Professionalism and Credentials

Nurses General Nursing

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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 think about having a baccelaureate be the entry-level for nursing? (I ask this as an associate degree nurse, who's going to be going for my BSN, so bear with me.) I realize that this has been an ongoing debate for decades, but hear me out. Nurses are constantly looking to get paid more (as we should be), and demanding more respect (as we should be). However, I good-naturedly ask, why should we be expecting those things if the entry-level education requirement is the same as an auto mechanic or a dental hygenist? Granted, we hold people's health (and many times lives) in our hands -- but shouldn't that be even more reason to demand a higher base education? True, with the nursing shortage the way it is, it's not necessarily a practical idea; but perhaps there's a way to grandfather in the existing ADN and diploma nurses and make a transition to the BSN requirement over a few years?

Second, it seems to me that many nurses (at least one's that I work with) are reluctant to get specialty certified in their fields (CCRN, CEN, etc.). Why? Sure, time is frequently a factor (especially if you have kids), but the reason I hear most is that there's no financial incentive from hospitals. So? What better way to reinforce that "a nurse is not a nurse" philosophy that to get specialty certified. Also what better way to impress upon patients, physicians, and the public that we're well educated and masters of our art than to get certification? Doctors love to get certified and credentialed because it increases patient confidence and garners collegue respect. Would it not do the same for nurses? The financial incentive (if you really need one), is that if the public see us as specialists, there will be more public support for paying us as specialists and professionals.

Just my $00.02 worth. Now I'm going to bed... :mad:

Hi. Well stargazer, actually no, the idea of MSN as entry level wasn't all effect. It's a goal that at this time one would not expect to take effect, but it is a goal that should be continually discussed and strongly considered as an alternative for the future.

You see, MSNers are the only level of nurses, outside of those with a PhD in nursing that can get credentialed individually as autonomous practitioners in the nursing profession. That does not mean that one will not experience problems that are generally inherent with anyone who has high levels of responsibility and accountability. The debate over increasing the educational standards in nursing has been going on for nearly four decades or more. So far, nursing has not achieved a mandate for establishing a different level of entry, but neither has nursing gained any more respect, wage and benefit fairness, or intellectual political clout from within or without.

Doctors on the other hand, pharmacists, and now therapists with their increased educational requirements (probably because of their smaller numbers), although not as diverse and flexible as nurses IMO, are able to call many of their shots and make then stick with legislators, insurance companies, the government, the pharmaceuticals and other vendors, as well as the patient. Outside of the relatively small number of NPs and some CNSs, nurses are not able to do this successfully most of the time.

Nurses are not primarily the helpmate of doctors to carry out orders and to do all his/her bidding. We are a team. There is nursing science and medical science. Both of these are vital and interdependent. Doctors are not qualified to be our supervisors nor to my knowledge is it in their practice act to do so. Nurses are. There is such a thing as nursing diagnosis and nursing orders. I use them all the time when I develop a plan of care for my patients in home health.

I'm still concerned about the overwhelming focus on skills and abilities as the only benchmark that determines a good practitioner. These are important, but I think it's the reason that nurses are considered technicians but the public and not professionals. We're lumped in with construction workers and the like. Our intellects are not well respected. It's been written over and over that the public does not give a rat's a** about education, but I believe that is untrue. I think that they are confused about nursing because there are so many ways to get into nursing. I also don't think nursing has marketed its image as professionals over the many years well. We've had people representing us and marketing us that probably haven't been at the bedside in years if ever.

No, education is not the cure all, but then nothing in life is. I think the excuses against moving nursing to the next level are a self-defense, because many of us did not truly get into nursing as a career.

Someone mentioned the big picture. I do feel that we will miss the boat, by not once and for all making a move in that uncomfortable direction. It won't be all of us, but many of us will do. We're still numbered in the millions after all.

To me the only way to be considered "professionals" is to be professional and regard each other that way. As far as how we are perceived by the "outside world" is understandable--to someone not familiar with what each degree covers it would seem unusual that you can receive an RN from an ADN or BSN, so most likely until there is a formal standard of a BSN for new grads this will be the case. As far as pay compensation I'm still unsure how that will be resolved-here there is no educational pay diff only for addition certifications, which I disagree with, I think there should be a pay difference by degree, but also by experience even a BSN grad couldn't hold a candle to the knowledge of an experienced nurse-I just don't think you guys are paid enough! Amoung ourselves, it is up to us to treat each other with respect as NURSES not ADNs or BSNs. I love the positive and creative ideas I've heard on this topic rather than the usual bickering-how many threads like that have we read and has any good ideas come out of the which is better argument?? I think eventually the BSN will be required for new grads and I love the idea of the 1 year preceptorship, think what great new nurses would be joining the workforce! I am going to become an ADN RN but plan to continue to BSN-although I do believe this will not make me better at actual patient care-but instead will make me better equipped if I chose to move to management, etc. It is also necessary for advancement. I can't wait to have my ADN and get out there and get my hands dirty-but I also feel that when the time comes to begin on the BSN it will only build upon the science that the first 2 years provided. (BTW there is a choice on what "humanities" one can take, rather than bowling I will probably take a foreign language, a WWII history class to help me relate better with those who lived through it that I may come in contact with, etc.--it is our education so we might as well make the most of it as we see fit for ourselves because we know in the end we will be a nurse.)

Sorry for all the rambling-I just get a little tired of the arguing I see here! Please more positive ideas everybody!!

Sorry, Mijourney, didn't mean to put words in your mouth. And I agree with pretty much everything you've posted.

Like it or not, the trend in medicine IS towards more education. Most pharmacists now have doctorates, registered dieticians have bachelor's degrees--even urology residencies were expanded a few years ago to include an entire year of nothing but research. You don't hear urologists saying, "Well, since I am basically just a glorified Roto-Rooter man, that extra year of education was completely useless and irrelevant."

I think a lot of the "respect" issue is going to come down to 2 issues: independent practice, and independent billing/insurance reimbursement. As I said, the dental hygienists now have independent practice status. How did that happen? Do dentist not have as strong a lobby as the AMA does, or did the hygienists somehow manage to get the dentists on their side?

Hi. Lausana, when you write about a BSN grad holding a candle to those of us who have years of experience in nursing, do you also mean to include experienced BSNers?

The point I'm trying to make is that we seem to be benchmarking educational credentials and experience off of new BSN graduates which IMO doesn't make sense. If you looking to make years of experience as a more valid indicator of a good nurse then education, then you can simply match the knowledge, skills, and abilities of all the levels of high performing nurses who have worked in the same area with equal years of actual nursing practice. For instance, you can find measurable ways to compare the performance of an LPN, ADN, diploma nurse, and BSN after each has practiced nursing for five years.

Years of experience unfortunately is not always the best indicator that someone has matching skills, abilities, and knowledge. Work ethic as implied in the topic on professionalism and credentials I feel is one of the best determinants of whether a nurse is meeting his/her potential. We may not feel it's necessary to expand our education beyond the basics, but with a good work ethic, I feel that more formal education can only be a plus.

Stargazer, I agree with your comments about independent practice. So, the dental hygientist are recognized as autonomous practitioners? Do you believe this is another way for dentists to get more money very much like doctors do with PAs or NPs? They can bill not only for the work they do but they can bill additionally for the dental hygienist? How ingenious.

Specializes in Pediatric Rehabilitation.

Actually, I've not heard the bit about the dental hygenist. They are also state regulated, so that may not be the case here yet. BUT, that will hurt them more than help. Before when the dentist was not physically in the office, the hygenist could not see patients. Now they will be forced to work when they normally would have been off or at least, off their feet. I don't see where this benefits them, but I don't know the specifics of it either.

HI,

I envy all of you because most of you are finished with school.

Nursing is my second career choice and I'm very non-traditional, my oldest son is in college too.

I started out last fall in a BSN program at a wonderful Catholic College and have taken some really meaningful classes like Christian Ethics, Philosophy, Ethics, Liturature, Crit. thinking, not to mention many science courses.

For me personally I am transferring to an RN program at another Catholic college to get the associate degree. Four years is a long time without money and after talking with several RN's and re-thinking my goal path, this is the right decision for me.

Eventually I would like to get the BSN or perhaps RN to MSN. I really am excited about finally being able to get into clinicals and "do" something. I don't regret any of the classes that I have taken so far.

I just feel that "just one way" does not work for everyone, you have to choose the program and path that is right for you. Whether it is LPN, RN, BSN, etc.

mkue

Tracy, being independent practitioners benefits the dental hygienists by providing them more employment and entrepenurial options. Just think: they can form their own agencies and contract with dental practices, with schools to provide education and screening, with businesses to provide employee screenings and cleaning, with rural and underserved urban areas who don't have access to dental care.

My own company provides on-site dental care for a specific category of employees. Once hygienists were approved for autonomous practice, we immediately moved to hire them to provide cleanings and screenings in between dental visits. Ultimately it will free the dentists to do actual dental work, decrease the numer of dental visits required, and save my company money. Win-win situation.

Think what nurses could do if we were able to practice autonomously! :)

Ok, careernurse your right art appreciation is not going to make me a better nurse, but organic and biochem, microbiology, pharmacology, pathophysiology, nutrition, and sociology are. Fundamentals of speech is going to help me talk in front of a group better, intercultural communicatoions is going to make me understand why some of my patients act the way they do. statistics is going to help me do and understand research, which is the basis of everything we do. these are some examples of what makes the BSN's an asset. with in 6 months bsn's and adn's are at the same level clinically. Their knowledge base is much stronger than any ADN nurse unless that nuse has a degree in a science. I am an ADN, my wife is a BSN and she is by far a better nurse than I , because her understanding at the base level of what we are is more developed because of the classes I mentioned. Think before you speak. I understand now what the ANA was trying to say and do I think they just went about it all wrong, like most of the things they do.:D

Specializes in Pediatric Rehabilitation.

The classes described above that differentiate BSN from ADN (supposedly) WERE required for my ADN.

Specializes in Pediatric Rehabilitation.

Stargazer,

Honestly, I'm not trying to be negative here, so bare with me. I still don't understand, or see the benefit. Dental Hygenist are in nearly as big demand as nurses, so they don't necessarily NEED the employment options. I've not discussed this with my mom or sister yet, so I don't know their opinions. That profession has never been a big one to carry liability ins. Does this mean they will now need to carry that? When I was in elementary school(LONG time ago ;)), my mom would come every year to do education and screening, independantly. That's not a new concept. What were dentist doing that wasn't actual dental work?? What are the limitations of what the hygenist can and can't do? How does dental hygenist set up a portable office to provide these services?? Are we talking about going out and educating people, looking at teeth, advising, passing out a few toothbrushes and floss OR are we actually talking about going out to the people, taking the cavatron, taking the polisher, taking the xray machine, etc?? I'm confusalated..pweeze help me.

Hi all y'all

[comments after the quote]

Originally posted by Lausana

To me the only way to be considered "professionals" is to be professional and regard each other that way. As far as how we are perceived by the "outside world" is understandable--to someone not familiar with what each degree covers it would seem unusual that you can receive an RN from an ADN or BSN, so most likely until there is a formal standard of a BSN for new grads this will be the case.

Amoung ourselves, it is up to us to treat each other with respect as NURSES not ADNs or BSNs.

I will probably take a foreign language, a WWII history class to help me relate better with those who lived through it that I may come in contact with, etc.--it is our education so we might as well make the most of it as we see fit for ourselves because we know in the end we will be a nurse.)

Sorry for all the rambling-I just get a little tired of the arguing I see here! Please more positive ideas everybody!!

VERY well said, Thank you!!!!

Professional is an ATTITUDE!!! NOT a degree.

Do we ALL need to continue learning new things? [this includes the nuts & bolts of health care as well as the 'useless' things like music, art, needle point and such] YES!!!! It helps us relate better to our clients.

Which is better, someone with a four year degree [bSN] or some who has a 2 yr ADN + 2 extra years of electives?? or someone like Fred S who after getting his BS in English and teaching for a few years went back and got licensed as an LPN? [because that was what the school closest to him had].

Regardless of what our degree is, we still MUST

relate to, and talk with our clients on their level. Regardless if they are a 3 year old in with a fracture or the parents [who are still in high school] of a premy on a vent or one of our MDs in having a baby by c-section. I use these examples because I do Maternal-Child services when I'm not flying a desk.

It does not matter what our [job] function is, MSN, BSN, ADN, LPN, CNA or housekeeping -- Unit manager, DON, or staff nurse. We should all be part of the team, concerned with delivering good care to those entrusted to us.

To be treated like professionals we need to ACT like a professional.

Maybe a required class in ALL health care schools we should have 'professional behavior 101' :}

Originally posted by BrandyBSN

Matt wasnt starting a "who is better than who" debate. However, I find your comment about "hospitals prefering ADN nurses over BSN nurses" to be obsurd. I have seen many advertisments for RNs, with "BSN PREFERED", but I have yet to see one that says "ADN PREFRERD". If you find out of these, please post the address of the job listing page, so that I can be corrected.

Neither makes you are better bedside nurse than the other. However, the compensation issue is valid.

Looking at most adverstiments in many areas of the country, the hospitals and other facilites advertise for RNs, LPNs and NARs or CNAs. The pay here for a BSN in comparison to a ADN is fifty cents a hour in my area. Pay difference that are measurable are years of experience and job title for example, supervisor or nurse manager.

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