Should nursing programs be extended?

I truly believe that the problem lies with real-world nursing being on a different scale than the classroom theory nursing.

Do clinicals and classroom instruction include any significant instruction regarding patient satisfaction surveys? Or discuss the amount of resistance to be encountered from the patients when doing what's best for them? Or even go further than a broad introduction to community health? (Home health requires a degree of professional autonomy that new nurses simply do not have).

I agree that since patients are being discharged faster, a semester with a practicum devoted solely to home health would be extremely beneficial. But a year, I'm not sure anyone would agree to that length of time on a supposedly-stable clientele.

It is my opinion, based on many years of experience, that the general public is controlling any field that wears scrubs. A few of us still stand our ground with evidence-based patient care, but it is definitely NOT easy because although it is needed, it is not what the patient wants. The sweet, innocent puppy-dog look that once was when nurses appeared is lonnnnnng gone. Because of this, institutions want experienced help to offset the possibility of lawsuits (feel free to insert patient safety in here wherever you choose).

Home health agencies are small and privately owned for the most part, true? You are getting these inexperienced folks because major healthcare environments (where there are enough people available who can actually train the newbies how to be nurses, and provide assistance as needed) can afford to have their pick of the litter.

As such, they demand a year or more of experience and can keep the doors closed to these new folks if they so choose. I dare say that most of your new hires have had the doors slammed in their faces elsewhere prior to arriving on your doorstep, and your 4 month training process still counts as paid nursing experience....8 more to go before your new hires have the keys to unlock door #1.

Unless hospitals develop hospital based nursing programs like the previous poster stated, then I don't think extending education in a brick and mortar school will help much. Nursing students don't receive enough clinical time and are mainly preparing for the NCLEX. That's why hospitals are developing residencies and internships! I just graduated and I am working in a residency. I am so thankful for the opportunity to be in a residency, otherwise I would be lost!

The diploma nursing programs of yesteryear were shorter in length (28 to 36 months), yet produced new nurses who were able to hit the ground running in a functional manner several months before graduation.

The length of nursing programs should not be extended. More time will not help the core reasons for one's inability to get up to speed. Rather, the nursing profession shot itself in the foot by moving nursing education away from the hospital and into academic settings such as community colleges and universities.

Nursing leaders probably envisioned more respect for the profession if our education was shifted into academic settings. However, this move was fraught with unintended consequences that reverberate to this very day.

This.

The diploma nursing programs of yesteryear were shorter in length (28 to 36 months), yet produced new nurses who were able to hit the ground running in a functional manner several months before graduation.

The length of nursing programs should not be extended. More time will not help the core reasons for one's inability to get up to speed. Rather, the nursing profession shot itself in the foot by moving nursing education away from the hospital and into academic settings such as community colleges and universities.

Nursing leaders probably envisioned more respect for the profession if our education was shifted into academic settings. However, this move was fraught with unintended consequences that reverberate to this very day.

i concur with the commuter.....

I've come to believe we need to change the model of "transition to practice" -- by having a better-defined step in between school and practice. The realm of internships, residencies, externships, etc. needs to be fleshed out and made more prevalent. It's not realistic to expect a new grad of any program to step into 21st century practice without a transition period.

Even the new grads of the "old diploma programs" could not step into the practice world of today without a lengthy transition. I live in an area in which 4 diploma programs have closed/converted in the last 15 years -- the last one just a year ago. Those new grads couldn't do it on day #1 either. That's what convinced me that the need for transition programs is universal and not just for grads of the more academic programs.

in 1972 I graduated 11am, and was charge nurse in CCU, that evening at my hospital based program.....of course I had spent solid 9weeks on same unit for charge nurse experience last of my senior year.....

The diploma nursing programs of yesteryear were shorter in length (28 to 36 months), yet produced new nurses who were able to hit the ground running in a functional manner several months before graduation.

I agree with you 100%. I have a friend who graduated (ADN), passed boards and had never started an IV. There is no way that would have ever happened in a diploma program. There are still some diploma programs around, and they have a lot more clinical hours than the colleges do.

The diploma nursing programs of yesteryear were shorter in length (28 to 36 months), yet produced new nurses who were able to hit the ground running in a functional manner several months before graduation.

I agree with you 100%. I have a friend who graduated (ADN), passed boards and had never started an IV. There is no way that would have ever happened in a diploma program. There are still some diploma programs around, and they have a lot more clinical hours than the colleges do.

Yes.

I don't see why they can't combine all the extra fluff of the BSN (you know of which classes I speaketh!) with more clinical hours.

SATURATE the students with clinical. It's the only way they are going to learn.

I personally have made the same statements typed by Commuter. Only just recently have I come to question this after seeing the deliberate tract AWAY from acute care hospitals which is only set to increase in the coming years. I think residency programs that fill the gap between a school's generalist approach and a given specialty's obviously focused approach should be much more widespread.

I have seen a definite shift in both nursing education and employers over 30 years. Back in shangri la, nurses had lots of clinical experience, especially diploma nurses, and employers valued employees and a majority of those employees stayed for a few years. Fast forward to now and we have BSN programs almost exclusively that limit clinical experience to a small fraction of "lesser degrees" with the attitude that the employers can teach them the "hows", universities focus on the "whys". This has made U.S. nurses the best educated in the world which no one would argue is a negative. The problem is employers were presented two challenges to the traditional orientation process, NCLEX and employee mobility.

NCLEX changed the 4 to 6 month licensure process to a few weeks, eliminating the Graduate Nurse position. Pre computerized NCLEX, GNs were working with a preceptor full time for at least 4 months after graduation before holding a licence in their hand. These nurses came off orientation with a vast amount of supervised situational experience. This gave employers ownership of successes of the RN, but more importantly, it gave employers ownership of the employee's shortcomings. Employers were slower to implement a disciplinary track to correct errors and took an educational approach. This created a more desirable workplace that encouraged employees to stay. The current system has employers hiring RNs, with no real differences from experienced RNs as they have their license in hand. Employers are no longer forced to wait for licensure, therefore they minimize investment in education and accelerate the orientation process. This desire to expedite the process has led to a disciplinary track towards correcting behavior which has left the majority of nurses to "fake it until they make it", leaving them dissatisfied with their employer. Nurses on our unit average less than two years, making the employer view the return on investment to be poor.

New nurses are being short changed by both parts of the system. The lack of clinical expertise has put that burden on employers. Employers have put that burden back on the nurse, expecting them to already have this experience. I feel sadness for new nurses as they are being short changed. My orientation back in the '80's was almost 7 months, and exclusive day shift for 1 year after that, a stark contrast to the current 6 weeks and working full time nights. I wish both educators and employers in the nursing field would look at the ultimate end user, the patients, and make an investment for them.