Dialogue  

Frankly, I wonder if we are artificially inflating requirements for nursing, or whether the prerequisite load required in most ADN programs should be reconsidered and the ADN programs be made into BS programs.

The outstanding facts are these:
ADN is the current entry level degree and AD nurses demonstrate safe practice in all areas of RN activity.
NCLEX-RN pass rates for ADN grads are at LEAST equivalent to BSN rates nationwide.

I think it is important that nursing avoid the situation medicine finds itself in, with physicians who are frankly overqualified to provide primary care. This has been a boon to advanced practice nursing, as it has opened up a very nice niche for NPs, but do we really want to emulate that in basic nursing practice, with nurses who are overqualified to provide basic care, creating a niche for 'care technicians'?

Reflection on: Academic/Professional Progression
in Nursing
Submitted by: Cynthia Archer-Gift, PhD, Ed. Sp.C; RN
Date Submitted: October 29, 2007

Thank you for setting the tone for this very important conversation, it is long overdue. I firmly believe that it is critical that we as a profession should have one entry into practice (BSN) that is recognized by all state boards of nursing in this country, and by employers in our various communities. It is for the common good of communities we serve and to the benefit of health care organizations - both public and private- to form partnerships with nursing academic institutions in support of educational funds and flexibility with employee scheduling to make it possible. I am in agreement with all of your recommendations as stated. We as a profession, cannot afford the luxury of waiting or continuning this debate. One thought that I have is that in order to inspire the spirit and desire for life-long learning with our graduates, those of us who serve as mentors may need to make a commitment do so as "life-long" mentors. Since many of our graduates may have challenging situations that may impact on their desire to continue with formal learning.

Reflection on: Academic/Professional Progression
in Nursing
Submitted by: Pat Recek, MSN, RN
Date Submitted: October 26, 2007

The NLN prides itself for being the national voice of all nurse educators; however, in these dialogues there is no mention of the PN/VN and their progression through the profession. I would look like to see more LVN to BSN programs that would give credit for previous education/work experience and be offered in a variety of formats to increase the accessibility for students. Encouraging and providing avenues for the LVN/LPN to obtain a BSN will also increase the diversity of the nursing workforce because this group of students very often more closely reflects the diversity of the community in which they work.

The NLN responds...

Several years back Dr. Malone coordinated the Teagle LPN to BSN study that involved six states. It found that LPNs who chose to go back and get their BSNs were highly successful. Creative ways of providing the education had to be developed including the use of portfolios and meeting clinical placement requirements within one's own institution but on a different unit. These nurse-students were also paid for their work.

The NLN will address the LPN academic progression issue in a future Reflection & Dialogue. Thank you for your comments and support.

Reflection on: Academic/Professional Progression
in Nursing
Submitted by: Yvonne Cales, BSN
Date Submitted: October 25, 2007

I have thought about this issue because I am living it. I don't think that forcing nurses to get degrees is necessary. I do however feel that nurses need to advance the profession, stay current and contribute. In the educational and employment forums, I think that evidence based practice and how to be empowered should be emphasized. I think that current topics need to be presented, internet searches requested of the staff and students and to use journals. If the agreed upon goal is ultimately to provide safe patient care, then a degree is not necessary. What is necessary is that the nurses are empowered to contribute and to be change agents in their facilities and to take their positions as patient advocates high up the priority ladder.

Reflection on: Academic/Professional Progression
in Nursing
Submitted by: Pat Dunn, PhD, RNC
Date Submitted: October 25, 2007

I teach in a BSN program. During clinical experiences in hospitals the AD and diploma RNs frequently express friction, conflict, and antagonism toward the BSN students. This dissension bewilders the students as they simply so not understand why anyone would resent someone working toward a BSN degree. If the proposed legislation is passed, that is for RNs who graduated from diploma or associate degree programs to obtain a baccalaureate degree in nursing within 10 years of initial licensure, perhaps some of the disunity and fragmentation, both within the nursing profession and between nursing and other professions, will decrease. This act would also position current younger nurses to advance their education as they may consider entering RN to MSN or RN to PhD programs. This could have a positive impact on the current nursing faculty shortage by increasing the number of nurses qualified for a teaching role.

Reflection on: Academic/Professional Progression
in Nursing
Submitted by: Linda Tieman, BSN MN FACHE
Date Submitted: October 25, 2007

Until we create the belief system that we are a profession and not a trade, that what nurses' work is demands synthesis of information, critical decision-making, and leadership at all levels, this debate will continue and sap our resolve and resources. When we study what other healthcare professions have done, we can learn about managin major change. When I graduated in 1969 from a BSN program I dealt with the "who do you think you are..." but that dissipated quickly when I bacame a real colleague of those nurse. For me, having a liberal education was crucial, even then. Being exposed to broad ideas and thinking enriches every person, particularly the recipient of our service, nursing care.

Reflection on: Academic/Professional Progression
in Nursing
Submitted by: Mary Walker, MSN, RN, CCRN, CCNS
Date Submitted: October 24, 2007

I originally went to an associate degree program. The main reason was that I knew I wanted to be an RN and my parents did not have the ability to pay for a 4 year degree. I knew all along that I wanted to continue my education. The problem I had was trying to get into a 4 year school. With a husband in the military I found myself getting a bunch of credits that were not necessay if all the schools would just come up with a common core of knowledge. Nursing education needs to be accessible to the masses. We need to stress the importance of a BSN early on during the high school years. Counselors need to be more knwledgeable about the admission process and assist studnets with thier applications. In the late 60's when I graduated from high school I received no guidance from the counselors. I had no clue about scholarships. I thought it was up to me to get an education. If I had been given direction in high school and appropriate assistance I would have gone straight for a BSN. It took me many years to get my BSN and along the way I obtained another associate degree and a bachelors degree. Once I obtained my BSN I went on to graduate school. I am proud to be a RN.

Reflection on: Academic/Professional Progression
in Nursing
Submitted by: Sandra L. Jamison, DNS, RN
Date Submitted: October 23, 2007

I am deeply concerned about the nursing shortage but in contrast to others, do not believe that it is the responsibility of the nursing profession to sell out to the business world and graduate/provide nurses who cannot represent the interests of the patient to the remainder of the health care team because of lacking the very minimum of a college degree. No other health professional has less than a bachelors and most hold a masters. Why? Because the complexities of health care today require a broad education, not just a set of skills and mastery of a particular set of knowledge which can be measured on a multiple choice test.

It is natural that AD nurses are the predominant bedside caregivers because they graduate in much larger numbers. Hospitals generally prefer them because they are less independent and fit into the system. The question is, what does this mean for the quality of the care the patient receives. Early research has demonstrated that level of education relates to outcomes of care. More will need to be done to validate this.

In the interim, it is critical that baccalaureate level nursing become more accessible to non-traditional students! It is imperative that there be financial support, flexibility in scheduling, social supports etc. to make attaining a BSN feasible. Secondly there must be plan for seamless articulation from AD education to BS for those who cannot start their nursing careers as professional nurses.

I don't know if the nursing profession has the internal strength, unity and resolve to respond the health care needs of the public rather than capitulating to the business of health care. Right now it does not look as if we do but I continue to hope and support those pressuring for one level of entry to practice.

Reflection on: Academic/Professional Progression
in Nursing
Submitted by: Maureen Wallace EdD, RN
Date Submitted: October 22, 2007

As an associate degree educator in NY state, I strongly support this creative initiative to advance the entire profession of nursing.

Finally, a solution to a debate that has been raging since I entered the profession, some 40 years ago. This solution values all graduates, acknowledges the diverse pathways that students must use to attain their dream, yet sets the ultimate goal at a level that will advance the entire profession

Reflection on: Academic/Professional Progression
in Nursing
Submitted by: Victoria E. Graham, MSN, RN
Date Submitted: October 19, 2007

Just an impulsive thought about the recent NLN Reflection and dialogue:
We must take care to avail those furthering their education to grants and monies available, and to ensure that our professional call for education is necessary to reflect the needs of our patients and communities and not to enhance university coffers.

I am looking into doctoral programs, and the $800 per credit is frightening, upon first glance.

Reflection on: Academic/Professional Progression
in Nursing
Submitted by: Roselyn Tomasulo, MSN, RN
Date Submitted: October 16, 2007

Regarding this issue of life long learning and progression in our profession, there has been much debate over the last 30 years as I have been in practice and as noted in the reflection. We continue to undermine our profession and our mission as caregivers with these debates.

State proposals, mandates are one way of dealing with the issue however, I do not feel that it will necessarily address our workforce needs, which is imperative at this time.

As an educator in practice and academia, I have seen fewer and fewer advanced degree nurses, namely BSN and certainly not MSN, at the bedside. My concern is with this and this alone. Associate, diploma and licensed practical nurses are a majority of the nurses rendering care. They are the workforce. The threatened nursing shortage is here and excluding this part of the discussion is a major oversight and detriment to our profession.

As a BSN entry-level nurse I had the opportunity to attend a competitive affordable institution, with financial assistance through a state scholarship. This was invaluable.

Now we need to focus on not only the ease of obtaining an advanced degree but flexibility in obtaining this degree through allowances for family, work etc. Our "nontraditional" students as we have named them are in the majority and are becoming customary or "traditional". In addition, the focus should be the importance of the nurse at the bedside, caring for the client who needs us and who has become more complex.

Continuing formal education into nursing practice should be rewarded with sensitivity to the workforce as parents, caretakers for elderly parents, etc. Incentives such as financial, flexible scheduling and otherwise are important to our profession in the academic world as well as in nursing practice. Seamless transition to advanced practice is important, as is the focus of education to be in caring for the client. That will portray true leadership in our profession.

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