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What makes a good nurse?

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Recently there was a very interesting conversation on Twitter during the weekly RNChat : Twitter Chat June 2, 2011 9pm EST

I won’t go into the details about the specifics of RNChat, I think I’ve covered them before. I highly suggest attending one if you’re interested in learning more the nursing profession and the challenges we face, or would like to chat with Nurses on Twitter who have a passion for their profession.

So this question was posed: Nursing Education: What legacies in Nursing Ed need to be ditched and what ought to replace them?

The conversation bounced around many themes for this topic. Everything from standardization of education requirements, standardization of CEU requirements across the nation, incorporation of the internet, informatics and many others.

As this topic progressed the pulse of the conversation seemed to change gears a bit. All of sudden it was about the age old question in nursing BSN vs. ADN.

This debate sparked other opinionated question like:

  • Is one better than the other and why?
  • Should BSN be the basic requirement for an entry-level RN?
  • ADN nurses have better prepared than BSN?
  • ADN nurses get more experience at the bedside during their schooling, so they are better prepared for the bedside as new grads?
  • BSN nurses have better critical thinking skills?
  • Should employers require nurses to get their BSN?
  • Who’s going to pay for it?
  • Are ADN nurse being shuffled through their schooling too fast just to meet the needs of the nursing shortage?

The conversation sort of hopped all around for quite a bit. Through it all I noticed that individuals were actually taking sides. We were getting territorial – even in cyberspace about this topic!

It seems the ADN nurses were taking the defensive stance on being a good nurse even without the auspicious bachelor’s degree. While the BSN nurses were of course promoting the advancement.

I gave you that very long intro to ask a simple question. What makes a good nurse?

Is it their degree? Is it their school of nursing where they got their entry-level education? Do ADN nurses make better nurses due to increased clinical time during their entry-level education?

I don’t know about you, but initials after someone’s name never made them ‘GOOD’ at what they do. I have met some of the most educated and highly trained individuals who make the worst clinicians. While some of the best nurses still only have their diploma.

What really makes a good nurse?

Is it a fine combination of skills, education, time in grade, compassion, humility, caring attitude, and that can-do attitude?

I think the answer to this question is so complex and so fragmented that we probably will never know the real answer. And the fact that we cannot answer this question in simple terms makes our profession all the more suspect.

I know I’m running circles around this concept but let’s think about in terms of advancement of our profession. Is advancing our education the answer to increasing the quality of our care?

We could sit here and argue about Evidence Based Practice and accepted norms, but in the end we as nurse are required to constantly ask the question, ‘Why’. We do it every day in our practice, regardless of work setting. So we ought to ask the same question about what makes a good nurse, because in the end don’t we reap what we sow?

My apologies for skyrocketing off on a tangent about this topic, I just find it mind-boggling and fascinating that we still can’t come to an agreed collaborative answer.

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20 Responses to What makes a good nurse?

  1. August

    I’m personally not a big fan that anybody is even discussing this! It’s pointless and leaves us all thinking we are better than one another! That isn’t the case by any means!! I am an LPN with over 4 years experience as a nurse on a vent/complex respiratory unit and personally can run circles around the RN’s that attempt to work my unit!! Every nurse whether it be LPN, ADN, BSN, MSN,etc. has their ” forte” so to speak! The fact that you have more education does not make you a better nurse, it just means you went to school longer than the person you’re having the discussion with!!

    • Kim

      I have been an ADN-RN for 16 years and have worked with many different levels of nurses. I would have to say I have worked with some LPN’s that I would say have much better skills than some RN’s. Also I worked at a teaching University Hospital and most of the BSN RN’s that were new to the field had never even had the opportunity to start an IV and did not have good clinical skills at all! I know as an ADN RN we could not graduate until we passed every clinical check off in lab as well as on patients with our Clinical Instructor standing over us!!! I just feel like it all depends on where you go to school and what your current situation is when you enter Nursing School as to whether you may be a single mom and can’t go 4 years at the time or you may not have the money to go!!! Most of your experience comes from working in the field anyway so I just don’t see the big issue here! I only have two classes to have my BSN and I just don’t want to go back to school at this time! I may at another time but just can’t right now! If I do go back I will go from ADN to Master’s anyway so I really don’t see the point in a BSN!!! Just my opinion as everyone has their own. I feel like as long as the patients are taken care of safely that is really all that matters!!!

  2. Christie

    My opinion on this subject is just this.There are jobs for all degrees of nursing and it doesn’t matter if you are an RN with an ADN,BSN,MSN or an LPN, what matters most is that you truely love your job and are good at it. I myself am an LPN who has worked for 6 years in long term care. More than once I have been asked by others WHEN I was going back to school (when not if). Well as of right now I don’t see myself going back to school. I am perfectly content where I am right now, at this education level. The world of nursing is geared to believe that if you’re not an RN then you’re not really a nurse, then if you’re an ADN then you’re not finished with school and so on. Well I say, If you are happy where you are then stay there, if you desire to advance, then do that, but in the mean-time be happy for and appreciate each other and our different roles in nursing. We are all needed, there are jobs to be filled at all degrees and this includes CNA’s.

  3. Sean Dent Scrubs Blogger

    @August this was never about who was ‘better’, I’m referring to the quality of care. And your reaction is why this conversation needs to continue. Your feedback is greatly appreciated.

  4. kathy

    I remember this being a topic heated discussion back in the ’70s . Having started as an LVN, I went back to school and obtained my ADN. Now at the ripe old age of 56, I have gone back to school to get my BSN. Each phase of nursing has its merits, and I know that there are gifted and not so gifted nurses at each one of these levels. Some some nurses are better at some types of nursing than others. It is all really a matter of perspective and we all enrich the field of nursing regardless of our educational status.

  5. Sean Dent Scrubs Blogger

    @Christie well said. I think you hit the nail on the head with being content in your current level/position/job. Thanks for the comment!
    @Kathy ” It is all really a matter of perspective and we all enrich the field of nursing regardless of our educational status” – absolutely perfect statement. Thank you.

  6. Rakhel

    I remember when I first started in nursing, I am an ADN and there were 3 other new nurses starting at the same time as me, all BSN’s. My preceptor was shocked at how much I knew and how confident I was with patients. I work in postpartum and my 3 new co-workers hadn’t even taken an OB course!

  7. Sean Dent Scrubs Blogger

    @Rakhel Thanks for sharing! And congrats!

  8. Terra

    I have not been a nurse long but know being an LPN has allowed me to be at the bedside doing patient cares…I dont know where else I would want to be. Someday I may perhaps go back since my ultimate goal is Occupational Health, but I find I am really liking what I do at the LPN level. Agree with many that most can get through school but only a select few make great nurses and the short time I have been doing it has really turned me off to the type of ugly people I have met along the way. I had a vision in my head of the kind of person a nurse was suppose to be like and I am just not finding that vision in people. I hope we can just get to a point where we can work on being good nurses and providing excellent care to the people that require our services instead of bickering over what initials behind our names makes us. I would hope someday the words “team” and “collaborative” really do mean something in the workplace instead of just saying it exists to appeal to those around us. A “good” nurse know’s the meaning of these words.

  9. dawn sulley

    I agree…LPN, RN, BSN…..it’s the informaton that the nurse is willing and eagerly to absorb and apply it…Nursing is common sense…all the textbooks in the world are not going to completely make you a good nurse. Nursing is about caring, and if you dont’ care…you aren’t going to learn the advancements in your job. I, a RN, have seen another RN sit at a desk, after her report of patients, while HER patient for thatshift, was beign bagged by RT to increase the stat’s above 50%….the patient was a new trach to vent!!! Her excuse….I am new!!! OMG!!! I don’t think the patient gives a crap….I stayed 45 minutes past my shift along with 2 other LPN”S!!!!! and made sure the patient was admitted safely…or the doctor at the VA in Nebraksa that kept throwig away the sperometers because he kept telling the patient to blow into it and it wasn’t working, so he threw them away…he caught me to get him another one, after I saw 3 in the garbage!!! So, maybe the examples of all levels of stupidity need to be brought to a nation wide live broadcast and then people realize that it doens’t matter if you are lpn, rn, bsn, from the school…it’s the years of experience, hard work, TAKING NOTES….that make a good nurse or anyone in the medical profession!! There is stupid in every profession and most of it is because the person is in it for the wrong reasons, money….not compassion for human kind….God knows the difference!!

  10. dawn sulley

    School prepares anyone with the basics….it’s the life’s experiences on the job that truly concrete the abiitities of a nurse. Don’t compete with eachother, that;s that business world’s people’s addition to the kind of life they just aren’t happy with!! I work registery for that exact reason….I just want to do my job, I LOVE and DO WELL, and don’t want the politics that the office staff always seems to drag on to the floor…I don’t care about the stupidity of their obsession to compete…the patient’s life isn’t a game….you think about that….that nurse may be yours someday.

  11. Monique

    I love helping people so much and through Gods blessings I was able to become a nurse.I truly dont understand why we need titles in the first place. Caring,compassion,dignity/respect for human life and love of your God given gift-that’s a TRUE NURSE.If you are in it for the paycheck GET OUT-someone’s life depends on a TRUE NURSE! God bless all who serve.

  12. Sean Dent Scrubs Blogger

    Whew! This was my first chance getting back to this post. I’m so very glad everyone felt so passionate about this topic.
    This was the point of my post, to spark the conversation.Thank you all for your input and your stories! Awesome stuff.

  13. Hi..
    It is really hard to say which one is better than the other one.Both the degrees are of equal importance.It depends mainly upon the person who is doing it.BSN or ADN.

  14. Sean Dent Scrubs Blogger

    @LPN BSN Very good point!

  15. cherie ann rojek

    I AM A LPN FOR 18 YEARS AND I AM CERTIFIED IN PEDS,GERIATRICS,ADULT,FAMILY,OB-GYN,ACUTE,EMERGENCY CARE. I HAVE LEARNED ALONG THE WAY OF MY CAREER. I WENT TO THE SCHOOL OF HARD KNOCKS & REALITY. I AM A AWSOME NURSE ,I ALSO HELD ADMINSTRATION POSITIONS & WORKED WIT THE GOVERNMENT ALSO. WOW ALL THIS AND I AM A PROUD LPN AND I CAN GUARENTEE I SURLEY CAN RUN CIRCES AROUND RNS & I HAVE HAD TO TEACH RNS ON HOW TO DO A TASK THAT THEY SHOULD HAVE KNOWN HOW TO DO IN SCHOOL!! I HAVE ALSO HAD A RN SUPERVISOR WHO DID NOT KNOW HOW TO USE A MED -CART OR COUNT OUT NARCOTICS!! WOW SCHOOLING APPLIES ONLY TO GAIN A TITLE!!! YOU HAVE TO MAKE YOURSELF WHAT YOU WANT & ACHEIVE IN THE FIELD OF NURSING !! I REMEBER WHEN THEY WERE TALKING OF GRANDFATHERING LPNS TO RNS .WHAT EVER HAPPENED TO THAT?? I SURE SEE IT COMING SOON!!

    • skeeter RN

      As an RN I have been shown/learned many things from LPNs, at the same time I have taught them things, thats called supporting each other regardless of our degree or title. It doesnt nullify the need for further education. There are many things that are not taught in nursing school, but there are vital things that are. We learn a lot from experience as we spend time in this field. I dont forsee “grandfathering” LPNs to RNs as realistic but there are some great programs that give credits to LPNs for their education and experience when they decide to go on for their RN. I spent many years as an LPN then went back to school for my ADN so your comments are insulting to me, I didnt wait to be “grandfathered” in, I didnt presume to “be better than an RN”. I worked very hard to become what I wanted, and I respect all those who have.

  16. Sean Dent Scrubs Blogger

    @cherie I tend to believe ‘schooling’ is more than just a title in far too many aspects. You are right: we do make it what we want. Thank you for your feedback.

  17. skeeter RN

    It really seems like a simple answer to me. What makes a good nurse is a combination of skills and caring. You can graduate at the top of your class and have all the knowledge in the world, but if you truly dont have empathy and “care” for the patient you wont be a good nurse. On the other hand you can care very deeply for a patient and not have good nursing skills, then you are still not a good nurse. I was an LPN for 12 years, and very happy to be an LPN, then decided I wanted more so went back and became an ADN which I have been for 23 years. I have extreme respect for LPN, BSN, MSN, etc as long as they have the skills and truly care about the patients. There is much to be said for furthering your education, and those of you who are critical of other nurses for doing it need to rethink your arguments. Personally, I am content with my current status, love my job, and have found “my place” in nursing. I have worked with some awesome LPNs, BSNs, MSNs, and FNPs. Ive also worked with some terrible ones. That is how I reached my conclusion–You can teach skills but you cant teach someone to care, that has to come from the inside”.

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