Perpetuating contentions between kinds of nurses

[jjjoy, LPN]

From what I hear, it seems that many nursing program explicitly and implicitly teach different interpretations of the different kinds of nurses, worsening contentions between nurses.

For example, RNs may be taught that LPNs have a very limited scope of practice and limited education on physio, pathophys, etc, that RNs need to closely supervise the LPNs they are working with, and that LPNs weren't trained in critical thinking or the "whys" of nursing care. LPNs, on the other hands, may be taught that their role is almost identical to RNs, that their training is almost identical, and that they shouldn't let RNs dictate their practice. So when these two types of nurses start working together, they quickly step on each other's toes. RNs

BSNs may be taught that a BSN education is ADN education *plus* research, professional issues, and other mind-broadening bachelors' content, and that it's their responsibility to bring these other angles and broader views to their colleagues who may not have been exposed to these issues in depth. ADNs may be taught that academically the only difference between the programs is that BSNs take management classes, that meanwhile BSN programs don't prepare their students for clinical work. Again, when these two type of nurses start working together, misuderstandings and assumptions can easily cause problems.

It seems like those with less training/coursework requirements perpetuate the "we're just as good as them, if not better" ideas while those with more training/coursework requirements perpetuate the "our education should be the minimum requirement for (fill-in-the-blank) work." Such feelings and opinions are understandable, and different groups will always disagree, but the fact that many nursing programs actually perpetuate such strains between groups doesn't help.

The reality, however, is less than clear cut. LPN roles vary so much from facility to facility and state to state, that it can be unclear what the professional differences are between the two roles. ADN and BSN programs also vary a lot in content so that one can't make consistent comparisons between the two different types of programs.

So it seems that students are also taught in the politics of protecting and expanding one's professional turf (as LPNs, ADN-RNs, BSN-RNs), as opposed to clearly defining the legal and practical (day-to-day) definitions of one's professional practice.

Just some thoughts... :typing

[Flames9_RN, BSN, RN, EMT-B]

In my opinion its not the degree or title(RN, LPN, etc) the makes a good nurse,its the person itself. A person can have all the fancy titles, degrees they want, and still be a crummy nurse. I respect people on their abilities, not their schooling or title.

[Altra, BSN, RN]

:typing Excellent post, jjjoy.

[pagandeva2000, LPN]

What is distressing about all of this is that there is always one nurse that thinks she/he is better, more entitled or more knowledgable and needed than the other.

It is so true, the LPN scope of practice is as varied as there are people, and it does get confusing. There are vocational school graduate LPNs, community college graduates that earn a certificate, and I am just hearing a few weeks ago here on allnurses that there are even a few associate degree LPN programs here in the US. And, of course, we don't really have to get into the associate degree vs. diploma versus BSN nurse battle cry...

The way I define myself is that I am a valuable member of the health care team, and that is it...there is no reason for me to say that I am 'just as good as, my educational level is the best because it is hands on, etc...' I can't say whether or not the nursing schools perpetuate this (because I wasn't exposed to that, per se), but that nurses themselves continue to drag out this problem-nurses on all levels.

I believe there is a place for everyone on the food chain in nursing, and a person should utimately do what is most comfortable for them. If obtaining your BSN/MSN will make you feel more complete, then, do so. Just the other day, I had a conversation with an RN who said to me that she feels I should return to school to become an RN "...because it is just one more year, and you would be able to contribute so much to the community. You have just what it takes and you shouldn't do it for yourself, but for the community that needs you". I had to snap my head back at that one and respond that I personally refuse to go back to school for something I don't want and am not comfortable with for anyone else; also, I feel it would not be beneficial to myself or the patient to take on a role I clearly stated I have no interest in pursuing because the outcome would show poorly. And, I KNOW that each time I come to work and care for the patients, teach them in a manner they comprehend, that I am already contributing to the community and feel complete because I am comfortable in this role. I am not going to return to school to compete with the scholastic Joneses, or impress anyone.

Hey, I am not emotionally take on the debate on who is best. I am interested in the threads that come about on this because I like to know how people think/perceive these trends in nursing, but, nothing they can say that will make me feel 'less than, below, or not worth' what I do.

Great subject, jjjoy!

[llg, PhD, RN]

Good post, jjjoy.

However ... I believe that it is the lack of clear distinctions that is the underlying problem with all the different types of educational programs. As a profession and as a society, we would be better off if the distinctions were clear and people could associate the qualifications/credentials of an individual nurse with a defined set of skills and knowledge. To have "the lines" all blurred and fuzzy creates confusion, doubt, and dis-harmony that is not good for nursing or for society in general.

I believe that as a predominantly women's profession, nursing has failed to clarify its the knowledge and skills required for the various nursing roles because "nobody wanted to hurt anybody's feelings." In the process, we have created a mess of confusion that needs to be cleaned up.

[leslie :-D]

jj, what a wonderful post!!

begrudgingly, i will admit to some of those stereotypes.

when i went to nsg school, it was drilled into my head, "you are a baptist nurse", which was a very elite, sought-after diploma program.

when we graduated, we were expected to hit the floors running, and that's exactly what we did.

of course there were blips and the need to orient to the where, how, what.

but from the feedback of other baptist grads, we were confident.

by the time we graduated, we were expected to handle 4 pt assignments in med-surg, with no one following us.

and yes, i have wondered about the differences in lpn/rn, and adn/bsn.

yet when it comes down to the nitty gritty, the ideal nurse will have extensive clinical exposure and indeed, know how to critically think.

if they can do that, the letters that follow mean nothing to me.

again, thank you for this thread.

hopefully it will enable us to discuss more of our commonalities than our differences.

leslie

[nursecass]

This is a great post!

I have seen this same thing. I went to school to get my BSN, but worked as a tech all through school with others getting their BSN and ADN-and it wasn't the education that separated us-it was the attitude. And now that I work as a nurse on a floor with both ADN's and BSN's I find the same to be true. Some nurses are awesome, some should just retire or recareer, but neither group is based on what education they have. It just depends on their attitude and love of nursing in general.

One of the interesting things that I have noticed though is that on our unit when people go back and get their BSN they put it on their name tags "Jane D, RN, BSN", but those of us who have our BSN out of school are sort of frowned upon for putting it on there. (I don't have it, but one of the other new grads did and got hassled from some of the older ADN's about having the BSN label right there and went and changed her badge because of it) It just seems very odd, and while I understand being proud of an accomplishment (going back and getting the BSN), I'm not sure why it's ok for those people to advertise it and not those that just got the BSN to start with (which was also an accomplishment). Just more food for thought I guess.

[pagandeva2000, LPN]

Good post, jjjoy.

However ... I believe that it is the lack of clear distinctions that is the underlying problem with all the different types of educational programs. As a profession and as a society, we would be better off if the distinctions were clear and people could associate the qualifications/credentials of an individual nurse with a defined set of skills and knowledge. To have "the lines" all blurred and fuzzy creates confusion, doubt, and dis-harmony that is not good for nursing or for society in general.

I believe that as a predominantly women's profession, nursing has failed to clarify its the knowledge and skills required for the various nursing roles because "nobody wanted to hurt anybody's feelings." In the process, we have created a mess of confusion that needs to be cleaned up.

I do agree that there should be clearer distinctions. For example, I brought up at work a few weeks ago, that LPNs and RNs should wear different colors. I have no issues in the fact that we are both licensed nurses, however, the scope of practice is different, and it does annoy me when providers come and request something from me that I am not authorized to do because of my scope of practice.

I desire for nursing harmony...the bottom line is that at this moment, we all exist, most of us are trying to earn an honest buck instead of knocking a stranger upside their heads for their purses and most of us do care about positive outcomes in patient care within our scopes of practice.

What I would like to know is what can we do to unite regardless of our educational prudentials. What affects one group of nurses trickles down to the rest of us, so, there is no reason why we can't present a united front, for once.

[DaretoDreamRN]

"One of the interesting things that I have noticed though is that on our unit when people go back and get their BSN they put it on their name tags "Jane D, RN, BSN", but those of us who have our BSN out of school are sort of frowned upon for putting it on there. (I don't have it, but one of the other new grads did and got hassled from some of the older ADN's about having the BSN label right there and went and changed her badge because of it) It just seems very odd, and while I understand being proud of an accomplishment (going back and getting the BSN), I'm not sure why it's ok for those people to advertise it and not those that just got the BSN to start with (which was also an accomplishment). Just more food for thought I guess."

That is just amazing to me that other people will have a problem with you displaying that you have a Bachelors degree. there are nurses on my floor that graduated with a BSN and they choose to display it while others dont really care. I went back to school to get my BSN and it was an accomplishment FOR ME,so i chose not to change my badge. When i got my BSn , i didnt see any flashing light that stated " Now you are a great nurse, and u are better than an ADN nurse" and i didnt think that will happen" .Im still a nurse and i dont get paid a dime more ( at my hospital) compared to those with an ADN. If I think its awful to think that somone will kinda harass me because i went to a traditional four yr college, got my BSN and displayed it on my tag. If someone told me that ill nicely tell you that "if you have a probelm with it, then avoid looking at my badge":saint:!!!

I think as nurses (LPN, ADN , or BSN), we need to realize that we are all NURSES to our pts not " My nurse with a BSN or ADN or an LPN". The pts could care less. They need to know that you are competent to take care of them, and we need to work on that. If people choose to stay as LPN's, RN's with an associates degree or Rn's with BSN. Its okay. Its a personal choice, not a forced choice. There are so many positions out there for "nurses" in general.

[jjjoy, LPN]

"I think as nurses (LPN, ADN , or BSN), we need to realize that we are all NURSES to our pts not " My nurse with a BSN or ADN or an LPN". The pts could care less. They need to know that you are competent to take care of them

I agree that what's important is that nurses are competent. But, of course, the question of educational requirments is a different issue than competency. A person could easily be competent in any of number of different professional specialities without any formal education. However, most societies eventually formalize professional education such that to legally practice, one must have completed that training... regardless of one's practical competency.

For example, we all may know a tech or two who know as much as or more than the nurses or doctors in certain areas. But we also know that they cannot professionally fill the role of nurse or doctor because they don't have the proper training and licensure. So I don't see that it's quite as simple as "we are all nurses."

"Nurse" is a linguistic title and is subject to change in usage. Back when, the powers that be might have decided to call LPNs "Licensed Nursing Technicians"... could they now argue "I'm a nurse, too!"? ... or some nurses back when might well have been called "Convalescing Nurses" to differentiate them from wet nurses and instead of RNs, we'd have RCNs.

I know many nurses get upset when Medical Assistants call themselves nurses. Clearly, they aren't licensed nurses, but many do have formal training and certification and the tasks they undertake often fall what is traditionally considered nursing care. If a MA is as competent as a licensed nurse, would you be upset if they called themself a nurse. What if instead of medical assistant., they were call "Unlicensed Medical Office Nurses"? Would you still say "we are all nurses" and all that matter is competency?

Just food for thought

[llg, PhD, RN]

What I would like to know is what can we do to unite regardless of our educational prudentials. What affects one group of nurses trickles down to the rest of us, so, there is no reason why we can't present a united front, for once.

What can we do? We can support efforts to clarify the different levels of education and promote consistency in the content and standards of each level. If we all stopped claiming to be alike and had clear distinctions ... then we could be honor/respect what each had to offer and unite behind a clear, consistent description of the nursing community.

[KarmaInMotion]

Let's not forget about doctors and/or institutions that push the lines of qualifications in order to cut costs. This can only lead to more confusion. The relative of mine that is an MA claims the doctor she works for refers to her as a nurse (she claims no one there knows what an MA is [qualification wise maybe I'm guessing?]) . She also says they have her do things she's not qualified to. By the way she explains it, I can't help but to wonder A) if she gets a kick out of being reffered to as and given the duties of a nurse as an MA. (she brings this up often and didn't seem as concerned about it, yet I felt uneasy for her about it) and B) Who doesn't know what an MA is with all the adverts for them everywhere now?

Anyway, if this sort of thing happens once, this can not be an isolated one time issue. So then apply this to many different settings and more different scopes of patient care. Stir in attitudes and personalities, press puree and we have a nice container of muck.... ARGH It's like an odd overlapping of qualifications, experiences and expectations. :doh: I think this is a great issue to discuss. But aside from trying to remain proffessional and work on solving the difficulty as we approach it personally, have no clue how to work on it on a broader spctrum.