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 think the people who care about what sheepskins one has, are the colleges and universities. Part of the reason is it is how they insure they have a market. If they require MSN to teach, then they know they will have some number of customers. If all that is required to teach is X years of nursing experience, they loose potential customers

I'm not knocking further education, but when it is done at the expense of qualification due to experience I become suspicious. We need merit/experience recognition certificates.

To practice as a Doctor of Medicine, you must work in a hospital. In this country you can become a Doctor of Nursing without ever actually working as a nurse. This is nuts!

My nephew is becoming a pilot. Before he can even register for various courses he has to have various amounts of flight time under various conditions. Thus a pilots license implies theoretical knowledge actually applied to storms, night landings, engine failures, etc.

Somewhere here I read a post about a NP program that requires a year of paid hospital nursing. I think something like this is the way to go.

The ignoring of nurses with years of experience by the educational system is an abomination.

I think In-depth knowledge obtained through experience is valid. Perhaps it is more valid than knowledge obtained solely academically. And I'm speaking as someone who really likes school.

When a BSN means X years of working experience in addtion to two more years of school, there might be a larger percived difference between the ADN and BSN. As it stands now it is truly an academic excerise.

In short, If my child is in the hospital and I'm given a choice between a new MSN grad without any experience, and a ADN with four years of experience, I'll take the ADN.

I've said it before. I'll say it again... There is no way to measure experience and expertise. I happen to have a BSN, but that's because it gives me more flexibility in the areas open to me. (The home/community agencies I've worked for only accept BSN's.) I also think the BSN makes me a better rounded individual and has taught me more than one way to think about things. I loved Brandee's statement that her music background helps her with auscultation and percussing. I can't tell you how long it took me to get those things down!

I think that nursing is an art as well as a science. We have to be able to synthisize the information we recieve and put the puzzle pieces together. The more experience we have in different areas, the better able we are to do that. Is my origional degree wasted? Nope! I'm bilingual, so can speak to our latino population in their native tongue and give better care. I function comfortably in different cultures because of my sociology back ground. I'm able to think through problems because of the logic and programming classes I took. These arent' directly nursing related, but they've helped me immeasurably!

Having said all that, I'd give my left arm for the 10+ years of experience in clinical areas that some of you have. One of the things I love most about this BB is when some one says "I ran into such and such a situation. What do you think?" I read the responses and think, "Oh! I didn't think of that! It makes sense in light of..." and I learn.

I think that we need the education to further ourselves as a profession and to make others value us more. Most of all, we need to quit bickering!

Originally posted by CIY629

WHO CARES about what type of "degree" a nurse holds. The only thing that matters is that we all remember that we are here for the benefit of our patients.

While I understand your point, the fact is that the public cares what type of degree a nurse holds. We all know that there are nurses of all levels of education that are the best at what they do, whether LPN, ADN, or BSN.

But --

My point in starting this thread was that education and credentials are very important in our society. Like it or not, nurses with BSNs are going to be looked upon as being more professional and competent as a whole. Now, you can rant and rave against this point of view all you want. You can rant and rave against how much our society values money and how we should all do things for others out of the goodness of our hearts ... but when your electricity gets turned off it won't do you any good. All the yelling about how "I'm a professional no matter what my degree" doesn't do you any good in a society that values education and credentials. If we want to start getting a voice in our future, if we want to be taken seriously as a group, and if we want to attract younger, newer nurses, we have to appear professional in the eyes of society. One step in that direction is the BSN.

Quite a few weeks back in another thread, someone posted a survey done by the ANA, or other such group. (I wish I could find it myself, but it's lost in the ether. If anyone can find it and post it, I would really appreciate it...) The survey showed that a large majority of the public felt that nurses should have a bachelor's degree at the very least -- many wanted nurses with a Master's. An interesting point, I think.

I ask another question: if it really doesn't matter what degree you have to be a nurse, why have them at all? Why not treat it as a technical trade? We could start off as Apprentice nurses, move our way up to Journeyman status and finish of as Master Nurses. That would make nursing even easier to get into than it is now with the Associate programs. Maybe this would attract more nurses.

Well I wasn't trying to sound harsh but my family members have had ADN, BSN, MSN, and NP nurses. My opinion is that while it may be true that BSN are more marketable than ADN does this necessarily mean that the BSN is the best choice. Ok so suppose they decide that a BSN is the minimum ed requirement for all nurses. Then we will certainly have a MAJOR shortage of nurses. I probably could have went to a university and enrolled in a BSN program which I would have like to do but I had family circumstances that would've made it impossible to stay away from home. Yes, I am glad that there are 2 year com. college nursing programs that will allow me to stay home and take care of sick relatives yet help me advance my career. I do know that in the past year of this program I have had to work my butt off I do not find it to be easy but I want to be a nurse and eventually when I am able financially after I graduate from the ADN program I will go back for my BSN. We all have to be realistic here college is not for everyone and that is that. We should stop and think about that. The medical profession could/might be missing out on some wonderful nurses all because they may lack the money or time to start off their education in a BSN program. :cool:

Originally posted by CIY629

We all have to be realistic here college is not for everyone and that is that. We should stop and think about that. The medical profession could/might be missing out on some wonderful nurses all because they may lack the money or time to start off their education in a BSN program. :cool:

Yet again, I think the point is being missed. What if we said that society was missing out on great physicians because "college isn't for everyone"? No, college isn't for everyone -- but maybe we should be worried about putting our lives in the hands of someone who didn't feel that college was for them.

A lot of talk seems to be centered around the fact that there is a nursing shortage. I ask ... if all of a sudden people could become RNs after six months of schooling, would that end the nursing shortage? Of course not. The fact that a four year degree might be required does not keep anyone out of nursing. It certainly doesn't keep people out of more prestigious and higher paying fields like computers and business. In fact, in those fields, more and more people are getting higher degrees.

What keeps people out of nursing is a lack of respect and a lack of adequate financial compensation. Respect comes from many sources, but a major part of gaining the respect we deserve is by stepping up to the plate and demanding that our nurses have the best d@mn education possible. In the eyes of society, that means having at least a Bachelor's degree. Once the degree issue is settled, we can start demanding higher compensation -- along the lines of other fields where a degree is required for entry.

No matter how we look at it, the nursing shortage isn't going to be solved immediately. At this point it could be decades. Making the requirements for entry easier aren't going to solve the problem.

[

What keeps people out of nursing is a lack of respect and a lack of adequate financial compensation. Respect comes from many sources, but a major part of gaining the respect we deserve is by stepping up to the plate and demanding that our nurses have the best d@mn education possible. In the eyes of society, that means having at least a Bachelor's degree. Once the degree issue is settled, we can start demanding higher compensation -- along the lines of other fields where a degree is required for entry.

No matter how we look at it, the nursing shortage isn't going to be solved immediately. At this point it could be decades. Making the requirements for entry easier aren't going to solve the problem. [/b]

I'm not feeling this lack of respect. Perhaps the problem is yours alone.

Changing the requirements will make the nursing shortage worst.

Not the way to go in my opinion.

Quite a few weeks back in another thread, someone posted a survey done by the ANA, or other such group. (I wish I could find it myself, but it's lost in the ether. If anyone can find it and post it, I would really appreciate it...) The survey showed that a large majority of the public felt that nurses should have a bachelor's degree at the very least -- many wanted nurses with a Master's. An interesting point, I think.

I ask another question: if it really doesn't matter what degree you have to be a nurse, why have them at all? Why not treat it as a technical trade? We could start off as Apprentice nurses, move our way up to Journeyman status and finish of as Master Nurses. That would make nursing even easier to get into than it is now with the Associate programs. Maybe this would attract more nurses. [/b]

I remember a previous thread mentioning one patient believe that most nurses had a four year degree. I didn't see a survey and I question if one even exist that reflects what you stated in the above paragraph.

Matt, what is so wrong with ADN nurses? They attend an intense program that prepares them to work in many areas of nursing.

Like all nurses, they gain more knowledge through their experience.

I am the person who posted the Harris poll results on another thread. Although I do not wish to personally debate this topic (I see both sides of the issue), I thought I would post it again since it was brought up.

Harris Poll reveals Americans fear effects of nursing shortage on quality of health care

Study also shows public trusts information provided by nurses as much as doctors

INDIANAPOLIS, IN - As a national nursing shortage builds, more than half of Americans believe the quality of health care is affected "a great deal" by a shortage of nurses, according to a new Harris Poll released today.

The nursing shortage is posing an increasing threat to the quality of care in hospitals and health organizations, and this poll reflects the general public's concern. Only four percent of respondents said the quality of health care that people in the country receive was not affected "at all" by a nursing shortage.

Sigma Theta Tau International, an honor society of nursing, and NurseWeek Publishing Inc., publishers of NurseWeek and HealthWeek, a nursing and health care trade publication, commissioned the poll, conducted by Louis Harris & Associates, Inc. More than 1,000 people were surveyed in this public opinion poll, conducted in June. The groups collaborated to conduct the poll to gauge attitudes about the nursing profession.

Despite 2.5 million registered nurses in the United States, a shortage exists in nurses with needed specialties, skills and experience. Nurses are in particular demand if they demonstrate a high level of skills in the operating room, recovery room, emergency room or pediatrics. Hospital recruitment efforts to reverse the shortage include big sign-on bonuses, salary increases and tuition reimbursement plans.

Other poll results include:

1) An overwhelming majority of the public (92 percent) said they trust information about health care provided by registered nurses, ranking nurses even with physicians.

2) 85 percent of the Americans said they would be pleased if their son or daughter became a registered nurse.

3) 76 percent of the public thinks nurses should have four years of education or more past high school to perform the duties of their job.

4) When asked about specific duties of registered nurses, 91 percent of the public recognized they monitor patient care, but only 14 percent recognized that nurses prescribe medications.

1) Public's trust of nurses

An overwhelming majority of the public (92 percent) said they trust information about health care provided by registered nurses, ranking nurses even with physicians. Nurses ranked higher than teachers (62 percent) or journalists (51percent). Only two percent of respondents said they didn't trust health care information "at all" provided by doctors or registered nurses.

2) Nursing as a career

Americans on average would be considerably more pleased if their son or daughter said they wanted to become a registered nurse than a journalist or a lawyer, and much more pleased if they wanted to become a registered nurse than a police officer. Nursing ranked roughly the same as teaching. On a scale of one (very displeased) to 10 (very pleased), respondents were asked to rate how they would feel about their son or daughter choosing a certain profession.

3) Education levels for nursing

When asked about the education of nurses, nearly one-half of the public said nurses should have four years of education beyond high school. Three out of ten Americans think nurses should have five to 10 years of education beyond high school.

The education level of nurses continues to be a hot topic, as diverse nursing groups across the country seek to make the baccalaureate degree the standard entry point into practice. Nurses now only need an associate degree for RN licensure. Entry-level BSN enrollment has fallen 6.6 percent from a year ago, dropping for the fourth year in a row, according to the American Association of Colleges of Nursing.

By the year 2000, the U.S. Department of Health and Human Services projects there will be 596,000 registered nurses with a BSN, with a need for 854,000 baccalaureate nurses. Nurses with five or more years of education (Master's or Doctorate degree) are projected at 175,000, with a need for 377,000 in the health care system. Projections for 2010 and 2020 continue to drop off significantly in each degree area.

4) Nursing's role in health care

When asked about specific duties of registered nurses, the public recognized that nurses monitor care and provide counseling to patients, but were less aware that nurses diagnose, treat and prescribe medicines, which are duties of advanced practice nurses. Responses were as follows:

91% said nurses monitor the condition of patients

69% said nurses provide counseling to patients

34% said nurses diagnose health conditions

23% said nurses decide on treatments for patients

14% said nurses prescribe medications

http://www.nursingsociety.org

http://www.nurseweek.com

Remember there is no Eutopia.

Personally, I find that there is nothing wrong with the ADN programs, and everyone has the right to choose their own educational path. If there are 1 million nurses, then there are 1 million INDIVIDUALS with family concerns, money concerns, and a zillion other things that go into the decision making process. I was 17 and paying my own way. And at 17, 22 months sounds long enough, not to mention 4 years !?! I would be sooooo old when I finished the BSN program!!

I have been an ADN RN for more than 25 years BUT I am 3 semesters away from completing the ADN to MSN program and boy do I wish everyone had the desire, opportunity, personal need, time, money and employee/family/friend support, etc, etc, etc, to do it.

After I graduated from the ADN program I vowed NEVER to step in a classroom. (never say never)

I LOVE IT, I love the classes, I love learning, I love the hard work, I love writing papers I have learned that there is so much more out there..... I think quite often I (we?) have a little tunnel vision and only see what is around us, forgetting that there is a HUGH health care world.

Am I a better nurse because of the education? I don't know, kind of, sort of, maybe, possibly, could be, although, I haven't learned any new technical skills, unless you count a mean powerpoint presentation set to music :rolleyes: AND I know how to make a brochure :-), plus I know more about APA format than I EVER wanted to.

Most of the people that I work with thought that I was working on a second masters. Our name tags only say RN

I don't have a crystal ball, I haven't a clue what the future will bring, but I want smart, talented nurses taking care of my family, does that mean an ADN, BSN, MSN, who knows?

But I really am afraid that if we place a minimum of an MSN, as one person suggested, I'd be lucky if I had a nursing assistant under the direction of THE RN somewhere in the state, taking care the people that I care about.

The next few years should be interesting.

Kat

;)

Matt-

"What if we said that society was missing out on great physicians because "college isn't for everyone"? No, college isn't for everyone -- but maybe we should be worried about putting our lives in the hands of someone who didn't feel that college was for them. "...

"The fact that a four year degree might be required does not keep anyone out of nursing. It certainly doesn't keep people out of more prestigious and higher paying fields like computers and business. In fact, in those fields, more and more people are getting higher degrees."

Good points to ponder......

Another point would be that b/c nursing has ADN programs it attracts a different sub-group than say degree's that require higher standards. This ties also ties into how we present ourselves (my discussion on professionalism and how we dress).

Many higher degree professions would not even think of coming to a meeting in jeans, but we do it everyday. Again, we have a different mentality than higher degree professions. I don't think requiring a BSN would worsen/cause a nursing shortage. If people really want something in life-they will go after it no matter what. I would also like to see more MSN's at the bedside. I myself am in the process of applying to grad school, but I love bedside nursing. I would love to stay at the bedside after graduating, but be offered a higher salary.

Another idea, we could restructure and call ADN's nursing assistants. Just like MD's have physician assistants.

Just my analysis.....

Julie M.,RN

Originally posted by mcl4

Matt, what is so wrong with ADN nurses? They attend an intense program that prepares them to work in many areas of nursing. Like all nurses, they gain more knowledge through their experience.

Nothing is wrong with ADN nurses -- I'm one myself, remember. An ADN certainly can be a better nurse than one with a BSN, just as an office executive with a Bachelor's degree can be better at his or her job than one with an MBA. But I'm willing to wager that the MBA gets more money and more respect from the public at large.

Personally, I don't feel a lack of respect. However when talking about public perception, I think the general populace feels that nurses and nursing don't get respect -- we certainly don't get the money. By insisting on a higher education level we can raise the public perception. I write it again: The fact that we hold lives in our hands is reason enough to demand higher education as a baseline. I think the Harris poll is revealing in that half the population thinks that nurses should have a four-year degree.

The posts I've been reading seem to indicate that most nurses see themselves as task-oriented technicians, and that a higher degree is usless. That's fine, I guess, but then let's stop hanging on to the idea that we're more than that. If we're really about patient advocacy, if we really do need to know pharmacology, physiology, psychology, and have cracker-jack critical-thinking skills, let's demand higher education. It's odd ... nurses seem to be so frightened of demanding more.

Originally posted by mattcastens

Nothing is wrong with ADN nurses -- I'm one myself, remember. An ADN certainly can be a better nurse than one with a BSN, just as an office executive with a Bachelor's degree can be better at his or her job than one with an MBA. But I'm willing to wager that the MBA gets more money and more respect from the public at large.

Patients do not know the level of education of many nurses and frankly their concern is that a nurses are able to give safe care. Having a MBA doesn't gurantee this and some nurses with a higher level of education have a difficult time applying what they have learned. Many times a nurse's gut instinct makes a difference in the care of their patients which is something you don't learn from a book. Matt, if I could clearly see the difference between a nurse with a BSN or an ADN, I would agree with you.

The nurse I respect the most on my floor has an ADN. Her organization skills as well as the quality of patient care she gives has earned my respect. She recently moved into a supervisor role and has improved conditions on our floor.

Personally, I don't feel a lack of respect. However when talking about public perception, I think the general populace feels that nurses and nursing don't get respect -- we certainly don't get the money. By insisting on a higher education level we can raise the public perception. I write it again: The fact that we hold lives in our hands is reason enough to demand higher education as a baseline. I think the Harris poll is revealing in that half the population thinks that nurses should have a four-year degree.

The posts I've been reading seem to indicate that most nurses see themselves as task-oriented technicians, and that a higher degree is usless. That's fine, I guess, but then let's stop hanging on to the idea that we're more than that. If we're really about patient advocacy, if we really do need to know pharmacology, physiology, psychology, and have cracker-jack critical-thinking skills, let's demand higher education. It's odd ... nurses seem to be so frightened of demanding more.

The nurses at the hospital you work at took the sweet contract deal that ensured them of not going on strike, but having their wages match the ones that might go on strike or did go on strike. Your hospital was the first to settle knowing that their wages would match others hospital nurses that went on strike. I did not see North Memorial nurses tactics when negotiating their recent contract as helping the future of nursing. I don't put the nurses at North Memorial as demanding more respect from the public, improving nursing wages and work conditions.

Finally, I have read most of the messages and I do not see them reflecting that nurses feel their job has been task orientated. I have not read nurses stating that higher degrees are useless, but there are different ways of obtaining a nursing license and a degree does not guarantee the best nurse.

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