Professionalism and Credentials - page 4

OK, just some thoughts here so early in the morning (after work...) I've been thinking on how we can improve the image of nursing and a couple of thoughts come to mind. First, what do people... Read More

  1. by   NRSKarenRN
    When I was in LPN school in 1976, we started classes the first week in September, Monday thru Friday 8 AM to 4:30 PM with a 45 min break for lunch daily. This continued till last week in August. We had one week off between Christmas and New Years and off holidays. Many LPN programs continue this training today, some having science requirments taught by community college instructers and gaining associates credits.

    The length of time we spent would be almost equal to the length of current ADN nursing clinical time. I suspect that LPN role would be shifted to community colleges with each license level being grandfathered due to new educational requirements.
  2. by   Mijourney
    Hi. Now is an excellent time to look at the nursing infrastructure. From all indications, the nursing shortage will only become more acute and ingrained as time passes. We've got large numbers of boomers knocking at the door of retirement. Most of us, if we'd admit it, know that boomers and their children are very demanding when it comes to their health and well-being. They want and expect near perfection it seems.

    Now that I think about it CareerRN, it may not be such a bad idea to establish an advanced NCLEX where half of the test incorporated junior and senior level general ed college courses such as bio and organic chemistry, bacteriology, biostatistics, physics, epidemiology, and etc. As you suggested, ANY nurse could challenge that test to see where they stand in terms of knowledge. These subjects could be incorporated in an applied manner so that test takers will get an idea of the relevance of these courses. Of course, we know that this won't test hands on skills or abilities which I feel much of the argument is about. As you agreed, the problem is the variation within each nursing program. So maybe each test taker can have their nursing school submit a curriculum from the time they were in the program for comparison. Perhaps that would give nursing programs an idea of how they should set up or revamp their program.

    As far as the statistics for NP pay and NP vs PA pay, I don't think the gender issue will ever change as learn as the AMA is in charge and women in general get less pay then men (I personally think there should be a markdown of prices for women when we shop-let me stop before I go on with this). Essarge, if the pay for NPs that you quoted is the national average, then in my neck of the woods, it's considered a very good salary. Most RNs that I know do not make that salary unless they work overtime, have worked in the same place for a long time, or are in mid to upper management. This also depends on where they work.

    I guess what I would like to know from someone who has an MSN is whether you work longer hours or more days for your pay. As a home health nurse, this is a dilemma I've been fighting with for a while even though I work part time. The paperwork is tremendous and burdensome. If there are any out there in home health, can you tell me what the typical job description for a nurse with a master's is and the pay? Do you feel it was worth it for you?
  3. by   Charles S. Smith, RN, MS
    Matt and others..this debate has raged on for over 40 years now...yes 40! The biggest surge in the debate was in the 70's and it died a horrible death. Without casting aspersions on anyone's choices in life, here are a few things to consider:

    1. What level of education/professional entry will give RNs the biggest market advantage? In my view, at a minimum it is the baccalaureate degree. In fact, I am a proponent of the Master's degree for entry into professional practice. Before eyes turn red and steam begins to roll out from your ears, hear me out. We live in a market driven economy. A significant basic tenet of our economy is supply and demand. When a profession controls supply of its practitioners and the profession has a unique service that only that profession can render, automatically the demand for those services is higher and the profession can then demand compensation commensurate with the education and increased need for services. People always pay more for scarce resources...RNs are a scarce resource, yet we continue to act as if we are bargain basement rather than Saks Fifth Ave....

    2. Professionalism is NOT determined by the tasks one performs. If RNs continue to hold on to the task debate, we will certainly never gain ground. It is true that CNAs, LPNs, RNs can all do many things that overlap. It is also true, that as nursing has grown, we have inherited tasks from MDs (things they no longer wanted or needed to do), and we have also passed tasks along to others. What sets a profession apart from others and makes it distinct is its body of knowledge and the ability of its practitioners to think, conceptualize, be analytic, generate solutions, solve its issues from a scientific base..etc. We can all learn tasks to some degree or another. Not all of us are equipped for the intellectual rigor required of professionals.

    3. And the final thought, is employment status. When one is employed by another, one is labor, pure and simple. Labor functions at the whim and will of the employer who has the ultimate control. If RNs do not generate our own income based on sound business models, we will be constrained to low paying, low status jobs...not meaningul work.

    I certainly understand that these comments will cause heartburn for many. Don't take them personally...this is about the future of our profession and we have many choices about that future, as long as we are willing to look past our own comfort zones. My best to all
  4. by   Charles S. Smith, RN, MS

    First, most NP's are CERTIFIED through a MSN program. They have a separate board to sit for that is designed by the American College of Nurse Practitioners.

    Point of clarification Essarge...NPs are EDUCATED at the Master's Degree level through state approved programs that prepare RNs to sit for the certification exam. Once the examination is successful, the RN can then be CREDENTIALED as a Nurse Practitioner, but then must be LICENSED by the individual State Board of Nursing to practice. MS programs educate and verify a minimum standard of education needed to sit for the certification exams....

  5. by   BeachNurse
    Chas, I really like your thoughts and insight into this issue. My response under the thread about our education not being valued did, in a sense, focus on the task-oriented view. I personally got out of hospital/bedside/floor nursing relatively early in my career because my knowledge and ablility was not appreciated. My loyalty to patient advocacy was snubbed and ignored and I felt like some little worker bee with no independence or autonomy. Unfortunately, that type of thing is inherent in hospital nursing.

    I extracted myself from that environment and am now flourishing as a clinical research coordinator. HERE I am valued and treated like I AM "Saks Fifth Avenue", although not necessarily paid that way. (hee hee).

    I completely agree with you about raising our standards..many nurses would like to complete the BSN and move on the Masters level. It sounds great if we could ALL be Master's prepared, thus bringing about some change in how the profession is viewed, how we are compensated, etc. This would be a massive change. It sounds like a pipe-dream right now, though.

    At this point in time, many nurses bust their butts going back to school, taking certifications, etc. with no professional acknowlegement or reward. It could be hard to convince an entire population of nurses that the Master's is the way to go for the entire nursing profession.
  6. by   Charles S. Smith, RN, MS
    Hi Beach...thanx for your comments. The reality of the situation is that we don't have to have all or nothing right this minute. The emphasis is placed more effectively if we move the dialogue to how we must adjust our thinking so that our actions can follow. Many of us are stuck within the boundaries of our own situation, not realizing that there is a great deal of paralysis there. You have stepped out of the clinical role into something more fulfilling, just as I have. My basic nursing preparation was associate degree. Even in the early 70's I realized that my AS in nursing would not and should not sustain me in the future. I had the choice to stay at that level of education or move forward. I chose the hard road. My basic preparation was a good one, but it prepared me to be an employee, follow orders, do tasks according to someone elses direction and to basically be a loyal and good nurse. There is so much more to nursing than what we have been led to believe. We can change the course of our professional futures. It is a choice, not a pipe-dream. And it starts with the person who stares back at you in the mirror in the mornings... :-)

  7. by   nurs4kids
    As usual, you make very intelligent comments. I agree that it would eventually help the respect of nursing if the minimum was raised to the level of BSN or above, but one small thing still concerns me. What will that do to the current shortage??? Would it force employers to pay nurses more? Would we gain more control? OR would we be making more yet working twice as short because we've eliminated people (ie; women with kids) who can not sacrifice four years of education?? I have no problem with the thought of being forced to return to school for my BSN (I plan on going back as soon as kids start school), although I'd probably be grandfathered anyway, BUT my concern is for staffing in the future. The other sad thing, the general public has NO idea what it takes to be a nurse. I am often asked if it took me 1yr, 2yr's, etc. So, alot of public education is needed. I'd love to see the curriculum standardized and the NCLEX standards raised. I'm frustrated to see some of the ignorance that is able to make it through nursing school AND pass the NCLEX. I also think a skill and critical thinking test should be required. It's pathetic that someone can enter the profession without the knowledge of what a NG tube looks like, let alone how to place one. In the past year, I've oriented several new nurses that are unable to calculate SIMPLE meds, and further lack the common sense to know if their answer is logical, let alone correct (ie; dose=7mg. Vial 50mg/ml. Answer = .5ml) It's OBVIOUS that that is waaay off, but many lack the ablilty to look at the logical side of that problem. These type problems are NOT associated with type education, or even with institution. These problems are just like our primary education problems, people are slipping through the cracks. We MUST find a way to demand a certain amount of knowledge and skill for nursing. Perhaps we should begin to be more critical of our own coworkers, to demand they be accountable if they hope to stay in this field. I don't know the answer. I can see where raising the entry level to BSN may help our image slightly, but I think until we REQUIRE a certain knowledge and skill base REGARDLESS of degree, we will still be debating this issue into the next century.

    There's a misconception that the ADN/ASN's here feel their toes are stepped on by this discussion. The problem is the message that they are less prepared than BSN's. That is, again, a very generalized accusation and it just is not true. There are good and bad nurses of ALL educational levels. The problem is NOT the education level obtained, it's the education gained and/or retained

    Chas, I really wish you'd become political and lead us into the future. You have the education, logic and leadership we need!!
  8. by   KatWright
    I have been a nurse for > 25 years and worked with several different delivery systems. Team nursing, primary nursing and now a "re-design" using CNAs Techs and RNs.
    With team nursing we had RNs, LPNs and nursing assistants.
    Primary nursing was RNs only. I'm not sure which one I prefer because each one had their place at the time.

    As far as degree, I'm not sure how I feel.
    I am an ADN and DARN good. I have 3 certifications: Med-Surg, Geriatrics and Oncology. I did them at the time because I wanted the mony ( we get reimbursed for the test and a one time 2% bonus- which is about $1000 - and it comes right before Christmas!! :-) However, once I had them, boy did it make me more marketable, I can be an expert witness ($100/hour!!) for any lawyer that isn't doing a case involving my hospital or doctors.
    I have climbed our clinical ladder to the top.
    Most people have been surprised that I am back in school for my masters (AD to MSN bridge) because they thought that I already had it !!
    Alot of it is how you carry yourself. You can be a jewel or a jerk with or without an advanced degree !!

    Also, I must say, I have worked with some LPNs that could work circles around some of the BSNs that I have worked with.
    LPNs still have a place in nursing but unfortunately the laws in some states do not allow them to give IV meds and a few other things, so it makes it a logistical nightmare when the patients have a higher acuity than they did several years ago.

    It's all about the individual, their work ethic, technical skill mastering, people skills and whether they are willing to learn.

    I took silk screening as an elective, (I'm not sure how it helped me in nursing, except that I am a very creative person)

    Now for the masters, I am choosing the electives a little better (for me)....Conflict management, death and dying and I may even take a Writing for nurses course. I choose courses that I identify that I need and that will hopefully help me in the next few years.

    In my area, the ADNs have always done better on the boards than the BSNs from several area schools. And I find it interesting that I can tell which of the new nurses on my unit came from a local school and which nurses came from a school out of the area. I hate to say the the local grads are not the stars.
    Because of the nursing shortage, I don't see a hiring difference because some areas have been hit so hard, but if the hospitals are smart, they will look at the degree as they look at advancement in their institution.
  9. by   nurs4kids
    Very well said!! For years, the pass rate on NCLEX here has been the same as there (2 yr colleges higher), but recently that has changed. The NCLEX, however, is NOT reflective of nursing capability, nor is the degree obtained. It seems to me that the ADN's come to the floor more capable of providing nursing care INITIALLY, but in a very short time the BSN's gain the hands-on skill needed to be equal.

    The one big difference I find in the two levels, well in all levels of nursing actually, is the higher the education obtained, the more "class" the person shows. Generally speaking, the BSN's are more articulate, more capable of presenting themselves as intelligent, than the ADN's, the ADN's more so than the LPN's, etc. This, I feel, DOES reflect in education and therefore is very influential in the image of nursing. I'm not so sure this is due to the education received, or the enviroment associated with the economic status which allows one to obtain a BSN vs ADN vs LPN. <ducks> okay, I know I'm in for a chewing on this one, but it's just MHO..and after all, I'm only an ADN
  10. by   mattcastens
    As the initiator of this thread, I'd like to make a few more comments.

    First, I am an ADN -- remember that -- admittedly, one who is working toward his BSN.

    Next, I did not start this discussion, it is one that has been going on for decades.

    Third, I didn't start this discussion as a debate on who made better nurses. In fact, that issue is irrelevent! My point is that a higher level of education is smiled upon by our society, and if we are to advance the image of nursing, we should get that through our heads!! Look at a business model: do all managers have their MBA? No. Are there great entreprenurs that don't have that high level of education? Of course. And yet, thousands of MBA students graduate every year. Why? Because it opens doors and garners respect. Are some LPNs better nurses than RNs? Yes. Are some ADNs better nurses than BSNs? Of course. However, as I pointed out before, nurses will suffer (and have suffered) if society sees us as only needing a two-year education -- the same as an auto mechanic or dental hygenist, instead of higher education. We hold lives in our hands! That reason alone should demand higher education as our baseline.

    Also realize that no matter what we do (save an outstanding increase in pay), the nursing shortage we have now will not be solved in a short period of time. Why? People aren't interested in nursing. To foster that interest, it would be to our benefit to play up the high level of education that should be needed.

    Lastly, the issue of second-career nurses is a valid one. These people can be accomodated by having an extension-type program that includes only science and nursing classes. It would be for people who already have baccelaureate degrees and would be a two-year extension onto their existing degree.
  11. by   nurs4kids
    I've seen it twice here, now I have to correct the misconception. Dental Hygenist are EXACTLY like nursing with regards to education. There are different ways to obtain a hygenist license. Many hygenist DO have Diploma and MANY have a Degree. Several also sought the precept route that is available in some states. As the daughter and sister of hygenist, I'd like to add that to downplay one profession while trying to raise ours does NOT help our cause. I watched my sister go through hygenist school. Her studies were very closely related to mine, only difference is that at a point her focus was turned toward one part of the body rather than generalization. I remember my mother coming home from work after seeing 12 patients/day, barely able to walk. I watched both of them travel across states in order to obtain the necessary CEU's for their license. My point is, that just because we haven't traveled the road, don't downplay their profession.

    This is an example of the same thing that happens with nursing. The public DOES see nursing as it sees hygenist, because it is closely related. Both are female dominated, therefore have been suppressed. HOWEVER auto mechanic only requires a few tools and a good shade tree. Do I have to point out why the pay between the three is close to the same?? Maybe I'm just blind, but I just don't see the respect as the same. I like to think I'm much more valued by my patients than their mechanic. I guess it just depends on a person's values.
  12. by   KC CHICK
    matt, I'm exactly did you not expect the responses to be this way??? There have been many other threads on the SAME subject w/the SAME types of responses. You opened the can of worms again, knowingly or unknowingly.....sorry, but it's true. Not only that, another thread was created out of windfall from this one.....over the EXACT SAME SUBJECT!!

    I think this dead horse has been kicked a few times too many. Please let him be.
  13. by   Mijourney
    Hi. Chas, you know how to make a difficult position more pallitable. Your response is refreshing to me. Matt, interesting suggestions. Nurs4kids, it's good that you're willing to see the education and credentialing situation from all angles, and you were very articulate in doing so. I know you were writing about BSNers being more articulate in a general way, but I find quite a few of us with diplomas and ADNs that are not close to half bad. Keep in mind that a growing number of diploma nurses and ADNers have other degrees. Fergus, you seem to be one of the rare ones that indicated that you would go back to school if your expenses where paid for. Does that mean that for some of us, no matter what type of incentive or support, we would not make any efforts to further our education for the gain of nursing as a whole?

    Even though it may not be discussed on the job, there is an underlying competitiveness among the various workers who comprise nursing. The problem is how do we get our discussions and debates beyond the concerns of superiority into concerns of surviving and thriving on this bb? I don't believe that simply ignoring this issue will help, because I feel the nursing profession is sinking deeper into quicksand. With all the intelligence and talent in our profession, we deserve better then that.

    Correct me if I'm wrong, but aren't most MSN programs applied programs meaning that the nurse learns a combination of skills, theories and beyond? Isn't it the MSN nurse along with all the other types of nurses that do the work that the PhD nurse uses for research and development? Are more NPs in administration or actually working in health clinics or doctor's offices? Aren't most MSNers at the frontline in a different setting or way? In my neck of the woods, I've observed that many of the people in nursing administration have diplomas or ADNs. If MSNers worked at the bedside in a hospital, for instance, wouldn't it be better that they do it as individually credentialed practitioners like the doctors instead of employees of the hospital?

    I understand the concern for immediately increasing the number of nurses and CNAs in our profession. I agree we want our public to feel confident that there is enough of us there in their time of need. But, I'm more concerned that as we progress in the information age where knowledge is increasingly becoming a commodity that we don't find ourselves totally marginalized in the health and medical care system.