Nursing education: How much is enough?

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My confession: I am a two-year Associate Degree RN who resisted going back to school for a BSN for 30 years. Oh, I picked and piddled with it a few times, but never went all the way. That is, until four knee surgeries in four years put me “on the bench,” unable to work and needing to do something to avoid losing what was left of my nurse’s mind.

As it happened, the local university now offered an RN to BSN program online, which I could do on a laptop from the comfort of my recliner. Also, I figured this was something that I should do before I died, since both of my children had their degrees. One must set an example for the family, after all!

30 years ago, my getting a BSN would have been quite the exception indeed! In the 1970s nursing education began to change from the two-year associate degree and three-year hospital diploma programs to the four-year bachelor’s degree as the “entry into practice” level of preparation for RN licensure.

It is important to recall that the three-year diploma programs had long been the “traditional” nursing schools and the two-year programs were developed as part of the Cadet Nurse Corps, designed to meet the wartime need for nurses at home and in the military during WWII. (Yes, I AM also a dedicated history buff!)

Instructors usually held a Master’s degree as the highest level of nursing education at the time. A BSN nurse working a hospital floor was rare indeed. There were no doctoral programs in nursing. Educators who attained a doctorate usually did so in education.

(Oh yes: We had a nursing shortage back then also. But nobody seemed too concerned about what would happen when we, the lowly 2 and 3 year program graduates, retired!)

In an attempt to cope with the diminishing number of  primary care physicians, particularly in rural areas, we saw the advent of the Advanced Practice Registered Nurse (APRN) with a Master’s degree required for entry into practice at that level.

Until recently. Now the APRNs are being required to go back to school for a Doctor of Nursing Practice degree so they can continue, in many cases, to do the same work they are doing now. And, in many cases, take on a large student loan debt to pay for the extra degree-starting around $20,000 or so at an in-state school–at a time when many are approaching retirement in 5-10 years!

This begs the question: Why not just go a bit further and become an MD instead of a nurse in the first place?

We live in a time when knowledge is exploding, technology is adding complexity to our work, and there are more opportunities to work in more settings than we’ve ever known in the history of nursing. Many organizations are expecting more highly-educated nurses (younger and cheaper, of course!). The public also wants nurses to be more knowledgeable and more adept. This is part of the reality of modern healthcare.

Perhaps. But the public ALSO demands enough capable and caring bedside nurses so they don’t have to worry about being cared for when they must go to the hospital. After all, people don’t go to a hospital to see a doctor–they go because they need nursing and therapy, which require a higher level of care than they can get at home. And many times the nursing and therapy follows them home after the hospitalization.

Will nursing improve with more “alphabet soup” behind an RN designation? Or is the requirement of yet another degree merely part of the ongoing effort to make nursing “respectable” as a real profession?

I continue to support the kind of training we received in the ‘short’ programs. We learned that Principles Guide Actions (the motto of my two-year program) and that not everyone is cut out to be a nurse. It was and still is extremely hard work and only the fittest will survive. I don’t believe we are doing a kindness to allow someone to continue in the programs who is not willing to do what is required at the bedside. Nor do I believe that any nurse, no matter their level of education, should ask someone else to do what they themselves are not willing to do.

The challenge is how to incorporate what we referred to as training into the four-year BSN programs for initial RN licensure. Somewhere there must be a common ground.

The epilogue? I finally finished the BSN in May 2010 and walked (with a cane, of course, so as not to fall down on the stage–safety first, after all!) at graduation.

In youth we learn; in age we understand (Marie von Ebner-Achenbach, Austrian novelist).

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