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've mentioned on other threads that I'm not too hung up on the whole "professional" thing. As a former tradesman, I see a lot of value in that model: apprentice, journeyman, master. And I don't think my admiration for diploma programs is much of a secret, precisely because they sound like they have some elements of apprenticeship to them. But while an apprenticeship model may be best for the "art" of nursing, I don't know that you can really cover the science that way. It occurs to me, lately, that we have more in common with surgeons than physicians--what we do is an intellectual exercise, to be sure, but a very large part is manual skill, and instinct or intuition certainly plays a part. I was talking to a nurse I work with about times he has told a doctor that a patient "just doesn't look good," and has been taken seriously by the MD. I can almost imagine a mindset that would be appalled by such a situation. There's a side of me that doesn't know whether to be amused or disgusted by nursing diagnoses like "Disturbed Energy Field" (as evidenced by what? Bad karma? Demons?) But I've seen objective improvement with therapeutic touch, and seen speaking in a low, calm voice work when Ativan doesn't.
I don't know how you can get that stuff from school. But I'm still thinking about it.
I think a "Professional Nursing Degree" would be great. Sort of like Medical schools are within another University campus, but are autonomous, and assign their own degree.
My fantasy College of Nursing: It could either be free standing, or within the campus of a community college or University. You would complete a core of the normal requirements of a AS degree, then go to the College of Nursing and complete _____ more for the PDN (professional degree in nursing). When you're done with that, you are a few steps away from the BSN, if there was even a need for it anymore.
I've been thinking lately, with all this ADN/BSN discussion, that people (outside of nursing) look at the ADN degree as "just another Associates degree". I don't have any associates degrees, so I don't know for sure, but I would be willing to bet that the nursing program is the most rigorous program at most CCs, and doesn't get the respect it deserves since it is lumped in with everything else. If credits were given strictly on hours spent, the nursing students would have many more credits than other students. Am I making any sense?
I agree completely. The main problem with the ADN is not that is doesn't prepare one to be a nurse, but that it is not looked upon as a "respectable" degree. It's not an easy program, and the many hours spent in clinicals and the extra study time do not receive justice with the term "Associate Degree."
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Suppose it doesn't have to be? Suppose that nursing is truly autonomous and we can make our own schools with our own rules?
so maybe go back to diploma preparation? Cause that is the closest thing to nursing making its own schooling I can think of.........other than college-type degree programs.
I would not be upset to see the diploma education come back. THAT was NURSING education.
But then it's not a MSN or BSN, so where would the "respect" be?
Maybe something like nursing school requires all candidates to have at least an Associates in Science--then on to nursing school with a lot of clinical and theory?
Once again I'm encouraging everyone who participates in this thread to truly think outside the box and not consider practicality of application so much as what student nurses need.
I'm so impressed with this piece's abstract I'm going to quote it here (boldface added by me) as a guide for those of you who are so locked into the idea that if it isn't an ADN, it must be a BSN or Masters.
Suppose it doesn't have to be? Suppose that nursing is truly autonomous and we can make our own schools with our own rules?
Being autonomous and having the necessary core requirements are two different things. Nursing, as far as educational requirements are concerned, are pretty much autonomous within their state's educational system. To make our programs with their own individual set of requirements, is to invite disorder and disarray, and will not necessarily lead to improved nurses but ones with even less knowledge and skills some all ready lack.
Sorry but inviting people to think outside the box, in this case, leads directly to a less professional standard then there already is. What you are suggesting, IMHO, is a step backwards. It is not, IMHO, a step forward.
To make our programs with their own individual set of requirements, is to invite disorder and disarray, and will not necessarily lead to improved nurses but ones with even less knowledge and skills some all ready lack.
I disagree, but I do respect and understand your opinion.
Would you agree with the idea that nurses today are entering the workforce with an insufficient amount of clinical time? Would you say that our current programs lack enough Gen. Ed. courses? Or perhaps not enough Nursing Theory is being taught?
Specializes in Telemetry, ICU, Resource Pool, Dialysis.
Angie, I agree with you about not enough clinical time. It's true that the schools are not producing fully functioning nurses, but nurses with enough knowledge to learn on the job. Which works sometimes, but not always. 6 weeks of "orientation" is not enough to make a new grad fully funtional. What would happen if doctors got out of med school and had a 6 week orientation in their chosen practice, then were left on their own?
New nurses are quitting after 6 months to a year because it's too much to assimilate. My first year felt like hell. I was nauseated for months. People expect them to magically have the knowledge of 10 years of nursing practice. Mistakes happen during this time. Some grads are well supported, others are thrown to the wolves. What's the answer? There is no place in current nursing programs for more clinical time, as someone else mentioned, that time is hard enough as it is to come by. But diploma schools HAD that training. The student nurses were like residents.
I think your idea of a base associate in science is great. Then diploma-like education on top of that. I seriously don't think the schools or the hospitals care about what happens to new nurses once they've paid their fees and finished, or filled a staffing need for 6 months - and it's going to take THEM making changes for anything to happen.
What about leaving things the way they are, but forcing hospitals into some kind of standardized training period protocol?
I've been thinking and saying for some time now that the nursing shortage would be in part alleviated if we went back to diploma or hospital-based nursing education. At the end of your student time, you would have to give back some years of employement there to offset the educational experience. It would allow students to get REAL experience and allow hospitals to train their nurses along their own guidelines, although some sort of standardized requirements would be necessary as a foundation.
My sister trained that way before I did the ASN-ADN route. I believe she was far more ready that I to "hit the floor" although I had good clinical time. I learned so much more in the first 1 year AFTER I graduated than I did during nursing school itself.
I remember one of my instructors, whose favorite word was behoove saying that if you didn't get your breaks, you were a poor time manager. I guess that's in the school world. Later, when I was helping to instruct OB rotation students for the same school, different instructor, the students would say. "It's time for my dinner break. Is this a good time to go?" I'd tell them that of course, they should go on this scheduled dinner break. Your patient will deliver while you are gone, but it might be the last dinner break you ever get as a nurse, so by all means, go." There are times when you just CANNOT go on a break. As much as we all want to stand up for ourselves, that's the truth of it.
Love the idea of a hospital based foundation and go on to other levels.
Angie, I agree with you about not enough clinical time. It's true that the schools are not producing fully functioning nurses, but nurses with enough knowledge to learn on the job. Which works sometimes, but not always. 6 weeks of "orientation" is not enough to make a new grad fully funtional. What would happen if doctors got out of med school and had a 6 week orientation in their chosen practice, then were left on their own?
New nurses are quitting after 6 months to a year because it's too much to assimilate. My first year felt like hell. I was nauseated for months. People expect them to magically have the knowledge of 10 years of nursing practice. Mistakes happen during this time. Some grads are well supported, others are thrown to the wolves. What's the answer? There is no place in current nursing programs for more clinical time, as someone else mentioned, that time is hard enough as it is to come by. But diploma schools HAD that training. The student nurses were like residents.
I think your idea of a base associate in science is great. Then diploma-like education on top of that. I seriously don't think the schools or the hospitals care about what happens to new nurses once they've paid their fees and finished, or filled a staffing need for 6 months - and it's going to take THEM making changes for anything to happen.
What about leaving things the way they are, but forcing hospitals into some kind of standardized training period protocol?
Interesting thoughts.
Do you think the dissolution of diploma schools did both hospitals and nursing students a disservice--we lack clinical skills and experience; hospitals now have to basically train the new grads and pick up on the costs (and liability)?
Do you think the dissolution of diploma schools did both hospitals and nursing students a disservice--we lack clinical skills and experience; hospitals now have to basically train the new grads and pick up on the costs (and liability)?
Angie....exactly what "tntrn" shared is exactly what I talked about on my previous post here. I believe the "dissolution of diploma schools" was a huge mistake, and yes, because of the way nursing has been mismanaged since "college degreed programs in nursing" came along, it has done the nursing students a major disservice...THUS...the weak spots in nursing today.
Angie, I agree with you about not enough clinical time. It's true that the schools are not producing fully functioning nurses, but nurses with enough knowledge to learn on the job. Which works sometimes, but not always. 6 weeks of "orientation" is not enough to make a new grad fully funtional. What would happen if doctors got out of med school and had a 6 week orientation in their chosen practice, then were left on their own?
New nurses are quitting after 6 months to a year because it's too much to assimilate. My first year felt like hell. I was nauseated for months. People expect them to magically have the knowledge of 10 years of nursing practice. Mistakes happen during this time. Some grads are well supported, others are thrown to the wolves. What's the answer? There is no place in current nursing programs for more clinical time, as someone else mentioned, that time is hard enough as it is to come by. But diploma schools HAD that training. The student nurses were like residents.
I think your idea of a base associate in science is great. Then diploma-like education on top of that. I seriously don't think the schools or the hospitals care about what happens to new nurses once they've paid their fees and finished, or filled a staffing need for 6 months - and it's going to take THEM making changes for anything to happen.
What about leaving things the way they are, but forcing hospitals into some kind of standardized training period protocol?
First lets look at education, yes it is specific information and skills but it is also the ability to think. Don't mix up education and training (or skills) I agree that it would be nice to pop out nurses who could hit the road running (and not to compare, what can medical students do on July 1? ) If you have the background information and problem solving skills you can learn the nuts and bolts quickly (the training part, yes training we are now training patient families to complete technical skills that were once reserved for nurses) . Nursing is not about how you start an IV it is all of the background information that is important to take care of it, it's use what can go wrong etc. Starting an IV is a skill,( just the tip of the iceberg) that I learned or was trained to do
. I was a Critical care coordinator, on our prehospital unit we ran 2 paramedics and a nurse. The paramedics had the skills but the nurse had the assessment and assimilation skills. The patients saw unconcious patient, the nurse could look in the medicine cabnet and probably figure out why.
I have taught technical skills (like IVs)to sea captains (before some of the new regulations) so that if there was a problem at sea they could do what they were told to do. Let's stop confusing the "technical" with education.
Let's not confuse how to do it with what needs to be done.
I am an OLD BSN graduate and yes I started with diploma grads and ADs, it
WAS HELL FOR ALL OF US. None of us had ever put in a foley.
What was missing and what is still missing is the education of assimilation skills, problem solving, decision making and a reality course on what it really is like to be a nurse. I think that I may have an idea for a new reality show!
Perhaps we should encourage hospitals to do more nursing internship programs where nurses could be trained to do the technical stuff.
I hope everything is spelled right.
And one more thing, I have an MSN and I didn't learn allot of material that I could not have gotten by reading on my own, I learned new ways to think about things and put principles into practice.
Specializes in Telemetry, ICU, Resource Pool, Dialysis.
Perhaps we should encourage hospitals to do more nursing internship programs where nurses could be trained to do the technical stuff.
.
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."
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nursemike, ASN, RN
1 Article; 2,362 Posts
I've mentioned on other threads that I'm not too hung up on the whole "professional" thing. As a former tradesman, I see a lot of value in that model: apprentice, journeyman, master. And I don't think my admiration for diploma programs is much of a secret, precisely because they sound like they have some elements of apprenticeship to them. But while an apprenticeship model may be best for the "art" of nursing, I don't know that you can really cover the science that way. It occurs to me, lately, that we have more in common with surgeons than physicians--what we do is an intellectual exercise, to be sure, but a very large part is manual skill, and instinct or intuition certainly plays a part. I was talking to a nurse I work with about times he has told a doctor that a patient "just doesn't look good," and has been taken seriously by the MD. I can almost imagine a mindset that would be appalled by such a situation. There's a side of me that doesn't know whether to be amused or disgusted by nursing diagnoses like "Disturbed Energy Field" (as evidenced by what? Bad karma? Demons?) But I've seen objective improvement with therapeutic touch, and seen speaking in a low, calm voice work when Ativan doesn't.
I don't know how you can get that stuff from school. But I'm still thinking about it.