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.
Or maybe nursing schools and hospitals should partner much like medical schools and teaching hospitals do?
Now I like the sound of that! The externeships that many schools of nursing require are an excellent experience for students- they work with a preceptor (for pay) to learn how to "put it all together" in the hospital environment. Our hospital is beginning a nurse residency program for new grads that lasts 12 weeks- lots of clinical, lots of time to meet with experienced nurses to talk about the adjustment, problems, ask questions, and learn. I think residency and externeship is definitely the way to go. The biggest challenge for new grads seems to be organizational skills, and how to put together all the knowledge they have so that they can be competent in the fast-paced hospital environment.
Technical skills (IV's, catheters, dressings) are not what makes a good nurse- those skills will come with experience. It's the critical thinking and being able to organize, prioritize, and individualize care that helps you survive.
Perhaps if this were in the OR/Periop board, i would.
Hi, Marie. Sorry you can't attend the diploma program you want. I remember when NYC had two diploma programs affilated with A-one colleges - Columbia and Cornell. You could finish your two years or pre-nursing anywhere and your last three years in NYC at the above hospitals and get a BSN. Costs for the three years were minimal - usual costs of diploma programs. But what people are missing here, unless the federal government shifts the cost of the nursing degree from the student to the hospital it won't happen. Hospitals, I don't believe, can bear the brunt of educating students without shifts in federal funding and I doubt the colleges would lobby for that. But back to my question, its not an OR question. It's an education question. I simply want to document anything in the nursing curriculum with what "nursing" is in the OR. And why is it perceived as an insult that the ORN would be something less than an RN. They receive the same amount of schooling as an ADN and should be paid what other ADN's in the hospital are making. It's simply a way to train a person in the highly technical world of the operating room so that the hospital is not put in the position of having to do it. You'd still take the same science courses as the RN students , but you'd also be trained in the skills you need to know to scrub and circulate, including pharmocology and systems management. Its not that its a lesser position than an RN, its just a highly specialized nursing degree pertaining to the OR. Since you would be taking science courses with the other RN students, these would be transferrable for anyone who wants to continue their education. The OR is an intensive care area and I don't see enough intensivist nurses choosing it as a specialty and believe its unfair to the institutions to have to provide training from practically from ground 0. In this scheme, there would be no more OR techs - everyone would have two years of education under their belt and be in a much better position to advocate for the patients and for themselves. Again, this has nothing to do with demeaning the RN - its just providing better care for the patients with people who are trained to perform more skillfully in their chosen area. And it might be cheaper for the student who will be providing scrub tech skills which they can acquire the first year and could work as a scrub tech during the second year while learning circulating skills, getting their ACLS, etc.
Your point is well taken. However, that 15yr nurse is a dwindling resource and our focus here is on preparing new nurses and what can be done to better the education process. The question was posed to help others think about the differences and, perhaps, spark some ideas, like externships, that might produce results. The point is not moot to the issue at hand.
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.
Your point is well taken. However, that 15yr nurse is a dwindling resource and our focus here is on preparing new nurses and what can be done to better the education process. The question was posed to help others think about the differences and, perhaps, spark some ideas, like externships, that might produce results. The point is not moot to the issue at hand.
Which brings us to another interesting facet of the emerging nursing shortage--attrition. Attrition of longtime nurses by retirement will seriously undermine the resources of the hospitals to orient and train new grads.
Do we need to start thinking about solutions to this problem now, with a burgeoning aging population with all its attendant illnesses?
The OR is an intensive care area and I don't see enough intensivist nurses choosing it as a specialty and believe its unfair to the institutions to have to provide training from practically from ground 0. In this scheme, there would be no more OR techs - everyone would have two years of education under their belt and be in a much better position to advocate for the patients and for themselves.
I've never heard of the OR being refered to as "intensive" care area. I have always heard it refered to as "specialty".
If somebody made me world dictator in charge of nursing education tomorrow, I think I might redesign nursing this way:
2 years of adult nursing core courses and hard sciences with increased clinical practice and devoted to producing generalist nurses in adult medicine. Graduates would have an ADN.
A year of advanced practice for those nurses who want to go into specialties, like critical care, pediatrics, maternity nursing, and psychiatric nursing. This would be followed by six months of internship and result in the equivalence of a BSN..
Two years of additional advanced practice courses to give the equivalent of an MSN for those nurses who want to go into nursing management or any of the clinical specialist roles as nurse practitioners.
This would have several advantages: the pace of the first two years could be slowed considerably, thus retaining the younger students who traditionally do much better at four year programs while allowing the older students with work and family committments to enter practice through a two year program. The increased clinical practice would help new nurses feel a bit less thrown to the wolves when they get into the real world of 10 patients per shift on a med surg floor. Generalists in adult nursing would no longer have to fear that shift from hell being shipped into a specialty like pediatrics when they haven't calculated pediatric drug dosages for 10 years.
The advanced practice courses followed by internship would deliver more nurses who actually know what they're doing in the various specialties, especially when combined with a set number of hours for internship at med surg pay, obviously with an increase once the internship is finished. We'd no longer have to confront those shifts when some suit tells us "a nurse is a nurse" and throws us into a specialty unit we haven't ever been in and certainly haven't studied since nursing school, which may be many years in the distant past.
The advanced degree courses would provide us with the nurse practitioners we have today in the same specialties.
This scheme would end forever the conflict between the BSN and ADN nurses over which course of study produces a better nurse. Nurses would be respected and remunerated for what they actually know about nursing, instead of debating whether 2 years of Modern Western Civilization, college level math and English Literature before one tackled the nursing core curriculum is any better than jumping right into nursing from the beginning.
Since nobody's about to appoint me world dictator (and I'd run screaming if they did), I throw this idea out for debate. It's something to consider, anyway.
I find it strange that only in nursing is it acceptable to have an associate degree. If you went into business, teaching, computer science, marketing or any other profession you wouldn't be looked at with just 2 years of education. I believe that is why nurses aren't more respected. We should all be required to have a BSN and employers should help nurses achieve that so that all nurse would have the same basic educational level as the rest of the professional world.
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.
Oldiebutgoodie
Amen on the care plans! Personally, I think that we need the core classes for the Associate Degree because that lays the foundation for further learning and for developing professionalism. I do think that too much time is spent on care plans. Those are hours that could be spent on theory. I also think that 4 semesters of nursing (the amount we are required to take in the ASN program in GA)is just too much info too fast. I have often thought that I wish I had the time to really get a good grip on this stuff. I am able to make good grades, but we go through it so fast, I don't feel that I am retaining a lot of it. Our school has a high pass rate on NCLEX, but I just don't feel that I will be as prepared as I'd like to be. I can't imagine how they could better prepare us in the same amount of time, though. It takes a full 3 years, going summers, to get through our ASN program as it is.
Now I like the sound of that! The externeships that many schools of nursing require are an excellent experience for students- they work with a preceptor (for pay) to learn how to "put it all together" in the hospital environment. Our hospital is beginning a nurse residency program for new grads that lasts 12 weeks- lots of clinical, lots of time to meet with experienced nurses to talk about the adjustment, problems, ask questions, and learn. I think residency and externeship is definitely the way to go. The biggest challenge for new grads seems to be organizational skills, and how to put together all the knowledge they have so that they can be competent in the fast-paced hospital environment.
Technical skills (IV's, catheters, dressings) are not what makes a good nurse- those skills will come with experience. It's the critical thinking and being able to organize, prioritize, and individualize care that helps you survive.
A nurse residency program sounds like a great idea. Thankfully, we are getting a lot of clinical experience at both of our local hospitals. We are also required to be team leaders during our clinicals. Organizing, prioritizing, and individual care are a very important part of our clinical experience. Our instructors expect us to be able to work on our own by the time we finish our second semester of Med-Surg nursing. They are there if we need them, but they expect that most of the need will be in practicing new clinical skills. I just feel that we are shorted on the theory. Medical knowledge is growing so rapidly that it will become increasingly more and more difficult to cram what we need to know into an ADN or ASN program. (Mine is an ASN with all of the normally required core: humanities, computer skills, histories, foreign language, ect. required along with the nursing. Algebra is the one exception, although I took it anyway.) If we had to work as CNA's a year before getting into the program, we would have had the time equivilant of a Bachelor's degree by the time we received our Associate Degree. I am not aware of any other Associate Degree program in any college that has such long and tough requirements.
My instructors seem to think that any state initiatives requiring a Bachelor's will be a very long time in coming because of the nursing shortage. They said that would just make it even more difficult to recruit nursing students. For the BSN, in addition to another full year of nursing, you have another full year of core classes added. By the time I complete my BSN, I will have been in school 5 full years, summers included. In our state you can complete the Physician's Assistant program in the same amount of time ( making 3 times the salary) and until last year you could complete the Pharmacy program in that amount of time. (It's a doctorate program now.)
Something is just out of balance here, especially when we are continuously told that we must know more than the doctors do about drugs because we are the "last barrier to harm."
Specializes in Telemetry, ICU, Resource Pool, Dialysis.
Amen on the care plans! Personally, I think that we need the core classes for the Associate Degree because that lays the foundation for further learning and for developing professionalism. I do think that too much time is spent on care plans. Those are hours that could be spent on theory. I also think that 4 semesters of nursing (the amount we are required to take in the ASN program in GA)is just too much info too fast. I have often thought that I wish I had the time to really get a good grip on this stuff. I am able to make good grades, but we go through it so fast, I don't feel that I am retaining a lot of it. Our school has a high pass rate on NCLEX, but I just don't feel that I will be as prepared as I'd like to be. I can't imagine how they could better prepare us in the same amount of time, though. It takes a full 3 years, going summers, to get through our ASN program as it is.
sort of off the subject, but...
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?:)
Which brings us to another interesting facet of the emerging nursing shortage--attrition. Attrition of longtime nurses by retirement will seriously undermine the resources of the hospitals to orient and train new grads.
Do we need to start thinking about solutions to this problem now, with a burgeoning aging population with all its attendant illnesses?
And that is precisely the issue that drives me to ponder the ideas in this forum. I'm 48, a new LPN going for the RN and looking at the fact that I may likely be off bedside in 25 years or less. Who and how will we train to take my place? Moreover, given that I'll be taking care of aging brothers and sisters, who will be there to give me a hand when MS floor loads start looking more like those in LTC? Getting more experience for the educational $$$ and decreasing the $$$ spent in preceptorships for nurses that discover, too late, that this isn't really the job they trained 4yr for seems to be a key.
Another thought. Slots in NS are hard to come by, not enough nurse educators. If we ladder the programs and have some exit at the different levels we might conserve slots for the advanced levels and create more openings.
Haven't read all 11 pages of replies but I have always felt there wasn't enough clinical instruction in the BSN program. My solution was to work in a clincial department during the summers of my junior and senior year. I ended up providing some lectures during my senior year as none of my instructors had ICU experience and wanted to present some of the machinery we use to monitor patients etc. It was because of that experience that I was able to go straight in as soon as I had my board results. I've always encouraged nursing students that I've met to work in a hospital setting during their summers off of school instead of retail or lifeguarding. You learn much more from the real life experiences and the nurses you work with than in those few hours of clinical during the semester. I wish they would make it mandatory.
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nursemaa
259 Posts
Now I like the sound of that! The externeships that many schools of nursing require are an excellent experience for students- they work with a preceptor (for pay) to learn how to "put it all together" in the hospital environment. Our hospital is beginning a nurse residency program for new grads that lasts 12 weeks- lots of clinical, lots of time to meet with experienced nurses to talk about the adjustment, problems, ask questions, and learn. I think residency and externeship is definitely the way to go. The biggest challenge for new grads seems to be organizational skills, and how to put together all the knowledge they have so that they can be competent in the fast-paced hospital environment.
Technical skills (IV's, catheters, dressings) are not what makes a good nurse- those skills will come with experience. It's the critical thinking and being able to organize, prioritize, and individualize care that helps you survive.