let's pretend that we agree to disagree on the adn vs bsn debate and start all over again with nursing education. let's call it a "professional registered nursing degree program."
first, answer the poll question: do you believe that the rn's educational needs--both clinical and theoretical--are fully served by today's adn or bsn education programs?
then, tell us what types of courses today's nurse needs in order to be best prepared to enter the workplace.
I have a totally different view of care plans now than I did while I was in school. I, like everybody else I knew HATED them. They were the bane of my existence. But, it turns out, they ARE the nursing process!!!!! They are the skeleton of nursing theory. The nursing process is how I think at work now. I did so many of those darn careplans that I could do it in my sleep - and it pays off, believe me. It's comparable to being forced to learn your times tables in grade school. It pays off later on, doesn't it?:)
Thanks for that input. That is encouraging to hear. After all those care plans, we started doing our documentation on the hospital forms this past semester. On those, you have preprinted nursing diagnoses to choose from that you prioritize. From that point, you document your patient care. I just always wondered why they didn't just teach us straight from those to begin with, instead of the frustration of hours spent on portions of care plans that we never will actually use. Our instructors have insisted that it is teaching us to THINK the nursing process.
For starters, I'm a diploma grad and proud of it! Mine is an "old" argument. Granted, our three year, intensive program was short on things like humanities, math and the like, however, we learned to be nurses. We were prepared, knew what we were getting into, and had a different outlook on what our responsibilities would be.
Somewhere along the line, nurses decided that in order to maintain credibility in the healthcare world, we needed to attend college. I am the first to admit that continuing education is an absolute must, however, the foundation must be built first. I wonder if it is in current BSN programs.
Revamping the entire nursing education track, for all nurses, makes the most sense. One type of program which would combine sufficient clinical, theoretical and basic training adding work-study components seems to be a great alternative to the myriad of programs out there today. While a five year course combining all of these elements seems long, it might be the answer. Northeastern University in Boston has such a BSN program and it seems to offer the best of both worlds. It allows people to train and at the same time provides a small stipend. The work-study tracks truly prepare nurses to nurse!
Providing only one type of program, one degree, would lessen the confusion. It's hard enough for others to figure out who's a nurse, a tech, an MD since everyone dresses in scrubs these days. With so many types of nursing programs, the general public can't decide who's who.
Nurses frequently compare themselves to physicians. In the US, there is basically one... and only one... form of medical education leading to an MD. It's about time RNs do the same!
Nursing needs to put this issue to bed soon because the patient is in dire need of care! We've made our educational programs laughable while we try to decide what's the best course. While there are now more men entering the profession, woman now need a reason to choose nursing over other higher-paying professions that were once only for men. The sooner nurses decide who they are and how they are educated, the better off we'll all be.
Hi y'all I'm a first timer on here, although I have been reading the forums for a while. I just feel that this is an issue that is important to comment on, because it's an issue that people will individually take personally.
A little on me for perspective purposes, I have a bachelor's degree, but not in nursing. I went back to school and got my AS in Nursing.
I don't think the question about BSN v. ADN can specifically be broken down to "what classes" or "what clinical experience." Because, let's all be honest, book knowledge is great and experience student-nursing is great.... but true knowledge comes from hands-on experience as a practicing RN.
I believe the debate can be looked at from a broader perspective, that can be applied to all professional careers. Please know what I am about to say is NOT a dig on anybody, but... there is a certain amount of discipline implied when someone carries a bachelors degree. Furthermore, I think that many of the professions that require a bachelor's degree don't require it because the person holding it has more knowledge than someone without it, but because the person holding it went the extra mile, took a lot of classes they despised but did them well, and finished a 4-year degree because they had the determination to do so.
Do I think that someone with a BSN is a better nurse than myself? Absolutely not. Do I think that pay differential should come into play between myself and someone with a BSN? No, I think that should start at Master's level. Do I plan on eventually going back and finishing classes for my BSN? Absolutely!
I believe in education, and I believe nursing is a profession. A professional nurse should always strive toward making him/herself more knowledgaeable. I don't think a nurse with more letters after their name is BETTER, I think they are more disciplined and show that they strive for more from themself.
Thanks for letting a nebie get on a saopbox
you sound just like me
I have a BS in poultry science, of all things. I was premed, but i didnt get into med school. So, when i graduated i got a job i hated out of school and i decided to go back to school for my RN...i was ready to start working in something i really liked so i didnt feel like jumping through the flaming hoops to get into a BSN program when i already had a biology based BS degree. A lot of my classes at NCSU helped me get more out of the classes i am taking now at Community college. I kind of feel like i am more ahead of the game than some of my fellow classmates right out of college.
Someone mentioned other professions requiring a BS............HR people have explained to me that a BS degree doesnt mean you know all that you need to know to perform the job.........it tells HR recruiters that you are "trainable" that you have the mental ability to learn what you need to learn on the job....... Everyone has on the job training. If i had worked in the poultry industry.....they would have retrained me to do what they want me to do, not what i was taught to do in school..........They say, thats nice, but this is the real world and it doesnt happen that way. That doesnt mean that while i was an intern i didnt want to say i told you so when a farm broke out with a really really contagious disease because the proper biosecurity measures were not taken.......but its their dollar.
I am currently attending a diploma program, (I graduate in 84 days). I feel that my program is superior. Our last semester consists of 2 weeks in the classroom focusing on professional nursing responsibilities, and the other 6 weeks consist of 144 hrs. of clinical time with a preceptor(we work with the same preceptor the whole time). If you really look at the length of time for the diploma program vs. the BSN, they are not that different. I had to take 3 semesters worth of prereq.'s prior to starting my program(19 months),also I don't get summers off. If the BSN program is 4 years with summers off, the diploma program works out to be about 2 semesters less. Alot of my friends have attended BSN programs, aftering comparing clinical experiences, I feel I am getting a slightly better experience. I guess I have also been fortunate enough to never have been treated poorly because I am in a diploma program. I do think that the hospitals should be picking up the extra responsibility to further train new nurses appropriately, after all they are the ones responsible for the nursing shortage, and now they are doing nothing to keep nurses in the field past 5 years. Back to the original point: I think the ideal nursing program would have more clinical time with a preceptor (like the intern positions), and projects in theory based on the patients disease process that you cared for in clinical. By consistently presenting case studies you are applying theory to practice, and helping to further educate the other students about areas they have not experienced. So other then the one on one clinicals, the only other change I would make is the waste of time prereq.'s(which I know is never going to happen). I know in the future I have the opportunity to make good money, but I don't consider $18.25/hr to start good money, when my license is on the line everyday. In conclussion, I would like to point out that I have been told that the NCLEX has been made harder (multiple answer questions etc.), they did this because we are getting smarter.
I've never heard of the OR being refered to as "intensive" care area. I have always heard it refered to as "specialty".
We render people unconscious and paralyze them all day. They depend on anesthesia to provide oxygenation, ventilation, treat cardiac arrythmias as they occur, monitor urine output and adjust fluids as needed. When any person requires complete one on one care, that's intensive care in my book.
OR personnel have to handle life threatening emergencies during surgery including pulmonary embolism, loss of cardiac perfusion, airway disasters - and the large majority of these crises have to be handled on the spot. That's why we're(hopefully) over-prepared in anesthesia because all sorts of scary things can happen. Its very frustrating when the nurses don't know how or what to hand you when the going gets bad. That's why I'd like to see all OR personnel trained as intensivists. These things don't happen often which is why its difficult to be a well oiled machine when they do happen.
There is a great point being made here. Indeed, as a non-traditional, I have MS level education in computer science and the degree of discipline required to gain that is a tremendous factor. One I hadn't stopped to fully consider as contributory to the difference between my motivation in the ADN program and some other's who have not had the discipline. I find the idea that a BSN does imply dedication and discipline to be a sound one.
Something that comes along with that idea is noting the discussions about the various "tracks" into nursing. It is becoming clear that the variety of entry points into the profession have some solid advantages. It seems, however, that what we need is to unify our professional training while at the same time allowing for more opportunities for real world experience. This appears to be becoming the concensus.
In unifying the level of education to a BSN we could project the discipline and integrity of a well-defined body of knowledge. In laddering the experience for license within the program we can allow licensed practice outside the classroom. A thought comes to mind, borrowed from many states experiences in licensing new drivers. What about conditional licenses?
Let's say that, after 2 yr of study we have enough knowledge and clinical preceptorship to sit the NCLEX-PN boards. A license can be granted based on a diploma at that point. Then its on to the ADN level of nursing skills courses. Again the NCLEX-RN would be the passing standard, but instead of receiving an unconditional license, the license could be granted conditioned on successful completion of a BSN degree. That way we allow practice while finishing the degree, but ensure the professional integrity is maintained by requiring the BSN as a minimum level to maintain licensure unconditionally.
What about it?
you sound just like me
I have a BS in poultry science, of all things. I was premed, but i didnt get into med school. So, when i graduated i got a job i hated out of school and i decided to go back to school for my RN...i was ready to start working in something i really liked so i didnt feel like jumping through the flaming hoops to get into a BSN program when i already had a biology based BS degree. A lot of my classes at NCSU helped me get more out of the classes i am taking now at Community college. I kind of feel like i am more ahead of the game than some of my fellow classmates right out of college.
Someone mentioned other professions requiring a BS............HR people have explained to me that a BS degree doesnt mean you know all that you need to know to perform the job.........it tells HR recruiters that you are "trainable" that you have the mental ability to learn what you need to learn on the job....... Everyone has on the job training. If i had worked in the poultry industry.....they would have retrained me to do what they want me to do, not what i was taught to do in school..........They say, thats nice, but this is the real world and it doesnt happen that way. That doesnt mean that while i was an intern i didnt want to say i told you so when a farm broke out with a really really contagious disease because the proper biosecurity measures were not taken.......but its their dollar.
I started out as an LPN, then ADN and now recently a BSN. As I progress in my nursing career, I have realized the growth that has taken place with the additional education. Only those who take the plunge will realize the difference it makes in developing your own nursing philosophy as well as broadening your scope of practice.
I started out as an LPN, then ADN and now recently a BSN. As I progress in my nursing career, I have realized the growth that has taken place with the additional education. Only those who take the plunge will realize the difference it makes in developing your own nursing philosophy as well as broadening your scope of practice.
That's very interesting to know, but how would you respond to the thread question? Are you saying that our current system serves nurses' needs and that no revamping is necessary?
Just trying to clarify here, since the poll results today reflect that fully 60% of respondents do not feel that the educational programs we now have are adequate.
It's not the technical stuff that worries me. It's hard to kill someone trying to start an IV or put in a foley. That's the easy part. It's that period of time where you are putting the puzzle together. Some peices are textbook stuff, some are critical thinking. There is not enough time in normal orientations for most new grads to be able to get the puzzle together and use it effectively and safely. I had a terrific orientation, with a fantastic (diploma grad) mentor. But that first year, I was dependant on others for peices of the puzzle. I missed things, I didn't put 2 and 2 together sometimes. I learned from my mistakes, but at whose expense??? What about the grads who get horrible, cheap orientations? Look around this board, you'll see threads like, "Is 3 weeks enough" "My manager says I'm doing so well, I get off orientation early" Who's benefitting from that?? Certainly not the new grad. Not the patients. The hospital is. It's happening all over. It's happening at my workplace, right now.
Doctors learn to think like a real doctor during residency. When do we get do it? On the job. That's not OK. We need some kind of standardized support, internship, whatever, that hospitals are held to. Longer than 6 measly weeks. It will help with retention, errors, stress. And alleviate the "shortage."
Stepping off the box for now...
I too am a "second degree" RN. I chose the ADN at my local technical college only because the waiting list for BSN prgrams was rediculous and I need to BSN to get paid better because I work for the government. In the area where I live, local hospitals have little if any differential for ADN vs. BSN in pay or responsibility, so I've been told. I work for the Federal government where the pay difference is significant enough to drive me to get my BSN, i.e., $37,000 per year for ADN w/2yrs experience vs. $49,000 for BSN with same experience. My point here is, I don't believe that one program better prepares the new graduate than the other one does. Case in point - a new grad from BSN program was hired for the same job as me a couple of years ago - she quit after about 4 months because she was not getting the proper precepting that ALL new grads need - the story told was that new grads don't belong in primary care outpatient setting - then along comes me, ADN new grad, they have to give me a shot at it because the govt paid for my school. I got 2 weeks with one of the supervisors, then was assigned to a physician and told to "ask if you need help". Who is watching over me to catch me "when the pieces of my puzzle are missing and I don't know it"? NO ONE. When I'm on the phone with a patient trying to sort out if he needs to be brought in to see the doctor or when my doctor is not here and I have to decide if a patient phone request can wait until he returns or if I need to get another doctor to review it - no one reviews these behind me? In my experience, the idea that new grads get OJT is a JOKE! Unless you are hired for an ICU, most of us are getting the minimum that they can give us - no wonder we aren't staying. Was it the BSN new grads fault that she didn't get a "proper preceptorship"? Was I, the ADN new grad any better prepared? NO to both...but in an earlier post, someone mentioned that Canada has it's nurse do year long internship - I would love that - I go home everyday, worried that I may have hurt someone by what "I don't know that I don't know". In the ADN program that I just finished, they had to cut some of the clinical hours because the state added another course to the mandatory Gen Ed classes for AS. When we, the students, asked for more lab and clinical time, we were told that they couldn't give us more because the program would exceed the max no of hours for AS degree. Hum! What does that say......we got a grand total of 80 hours with a preceptor at the end of our program - ours just happened to be in December - my assigned preceptor was off or called off EVERY day that I was scheduled, so I was put with "who ever was available" - what a joke......I vote for the return to hospital based nursing programs with a minimum no of gen ed courses PRIOR to admission - I'm old enough to have friends who went that route - they came out MUCH more ready to be nurses. In my opinion, college based programs assume that the employer will spend the needed time to FINISH the training - but it's just not happening unless you are lucky enough to get hired by a hospital that is tied to a university - the others are just wanting a "warm body". I question my decesion everyday, unfortunately, I didn't have a choice as to where I would work after I graduated........I'm counting the days until my obligation is paid back and hoping that a university based hospital will be willing to hire me and invest some training in me. Too bad I didn't get that in school.....
I am currently attending a diploma program, (I graduate in 84 days). I feel that my program is superior. Our last semester consists of 2 weeks in the classroom focusing on professional nursing responsibilities, and the other 6 weeks consist of 144 hrs. of clinical time with a preceptor(we work with the same preceptor the whole time).
Both the BSN and the ADN programs here require 140 hours of clinical time with a preceptor at the end.
Okay, my 2 cents. If you are simply addressing the issue of preparing a nurse to be able to function as a nurse in a real world environment, then I think internships are something to consider. Clinicals in school for me were a joke. I spent more time worried about completing the paperwork for school than I did caring for patients. Also, we were so limited in what we could do because we were not yet RNs.
I did a five month internship at a large teaching hospital. It was great because it allowed me to transition to the real work environment while being protected from rushed orientations and being thrown to the wolves when staffing was short. There were also whole day classes about once a week. These classes went over every system of the body and diseases commonly seen with the systems. They also discussed management of a patient with that disease/problem. I know we learned most of that in nursing school, but the review while actually out there working was extremely helpful in cementing it in my mind. They were taught by clinical nurse specialists working in the hospital dealing with the real world application of that stuff every day. After the 20 week internship, I then went on to have a normal orientation on my unit of hire. The point is, by the end of the internship we were all feeling more confident and capable of working as nurses. It really was like an extension of nursing school. The advantage to the hospital for providing this was a one year contract.
I can't answer the question of who should be responsible to requrie something like this (nursing school or hospitals), but I do believe it should be considered as a solution to the question posed. As has been previously stated, physicians do not walk out of med school and become doctros overnight - they have residency. Maybe the same thinking should be applied to nurses.
Pricklypear, and others, have made a point that doctors learn to put the pieces together during their residency and argue that nurses should get this opportunity. I feel that it is a good point but somewhat misguided.
First of all, residency programs are afforded to those who have graduated medical school. These are real MD's who then match for residency in an area of specialty. They are, in effect, getting "on-the-job" training. This is not at all dissimilar to nurses who get hospital preceptorship (orientation) after graduation. What is the difference then.
To truly understand, medical students get their 4th year as a clerkship (MS) and get to do all the things a real doctor does under the supervision of a physician. This is just like the training we get during clinicals. We do the nursing but must defer and otherwise seek the instructor's help to deal with things like telephone orders and other things that student nurses are not allowed to do (your mileage may vary depending on state).
After that come the years of internship in which each new graduate gets a rotation in the various specialties. Again, similar to NS in that each rotation we go through shows us a different aspect of the profession and the requirements of its participants. Once internship is finished, and boards are taken then the graduate is a Medicinae Doctore or M.D. (and we become nurses LPN/RN).
Earlier I proposed the idea that a conditional license be granted the ADN level graduate. The condition being the continuation of training/education to the BSN level. In my mind I can envision this as being similar to that of the transition between a medical student (MS4) and MD. Perhaps some wiser heads can flesh out this idea.
I'm a first timer on here, although I have been reading the forums for a while. I just feel that this is an issue that is important to comment on, because it's an issue that people will individually take personally.
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Stepping off the box for now...
Pammie
75 Posts
Thanks for that input. That is encouraging to hear. After all those care plans, we started doing our documentation on the hospital forms this past semester. On those, you have preprinted nursing diagnoses to choose from that you prioritize. From that point, you document your patient care. I just always wondered why they didn't just teach us straight from those to begin with, instead of the frustration of hours spent on portions of care plans that we never will actually use. Our instructors have insisted that it is teaching us to THINK the nursing process.