Is the licensure system for nursing harming the profession? - page 2

Licensure system could use an overhaul Stronger link between educational programs and practice roles could benefit the profession By Carolyn Williams, Ph.D., RN, FAAN (President, American... Read More

  1. by   JillR

    Good points. The ADN is more lucrative. I am all for continuing my education, and am willing to spend the money to do so, but I do not want to add another $20,000 on to my current student loans without equal compensation, and equal it is not, at least in my area. There is one hospital that I know of that is REALLY committd to their RN's continuing thier education and that is the UW in Madison. The others are pretty much a joke. Unfortunately the UW is too far for me to drive to work there as the pay is not much more than I make now. I may consider it in the future.

    If there were a program here that were both reasonably close and affordable, I would jump on it, but I have not found one that did not request you to take a bunch of liberal arts classes to augment their profits (as I see it). I do not need to spend $300 a credit to appreciate Mozart and Bach or Monet and Picasso, I already do that. I already understand not to take a study that looked at 20 white males between the ages of 25 and 35 years old too seriously because it is too small and does not represent a reasonable population. I know I have a ton more to learn, but please give me credit for what I already know, because there is nothing more frustration than spending money for a class because the powers that be assume that all ADN nurses are starting at the same knowledge base, and we are not.

    I know there is no perfect answer and that whatever is ultimately decided will not be perfect, but we need to start somewhere and work from there. I do believe that there needs to be some revisions, because what we have now is confusing and is not working.

    I also believe that respect does not come from the degree but from what we, as nurses, expect and will demand. I believe that we are treated disrespectfully because many have the idea that this is okay, that it is just part of our jobs. We need to quit accepting this. Respect will come when we demand it from each other, administration, doctors and the public, but it MUST start with each other.

    Respect each other we don't, just look at all of the LPN/ADN/Diploma/BSN ect debates on this board. All fo this my degree is better than your degree bull keeps us from the REAL problems in nursing and by continuing the debate, we are playing into the hands of administartors all over the country.

    As long as we spend so much energy arguing about who's degree is better, we are not focusing on REAL issues, such as patient care, safe staffing, mandatory OT and even continuing our educations. I mean who has the time or energy to do the important things when you spend all your time beating your heads against a brick wall and expending all your time and energy on non-issues.

    Insanity is doing the same thing over and over and each time expecting different results.
  2. by   lever5
    I have found animosity displayed towards my degree and certificaton. BSN/CCRN, I do not recieve respect for it. I no longer tell anyone about my level of education. I have always admired those that achieved greater education and have modeled my career after them. But, I believe there are those that do not have the desire, drive, will, or whatever to grow and belittle those that do. My degree does not make me better than a diploma nurse, not a better nurse, not a better person, not more knowledgeable. I just have it. Has anyone else felt this tension?
  3. by   yipididit
    I do not intend to piss anyone off here, but if I do......

    For so many years, RN's with diploma, ADN, and BSN have all worked towards the same goal and passed the same state boards. Why should anything change now??

    From my view, this has only created conflict within our own 'family'. Ever heard the phrase, 'if it's not broke, don't fix it'??

    So what if an ADN holds a position as Charge or Supervisor? Maybe he/she possesses qualities that are not found in another ADN, BSN, or Diploma nurse at that facility!! (such as exceptional managerial skills or organization skills or people skills)

    I worked as an Patient Care Tech for a wonderful ADN Unit Supervisor. Her logic, skills, and knowledge far outweighted others in this unit!

    Here is a little example maybe some can relate to. Remember when you were preg. with your first child? You were truly obsessed: reading baby books, learning your baby was 2 inches long at so many months, and picking out the PERFECT name? Well, some/most nurses have that same compassion for their degree wheither they hold a Diploma, ADN, or BSN!!!! They want to learn more and have the ultimate responsibility! I could honestly tell you, I would love to earn a BSN but at this time an
    ADN is all I can afford and manage. AND when I finish my ADN I may not be perfect, but I will still have the desire to learn and strive to further myself. In X years, I may be the greatest Charge (with ADN) you have ever seen. You may request to work odd hours with me because the working enviroment is so pleasant and you are fullfilled when you go home because you had time to REALLY TALK to your patients or everyone wasn't stressed because I have respect for you and you have respect for me!

    Could it be possible some are jealous or feel short-changed because they had to spend more time earning the same degree? Would you beat your mother or sister out of a position based on the fact you held a BSN and she held an ADN? It all comes down to WHO IS MORE SUITABLE for the position!!! How much did you know your first day as a nurse??????? How much do you know now? You dedicated actual time to learn your profession IN THE FIELD and learned alot, but you DID NOT LEARN ALL THAT in class while earning your BSN! I have read past BB's of how ADN's, BSN's are stressed wondering when they will feel like a nurse after taking that first job. We are all from the same pod and experience the same.

    Let's show love and compassion for others and be glad of their accomplishments, not take from them! Jealousy is the devils work.
  4. by   pama
    Excellent response. I agree!
  5. by   live4today
    I second that response, pama! Thanks for the eloquent message of truism that all nurses shoud take to heart, yippididit! We nurses of different educational levels created this chaos among us, and now -- I'm afraid -- we don't know where to begin to "repair the damage" that we set into motion some years back. This is the sad truth about our profession. The majority of nurses are women who successfully conduct their personal and family business with or without a degree, but get us all in a "work place setting", and our experience and knowledge already gained somehow is no longer "good enough" without us trampling on one another's choice of educational pursuits. If by passing the NCLEX exam fails to make a "nurse a nurse" regardless of whether she went to school 1 year, 2 years, 3 years, 4 years, or 5 years, then aren't we all barking up the wrong tree here with our "critical thinking points"??? Just something for us all to ponder, IMHO!!! How can we really solve this national crisis in our career field? Wouldn't it be to our advantage to agree to "get along" long enough for us to approach a common ground in order to establish a baseline for what is or isn't acceptable as an entrance level to nursing??? All this "war" about whose degree is better is really getting us no where, don't you think??? What should designate the road to fulfillment in nursing, and who should be the author of that designation and see to it that it goes into practice so all this bickering can come to an end??? Just more questions to ponder....

    "If we are always arguing the same old argument, then how will we ever advance to a solution???" -- by "Me"
    Last edit by live4today on Mar 6, '02
  6. by   live4today
    P.S. BTW, if the NCLEX exam is going to stay in effect as the only "proving ground" for a graduate becoming a licensed nurse, then the argument is not about what degree one holds, but how successful each graduate is in meeting the national board requirements in order to receive national licensure as a registered nurse, wouldn't you think???

    An LPN goes to school for "set number of time", sits for state boards, passes and receives licensed to practice as a LPN.

    A RN goes to school for "set number of time", sits for state boards, passes and receives license to practice as a RN.

    Now, after the LPN and RN graduate and successfully earn their license to practice as nurses, if they choose to further their education for career advancement, then and only then should more training, certification, etc. be a "qualifier" in designating that person as a "whatever they earned the extra training for".

    It has ALWAYS been an individual's preference in which nursing education they wish to pursue in order to sit for the SAME state boards. Nurses, you and I know this fact BEFORE ever selecting our choice of degrees. We all are aware that whether we go to a Diploma, ADN, or BSN program of study, that once we all graduate, we will not be "separated" at state boards to sit for "separate exams" just to obtain a license to practice as a registered nurse. The NCLEX exam only licenses each nursing graduate -- regardless of number of years spent in college -- to practice in a registered capacity as a licensed nurse. That exam does not imply that one's degree of study is greater or less than the other. That is not the purpose of the NCLEX exam!

    It's nothing the states are doing that is hindering us from being on "common ground" with one another. We, women (mostly) have created this mess and now we are reaping what we sowed years ago. Now, the question is: Do we set the ADN level for being all that is needed to practice as nurses like the LPN program is so designed to have one level of education in order to sit for their state boards???? Or, do we keep fighting over what degree should take preference???

    Perhaps if we just went to college and graduated from a two year nursing program, sat for boards, received our nursing license, and call it a day, we would all start to feel better about having the same level of education fit for the job.

    Quite frankly, if the two year programs are set up to be consistent nationwide like the LPN and the PA and Med school studies are, we would never have to be fighting over all these degrees, now would we??? Wouldn't you like to take your money spent for extra years in school to pass the same state board and spend it elsewhere in your life? I would! Why are we making this more confusing than it really needs to be? (((HUGS)))
    Last edit by live4today on Mar 6, '02
  7. by   Nebby Nurse
    "Lets not rock the boat. Why can't we all get along and not argue about which degree is better?" The issue is not about us, it's about the future of nursing education and the fact that the BSN is not a viable career choice for high school grads today. Why go to college for four years when you can make the same money and have the same responsibilities in less time for less money. There is currently NO incentive for a young person to enter a four year program. How many other businesses can the employer pay college grads and diploma grads the same salary and offer the same opportunities? Only in nursing! It is disheartening that nurses and future nurses are not only discouraged from pursing nursing education by employers who place no value on education, but by their fellow nurses who don't see it either.
  8. by   MollyJ
    Nebby Nurse--
    "The issue is not about us, it's about the future of nursing education and the fact that the BSN is not a viable career choice for high school grads today. "

    And I disagree that the chaos has been created by disagreeing nurses; it was created by a chaotic system of nursing education!

    Also, the state board, by design tests the common body of registered nursing knowledge and does not test the body of knowledge exclusive to BSN preparation.

    The triple level of preparation is a festering sore that needs debridement.

    The real challenges lie in defining in what is uniquely "nursing" and how many levels of nursing do we really need.
  9. by   hummingbird1
    I agree with Nebby nurse about not rocking the boat. Given the current state of the nursing shortage, I think there is more power to the ADN grad who can pass boards and practice in a more timely manner. As an "old" Diploma grad I firmly believe in the hands on training that is provided by the ADN programs. The BSN grads do not have the hands on clinical experience to make the transition from school to the work force. I think there should be coodos to the ADN program for educating the students in 2 years and if the student chooses a 4 year school then that is their choice.
    I am in a RN-BSN program and so far not much of what I have learned could help me with the next step towards a management position. I am afraid that the new grads at the 4 year level also do not receive what it really takes to run a med/surg floor just by having a bsn.

    I find it interesting that other professions do not "wear" their degrees on a name tag.

    For me, I would love to see the diploma schools make a comeback... just a thought...
  10. by   betts
    I agree with the comment that BSN programs address broader research and leadership skills. I do, however, disagree that problem-solving skills within the ADN programs are not addressed. The NCLEX for nursing inherently incorporates problem-solving skills. In passing the licensing exam, you are therefore acknowledged as having those skills.
    It is not lowering the standards of the profession to have ADN and diploma-prepared nurses enter our profession to engage in client, patient, and resident care. We've had diploma and ADN nurses functioning in patient care areas for many years. The nursing profession has for a long-time been attempting to change these requirements for practice.
    Client,patient, and resident care is truly the focus of the shortage. How can we entice more nurses to our profession? Instead of trying to push these programs out and contribute to the nursing shortage program, perhaps we should look in another direction.
    Already we have in our profession advanced certifications for various specialities. Perhaps in order to satisfy the differentiation of practice based on education, we should initiate advanced certification with BSN qualifications (or whatever qualifications are deemed appropriate), for the leaders and researchers in the nursing profession.
    This wouldn't dissuade new nurses from entering the field due to time and financial constraints, which is the case with BSN programs. And, if the education issue is finally put to rest, it may entice more people to enter the nursing profession as caregivers.
    Before anyone can categorically state that BSN programs prepare nurses more thoroughly than ADN or Diploma programs, they had better do very thorough research.
    Any healthcare facility that wants to stay ahead in the recruitment/retention war of nursing staff must create and maintain programs that are appealing to the student nurse, as well as the new GN.
    Two programs do just that - the Professional Nurse Assistant (PNA) Program and the new Internship Program. And, they must be reinvented and revamped. All to often, the expectations of students and their assigned nursing unit were often inconsistent.
    Duke University Hospital has evaluated it's programs and is marketing and incorporating tools for nursing programs that all hospitals should incorporate. All to often internship programs come and go with nursing shortages. When times are tough, they are budgeted for, but when times improve, they are one of the first programs to go.
    As to higher institutions of learning, they need to reassess the relevance of the GRE since this exam shows little relevance to the field of nursing.
    For more on the subject of the GRE go too:

    For more info on Duke U Hospital PNA Programs go too:
    Last edit by betts on Mar 8, '02
  11. by   Mijourney
    Hi. You're right. Although a worthy topic of concern, we don't have to debate and discuss the levels of education and degrees. Right now, employers, community colleges, the AHA, the AMA, and the media are in the driver's seat so the buck stops there. Even if there weren't a nursing shortage, these entities would not support a change from the status quo for RNs. So, while we continue to debate and discuss this issue, the case in reality is closed.
  12. by   RoaminHankRN
    I think there are more of us than them... there is power in numbers if we are united.