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:

I just got back from my American History class, and I was thinking a lot about the piano comment.

I have a very strong background in Music. I have taken courses in african, jazz, classical, and wind, as well as competition on the district, and state levels on a variety of instruments. Actually, this DID help my nursing technique!

When I percuss or ascultate a patient, to hear what structures are laying beneath the skin, the sounds are varied. Resonant, tympanic, flat, sharp, dull, brassy, and others. Each sound indicates a different underlying structure, or substance. If I would have never had a musical background, or had not received education in musical instrumentation theory, I wouldnt be as accurate in my patient assessments.

Also, I can be more present with my patients who may have carpal tunnel syndrome(7 years of piano), stripped off fingerpads (I played bass guitar in jazz), Lip and gum problems (I also play trumpet), shoulder aches (I ALSO play flute), and back problems (yes, I also played tuba, which is huge and heavy, as well as tri-toms, orchestra bells). You are probably asking be now, what is my point. Well here it is...

No matter whether a class I have taken as a separate nursing component, of is based solely on liberal arts and sciences principles, ANYTHING i have learned can be applied to my nursing practice in one aspect or another.

Architecture 101? You bet that can be applied. You have a patient come in who has been hit with an I-beam. What would that mean to a nurse who had no idea what an I-Beam was?

All the literature classes I have taken? You bet, those can be applied as well. By reading literature, I have learned about many different cultures, practices, and health beliefs.

Exploring Religions class? Again, yes, it can be applied! What is acceptable interventions within a cultures religious beliefs.

You see, you might argue that none of these have anything to do with nursing. But that is just not true. Every bit of knowledge and education that we have is fair game for use on assessments, interventions, and life process. These ALL add to my ability as a nurse. If you choose to look at them as if they have no value, that is fine, and I cant make you see them differently... however in the multi-faceted world of client care, education is the more the better. Less is not more.

BrandyBSN

OK, now this is getting way over board here. Now we have people saying that any of these non nursing focused classes makes a person a better nurse. Evidently, assessment and other nursing skills can be improved by taking "Astronomy 101, Music Appreciation 101, or knitting 101, etc..

No one seems to get the reality that these classes bring colleges big money when they are listed as requirements for graduation. That every college in one form or another offer these types of classes. Have you ever tried to move to a different college and had to retake their electives because they would only accept a certain amount of transfer credits? Do you not understand how much of this is based solely on generating revenue from students?

Now for argument sake how about the second career adult entering nursing. The life experiences they have accumulated many time amounts to far more than can be learned from any text. A teenager entering college is much different than someone who has actually lived and experienced life first hand.

If a BSN was based solely on more direct nursing education, then I do not believe there would be any disagreement to it. Each individual college is different as to what is required to achieve a BSN and this should not be the case. In fact, this opens up another can of worms. Who's BSN is better? If we are going to go to a strictly BSN requirement to enter nursing, then we also have to standardize all of them to make sure they are equal in nature.

Here is another fact to discuss. Every nurse who has passed the N-CLEX can practice as a nurse, but everyone who has earned a BSN cannot practice as a nurse. Yes BSN, AND, and diploma nurses all fail the N-CLEX. Does the N-CLEX have questions about ancient roman architecture, astronomy, or music appreciation? The version I took did not.

Personally I would like to see a 2 tier system. An entry level N-CLEX and then an advance N-CLEX that would be geared for higher education related to nurse focused education that should be obtained with a BSN. This would allow not only BSN graduates to achieve a higher status, but also all the older nurses who have accumulated the knowledge needed to pass over the years. Many nurses have accumulated a great deal of knowledge on their own through many sources including experience.

All education is a wonderful thing. I am going to further mine w/a BSN bridge this coming summer or fall. Maybe I will even go further in my education after I earn my BSN....my options are open at this point.

Just keep in mind, my friends, that there is presently a nursing shortage.... now and for 20+ years, or more, to come.(as were the stats in my trends class last spring) If it hadn't been for the lower cost and shorter time span of the ADN program, I may never have become an RN to begin with. This applies to many other hard working RNs towing the line w/their ADN degree. You may be depleting the hiring pool of RNs if you make the BSN entry level into nursing. Remember, the baby boomers haven't all retired yet!!!! YIKES...so many more to go......!

Professionalism and respect may not matter if hospitals decide to train UAPs to perform more tasks to make up for a lack of RNs in the workforce. I think the profession is between a rock and a hard place on this issue.:o

Brandy, about music, I played the viola for four years during jr high and high school.:)

CareerRN: Who on earth wants to take the NCLEX more than once...for goodness sakes!!??? The stress the 1st time is enough to send anyone to the nut house....

Is 2nd tier NCLEX testing going to accomodate for those RNs that have been working in a specialty field?? We all acquire a different knowledge base and skills in our specialties that you can not evaluate w/a standardized test. (I think its called specialty certification)

Specializes in LTC, MDS/careplans, Unit Manager.

I have a question.....what about the LPN's in all of this. What would happen to them. I am not at all trying to be sarcastic. I realize that I am "just an LPN" and do NOT have the education of most of you. I have, however been a nurse since 1993 and have gained some valuable experience in certain areas of the field. If RN's were required to have a BSN, would we eliminate the CNA's and replace them with LPN's?? I think experience has to account for something. I am NOT trying to gain sympathy fro being an LPN. This just happens to be the route I chose and I am comfortable with who I am. I do intend to further my education when time, money, and family obligations permit...but for now I am an LPN. I was just curious what you felt our role would be if the overall field of nursing were to shift.

Shari

OneChattyNurse..... BE PROUD OF WHAT YOU DO!! My mom is a Physical Therapist and Massage Therapist. She is presently finishing up her LPN training and will be graduating in December!!! I'm so proud of her.....she's semi-retired and getting almost straight As in her LPN program.

LPNs are awesome and have a big knowledge base. I was amazed at how much my mom has to learn and get tested over. You are important and needed in healthcare...I truely believe that. You'll be needed more so if the BSN is the entry level for the RN nursing profession. Why??? 'cause there will be fewer RNs to go around.....AND THEY'RE GONNA NEED SOME HELP - BIG TIME!:eek:

Specializes in LTC, MDS/careplans, Unit Manager.

KC CHICK.....I knew this would happen...REALLY.....I am not having an inferiorty complex. I just wondered, out of curiosity, what requiring RN's to be BSN's would do to the role of the LPN, if anything. I truely do not have a problem with who I am. Like I said...this is the route I chose. I never intended to begin a RN/LPN debate...I was just asking a question!!! It is sometimes difficult to "read" someone's tone or intent into a bulletin board message. I was just looking for everyone's input...not an ego boost!!!

Shari

Whatever, lady. I was just trying to help and offer some positive feedback. Can't you take a compliment?? Geez!!:rolleyes:

After all, you are the one that said you were 'just an LPN'. :confused: You got my opinion on the subject you were inquiring about....you can IGNORE any ego boost that you read as you see fit.

Specializes in LTC, MDS/careplans, Unit Manager.

KC CHICK....PLEASE...I sincerely did not mean to offend you or anything. I did not mean that I felt I was just an LPN...I consider myself a nusre regardless of my title...BSN, RN, LPN...whatever. Maybe I chose my words incorrectly, but as I said it is sometimes to "read" tone or intent. Again, I am sorry that I offended you...that certainly was NOT my intent. I will bow out of this conversation (not exactly gracefully) By the way, I did appreciate your comments about LPN's...I just did not want you to think I was fishing for them!!!

Shari

Hi all. I know this may set some of you off, but after reading topics on the education issue, I've decided that maybe nursing should look at establishing the master's level as entry level into nursing. I know that many universities do not require graduates from master's level programs to be licensed and registered, but maybe it's time that criteria for many master's programs be reevaluated. At this point, it's very easy to distinguish an RN with a master's degree in terms of education and average pay from all the other levels of nurses. To my knowledge, there are two different types of master's prepared nurses-clinical nurse specialists and nurse practitioners.

When it comes to education, there will always be points of contention between LPNs and diploma, AD, and BS RNs. I wouldn't be surprised if there are turf and education concerns between the nurse practictioners (NPs) and clinical nurse specialists (CNS), but I think that the points of contention between these two groups are not as nearly as big as between the LPNs and the various RN levels. In addition, I feel that establishing the master's level as entry level will give the nursing professional more political clout when it comes to determining our professions destiny.

Right now, NPs are being pushed back by the AMA on increased prescription priviledges and some other areas for increased autonomy. I saw another topic on the nurse reinvestment act. We should encourage more support from private industry, the public and our Congress for nurses to reach the master's level.

.......and how many new nurses do you think that would produce annualy???? Just curious.

Why not a second more intense N-CLEX exam that would test the knowledge base equivalent to a BSN nursing focused curriculum? This would allow those with BSNs to prove their superior knowledge base and would also allow those without a BSN the opportunity to prove that they are as knowledgeable. It would also allow for a clear dividing line for many other things such as greater compensation, advancement, and set a truly standardized qualification requirement for some positions. In other words, if a BSN, AND, or diploma RN decides to take the advanced N-CLEX and passes, then will they not have accumulated the same nursing focused knowledge base?

A specialty certification is a certification in a specialty. That is all. I have a specialty certification and it is specific to my specialty. The test was focus on my specialty. It was not an overall nursing knowledge exam. I do believe that there should be compensation for achievement as well as other rewards, but in many cases there are none. I have worked along side of other nurses without certifications who were being paid the same as me, and in the big scheme of things, I was seen as no different from them.

As for LPNs why should they be treated any different. They should be allowed to take the RN N-CLEX if they so choose. If they are able to pass it then they have proven they have the knowledge base to be a RN. The only thing that I can see is maybe a small requirement of one year or so many hours of employment in order to sit for the RN exam.

Actually, I REALLY LIKE many of the ideas posted here! two different NCLEX tests really would solve a lot of the bickering. If MSNs were the minimum, that would be ok with me, although a much higher salary base would be needed to pay off my loans :) But I would have to agree with KC Chick, we would have an increased shortage for a few more years. Call one set, either ADN or BSN nurses something else. Like ADN would be Registered nurse, and BSN would be Baccalaurete Nurse. Give each their own test, and their own salary base. Don't lump them together, and ENCOURAGE education! It seems that nursing is one of the few fields that discourages continuation of a formal education by not giving students an incentive to go on the second two years.

I love debate, but I hate letting things get personal. CareerRN, I did not mean that taking all of those courses makes me a better nurse than an ADN, i meant that taking those courses, In my opinion, makes ME and better nurse than I would be been without them, as it gives me a much wider scope of knowledge that I would not have had otherwise. I did it to better MYSELF, not to be better than someone else, so if I stepped out your toes, im sorry.

As for LPNs. I think that there will ALWAYS be a place for LPN practice, not not just as a replacement for CNAs. Some hospitals are phasing them out, but many of the outreach centers here are having a very hard time FINDING LPNS! They are really in need here, and the clinics are being shut down because their budget simply will not allow them to pay RN salary. I dont think that LPNs are utilized nearly as much as they could be.

It is very difficult to stay objective in debates like this :) I am 100% for continuing education, but I would never claim that classroom education outweights years of experience. I can read about things until I am blue in the face, but its DOING it that really sinks it in. These ideas and recommendations are not meant to apply to those already in the work force. They are only ideas of ways to distinguish new grads, and those with no real OTJ experience.

What would be so bad with having separate tests for the different degrees? It sure would clear up a lot of the hard feelings and bitter attitudes. We wouldnt be comparing apples to oranges anymore, and there would be a distiguishing title of each. Just my ideas.

As always Anne, although we dont always agree, I like your style.

BrandyBSN

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