After reading several threads regarding the entry-level MSN programs and which level of nursing education should become the standard, I want to share a classroom discussion I had a while back...
What if a MSN became the solid standard for entry into nursing practice? What if we all practiced in the role of a nurse practitioner? Now, I know that this will surely NEVER happen! But, a six year program leading towards a MSN degree with the outcome of a nurse practitioner may not be such a bad idea. Think about it... We could manager our own patients' care instead of the way a physician thinks it should. We could prescribe pain medication when a patient needs it.
Anyways, as I said it will probably never happen, but it was a very interesting discussion.
Specializes in acute rehab, med surg, LTC, peds, home c.
You could train a monkey to do alot of tasks, but that doesn't mean we should. Do not discredit the skills of another discipline that you know nothing about. Many people do that to nurses. They say "anyone can pass pills", but its not about the act of passing pills, its about the knowledge that you bring to your med pass. The ability to recognize side effects, know when to hold the med and knowing how to educate your pt on the med. It is the same with them. PTs are highly skilled practitioners of a very important discipline. And yes they should be very well educated. Its not about protecting anyones job, its about the best pt care. I see the difference between the older PTs that were grandfathered in with lesser degrees and the newer ones with advanced degrees and there is no comparison.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
There was never a nursing shortage and there never will be. The only shortage was a shortage of RNs who were willing to work under the conditions that hospitals provided.
*** Ya, ya I know. I was referring to local shortages. I well understand that there was never a real shortage if nurses. There are very real local shortages in some places at some times. That is what is was talking about. I guess I should have qualified my statement but I thought the fact that the much touted "shortage" never existed would be so obvious as to not need explaining.
You seem pretty intelligent so I feel pretty certain that you can see that its just a convenient excuse to keep the nursing market flooded with folks who don't have bachelors degrees.
*** I don't see that at all. I have seen it used as a excuse to import nurses. For what you say to be true BSN would have to be the standard and RNs who entered via other routs would have to be less desirable non standard.
I am not opposed to a union because I agree that is the only way nurses will prevent further input of nurses from other countries who are definitively not in a position to advance their personal or professional interests.
I also think that an MSN as an entry would not be a torture although I see no present need for that.
*** Oh no way. I question whether enough people would be interested in devoting all the time and money required for a BSN. No doubt in my mind at all that what we get paid would never justify a master for more than a few people.
Heck, when I log onto hospital career websites, there is no shortage of openings for PTs. Also, I noted with sadness that one website had "professional" positions listed and then another category with "nursing" positions. Ouch
*** That is very common. People who punch time clocks are seldom viewed as professionals. Please explain to me why you think the ADN to BSN rout would not work rather than the BSN as the only starting point?
FWIW I work in a 26 bed SICU of a large, Magnet, teaching, tertiary care / trauma center and the manger just hired for our unit is a diploma RN, no BSN even.
I also think you have the cart before the horse. Make the BSN useful and relevant and THEN work on making it standard. Ever study for a clinical certification like CCRN? That is the kind of stuff we should be learning in a BSN program.
Make the BSN useful and relevant and THEN work on making it standard. Ever study for a clinical certification like CCRN? That is the kind of stuff we should be learning in a BSN program.
Less theory, more clinical time. I think it's important to know the rationales of what we are doing but I don't think I need to learn about five different nursing theorists and the theory about why we are doing what we are doing.
*** I would be far more likely to support BSN as entry if BSN was a useful degree where one could learn thing helpful and important to nursing. I am an ADN who went back and got my BSN from a state university. All fluff and mostly useless.
Agree. My first BSN class is called "The nurse's way of knowing". My friend already took it and said it's such a waste of time.
I have read essays by those in nursing's "Ivory Tower" who seriously believe that the entry-level degree for nursing should be a graduate degree. In fact, the now defunct "ND" degree was an attempt to do just that, if I recall correctly.
Ideas like this are part of why I may speak derisively of the "Ivory Tower," i.e. the nursing academics at the graduate level who seem so far removed from the clinical foundations of our profession.
At this point, I have read relatively broadly in the areas of nursing theory, nursing as a profession, nursing education, etc (although I in no way offer myself up as an expert in any of these areas). I also have just over two years experience as a floor RN under my belt. I still find some of the ideas coming out of the PhDs utterly divorced from the real world of us RNs. Likewise, I now have some exposure to the similar theorizing regarding the role of the advanced practice nurse (APN), and again find the academics completely clueless regarding how that profession actually operates.
I have great respect and admiration for my profession; I wish I could have similar pride in our supposed intellectual leaders.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
At this point, I have read relatively broadly in the areas of nursing theory, nursing as a profession, nursing education, etc (although I in no way offer myself up as an expert in any of these areas). I also have just over two years experience as a floor RN under my belt. I still find some of the ideas coming out of the PhDs utterly divorced from the real world of us RNs. Likewise, I now have some exposure to the similar theorizing regarding the role of the advanced practice nurse (APN), and again find the academics completely clueless regarding how that profession actually operates.
*** I agree. The "scripting" (issuing RN a script that must be repeated verbatim by the RN to their patient) issue is a prime example. This is obviously an idea that came out of academia. The sad part is that it is not even an original idea. The whole scripting idea was tried and rejected by other industries and fields decades ago but it is just now getting a head of steam in nursing. It serves as both an example of just how far behind nursing education is and it demonstrates just how out of touch nursing education is with the real world of nursing.
The ANA should pick a date, say 8-10 years down the road, and say that there will no longer be diploma/ADN programs. The schools might protest, but as nurses it seems we would rather gossip and undermine each other than to band together and protest.
But the ANA has nothing to do with this -- in fact, they've been pushing for the BSN as the minimum entry to practice for decades, with no success.
Standards/requirements for licensure are determined by the state BONs, and the state BONs are ultimately controlled by their state legislatures (and state legislatures really like their community college systems) -- in order to make this happen, all 50 state legislatures would have to be convinced that this was really necessary. So far, only one state (N. Dakota) has ever passed legislation required a BSN for licensure, and they rescinded the requirement several years later. No other state has even come close (although one or two of them are talking about the possibility at any given moment ...)
The problem with nursing is that there is no scientifically based body of knowledge. Other disciplines, PT, OT, MD, even social work and psychology. Nursing on the other hand is basically fluff. As stated the real education is on the job when it should much completed prior to graduation and IS in other disciplines. I am going to get SO flamed for this but so what.
As a person with a heavy science and technical background and an advanced degree and have also taught at various levels including college I have a very good idea of why nursing is fluff. It is because the faculty are fluff. Their masters degrees are in things like education, leadership, etc etc.
In other discipline that are science based you will see a few people with MEds and things like that at the college level but mostly they are people that have advanced degrees in Math, Science, Pyschology, subjects where peer reviewed research has been done and reviewed by people that ARE QUALIFIED TO REVIEW IT. In nursing NOT the case. The "peers" that mostly review nursing research are often RN's that have gotten a masters on PhD in a NON science discipline.
What I see are people with very good clinical skills due to their years of experience. This is different from having good research skills. Good research skills require MUCH INTENSE training in research methods and evaluation and is NOT LEARNED BY REPETITION or years of experience. This typically requires FORMAL EDUCATION TRAINING which must nurses are AGAINST because they wish to believe we are all THE SAME.
It is true that after working for yrs and yrs in a clinical area one will get better and better at it. AND people in my opinion should be rewarded for their superior clinical skills, much attained through years of experience. BUT, research is a different animal.
Research involves understanding how to set up and analyze an experiment which sadly I have met few few nurses that know how to do, and I am talking about academics here. I believe this is why they do fluffy research and teach fluff. They dont KNOW advanced stuff, cutting edge stuff. They dont KNOW how to do research thus, nursing has no real body of knowledge.
IT is like this. I worked with a very pleasant man who had been in the job like thirty years. He had a bachelors degree. The rest of us had advanced degrees and all of us were also specialized. This man due to his years of experience could run circles around us with the regulations. He was the goto guy there. After all he had been working with them for thirty years and just about had them memorized.
But as far as analysing research, determining what would work, creating new pathways of discovery, he just was not even in the ball park. We loved the guy, he worked hard and did his part well, but as technology had advanced he was lost in all but the most basic thing. I personally believe this is where and why nursing is stuck. The lack of belief in advanced education will cripple any profession.
I thought this would be a great field to combine my previous background which was also in healthcare and eventually do research again. But alas, there seems to be too much catfighting in this field to really get anything done. My long term plan is to take my nursing experience back to my old field where something can get accomplished without backbiting and bickering about nonsense.
I have so many friends from school who are wonderful and so many here are too. It is very sad. I have said before and I will say again that from a business perspective the way things in nursing are currently set up is not cost effective at all and I cant imagine that more will not be done in the future to "get around" paying people to clean people and do technical skills.
This requires skill but does not require a college education to do. I can't imagine that businesses, hospitals etc with be eternally willing to pay someone 20 dollars an hour to clean people and put in foley catheters. I do not say this to be derrogatory and obviously these are very necessary tasks. Its just that what you get paid the bigger money for is always going to be either that what you do brings in more money for a company (ie sales) or that you have a skills set that is harder to acquire - and that usually means takes longer to acquie so that there are fewer of you.
. I can't imagine that businesses, hospitals etc with be eternally willing to pay someone 20 dollars an hour to clean people and put in foley catheters. I do not say this to be derrogatory and obviously these are very necessary tasks. Its just that what you get paid the bigger money for is always going to be either that what you do brings in more money for a company (ie sales) or that you have a skills set that is harder to acquire - and that usually means takes longer to acquie so that there are fewer of you.
I think you are a little too harsh in some of your judgments of contemporary nursing scholarship ... but I totally agree with many of your underlying points and would like to focus on our points of agreement.
Nurses are way to focused on a belief that "we all have to be the same." We need to acknowledge that there are different roles and functions within nursing -- and that they are hieracrchical in nature. There are many functions in nursing that should not require a BSN -- and that is OK. There are other roles and functions that should require higher education. The problem comes when we try to fit every nurse into every role regardless of her education, knowledge, and skills. There is an attitude of "She's a good nurse ... so, she can do the job" even if she doesn't have formal education for it.
I believe the problem has arisen because the needs of society to have nurses functioning at higher levels got ahead of the educational standards for nurses and the availabilty of BSN and graduate level education. Historyically, there has also been a tolerance for low educational standards among nurses because it is a predominantly women's profession and that has been used as an excuse not to require that nurses get more education. Hospitals needed managers, edcuators, etc. -- so they "made do" with whoever was available locally, regardless of their educational credentials. Over the years, the lower educational standards became the norm and the and the anit-intellectual culture in nursing flourished. (One of the worst sins in nursing is to be "elitist," right?)
I believe our best route for improvement is not to abolish the ADN as an entry level ... but rather to clarify the levels of education and the roles within nursing that are appropriate for those with each level of education. It would help enormously if there were some basic standards and guidelines that would establish a clear hierarchy that everyone would acknowledge. ... An ADN has been prepared to do A, B, and C. ... . A BSN is prepared to do A,B, C, D, and E. ..... An MSN is prepared to do A thorugh G . ..... A DNP is prepared to do A through G plus H, I, and M. ..... A PhD is prepared to do A through G plus H, J, K, and N. ... etc. ... We need to identify the content of what each academic degree teaches -- and then stick to those requirements when it come to hiring people.
As another posted wrote previously, that's what the Magnet program is doing. It is taking the bull by the horns at the point of hiring. It is establishing standards at the job level even though the government and educators have not established (or stuck to) similar standards.
The saddest thing about your post misplaced1 is that you are choosing to run away from nursing rather than to try to improve it. Nursing is of value to society and we need a strong nursing profession. Our leaders in the past have fought many battles ... won some ... and lost some. There are still many battles to fight. It's a shame that you will not be contributing your scientific expertise to nursing. We need it.
I would argue that we ALSO NEED expertise in non-scientific forms of scholarship and practice in order to fully capture the many different types of knowledge that we need to practice (qualititative methods, artistic methods, philosophical methods, etc.) There is where we probably disagree. It's common for people schooled only in the quantitative paradigm of the hard sciences to switch perspectives and "trust" the other research methods. It's also very unfortunate that some nurses have not been as rigorous in their use of all research methodologies as they should be. I recognize the problems of shoddy scholarship you mention ... but I wouldn't solve the problem by narrowing the methods used. I would solve the problems by demanding increased rigor in the use of all methods. There is where we disagree.
Also, I choose to continue the efforts to further develop nursing scholarship and to improve the profession, raise standards, and bridge the gap between the world of daily practice and nursing academia. I don't choose to abandon the fight.
Actually the ANA has been rather sucessful in pushing the BSN as mandatory for entry, just not in the way they had hoped.
Give you a hint: just who do you think is behind the "Magnet Status" award?
Having fought and mostly lost the battle to mandate the BSN via state boards of nursing, there are other ways to skin a cat (pardon the expression).
I agree with you that the Magnet program encourages hiring of BSNs vs. RNs with other preparation and it's no mystery or secret that the certification subsidiary of the ANA developed the magnet program. But the point I was making was to clarify for the other poster that the ANA does not, as s/he seemed to believe, have any statutory or regulatory authority to just say, "Ok, starting next year, no more ADN programs." I think it's reasonable to say that there's absolutely no chance of that happening any time in the forseeable future. :)
meluhn
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