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.
An excellent experience! My only comment would be that perhaps we shouldn't think of it as NS or Hospital but consider how partnerships might be fostered. Those who are diploma graduates may have valuable insight into how this could be undertaken.
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.
I really wish that I would of had a lot more clinical time during my school experience. One day a week was simply not enough for me to feel comfortable, and I think that if I would of had more clinical time, I would not be an inactive RN now, immobilized with fear at the thought of returning to practice...
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".
Well said! I, too, believe the bigger problem lies with the employers who do not have the time nor the staffing models to accommodate the new nurse. While my university required a CNA certificate to accompany an application plus a high GPA and SAT score, it still took two years of university/nursing gen eds while applying every winter to enter the following Fall. Once accepted on my second try, two more years for the RN of which students had the option to take LPN boards after the first year. Following the RN program and boards, only then could we apply to the BSN program with a copy of our RN license; there was no optional 4-year BSN. With that said, I feel my six years in school, plus hundreds and hundreds of hours of clinicals, taught me the "art" of nursing and how to write a great care plan (sarcasm implied). But by no means was I prepared for 21st century nursing and the demands put upon the floor nurse that are solely based upon a profit-driven healthcare system. As I was once told by an uppity administrator "nurses do not generate money, but doctors do"...the light went on.
I am now in Case Mangement with a focus on Hospitalist Medicine at a large tertiary hospital. Had I not found this niche, I would have left nursing altogether.
As a side note, I've been in nursing 8 years. Of my close group of nursing school friends, there are only 3 of us left in nursing. The other 7 have gone on to other non-nursing jobs or are unemployed with no desire to re-enter the field. Statistically, that's a dismal showing for a profession that's trying to figure out a way to keep their graduates from leaving in droves.
... I feel my six years in school, plus hundreds and hundreds of hours of clinicals, taught me the "art" of nursing and how to write a great care plan (sarcasm implied). But by no means was I prepared for 21st century nursing and the demands put upon the floor nurse that are solely based upon a profit-driven healthcare system. As I was once told by an uppity administrator "nurses do not generate money, but doctors do"...the light went on.
[/sOAPBOX:ON]
A classic, and deserving of a thread of its own. During my interviews, one of my [now] favorite instructors told me that her view was that nurses "come with the room" and that the future of nursing may lie in getting our services billed separately. For this to be possible careplans, and all those systems (NANDA, Omaha, Indian Affairs, etc.) will have to become standards of practice with practical effect on the bottom line. The more we decry them instead of finessing them, the more our services will remain "part of the room" just like the furniture and bedsheets.
In education, it seems that we do need to put the parts together to understand how best to serve both the client and the profession. Unless we graduate nurses wiling to do both we will suffer the impact on our profession that appears to be driving nurses away in droves.
A classic, and deserving of a thread of its own. During my interviews, one of my [now] favorite instructors told me that her view was that nurses "come with the room" and that the future of nursing may lie in getting our services billed separately. For this to be possible careplans, and all those systems (NANDA, Omaha, Indian Affairs, etc.) will have to become standards of practice with practical effect on the bottom line. The more we decry them instead of finessing them, the more our services will remain "part of the room" just like the furniture and bedsheets.
In education, it seems that we do need to put the parts together to understand how best to serve both the client and the profession. Unless we graduate nurses wiling to do both we will suffer the impact on our profession that appears to be driving nurses away in droves.
[/sOAPBOX:OFF]
As long as our professinal services are included with the "room rate", and the complementary roll of toilet paper, we will never be considered "money makers" to the hospital. Nurses need to become "independant contractors", like ER docs, and bill the hospital for our services. Malpractice can be had with NSO for $99 a year, and a business license should be about $25- 35. Set your rates, write a contract, and there you go.
Nurses who work supplemental would be ideal candidates for independant contractors, and nurses who work agency. Why should someone else get rich off of your professional practices, and you get peanuts. The saying goes, "everyone is geting rich from nursing except nurses". There is no reaon anyone has to work for an agency. Nurses are independant practioners by the nurse practice act. I called the Board of NUrsing here in Washington, and Seabury and Smith, who I have my malpractice insurance with and I was told the same thing. As long as I am working within my scope of practice, and the policies an procedurs of the hospital, I am covered by my malpractice insurance and the State Nurse Practice Act. Guys, look into it.
During my interviews, one of my [now] favorite instructors told me that her view was that nurses "come with the room" and that the future of nursing may lie in getting our services billed separately. For this to be possible careplans, and all those systems (NANDA, Omaha, Indian Affairs, etc.) will have to become standards of practice with practical effect on the bottom line. The more we decry them instead of finessing them, the more our services will remain "part of the room" just like the furniture and bedsheets.
I've heard that too. This "come with the room" mentality is what keeps nursing in the oppressive shape it's in. As a profession, we haven't done ourselves any service by allowing others to dictate our worth. After all, how many beds can you fill without a nurse?
A physician friend of mine has often said the only way for nurses to achieve respect (from administrators et al) is to be allowed to bill our services similar to how physicians bill (of course not at the same rate). You're right...a topic for another thread!!
Is this the idea behind the nurse corporations I've been hearing about... where a large group of nurses form a corporation and contract their services out to a hospital?
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I've heard that too. This "come with the room" mentality is what keeps nursing in the oppressive shape it's in. As a profession, we haven't done ourselves any service by allowing others to dictate our worth. After all, how many beds can you fill without a nurse?
A physician friend of mine has often said the only way for nurses to achieve respect (from administrators et al) is to be allowed to bill our services similar to how physicians bill (of course not at the same rate). You're right...a topic for another thread!!
Make no mistake, No one will "allow" it really. It will be an issue we have to FIGHT for.
This question is way to vague. Does it mean a new grad Nurse, or someone like me who has been practicing for the past 30 years. :sofahider New grads should have enough clinical and theory to know what they need to start practice. I on the other hand need, among other things, refreshers in basics (because we lose what we don't use). I mean how many of the L&D people want me to show up to work with them when the last time I was in a delivery room was in 1974! And I don't want someone from ICU to try and run the Psych unit I have worked on for the past 13 years. Could I transition into L&D, ED, or even ICU. Sure, but I would be in worse shape than the new grad because people would expect me to know things I haven't studied for years. So, if anyone wants me to answer this poll question, they better ask it better.
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.
that was the original question. i didn't have nurses returning to the workforce in mind when i asked it because there are refresher courses already in place for the nurse who is already licensed and wants to change specialties. but thanks for asking. :)
I can see where the idea of Tracks would be good if used in the last semester or as an added semester or at least as an elective. I started as an ADN, partly from an economic standpoint because it was a second career and starting at age 40, you need to get back to full time work, and partly because that's who accepted me first.
Nursing schools have a terrible shortage of clinical faculty. One academic instructor can lecture to 10 or 20 or 200 with about the same effectiveness. The problem lies in the shortage of Master's and Bacholors's prepared nurses willing to precept a group of clinical students. In Texas, the maximum number of students to instructor is 10:1. Some days, just seeing each one do one thing is a challenge if they are not all posted on the same unit!
After I completed my RN to BSN program, I really didn't feel any different and thought all the magic about being a BSN was pure hype. However, I knew it was the only way I could pursue my Master's degree. But, watching the BSN students in the clinical setting and afterwards in the internship our hospital provides, I can see that most BSN's don't have the psychomotor skills of bedside nursing that the ADN nurses have. They are a little better at delegation and operations of the unit, though. Just like the NCLEX, we start them off all the same and then send them into their assigned area of nursing. Occassionally, we find the intern made the wrong choice of specialty area and we do our best to facilitate a unit change. That usually works and salvages a nurse we would rather not loose.
Now about your "touchy-feely" comment. Our hospital is adopting the Patient-Family Centered Care Model. In some ways it could be called touchy-feely because we invite families to participate in the care of their loved one, even in the ICU. We have abandoned the old "Visitor Hours" and, within reason, family members can be around 24/7.
The nurses were reluctant at first, but now see how well it is working and keep implementing new aspects. Their families and patients are generally happier with the care they receive. Although the nurse, per se, doesn't sit and converse with the patient, they utilize those therapeutic conversation techniques while performing personal care, inserting IVs, doing the admission assessment, etc. The reason they learn the Therapeutic Communication in that wonderful sit down fashion, is to get them over their stage fright. Standing over a patient is intimidating to the patient and sends the wrong message. Sitting with the patient, while learning to communicate takes that authoritarian aspect away and it becomes two people conversing, less intimidating for both. From the information I've gotten from my clinical students that have come here after graduation, they are better prepared to weave the conversation into assessment and all of the many things we do with the patient and family. So learning how to be touchy feely is not really a waste of time. Therapeutic Listening may get you a piece of valuable information needed in discharge planning, too.
By the way, care plans are evolving into concept maps. But, that's a whole 'nuther story. And there's never enough time for all the pharmacology we need!
Rodeo RN (As in "This ain't my first rodeo.")
I think it would be nice to have "Tracks", so that those of us interested in Med Surg, for example, have more opportunity to delve into Med-Surg issues in more depth. I think that waiting until a Master's program to get that depth is too long of a wait.
I would revamp the whole care plan thing--too much time is spent on the wording of the evaluation,etc, when the core issue is "What do we need to do when a patient shows impaired gas exchange?".
My program spent hours and hours and hours on the client-nurse relationship, which is pretty unrealistic when the average nurse doesn't have time to sit for an hour and chat, using therapeutic communication.
I suggest more hard science, less touchy-feely. I am not dismissing the importance of the psychosocial stuff, but we get so much of it, and maybe we could use a little more pharm, for example.
or someone like me who has been practicing for the past 30 years. :sofahider New grads should have enough clinical and theory to know what they need to start practice. I on the other hand need, among other things, refreshers in basics (because we lose what we don't use). I mean how many of the L&D people want me to show up to work with them when the last time I was in a delivery room was in 1974! And I don't want someone from ICU to try and run the Psych unit I have worked on for the past 13 years. Could I transition into L&D, ED, or even ICU. Sure, but I would be in worse shape than the new grad because people would expect me to know things I haven't studied for years. So, if anyone wants me to answer this poll question, they better ask it better. 
.thumb.jpg.6eeb2c01c27cfd151d706238b7f6d6b7.jpg){kind=small}
rbnNurse
16 Posts
An excellent experience! My only comment would be that perhaps we shouldn't think of it as NS or Hospital but consider how partnerships might be fostered. Those who are diploma graduates may have valuable insight into how this could be undertaken.