Why nursing is going downhill fast...

[markdanurse]

Hello fellow nursing colleagues!

I thought I'd discuss some nursing issues that frankly, I find quite disturbing. Some of what I'm about to say may be inflammatory, but do not think for a second that I'm singling anyone out or a particular group out.

Let's talk about the AACN. This group does not certify or accredit any nurses. It is essentially a think tank that nursing leaders are using to make radical changes in the profession. Unfortunately, very little input is taken from actual clinician nurses into their views before the organization spews forth its ideas. AACN has decided to make all advanced practice nurses obtain a doctorate degree called the Doctorate in Nursing Practice (DNP) in order to meet entry level requirements for practice by the year 2015. Guess what?! The University of Washington implemented the requirement 8 years early. that's right, as of this year the MSN no longer cuts it for NP education as of this year at that university! This is a four year degree AFTER a bachelor's degree to become a CRNA, NP, CNS, or CNM. This is absurd, as many people choose to become NP's to circumvent medical school and not spend so much time and money into becoming a healthcare practitioner. I believe this is a waste of time because this degree will do nothing to increase the scope of practice for an advanced practice nurse and according to studies, the master's degree in nursing has prepared APN's just fine. (Read JAMA if you don't believe me.)

Now comes the next concoction, the Clinical Nurse Leader. This is a master's prepared nurse that is a generalist doing many of the same functions that a CNS already does. Furthermore, it is proprsed that this position will be the new minimal entry requirement for professional nursing. What??? Why??? The BSN will no longer be the minimal entry level requirement for professional nursing? I have researched this position extensively and see very little use for this clinician in real clinical practice...something that I think our current "nursing leaders" seem to be in denial about. BSN's will no longer be at the top of the food chain.

Why are these changes being made? Well, inferiority is one reason. Well PT, Pharmacy, Audiology, Law, etc. have done it...so why shouldn't we? Well, because nursing is not like these other professions! We should celebrate the fact we have different methods for people to become nurses. Nursing is flexible, unlike our rigid ancillary counterparts! Plus, we have a major shortage of nurses, and those other fields don't have a shortage of professionals. Why do we need to be like them? Let's be unique! We keep going for this "more is better" approach to nursing preparation.

Yet nursing is going downhill fast. Why? Because we all just can't seem to get along. BSN's talk down to ADN's and diploma nurses because the nursing leaders say this education is inferior. Well, now the CNL/MSN prepared nurses will talk down to the BSN's, ADN's, and diploma nurses. Then the PhD, DNSc, ND, DNP (four doctorate degrees in nursing...good grief!) will then talk down to the MSN,BSN,ADN,Diploma nurses. This is called intellectual elitism, and nursing sees it at its finest every day! Guess what? We are ALL RN's.

And despite what others may think, the eduaction is VERY similar, minus 3 to 4 classes taken at the BSN level that is not taught at the ADN or diploma level. Let's stop bickering and get along, shall we?

Now to really get you thinking. Nursing, since its inception, has relied upon the field of medicine. Nursing cannot exist without medicine unless you are one of those APN's who can practice independently. The idea of a PhD in nursing science is absurd based on a field that is controlled or dictated by medicine. Nursing is subservient to medicine, whether we like it or not! Look at what an audiologist, physical therapist, optometrist, lawyer, etc. does. These jobs have a very limited scope and skill set. Do you really think it takes a doctoral degree to do these jobs? Answer, NO! People did them just as well, if not better, when these positions were at the bachelor's degree level. But everyone wants to be a doctor of something! Why? We don't call these people "doctor" when we work with them. The APN will not be called "doctor" when he or she gets the DNP degree. Scope of practice didn't change for any of these groups when they had the doctoral degree forced upon them. So what's the point again? oh yeah, increased tuition to the universities and more title related ego for the nurse with low self-esteem.

It's just one nurse's opinion. What's yours? Speak up and let me know.

Mark

[llg, PhD, RN]

Why don't you tell us a little about your background so that we can interpret your context. It would help us put your comments in perspective.

[traumaRUs, MSN, APRN]

Mark - can you cite other references other than the AACN. Are you an APN? The info that I have rec'd says that the current APNs will be grandfathered in and not required to go back to school.

[CaLLaCoDe, BSN, RN]

oh yeah, increased tuition to the universities and more title related ego for the nurse with low self-esteem.

This final comment is my thought entirely, we are nurses not medical doctors!

[PHLEBOTOMIST_TO_RN]

Let them take away all the ADN's and lets see the shortage triple. Heads will be rolling and I for one will be doing this when that happens. The ignorance of the elitist is unbelievable.

[sasparilla]

Hmmm, will any of these advanced degrees include an increase in salary? If I'm going to have to go to school longer and spend a lot more money doing it, I'd better make more money so I can pay back my student loans.

[barbyann]

I am so sick of the "intellectual elitism" that rears its ugly head again and again. I am so much more than my degree. I have real life experiences that are so very valuable to my professional day to day life.

I think it was Benjamin Franklin that said "Don't let school get in the way of your education"!!!

[Tweety, BSN, RN]

Since the BSN is not the minimum standard to become an RN, I'm fairly certain the CNL will not be the requirement in my lifetime. The CNL has an entirely different role, and it's expensive to have them.

[zenman]

Why are these changes being made? Well, inferiority is one reason. Well PT, Pharmacy, Audiology, Law, etc. have done it...so why shouldn't we? Well, because nursing is not like these other professions! We should celebrate the fact we have different methods for people to become nurses. Nursing is flexible, unlike our rigid ancillary counterparts! Plus, we have a major shortage of nurses, and those other fields don't have a shortage of professionals. Why do we need to be like them? Let's be unique! We keep going for this "more is better" approach to nursing preparation.

Most of what you say I agree with. However, I think we need the "rigidness" of one entry level as it will decrease the concerns addressed in your next paragraph, among other things. Very few professions "shorten" their educational process to solve a shortage.

Yet nursing is going downhill fast. Why? Because we all just can't seem to get along. BSN's talk down to ADN's and diploma nurses because the nursing leaders say this education is inferior. Well, now the CNL/MSN prepared nurses will talk down to the BSN's, ADN's, and diploma nurses. Then the PhD, DNSc, ND, DNP (four doctorate degrees in nursing...good grief!) will then talk down to the MSN,BSN,ADN,Diploma nurses. This is called intellectual elitism, and nursing sees it at its finest every day! Guess what? We are ALL RN's.

And despite what others may think, the eduaction is VERY similar, minus 3 to 4 classes taken at the BSN level that is not taught at the ADN or diploma level. Let's stop bickering and get along, shall we?

[Shamira Aizza]

So what's the point again? oh yeah, increased tuition to the universities and more title related ego for the nurse with low self-esteem.

It's just one nurse's opinion. What's yours? Speak up and let me know.

Mark

1. Change is good; status quo equals slow self-termination.

2. "Actual clinical nurses" are largely disinterested in getting involved in the issues that are discussed by the AACN. For that reason, it's hardly reasonable to be solely critical unless you are offering an alternative. BTW; I disagree with most of what the AACN promotes, but there are few others making manuevers to maintain and improve the professionalization of nursing.

3. As of this year, a new grad MSN will still be entry level for NP's. In fact, many of the DNP programs require an MSN/NP degree to enroll. Additionally, it is not necessarily four years of education; for example, some of the programs take only two semesters and a summer session to complete. You could attend, say, Emory, complete an FNP program full-time in one year, transfer to even an Ivy league school (Columbia), and complete the DNP in 2 more years. Less time elsewhere, more time somewhere else. Generalizations sometimes work, but not in this discussion.

4. It's not possible to make scientific conclusions (i.e. via JAMA) about the adequacy of MSN NP programs when there has not yet been a comparison to the DNP practice...I hardly believe the DNP population is large enough now to make reasonable clinical comparisons.

5. There is no real shortage of nurses; there are lots of nurses out there simply doing something else besides nursing because they don't like being nurses. This tells me that the workplace shortage has nothing to do with the educational requirements, and is more influenced by working conditions. Manipulating the educational requirements will have little effect on exacerbating the shortage, because as it stands now, there are insufficient GRADUATE LEVEL PREPARED NURSES to teach the overwhelming number of applicants to nursings schools...applicants are being turned away, and the key to reducing the workplace shortage is in the workplace, not the colleges. And bickering is not productive, but neither are more false generalizations like saying the difference between an ADN or Diploma RN and a BSN RN is just 2-3 classes. I had to take almost 60 more credits to get my BS in nursing after completing my Diploma. BTW, ND programs have already started to phase out in favor of DNP programs; some schools are replacing their ND program.

6. Unless you are a Phys. Therapist, lawyer, or optometrist, I don't know how you can say these jobs don't require a doctorate; when it comes to representation, I wouldn't want a lawyer who hadn't completed a Juris Doctorate, or have my eyes examined by someone who hadn't completed a doctorate in optometry. In addition, this has served to maintain competition and higher standards among it's providers. These are successful occupations, and we should be observing them for what they are doing right rather than criticizing their progress.

Scope of practice will not change for NP's if they refuse to show professional progress. And I believe DNP's will be called "Doctor." I also believe the systemic implementation of a DNP program will be very good for nursing; for too long, the popular terminal degree for professional nurses was the PhD, and it was like many other PhD genres...publish or perish. The DNP offers a great alternative to nurses who want to share their practical skills in education, politics, and administration, without having to engage in something like research and publication.

The DNP is a great program, and I think it will be a great compliment to the industry. I hope it is able to co-exist peacefully with the still-vital PhD population, and my only concern is that it may dilute the PhD leaders in nursing.

The last comment seems to be a cheap shot with no relevance, and I think regressive thinking serves only to reinforce generations of stereotyping of the nursing profession.

PS. Here is my Scarlet Letter I'd like to display until my infraction points are gone for a post reported by lamazeteacher; I have 20 infraction points for suggesting that she was being surrealistic, assumptive, and speculative after she told me my viewpoint was "typical of other Arab viewpoints" and "sheer propoganda". My post was promptly removed.

[tenrec]

Look at what an audiologist, physical therapist, optometrist, lawyer, etc. does. These jobs have a very limited scope and skill set. Do you really think it takes a doctoral degree to do these jobs? Answer, NO! People did them just as well, if not better, when these positions were at the bachelor's degree level. But everyone wants to be a doctor of something!

I have to disagree with you regarding your comments on optometry. I'm an optometrist and the scope of my profession goes far beyond merely examining eyes for glasses these days. We perform plenty of medical procedures and even some surgical ones. In addition, most of us prescribe medications these days. The scope of practice and the "skill set" is not terribly limited, and it is growing all the time. I actually know an ophthalmologist who feels that in the future, optometrists will do anything opthalmologists do today except for advanced surgical procedures. It's definitely a doctoral degree field!