Making Nursing Education More Universal

llg, PhD, RN · Sep 7, 2016

I believe that there should be a core set of material that all BSN program include, but that programs should not be identical. The should be room in the curricula for different people (and different programs) to emphasize different things.

The universe of knowledge is very broad - and we should not stifle individual nurses or the profession as a whole by limiting the topics that can be included in the curricula to prepare nurses. Some nurses (and some nursing jobs) are heavily focused on physiology, etc. Others are not: they relate more to the social sciences and humanities. We should not all be alike and forced to study all of the same things at the expense of excluded other content (that is probably relevant to many specialties within nursing) fall by the wayside. My vision of the ideal curriculum would include a broad base of liberal arts courses in the Freshman year, followed by a core nursing courses in the next 3 years intermingled with a generous number of electives so that students could choose to double-major or minor in another field -- or continue to take a broad liberal arts program to enrich their understanding of people, health, the world, and nursing's role within it.

As for nursing theory, I believe all RN's should be required to take a theory course that acquaints them with the key theories of our profession and the basic history of our theoretical heritage. Once again, while there are a few "giants in our field" that everyone should be familiar with, we should not limit ourselves to only those theories. We need to continue to develop new theory as we continue to evolve through time -- and we should not hinder our growth and development as a profession by limiting the development of our philosophical, theoretical, and scientific foundation. My vision of an "ideal theory course" for entry-level (BSN) nursing students would spend the 1st half of the semester reviewing the historical development of nursing thought, familiarizing the student with the great thinkers of the past and the ideas they contributed to nursing (e.g. Nightingale, Henderson, Orem, Roy, Watson, Benner, etc.) ... and the 2nd half of the semester looking at what is happening today in the field of nursing theory -- situation-specific theories, practice models, etc.

AutumnApple · Sep 7, 2016

Hmph, I think I'm half way between where we are now and llg.

There should be flexibility, yes, in the form of electives. But you used the term "generous number of electives" and that'd be where we differ.

I'd go with a core set of requirements that all BSN programs must fulfill, with some electives to achieve a degree of flexibility and individuality. The focus though for me would be on becoming more universal, which unfortunately means becoming almost (but not entirely) identical.

The curriculum would be much like you already described. More focus on who has contributed to nursing theory up to now, a critical look at where we are now, and a definite push to make students consider where we want to go (as a profession) and how to get there. Classes should include issues we face today and prepare us to be leaders, not followers, with said issues. Politics, knowledge of the laws in place and how they work, deeper focus on research and how to identify suspicious "research findings" and most importantly leadership that directs us to support the profession rather than drag it down.

I think electives and individualized education pathways is best left for the MSN level. That's just me though.

contemplations · Sep 8, 2016

I am still a student, however, looking at the curriculum guides for the programs at my school, it's strange how different they can be. My university provides three undergraduate nursing options--an Associate's Degree, a Bachelor's Degree, and an RN-BSN transition for ADN grads.

I plan on going the ADN -> RN-BSN route. After comparing the curriculum guides, even when I complete my RN-BSN at the same school, I will not have taken several courses that the BSN requires for graduation. But, why is this? Both paths result in the same bachelor's degree awarded by the same university.

These are a few of the classes I will not have taken that the standard BSN requires:

1. Introduction to Chemistry & Biochemistry.

2. Pathophysiology (for nurses)

3. Intro to Genetics for Professional Nursing Practice

4. Nutrition

Yet, I will still be awarded the same degree as the people who were required to complete those courses and more. I understand that the RN-BSN is designed to be completed faster, however, these courses do not sound "unimportant" enough to simply be omitted from the curriculum completely to achieve a shorter time.

In this example, why are the students receiving different levels of education for the same degree? I would love to hear more opinions on this!

smartnurse1982 · Sep 8, 2016

Another post I made that (gasp) brought up the old "Should a BSN be the minimum requirement for bedside nursing?" topic up again. And it got me thinking:
We talk about if it should be or not but never seem to get anywhere with it.
Well, my problem with the whole debate is that nursing education is far from universal. In my opinion, at the ADN level, there is a fair amount of core requirements and theory. On the other hand, when we compare BSN programs to one another, the similarities are scarce.
This, to a degree, says to me we don't know what to teach at that level. It seems to advertise to the public that we have no universal nursing theory. If we can't agree on what our theory is, how will the public ever view us a profession worthy of respect?
So, I want to propose a few questions:
1. Should nursing education at the BSN level be made more universal? Or is it fine as it is, with each program having it's own unique flavor or personality?
2. Do you think the fact that we are so divided on what our nursing theory actually is promotes internal strife? Would having a more universal, core set of theories unite us? Or is the difference in opinion just a matter of flexibility?
3. If BSN education were to be more universal, what would be some elements that become a required part of their curriculum? Or do you think we can just do away with it and stick with ADN training being enough for bedside nursing?

You forgot about Lpn's.

Nurse does not automatically mean RN.

We can't address nursing education without addressing ALL nurses IMHO.

They are not some separate nursing entity.

carolinapooh, BSN, RN · Sep 8, 2016

You forgot about Lpn's.
Nurse does not automatically mean RN.
We can't address nursing education without addressing ALL nurses IMHO.
They are not some separate nursing entity.

I agree - but he was speaking of BSNs in this case.

(One of the best unofficial preceptors I had was a 23 year LPN. To me they have the toughest job.)

carolinapooh, BSN, RN · Sep 8, 2016

Medical and PA schools don't have identical programs, either. There's a basic core, just like there is with BSNs, but the programs vary greatly in concentration and focus.

I don't see this as a huge problem.

carolinapooh, BSN, RN · Sep 8, 2016

I am still a student, however, looking at the curriculum guides for the programs at my school, it's strange how different they can be. My university provides three undergraduate nursing options--an Associate's Degree, a Bachelor's Degree, and an RN-BSN transition for ADN grads.
I plan on going the ADN -> RN-BSN route. After comparing the curriculum guides, even when I complete my RN-BSN at the same school, I will not have taken several courses that the BSN requires for graduation. But, why is this? Both paths result in the same bachelor's degree awarded by the same university.
These are a few of the classes I will not have taken that the standard BSN requires:
1. Introduction to Chemistry & Biochemistry.
2. Pathophysiology (for nurses)
3. Intro to Genetics for Professional Nursing Practice
4. Nutrition
Yet, I will still be awarded the same degree as the people who were required to complete those courses and more. I understand that the RN-BSN is designed to be completed faster, however, these courses do not sound "unimportant" enough to simply be omitted from the curriculum completely to achieve a shorter time.
In this example, why are the students receiving different levels of education for the same degree? I would love to hear more opinions on this!

Duke has one option for the entry level BSN: the accelerated BSN.

There's no genetics course nor a required nutrition course. My patho course was at the graduate level and taken as part of the ABSN course. I've never taken a biochemistry course. One isn't required for admission. A general chemistry course is not required either (I've had two semesters, and two semesters of organic, but initially I wanted to go to pharmacy school - something working as a tech cured really quick). I just double checked their current requirements - and they're the same as they were when I went ten years ago.

So none of these are standard BSN courses, either. You're fine.

It's not a "different level of education". We're all getting the same level of education: a BSN. It's different required courses. The core is exactly the same, otherwise we wouldn't pass the NCLEX. (And I realize you're talking about a course designed for folks with an RN/ADN already, but still: you're BSN prepared regardless.)

contemplations · Sep 8, 2016

So none of these are standard BSN courses, either. You're fine.

Thank you for the response! I was starting to worry.

Buyer beware, BSN · Sep 14, 2016

OP: Nurses should own the means of production not hospital corporations. Nurses should control and promote one unified educational process and entry level degree. Nurses should not collude through staffing and accreditation with for profit nursing schools that function primarily as loan mills to take advantage of minorities, veterans and older folks displaced by a tepid economy looking to reinvent themselves.

Until these things are addressed, and much more, most of the prior threads are just over thinking a moot point as the medieval clerics did when imagining how many angels could fit on the head of a pin.

So universal nursing education, whatever that is, would be great if there were a universal plan to go with it.

AutumnApple · Sep 14, 2016

OP: Nurses should own the means of production not hospital corporations. Nurses should control and promote one unified educational process and entry level degree. Nurses should not collude through staffing and accreditation with for profit nursing schools that function primarily as loan mills to take advantage of minorities, veterans and older folks displaced by a tepid economy looking to reinvent themselves.
Until these things are addressed, and much more, most of the prior threads are just over thinking a moot point as the medieval clerics did when imagining how many angels could fit on the head of a pin.
So universal nursing education, whatever that is, would be great if there were a universal plan to go with it.

Actually, having a more universal standards for education would be a big step towards solving many of the problems you mentioned. Your post is a bit chaotic and hard to follow, doesn't really come to a point but, I think I'm getting your meaning.

Universal standards would hinder predatory schools for one. If everyone has to meet the same criteria to be allowed to offer BSN training, these schools lose their ability to make things up as they go along. Since everyone has to live up to the same standards, they no longer can claim to give the same education unless they actually do.

As far as nurses being in control of the professions destiny goes (as opposed to hospitals and corporations, as you put it), universal education standards will only help our cause.

We have no definition for what truly makes a BSN what they are. We've not set up the standards yet. Other institutions have, mainly the educational institutions that wish to profit from it. But as you can see, we (the nursing profession) has no idea what we think a BSN should be.

This leaves us looking like we are undecided about the whole issue. That is what leaves the door open for others to step in and tell us "This is how it's going to be."

If nursing makes the standards for education more universal, it means we have stepped in, answered for ourselves what we think defines "us" (from an educational standpoint) and answered the question for ourselves instead of being told.

As I said, the fact that our way of delivering education is so arbitrary and different from institution to institution...........is what makes us look like we're just making things up as we go along, and there is no real "nursing theory" or anything else to be taught.

Buyer beware, BSN · Sep 14, 2016

Actually, having a more universal standards for education would be a big step towards solving many of the problems you mentioned. Your post is a bit chaotic and hard to follow, doesn't really come to a point but, I think I'm getting your meaning.
Universal standards would hinder predatory schools for one. If everyone has to meet the same criteria to be allowed to offer BSN training, these schools lose their ability to make things up as they go along. Since everyone has to live up to the same standards, they no longer can claim to give the same education unless they actually do.
As far as nurses being in control of the professions destiny goes (as opposed to hospitals and corporations, as you put it), universal education standards will only help our cause.
We have no definition for what truly makes a BSN what they are. We've not set up the standards yet. Other institutions have, mainly the educational institutions that wish to profit from it. But as you can see, we (the nursing profession) has no idea what we think a BSN should be.
This leaves us looking like we are undecided about the whole issue. That is what leaves the door open for others to step in and tell us "This is how it's going to be."
If nursing makes the standards for education more universal, it means we have stepped in, answered for ourselves what we think defines "us" (from an educational standpoint) and answered the question for ourselves instead of being told.
As I said, the fact that our way of delivering education is so arbitrary and different from institution to institution...........is what makes us look like we're just making things up as we go along, and there is no real "nursing theory" or anything else to be taught.

Autumn Apple:

You're right! "Making things up as we go along." But who exactly is making those things up? You might study political and economic theory to understand that very often the "invisible hand" is making the decisions for those who relinquish important decisions to others in hopes they will be taken care of.

This notion is infantile and acceptingly paternalistic and not worthy of any group that purports to claim be a profession.

Autumn, please excuse my semi-ranting as the issue of ideological "universal precautions" if you will has been debated for a long, long time without much changing. Same polemics ad-nauseum but status quo as usual.

As you may live to observe, each generation tries to reinvent the wheel often falling prey to the profit motives of those who aren't nurses and could really care less about nurses or what we do to keep the machine running.