Nursing Education Must Change - page 2

An opinion piece written by June M. Harrington (retired nurse), and appears in the Providence Journal.... Read More

  1. by   Conqueror+
    Quote from Lillian2515
    Nurses are being replaced by medical assistants, LPNs, LVNs, and techs. While critical thinking is being practiced, most of the time it's not really necessary. Nursing, realistically, is still task oriented and charting. The nurses that I've had the priviledge to shadow are not using critical thinking. What is critical thinking anyhow? The ability to know that when you're patient has a SaO2 of 50% is in trouble? That's not critical thinking in my book.

    Without more clinical time the nursing "programs" are wasting time, energy and money.

    How are nurses being replaced with nurses ? A Licensed Practical Nurse is a nurse. The nursing skills you mention earlier in your post are quite familiar to LPNs/LVNs when their program is completed. I believe that standardized nursing education is needed but we also need to understand than LPN's/Diploma/ASN/BSN/MSN/NP/DNP's all bring something to the nursing table. We must respect each other before we can demand it from the outside.
  2. by   Lillian2515
    Yes they all do something for patient care and each aspect is very important.....none more important than the other.....but....sorry.....LPNs are not nurses. They do not hold a degree....just a certificate.....they cannot administer drugs without supervision or do any procedures without supervision...although I am well aware that many LPNs are doing things unsupervised....however, it's not in the patient's best interest since LPNs have nothing as detailed as a fully degreed nurse. Don't mean to upset or insult anyone, it's just the reality of the situation. LPNs are not nurses. They are techs with a more extensive certificate.
  3. by   Conqueror+
    Quote from Lillian2515
    Yes they all do something for patient care and each aspect is very important.....none more important than the other.....but....sorry.....LPNs are not nurses. They do not hold a degree....just a certificate.....they cannot administer drugs without supervision or do any procedures without supervision...although I am well aware that many LPNs are doing things unsupervised....however, it's not in the patient's best interest since LPNs have nothing as detailed as a fully degreed nurse. Don't mean to upset or insult anyone, it's just the reality of the situation. LPNs are not nurses. They are techs with a more extensive certificate.
    Diploma nurses don't hold a degree so they are not nurses either I guess ? I am not sure what state you live in but I have not been supervised in 16 years. Unless you are counting the shift supervisor in charge of every nurse on the floor including the RN's. A competent nurse is always in the patient's best interest. I am not insulted because you are obviously speaking from personal opinion with no real knowledge of Practical Nursing curriculum. Having completed my RN education recently I can make a valid comparison and I was indeed a nurse for the past 16 years.
  4. by   GilaRRT
    Quote from Lillian2515
    Yes they all do something for patient care and each aspect is very important.....none more important than the other.....but....sorry.....LPNs are not nurses. They do not hold a degree....just a certificate.....they cannot administer drugs without supervision or do any procedures without supervision...although I am well aware that many LPNs are doing things unsupervised....however, it's not in the patient's best interest since LPNs have nothing as detailed as a fully degreed nurse. Don't mean to upset or insult anyone, it's just the reality of the situation. LPNs are not nurses. They are techs with a more extensive certificate.
    Then why are they called "nurses?" If nursing is so task oriented and charting oriented without any critical thinking as you say, why not just hire a monkey that can read and tell it to do whatever this or that page of orders says?
  5. by   elkpark
    Quote from Lillian2515
    Yes they all do something for patient care and each aspect is very important.....none more important than the other.....but....sorry.....LPNs are not nurses. They do not hold a degree....just a certificate.....they cannot administer drugs without supervision or do any procedures without supervision...although I am well aware that many LPNs are doing things unsupervised....however, it's not in the patient's best interest since LPNs have nothing as detailed as a fully degreed nurse. Don't mean to upset or insult anyone, it's just the reality of the situation. LPNs are not nurses. They are techs with a more extensive certificate.
    Gee, you'd better explain that to all the BONs that license them as practical or vocational nurses ...

    And I've known plenty of LPNs I would trust with my life before some of the RNs I've known.

    (BTW, I was a diploma grad for many years, and "did not hold a degree, just a" diploma -- does that mean I wasn't a "nurse" before I returned to school? I assure you that the BSN completion program I completed (solely in order to be able to attend graduate school) taught me nothing about being a professional RN that I hadn't been taught better in my diploma program, with the single exception of the public health nursing course -- my diploma program didn't have any public health content. And I could (and still can) "nurse" circles around most of the BSN-prepared RNs I've known.)
  6. by   Lillian2515
    Some of you have missed the point. Don't diploma nurses pass the NCLEX-RN? Don't LPNs have a NCLEX-PN? Don't you have to have completed a certain number of hours to learn ....say....IV med administration....IVPB......anyhow, I'm not disputing a person's experience which is definitely worth more than any academia program I've ever seen....but.....ANA has very strict rules about what an LPN cannot do, although, as I said before I know a lot of them are doing nursing tasks that they are not legally supposed to do....also....let me ask you...if there is a medication error, who loses their license? Does the LPN take responsibility or the RN that gave the LPN the medication to administer....since LPNs are not legally allowed to administer meds unsupervised?
  7. by   elkpark
    Quote from Lillian2515
    Some of you have missed the point. Don't diploma nurses pass the NCLEX-RN? Don't LPNs have a NCLEX-PN? Don't you have to have completed a certain number of hours to learn ....say....IV med administration....IVPB......anyhow, I'm not disputing a person's experience which is definitely worth more than any academia program I've ever seen....but.....ANA has very strict rules about what an LPN cannot do, although, as I said before I know a lot of them are doing nursing tasks that they are not legally supposed to do....also....let me ask you...if there is a medication error, who loses their license? Does the LPN take responsibility or the RN that gave the LPN the medication to administer....since LPNs are not legally allowed to administer meds unsupervised?
    I guess I am missing your point ... Yes, LPNs pass the NCLEX-PN (practical nursing) in order to be licensed as practical nurses. And the ANA has no "rules" about LPNs at all -- the American Nurses Association is a professional organization (for RNs only, BTW -- a sore point for a lot of LPNs) with no regulatory authority at all; it makes a lot of recommendations about nursing practice, but none of them are legally binding. The state Boards of Nursing make rules about nursing practice (operationalizing the state Nurse Practice Act) within their respective states. In my state, LPNs are supervised by RNs but are legally responsible and accountable for their own actions, under their own licenses. It is the LPN who is in trouble for a medication error, not the RN in charge (except in the most peripheral sense). As a charge RN, I don't "give" LPNs medication to administer -- they do that entirely on their own (under my supervision).
  8. by   Lillian2515
    If they are under your supervision then they are not on their own. The point everyone is missing is that higher degreed nurses are being replaced by lesser degreed nurses or certified healthcare workers. Why would you bother to hire one ADN or BSN-RN for $25-$35/hr to take 3-4 patients when you can get two MAs or LPNs for the same $ but now taking care of 6-8 patients.

    This thread was originally about nursing school changes, not egos. I was saying that nursing students/healthcare workers need more time at the patient's bedside and less time writing research papers. I don't care what degree/certificate/diploma you have....without clinic time and hands on experience you can't possibly produce quality patient care. The extended academic courses that give you more initials after your name will be obsolete as the pressure to reduce health care costs rises. Academia doesn't mean squat at the pt. bedside.

    Conversely statistics show that mortality rates are increased by 31% if your NURSE has a BSN. How does that work out if your BSN doesn't give you enough clinic time to become competent?
  9. by   opensesame
    Quote from Lillian2515
    Conversely statistics show that mortality rates are increased by 31% if your NURSE has a BSN. How does that work out if your BSN doesn't give you enough clinic time to become competent?
    Really? This is not what I have heard. The AACN put out data a few years ago that indicates that hospitals with higher proportions of BSNs actually reduce overall mortality rates and failure to rescue events. I believe what the AACN was toting was a study out of the University of Pennsylvania.

    What study are you citing? I would love to read it.
  10. by   Lillian2515
    ooooops.....I meant mortality rates DECREASED by 31% with BSNs.
  11. by   AtomicWoman
    I am mainly w/elkpark on this. I think we should make the BSN the standard entry degree (I think elkpark and I might disagree on that point) and add a 6 month to 1-year hospital internship on the end of school. Yeah, I know, that idea is probably about as popular as bed bugs. But a lot of the objections that hospitals have to hiring and training new grads might be alleviated if new grads came to them with an extensive internship under their belt, where they had worked up to carrying a (supervised) full patient load before they got hired. It would also be a tremendous confidence-booster to the new grad. My profs who were diploma grads from way back told us how they hit the floor as new grads, ready to take on a full patient load and already being proficient at so many tasks that hospitals now have to teach new grads. Full disclosure: this is just my personal opinion, having recently graduated from a BSN program. The program was excellent at teaching us to think critically, like nurses, but not so good at teaching us to do nurse *tasks*. I really cannot blame hospitals for not wanting to teach us newbies in this lousy economy.
  12. by   TakeOne
    Quote from Lillian2515
    Academia doesn't mean squat at the pt. bedside.
    If that really is the case, we can limit the time and expense of physician training as well to one or two years of basic arts and sciences then throw them onto the floors to get their practical experience that way. I mean, that's how it used to be, right? Things weren't so bad then, were they! They did surgery without anesthesia, too, and some people lived through it so it must have been a good thing, right? We could even give surgery back to barbers to do!

    It's incredible how nurses who declare that nursing education must change and that nurses deserve more autonomy and respect will try to defend it with the antithesis and espouse that less book learning and more bedpan slinging is the path to that goal. Next we'll return to mandated residence in the student nurses' quarters and having only enough free time off the units to starch our white pinafores. No profession has ever advanced by refusing to move forward, but for whatever reason many nurses really do believe the past was infinitely better and that returning to the old ways is the key to success. Come on! No wonder we can't get anywhere.
  13. by   CuriousMe
    Quote from GilaRN
    What exactly is the problem with her model? This is almost an exact copy of a model that is currently used at a community college based paramedic programme where I am faculty. We "front load" the didactic experience over the first year, then the students spend a year doing hospital rotations and ambulance rotations while assigned to an experienced "preceptor." Then, during the last two weeks of the programme, we spend preparing the students for national registry.

    I seen nothing wrong with this as a nursing model assuming the students enter the programme with the appropriate pre-requisite classes. In this case, you are still looking at a three year course of study prior to entry into practice.

    Reading through this thread, I gather people are actually defending current models where nursing students may do a day a week and graduate with less than 700 hours of total clinical experience?
    But today's existing model also includes my BS program, where I'll graduate with between 1,300 and 1,400 clinical hours without sacrificing the theoretical aspect of my education.

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