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.
Angie, you did a nice job of setting a tone for this one.
Thanks, Mike. The poll seems to be bearing out my suspicions--50% of respondents feel that our nusing education is not adequate as opposed to about 22% that do.
I don't think it'd hurt to try to brainstorm out a few ideas about how to build a better-prepared nurse. After all, assessing and evaluating interventions are parts of the nursing process, aren't they?
And welcome to the Board, NewRNinNC! I think you'll enjoy it here.
I may be jumping the gun a bit on the RN thing... I just took the boards Monday. Shut off at 75. Eeek. But I think it's a passing shut-off and not a 'you suck, step away from the compuer' shut off. haha
My name is Mandy, by the way Nice e-mneeting all of you!
Let's put it this way: Is it really the responsibility of the employer to complete the new nurse's education? Can hospitals really afford to do this? Shouldn't we, as nurses, be concerned about what kind of drain that causes on health care resources?
Does nursing burnout begin at orientation? Is it because our educational programs are truly inadequate for our needs?
Would a partnership similar to a diploma program work better for the new grad's orientation?
What are new grads lacking? How can the nursing education be changed so that it satisfies those who say we need more well-rounded Gen. Ed. coursework as well as those who simply don't feel they've gotten a good grasp of "real-world nursing" while in clinicals at a college program?
I submit that the reason that the Diploma vs ADN vs BSN debate has raged so long is that NONE of them adequately prepare nursing students to work as nurses.
So we need to go back to Square One and redo nursing school education and standardize it into ONE PROGRAM nationwide.
What kinds of things must it have to meet the needs of today's nursing students?
Again, I think nursing schools for the most part are going a good job.
Can hospitals not afford to give proper training and orientation? Do they want safe nurses that they can retain? There are so many specialities out there now from day surgery, plastic surgery, cardiac, critical care, etc. etc. how is it possible for nursing schools to possibly prepare nurses ready to go. Employers owe to new nurses and they owe it themselves to offer effective training and orientation in these areas.
We as older nurses need to not expect new grads to be competent in their jobs. We need to stop being judgemetal of them with the "didn't they teach you that in nursing school........back when I was in nursing school we did it differently"........"all that book smarts is going to get you no where in the real world of nursing".
Doctors get 4 years of residency before they are allowed to set up practice. Can't nurses get a few months?
I may be jumping the gun a bit on the RN thing... I just took the boards Monday. Shut off at 75. Eeek. But I think it's a passing shut-off and not a 'you suck, step away from the compuer' shut off. haha
My name is Mandy, by the way Nice e-mneeting all of you!
Hi Mandy, good luck with boards. Welcome. Always nice to hear others opinions. :)
Doctors get 4 years of residency before they are allowed to set up practice. Can't nurses get a few months?
No need to:chair:.
Just throwing out some ideas that would help us get outta the box, is all.
I've been a nurse for long enough to realize that becoming a nurse is largely on-the-job, but quite frankly, I could've done with more clinicals.
I've preceptored enough new grads to see them frightened and overwhelmed with the demands of the job. I just have to wonder if getting used to this job has to be that difficult. I just have to wonder, when I hear that the average bedside nurse lasts only 5 years at the bedside, if there isn't a better way to prepare today's nurse.
I mean, should I have to expect that I'll go home in tears every night for a year as I learn my job?
Because that's often what new nurses tell me that they experienced.
It makes me think that nursing education is simply not truly doing the job of educating. We may learn quite a bit about A&P, about the Nurse as Manager of Care, about Pharmacology, about Care Plans and Cultural Diversity, but really when you get right down to it----what other job puts its trainees through what new nurses go through?
Could we not prepare them a little better, help them to survive at the bedside a little longer?
Perhaps we need to start looking at the entire process of nursing education--from the classroom years to the comfort zone years--in order to identify the problems and begin to solve them.
I think we could do without some of the general ed classes like History, Gov and PE (:barf01: for heavens sake). I dont need this crap to be a well rounded nurse..
I suppose that I can't speak for every BSN program out there, but the ones that are in Louisiana and Texas you have to take an entire semester (4 mts) of: Pathophysiology, Pharmacology, Health Assessment, Health Assessment Lab (where you actually perform ALL assessments on your partner), Nursing As A Profession, Fundamentals of Nursing, Dosage Calculation (an entire semester of calculating all of those lovely flow rates.... what do you do? Do we just trust what the IVAC says or do we know how to double check ourselves?)
Women's Health, Pediatrics, Med-Surg, Research Nursing (Informatics), Critical Care, Community Health, Psychiatric Nursing, and Leadership/ Management.
These are just some of the nursing class elements, I have not even mentioned the Microbiology, Chemistry, Biochemistry elements of the BSN degree. In my opinion these are all classes that are needed.
Now, having said that, I feel that the nursing education could be improved because you have only 2 days (16 hrs) of clinical (actual hospital time) per week due to having to TAKE all of these classes. So if there was some way to possibly finish up the lecture portion earlier in the semester, and maybe having 3 to 4 days of clinical per week...?? I don't know?
I do think that alot of our technical skills will come with OJT so that part does not really bother me too much. I think that as nurses we are with the patients more than anyone else and should have excellent assessment skills. Knowing for example that an O2 sat is not a reliable indicator of the CO2 level and that an ABG may be needed because the pt is possibly acidotic, is something that can't be learned in 2 days (or at least knowing the in's and out's about WHY this is occuring). However, although I haven't done many catheters (on humans anyway, lol), I feel that if I did 5 or 6 one day at the hospital, I would feel comfortable.
I do like the way the diploma nursing program does their clinicals, as I'm sure they had no "Graduate Nurse" shock like a lot of us have or will have because they are already oriented to the real world of nursing. However, I do know that unless we want a 5 yr program, something has to give. We can't have optimal clinical time (5 days a week) clinical and still get all the lecture that we need, and we can't have optimal lecture time and get 50 hrs clinical a week. So I think that if there was some way to reconcile the two, then that is something that should be improved upon. But as it stands now, if you have to choose between the two, it should be getting the education part because that is something that can't be learned in a short period of time. As I said before, you can start working as a RN and do nothing but IV starts for 2 days and become proficient, but I doubt someone would feel proficient at assessing and knowing when their patients were showing signs and symptoms of ARDS. I know that I wouldn't.
I feel that all entries in nursing serve a purpose and has a need. The ADN program is awsome and teaches their students exactly what they need to know to be a RN and focuses on the technical aspects which is great and needed. Give me an ADN who has started 50 IV's vs a BSN who has started 5 anytime, lol. I want whoever is going to hurt me the least! I think that the nursing field is big enough for everybody. But when it comes to getting respect from other HealthCare Professionals who hold Master Degrees or better, I think that the BSN should be the entry level for no other reason than to be on a somewhat even playing ground with the Dr.'s, PT's,and even Social Workers for goodness sakes, who don't hold peoples lives in their hands! I do feel that whenever these people talk to us, or see us performing our duties that we do gain their respect no matter what our entry level was.... for all ( Diploma , ADN, and BSN's) are worthy of respect. I just think it would be nice that when these people hear the word Registered Nurse, that right off the back thoughts of respectability and education came to mind. Not nurses having to PROVE that we know what we are doing before getting respect. Just like when we hear the word Physician.... educated, intelligent... these are words that come to mind first. We already have respect for him becoming a doctor we don't have to see him in action and then determine that he's worthy of our respect. I wish the same thing for the nursing profession too.
Truth be told, I think there's a lot to be said for leaving things as they are, too. It certainly isn't ideal, but I do think the different routes into nursing provide a variety of perspectives. My ASN may lack some of the academic preparation of a BSN, and some of the clinical experience of a Diploma program, but it does make it more feasible for someone with my life experience to enter nursing. The new kids going through orientation with me appear to have all the tools they need to become excellent nurses, but all of us need to gain experience to achieve that.
I don't think it's going to be possible to avoid fairly extensive orientation in the hospital for new hires, either. Each institution--each unit!--has its own policies and procedures, and no school could cover all of those.
Personally, I wouldn't see a problem in distinguishing between levels of education in entry-level nurses RN I and RN II, or Registered Technical Nurse and Registered Professional Nurse. At present, I don't really see enough difference between an ASN and a BSN to justify it, but it could be done. An RTN program could be the length of an ASN, but replace some of the Gen Ed with nursing. An RPN could be a BSN, with perhaps a little more liberal arts than a present ASN, but less than a present BSN, again adding more nursing.
I'm having a little trouble deciding what the difference in scope of practice would be, though. Maybe an RPN would be able to cover and LPN/LVN, but an RTN wouldn't? Or maybe an RPN could go straight into critical care, but an RTN would need prior experience in med-surg?
Even under the present system, I do feel a bit more pay for BSNs would be appropriate. Those leadership and management classes are worth something. Not as much as "real" nursing courses, but something.
I am afraid I would have to disagree with this concept altogether.
I'm an ADN student in a ladder program. We have to have trained as CNA to get in, earn a LPN diploma and license to go on to second year. I am second year now and a new LPN in LTC. I work at the same place I worked through my 1st year of school as a CNA.
ADN or BSN. I've seen the course lists, as I'm going to continue on for a BSN, and frankly the big difference is in humanities (Philosophy, Ethics, History), English Comp II, and courses on community based nursing, chemistry and management. The basics, A&P, assessment, Growth&Dev, Psych, Socio., Pharm and nursing care, are part of the ADN at my school and the BSN program I'm entering. The difference is that I'll take the last 2yr for my BSN as a licensed RN while many of my classmates will be waiting for the chance to take boards. Does this make better nurses? Consider that I'll have a BSN with 1yr CNA, 1yr LPN and 2yr RN experience while the straight BSN's could have only 4yr experience as a CNA or medaide. Which one of us would you feel better working with?
So what didn't I learn and am unlikely to be taught in school? How to deal with all the paperwork, doctors and other tasks that a working nurse has to. How to deal with patients on a continuous basis. How to manage more than two or three patients at a time. How to handle the exigencies of the job. Not having any other way to gain experience along the way leaves the BSN over-educated and under-trained. No wonder so many end their shift in tears! And the same thing would be true of a straight ADN program too, adding that the ADN would feel that their education isn't enough next to a BSN (which isn't true). We've got a perfect recipe for feeling overwhelmed which would yeild a high turn-over in new nurses.
I think that nursing programs ought to be laddered. Programs should be structured so that students enter as CNA's, gain LPN and ADN along the way and be encourage to gain experience outside of the classroom, even if its a part-time every-other-weekend-and-holiday job. That might go a long way to making better graduate nurses. As a plus, the student comes away with a clear appreciation for the different levels of training and scope-of-practice issues making delegation decisions easier. Another plus, if the student works under license, is that long preceptorships wouldn't be as necessary. Orientation would be to the facility and not so much to the profession itself. Add to that the ability to weed out those who discover that nursing isn't for them at an earlier stage in the education process and you have a recipe for better nurses who might stay in the field longer and feel better about their abilities on graduation.
No need to:chair:.
Just throwing out some ideas that would help us get outta the box, is all.
I've been a nurse for long enough to realize that becoming a nurse is largely on-the-job, but quite frankly, I could've done with more clinicals.
I've preceptored enough new grads to see them frightened and overwhelmed with the demands of the job. I just have to wonder if getting used to this job has to be that difficult. I just have to wonder, when I hear that the average bedside nurse lasts only 5 years at the bedside, if there isn't a better way to prepare today's nurse.
I mean, should I have to expect that I'll go home in tears every night for a year as I learn my job?
Because that's often what new nurses tell me that they experienced.
It makes me think that nursing education is simply not truly doing the job of educating. We may learn quite a bit about A&P, about the Nurse as Manager of Care, about Pharmacology, about Care Plans and Cultural Diversity, but really when you get right down to it----what other job puts its trainees through what new nurses go through?
Could we not prepare them a little better, help them to survive at the bedside a little longer?
Perhaps we need to start looking at the entire process of nursing education--from the classroom years to the comfort zone years--in order to identify the problems and begin to solve them.
I am afraid I would have to disagree with this concept altogether.
I agree, it's drastic, and nursing is probably already complicated enough with three levels of practice (LPN, RN, NP) without adding another. (I assume you're objecting to the splitting "technical" and "professional" nurses.) It also doesn't directly address inadequacies in nursing education.
It just seems to me that there's a divergence between those who want to "advance the profession" and those who are satisfied to be "just" a bedside nurse (I'm in the latter camp, if that isn't already clear.) Whatever the future of nursing, I think we're going to need both ongoing research and dressing changes. I can appreciate the need to be able to read research, but at this point in my career, I have a lot more need to be able to do a dressing change than to do research.
I'd like to see the future of nursing accomodate both schools of thought--somehow.
I'd also like to preserve the ability to advance in nursing in a step-wise manner. When I do go for my BSN, I'll have some nursing experience under my belt. Ten years from now, I may want to go for an MSN. But if I had to have an MSN to be a nurse, maybe I really would learn to drive big rigs.
Scenario: there is no ADN or BSN program. Create a universal nursing program that gives nurses the ability to start working as a professional nurse--preferably without a long orientation and preceptorship on the job post-graduate--that is rich in both theory and clinical.
I graduated from one such program, as did many here: the Diploma RN program. Mine was lobbied out by university proponents after over 100 years of graduating excellent nurses.
I believe the phasing out of Diploma programs is very sad...we had the best combo of theory and clinical and we actually DID graduate knowing how to teamlead on a medsurg floor, because we did it in our leadership rotation. Some here disbelieve me when I say this, but it is TRUE.
But...academia is the future of nursing today; and they want BSN's...so not much we can do about it other than dream...LOL!.
I Consider that I'll have a BSN with 1yr CNA, 1yr LPN and 2yr RN experience while the straight BSN's could have only 4yr experience as a CNA or medaide. Which one of us would you feel better working with?
To me that's a moot point. We all have to start somewhere. Sure if I was a manager I would hire you. But if it we between you and an ADN nurse with 15 years experience, I would hire the ADN nurse. There's always going to be persons with greater and lesser experiences than ourselves.
Just throwing out some ideas that would help us get outta the box, is all.
I've been a nurse for long enough to realize that becoming a nurse is largely on-the-job, but quite frankly, I could've done with more clinicals.
I've preceptored enough new grads to see them frightened and overwhelmed with the demands of the job. I just have to wonder if getting used to this job has to be that difficult. I just have to wonder, when I hear that the average bedside nurse lasts only 5 years at the bedside, if there isn't a better way to prepare today's nurse.
I mean, should I have to expect that I'll go home in tears every night for a year as I learn my job?
Because that's often what new nurses tell me that they experienced.
It makes me think that nursing education is simply not truly doing the job of educating. We may learn quite a bit about A&P, about the Nurse as Manager of Care, about Pharmacology, about Care Plans and Cultural Diversity, but really when you get right down to it----what other job puts its trainees through what new nurses go through?
Could we not prepare them a little better, help them to survive at the bedside a little longer?
Perhaps we need to start looking at the entire process of nursing education--from the classroom years to the comfort zone years--in order to identify the problems and begin to solve them.
I agree.
But I ask you, is it nursing school's fault these new grads leave in tears every night? Are the one's who don't go home in tears getting a better education? Could the job have any part in it? I worked with one of those nurses who went home in tears every night after we both finished orienting as new grads. Although I presumed it was her personality style (very high strung and anal), and her organizational skills (trying to do it all, unable to prioritize and let go of what didn't need to be done), but perhaps it was her education as we went to different schools. I don't know.
I'm not sure with all the differing jobs out there how nursing school can prepare you for the reality shock of being on your own, having high ratios and poor staffing, nurses eating their young and all the problems that send these nurses home in tears. Would longer clinicals with higher ratios in school help?
Nice e-mneeting all of you!
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UM Review RN, ASN, RN
1 Article; 5,163 Posts
Thanks, Mike. The poll seems to be bearing out my suspicions--50% of respondents feel that our nusing education is not adequate as opposed to about 22% that do.
I don't think it'd hurt to try to brainstorm out a few ideas about how to build a better-prepared nurse. After all, assessing and evaluating interventions are parts of the nursing process, aren't they?
And welcome to the Board, NewRNinNC! I think you'll enjoy it here.