and focus more on theory.

this doesn't affect me i have already finished my lpn year and am registered for the old a.d.n. program in august.

the school says they are changing things due to the community's need for nurses. i agree that our city is in desperate need of nurses and that some changes to the current curriculum could get people out faster but cant help feeling that the new graduates will be under prepared.

i enjoyed my nursing theory classes but they honestly haven't helped much sense i started working on the floor. i feel that most (95%) of useful information i learned was in clinical and that much of my critical thinking is based on the things i learned in prerequisites.

if i understand correctly, the 1+1 program is really a lpn-rn bridge program??? or is the opportunity in becoming a lpn in the first year (adn program) & 3rd year (bsn program) actually like being a nurse extern with a legal license to work???

at any rate, i think that having a lpn license & working as such while continuing the rn program (adn or bsn) could only be a positive thing. working as a nursing extern, students are often limited in the responsibilities that rns have. many aren't even allowed to pass meds or do treatments unless their rn co-worker decides to take the nurse extern under their wing & trust them enough to supervise them in that respect. with the nursing shortages & stress today, staff rns doesn't have the time to properly orient new grad rns, let alone supervise nurse externs. by working as a licensed nurse (lpn), it also allows more autonomy for the rn nursing student in order for them to increase & build upon their theory & skills learned while in school...the other perks would be being paid at the lpn salary as opposed to being paid at the nurse extern salary (lpn start out at: 17.64/hr or more & nurse externs start out at 13-14/hr in philadelphia, pa). by acquiring a lpn license, one is made to be more accountable while on the floor which can only aide in becoming responsible rns than if they only work as nurse externs.

i don't see it as being a bad thing if a state allows students to sit for the nclex-pn & i totally agree with mattsmom when she says that more & more nursing schools today are cranking out nursing graduates with less & less clinical experience. i fail to see the current direction that these nursing schools are going. they seem to think that it's the hospitals' responsibility to "teach" the new grads how to apply their clinical theories when in fact; the schools are responsible for that...they're being paid quite handsomely so the responsibility of maintaining a certain level of required clinical time should be a concern. i just don't understand how the hospitals are going along with having to make their staff show the new grads how to do clinical things...i would think that hospital administrators would want their new grads to be able to know at least the basics, especially those graduating from a bsn program. that degree states that this nurse has graduated with having to learn the "professional" nursing/scientific courses...therefore, these people should be able to start their position only to have to learn their hospital's way of running departments or unit...not actually teaching them how to do or apply skills & theories.

with that said, i don't agree with making student become cnas or lpns first or as part of the rn program...i think that stinks. no one should be made to pay for a license or certification that they don't want or desire. i'm just equating the 1+1 programs using lpn licensure as a legal way of getting rn students in working as nursing externs without any maximum hour limitations that some regular nurse externship might have as well as making further clinical instruction easier for the student in their remaining year(s).

someone has mentioned that this type of program are training students to be lpns, then completely change their concept & start educating the second or third year nursing student to be rns. again, i believe that the 1+1 program has the rn theory base from the start. this 1-1 program is only offering an option for the rn student to clep-out the nclex-pn which is only a bonus for the student who chooses to do so...provided that it's not a requirement of the rn program...that is.

as a side bar, i believe that some people go the route of lpn first because of many obstacles they have in becoming a rn. i understand that the traditional lpn programs run from 10 months up to 18 months (24 months in the case of lpn/aas programs) & that a lot of basic nursing instruction is crammed in...this includes basic critical thinking. i know of no lpns which would do a nursing function without knowing the reasons why or know what the expected or adverse reactions are. there has to be limitations as to what the traditional lpn programs are suppose to teach...hence having limits in the scope of practice...but that doesn't mean that lpn mean mindless nurse...they're educated for that level license which is not a easy program...contrary to what some rns are told or believe. it takes a lot of intelligence to learn basic nursing instruction in the matter that most lpn programs are designed...many lpn students drop-out because the program is very intense. i personally know some former lpn students that dropped-out or their lpn programs & switched over & graduated from a rn-adn/aas program. most nursing instruction in the adn/aas/bsn programs are done over more months, therefore, those students aren't made to cram their basic nursing courses like the lpn program does. i'm not judging or putting any particular program down either...i just was to point-out that being a lpn isn't fluff. i hope i'm making some sense here - moe.

MollyJ · Jul 9, 2002

critical thinking has gotten to be quite the buzz word. I'm sure someone somewhere has done a concept analysis on it and it would make interesting reading.

Over time, I have come to believe that critical thinking ability is just another way to say experience. I would certainly say that my critical thinking ability increases with each year of experience.

I know that BSN programs get banged for their "extraneous" requirements. I am a diploma nurse that attained a BSN then a MSN. I loved my pre-req's and since I took them "backwards"--after I had been practicing a while--I found them all relevant. Philosophy (which helped in the grounding in ethics), Anthro (life changing), English II (I just love lit and it helps me to think about so many current day dilemmas), Algebra II--all of it. You know Algebra is just another way to teach problem solving (what do I know? What do I want to know?)

Perhaps the best aspect of the BSN is it allows a nurse to be slightly older and built on the liberal arts and sciences foundation, which is the hallmark of advanced education vs technical education. After all, we deal with life and death every day; perhaps it is good that we are given so many more tools with which to think about the problems we encounter.

The BSN's advantages may be touted for the profession, but they are the maximum for the individual. It makes it easier to walk onto the next level to do something else when you grow tired or too arthritic or too worn out or old for the strenuous work of floor nursing. To all the nurses who say but, "I love floor nursing and never want to do anything else...." Grand. But there is insurance in knowing you have the options.

Though I think BSN's should be somewhat standardized, they also need to have flexibility to prepare nurses in a way needed by the locality they serve. So I don't think the ideal nursing education is cookie-cutter alike, but with flexibility to meet local or regional needs.

The greatest harm of the multiple levels of preparation IS ALWAYS seen in the divisiveness it generates during the discussions about it. Witness this thread and many others. This divisiveness is what nursing CANNOT afford and it goes on and on. The divisiveness itself is the single best argument for the unified level of entry, the BSN.

Electronic technology and distance learning makes it eminently possible for all ASN programs to be converted to BSN programs. At no time has the BSN for all been more in our reach. BSN programs such as research, community health didactic and stats can be offered by universities to even low population density areas via satellite download. Students in these low pop density places can still do their clinicals locally supervised by former ADN faculty.

Nursing has always defaulted by thinking small not big.

oh-agnurse · Jul 9, 2002

Molly---I totally agree with you. An ADN cannot go on for the MSN. They must first do the RN to BSN program. It is true that some nurses may not want a MSN: that is their choice. I still believe the BSN should be the entry level. Unfortunately, with the nursing shortage here, if not approaching the critical level, diploma programs may even brought back in numbers. Were these not set up by the government years ago to offset a shortage? (truly I'm not sure).

I myself love the challenge of floor nursing, but I know the stress level, and physical demands are continuing to rise. I want to move on in a new direction, and the BSN I have will allow me the opprtunity to do that, and the MSN even farther.

MollyJ · Jul 13, 2002

I don't seriously see diploma programs returning because their FIRST attraction to the hospitals that sponsored them (so long ago) was their ability to generate a cheap work force and rules governing the use of student nurses have removed that. Hospitals are finding it hard to afford their medical residency programs.

I am a poor nurse historian. But (as a diploma grad originally) my recollection is that diploma programs were the first form of "formal" nursing ed in the US, though some very far sighted nurses were, from the beginning, trying to move it into the college setting and it is astounding just how early in our (US nursing) history the first college based programs were.

I had a friend that used to say that Florence Nightengale's greatest contribution is that she tried to "clean up nursing". I actually disagree with her on that, but Flo's experiences in the Crimean convinced her of the need to have formal nursing training and I think she was a heavy influence in the model of diploma nursing early on. (Though she got much of her early nursing training in Germany, and I think her parents were pretty embarassed that their relatively high born daughter was doing this "thing" that was considered so low born.)

Hospitals found it to their advantage to have "nursing training programs" that essentially staffed the hospital over seen by maybe a "graduate" nurse or two. Student nurses often worked all shifts including night shifts, went to early morning chapel, got relatively little didactic information, slept and worked night shift. (Chaste and pious) OFTEN nursing programs were affiliated with hospitals, churches (Catholics, Methodists, Presbyterians and others) and NUNS. Some of this, early on, was to LOSE the camp follower image that nursing had from the Crimean War times (for example) and to bring order and respectability to the endeavor. I believe our traditional nursing cap is a symbol of our historical connection to convents and nuns. Still, this was also a serious effort to elevate nursing to a position of respect that it deserved. It was a double edged sword.

The history of nursing sometimes seems sad to me: we have so little been in charge of our destiny over time and that seems to be so true now still. Though i graduated from a diploma program long after reforms allowed us to be used as a free labor force, the diploma system was a patriarchy that encouraged us to see hospitals as benevolent masters. Baccalaureate programs lead the way in turning nurses into independent thinkers and ADN (and diploma) programs benefit from that legacy.

A serious study of nursing's past, I feel, is at least partly explanatory of why we are where we are today.

NurseAngie · Jul 13, 2002

Originally posted by SmilingBluEyes
Oh Agnurse, First *congrats* on your graduation. And, I agree... RN entry level should ideally be BACCALAUREATE..but first, my friend, you have to make it *accessible and available*, to all RN students/potential students!!!! Where I lived when I was getting my nursing ed. (Oklahoma), the CLOSEST BSN program was 100 miles away. SOOO-ooo, was it realistic for me to do this? As a military mom, I think NOT! Don't you think this frustrated me, since I already HAD an Associates Degree? YEP!

Now, here I am, 5 years later, working thru a University in Oklahoma, online, to earn that BSN I always wanted but had no access to. Til they make it easily accessible for ALL, it is unrealistic to expect RN's to all be baccalaureate nurses, period. And with the current shortage going on, you are not likely to make it happen anytime soon. Even if the individual states in the USA try to make it happen, they will find themselves forced to grandfather ASN/ADN- prepared nurses as RN's so as not to exacerbate the already critical shortage.

So your ideals, (while there is validity in them), that all RN's should be BSN-entry-level nurses are not offensive to me, but unrealistic and unlikely at this time! Having graduated a BSN program, I can see why one would say entry level should be at that point.....but there are many of us who *are* just as ambitious as you were, and desire to do the same, but lack the access, at least til we are already RN's and can attend an RN-BSN/MSN program that IS accessible, like I am doing.

Oh and just an aside, if you did not realize, there ARE CRITICAL THINKING SKILLS REQUIRED TO ENTER, LET ALONE, GRADUATE, AN ADN/ASN program!!!! TRUST me on THAT! I defy anyone working with me or observing me at my job to say I do not possess these "think on your feet" skills! Can't survive long in labor/delivery (or any area of nursing), without them...so please don't sell associate's degree nurses short IN THIS AREA!

sorry so long...guess this thread really struck some interesting cords in me! I appreciate all your insights here!

Oh My, I just posted a reply very similar to this on the Nurse Practitioner board! :eek: Well said.

:) Angie

NurseAngie · Jul 13, 2002

Originally posted by oh-agnurse
Molly---I totally agree with you. An ADN cannot go on for the MSN. They must first do the RN to BSN program.

An ADN cannot go on for the MSN??? Why not? Apparently they can. Vanderbilt offers a RN-MSN option as do MANY other programs. (University of Kentucky, Medical University of South Carolina, etc...)

:stone Angie