Dialogue Reflection on: Academic/Professional Progression in Nursing

Dialogue

I am currently on faculty in an RN Diploma program in Arkansas. My initial education was a BSN. I do believe there is value to be gained in continued academic education for RNs with AD and Diplomas but I am not so convinced that forced attainment of a BSN is the best course of action. Our hospital offers continuing education reimbursement but it falls short of the cost for most university tuition/fees. The area where I work and teach is poor and rural. While many of our graduates do go on to earn a BSN it is not possible for all. What will happen to those RNs who cannot attain the BSN after the proposed 10 years?

Applying the principles of diversity awareness and cultural competence to the nursing profession as a unique vocation/profession-based community and culture will provide the most comprehensive and inclusive solutions to this challenge and opportunity of academic/professional progress in nursing. There are significant socioeconomic biases and prejudices in requiring the BSN for entry into the practice of nursing as a healthcare profession. Establishing quality education and mobility programs throughout the nursing education and practice continuum from nursing assistant to the Doctorate of Nursing Practice will overcome these biases and prejudices. Certainly, nursing is one of the healthcare professions, but it has an unparalleled yet often contingent history and role in comparison to all other healthcare professions. There is room and need for all nursing education programs in a wide variety of settings: programs for nursing assistants, licensed practical/vocational nurses, and registered nurses. These settings include high schools, trade schools, non-university tertiary colleges and programs including hospital-based and nursing home-based programs, community colleges, and universities. What may be most crucial at this time, given the growing population of elderly, economic constraints, and consumer awareness is focusing on the education and required licensure/title protection including mandatory continuing education for relicensure through state boards of nursing of nursing assistants since nursing assistants provide the basic nursing care that is, more often than not, the foundation for the successful implementation of more advanced nursing care. For example, without basic hygiene, other infection prevention efforts related to surgical sites, invasive lines, and indwelling foley catheters are relatively useless.

Requiring the licensure of nursing assistants makes all nursing assistants, licensed practical/vocational nurses, and registered nurses accountable to their respective state boards of nursing, regardless of academic degree/degrees. Licensure also solves the title problem: licensed nursing assistant(LNA), licensed paractical/vocational nurse (LPN/LVN), and licensed registered nurse(LRN).

Thank you for this forum.

My original degree was an ASN in 1971. It took me a long time to get my BSN because my husband was in the military and everywhere we moved there was a differnent set of requirements. Thank goodness there was Excelsior (Regents when I went) because they worked with me and provided the opportunities I needed to get a degree. We need to have some kind of standard that will help students to progress. We need to be mentors and coaches to both the Associate and the Bachelor prepared nurse and provide opportunities for them to continue their education. We have to lead the way or else we are going to fall short.

From day 1 in school we need to ensure that the courses that are taken are transferrable to other institutions. Hospitals need to provide time off for employees to go to school. The time they give back is so valuable. Hospitals could form some type of alliance with the local universities and help with providing clinical sites and preceptorships so students can get their clinical hours completed. Hospitals can help universities by joining them in creating Dedicated Education Units. For the concept of everyone having a BSN and beyond it is going to take the work of the communities in partnership and the support of the state boards and legislature.

It looks to me like the main ones who want the minumum requirement to be BSN are the ones who have chosen to go for higher degrees. RN is RN is RN in my opinion. How many BSN and MSN nurses do we see at the bedside for long periods of time. Not many. The RN who wants to get out of bedside nursing is the one who goes after the advanced degree. Why should a BSN be a requirement, then? Who is going to help those nurses pay for their education? Not everyone gets free money for school from the government.

My original degree was an ASN in 1971. It took me a long time to get my BSN because my husband was in the military and everywhere we moved there was a differnent set of requirements. Thank goodness there was Excelsior (Regents when I went) because they worked with me and provided the opportunities I needed to get a degree. We need to have some kind of standard that will help students to progress. We need to be mentors and coaches to both the Associate and the Bachelor prepared nurse and provide opportunities for them to continue their education. We have to lead the way or else we are going to fall short.

From day 1 in school we need to ensure that the courses that are taken are transferrable to other institutions. Hospitals need to provide time off for employees to go to school. The time they give back is so valuable. Hospitals could form some type of alliance with the local universities and help with providing clinical sites and preceptorships so students can get their clinical hours completed. Hospitals can help universities by joining them in creating Dedicated Education Units. For the concept of everyone having a BSN and beyond it is going to take the work of the communities in partnership and the support of the state boards and legislature.

So glad to see us moving toward progressive licensing- I believe it essential for nursing safe practice . . . I still dont see how someone can get a "MSN" in a short time period without prior nursing experience and still see upper level entry without experience of "Novice to Expert" as a concern professionally that causes confusion about who is the expert and who is a novice.

The discussion of academic and professional progression in nursing is a healthy discussion. Considering patient care and safety, this discussion should continue. Any of the participants in this dialogue are aware of the Institute of Medicine publications regarding patient safety, the efforts of the National Patient Safety Goals, and recommendations from the Pew Health Professions Commission. With the transformation of public health care, exponential growth in technology, and burgeoning advances in nursing theory and practice, how could any thinking person not realize the need for advancing the profession academically including entry level education? Would not our patients benefit?

I am sure NLN is aware of the challenges of a nurse educator. For me, this is foreign soil that I was excited to embark upon. As a nurse of 25 years, and before retirement I wanted to give back to my profession. I am a recent graduate(Dec. 2009) I began exploring my options at universities and community colleges to begin as a novice nurse educator. In my quest to find the right fit, I have asked general questions of seasoned nurse educators here and there. Those with MSNs, and PhDs working in various educational settings.

The more I ask questions, the more disenchanted I have become. In part, and depending on who you ask; the more experienced they have, I got a feeling of "jumping out of the frying pan into the oven." Im sure their comments are based on various situations. Some of their examples like the unknown of the "fine print" on contracts or too much workload in ADN programs is making me question what is really happening on this side of the profession. Is unity only a dream? Is their not room enough for everyone interested in the nursing profession to serve? Is the entry into the profession really an issue? or are we making it an issue?

During my graduate studies my textbooks and professors were inviting and encouraging citing this is the right choice to advance the profession and share expertise. However, Im feeling "eaten" before I start. I recently wrote an article on my feelings... Mentors Do Not Eat their Young. They may not intend to, but... comments like ADN degrees are questionable could discourage someone from returning to school for advance education. I wonder if we can "just get alone" and support the hard work and efforts of everyone. We have many examples of individual who have risen to places un-heard of in years past. Some of them started in 2 year programs.

I would challenge those of us who want to see our sacred profession respected, that we respect the decisions of all stakeholders. Embracing our students and colleagues in their chosen arena should be our position.

Reflection on: Academic/Professional Progression
in Nursing
Submitted by: Lise Turner, RN, MSN
Date Submitted: June 30, 2010

Nursing is the least educated healthcare provider at the bedside. Physical therapy, occupational therapy, speech therapy and nutrition require more minimum education from their graduates than does nursing. Nursing is considered by many in the healthcare arena to be a "blue collar" job rather than a profession.

In the community there is still misunderstanding of what it takes to "get your RN". If we want to attract the brightest students/people we need to establish a baseline entry point. All other healthcare providers have done this and maintained their unity. To be a profession we need a college educated graduates. If we want to keep ADN and Diploma programs then go the way of physical therapy that has the professional and the assistant. Right now there is no incentive to get anything more than an ADN except personal satisfaction and growth.I am still waiting since the 1965 Social Policy Statement stated that the BSN would be the entry level education for Nursing. When is Nursing going to be in charge of OUR profession and not the community colleges, the nursing shortage, hospital administrators, etc!!!

Reflection on: Academic/Professional Progression
in Nursing
Submitted by: Peg Erdman, RN, MSN, CNE
Date Submitted: June 30, 2010

This is another debate that continues in nursing without resolution. This ongoing discussion tends to fracture, not unify, this profession. I came in to this profession through our local community college doors. First as an LPN, then ADN/RN, then on to a BSN program, then on to an MSN program, and will graduate with my EdD next spring. If the community college route had not been available to me, I know I would not be an RN today.

Any discussion that devalues the work and talent brought to this profession by ADN graduates is counterproductive and divisive. 61% of our current RN workforce began their careers as ADN graduates. We cannot provide the care needed without this valuable resource.

One of the previous comments mentioned the lack of BSN and MSN graduates that actually provide bedside nursing care. Think what will happen if our LPN and ADN caregivers are gone.

There is room in our profession for all of us. We need to value each member of this wonderful profession, and create a welcoming, mentoring environment that offers incentives and benefits for advancing education.

Reflection on: Academic/Professional Progression
in Nursing
Submitted by: Deb Boyer, MSN/Ed.,RN
Date Submitted: June 30, 2010

I have read the pros and cons of more advanced prepared nurses in today’s workforce and while I agree with some issues, I must respectfully disagree with other issues. For example, I do not think it is feasible to require all current bedside nurses to be baccalaureate trained. We have many talented nurses with the RN degree. The nursing shortage is too great to put our patients at risk by eliminating RN beside positions so we must grandfather current RNs. I applaud the effort to require continuing education for license renewal. Obtaining an RN license does not excuse the nurse from his/her responsibility to keep current. New diploma nurses and associate degree nurses are great stepping stones into the profession, but I believe these nurses now need to advance to the baccalaureate level to practice as future bedside entry level nurses to benefit the profession, and keep nursing on the same level as other professions. I was a diploma nurse for years so I feel I have earned the right to voice my opinion on this controversial topic.One of the reflections in the discussion was how to hold the profession of nursing accountable. I believe this can be achieved by getting nurses involved in their communities, in higher education, in politics and policy making, and in developing curriculum that meets the needs of today’s patients and families. I do not believe that nursing curriculum should follow one particular road-map. Programs throughout the country must be developed so they are consistent with the needs of their surrounding communities and the cultures that make up those communities. Respect and understanding of cultural diversity is an absolute must. If all curriculum were the same, the profession would become stagnant. There would be no new ideas and no progression into the future. I received my BSN and MSN/Ed degree from online programs and I have a great respect for the curriculum development in these programs, and how the faculty strives to meet the needs of the diverse student population. To be accountable to my profession, I plan to continue my education and be more active in my profession.

Reflection on: Academic/Professional Progression
in Nursing
Submitted by: Shirley Bass, MSN, APRN-BC, FNP/PNP, NE, RN
Date Submitted: November 11, 2008

Thanks for your response to incorrect information; I embrace the issue of progression and multiple entry levels.TSU Title III-funded Weekend/Evening Nursing Program has several entry levels: CNT-AAS/RN, LPN-AAS/RN, and LPN-BSN/RN. I see this as a method to address the nursing shortage.

Reflection on: Academic/Professional Progression
in Nursing
Submitted by: Dolores Minchhoff, RN, MS, FNP-BC
Date Submitted: November 11, 2008

I am excited at the prospect of the proposal to require all new graduates to have BSN within 10 years of graduation. I feel this is a move in the right direction for the nurse, the profession of nursing, and the consumer. Is there any happening with this concept at the national or state level?

Reflection on: Academic/Professional Progression
in Nursing
Submitted by: Sandra Baker, DNP,RN,CNE
Date Submitted: November 11, 2008

I commend Dr. Malone for setting the record straight re:the NLNs position on Academic Progression in Nursing.Her inclusive leadership style is much appreciated by those of us in Vocational and Associate Degree Nursing Education. We are all stronger when we work together, rather than against, one another. The dialogue needs to focus on the development of seamless pathways so all PN and ADN grads can easily obtain baccalaureate and higher degrees without repetition of content already learned in their lower division nursing courses.

Reflection on: Academic/Professional Progression
in Nursing
Submitted by: Phyllis L. Rowe, DNP, RN, ANP
Date Submitted: November 10, 2008

What an awesome and inclusive stand the NLN has taken in promoting the principle that there is a place for nurses at all levels of the Nursing Career Ladder! There are so many reasons this is the fair, just, and decent thing to do. It provides for:
1. Individuals who need time to adjust mentally and prepare academically/financially for their climb up the Career Ladder.
2. Congruence with the Nightingale Pledge in which nurses promise equal treatment of all.
3. Flexibility for nurses to meet their life responsibilities while attaining their ongoing nursing education.
4. Every nurse to hold their head high with the knowledge that they are valued for the unique contributions they make.
5. Attracting the best minds and most honorable persons, those who would view the nursing profession as a community of competent practitioners and scholars rather than a group of bickering rivals.
6. The nursing profession to spend its energy and resources growing and enhancing our profession, rather than in the unproductive debate about who or what is the best.

Among all the nursing organizations, many of which perpetuate the unhealthy competition, hierarchy, and exclusion in the nursing profession, the NLN can stand proud in its strong position that encompasses, indeed embraces, the diverse educational preparation within the nursing profession. Thank you for operationalizing the NLN core value of DIVERSITY, by “affirming the uniqueness of and differences among persons, ideas, values, and ethnicities.” Your leadership gives me great hope for the future of our great profession.

Reflection on: Academic/Professional Progression
in Nursing
Submitted by: Ann Killian
Date Submitted: November 10, 2008

As a member of the Idaho State Nursing Articulation Committee (ISNAC) I was gratified to receive word that the NLN is in support of educational programs that support the life long learner. By acknowledging learning that has been achieved whether in a university or a community college or diploma program the State of Idaho has provided direction to ASN, BSN and MSN programs throughout the state. The private universities in the state have also bought into the state articulation plan. This concensus did not happen overnight nor in a closet. It took representatives from all the nursing education programs in the state both public and private years of communicating (ten years) before we trusted each other enough to say, "I believe that you have educated your graduates just as well as we have."None of us who are nurses can say that all the learning needed to take care of people happened in the classroom; much of it happens at the bedside followed up by further personal study. Thanks, NLN for supporting LPN, RN to ASN or BSN-MSN programs that acknowledge previous learning!

Reflection on: Academic/Professional Progression
in Nursing
Submitted by: Barbara Borg, MSN, RN, CNE
Date Submitted: November 7, 2007

I am an associate professor of nursing in a community college in central Illinois and also serve on the board of the National Organization for Associate Degree Nursing. I attended the recent Summit in San Antonio and was very gratified at the many times Dr. Malone and Dr. Tagliareni emphasized NLNs support of the various ways a person may become a registered nurse. NOADN strongly encourages graduates of associate degree nursing programs to continue their nursing education. We also strongly feel that the decision to advance ones education is an individual choice. Thank you for clarifying this for everyone. We appreciate your continuing support of nursing education for all. Thank you again.

Reflection on: Academic/Professional Progression
in Nursing
Submitted by: CJ Ewell, MS, APRN-BC, FNP
Date Submitted: October 30, 2007

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 ones 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 futureReflection & 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 dont 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 reasonwas that I knew I wanted to be an RN and my parents did not have theability to pay for a 4 year degree. I knew all along that I wanted tocontinue my education. The problem I had was trying to get into a 4 yearschool. With a husband in the military I found myself getting a bunchof credits that were not necessay if all the schools would just come upwith a common core of knowledge. Nursing education needs to beaccessible to the masses. We need to stress the importance of a BSNearly on during the high school years. Counselors need to be moreknwledgeable about the admission process and assist studnets with thierapplications. In the late 60s when I graduated from high school Ireceived no guidance from the counselors. I had no clue aboutscholarships. I thought it was up to me to get an education. If I hadbeen given direction in high school and appropriate assistance I wouldhave gone straight for a BSN. It took me many years to get my BSN andalong the way I obtained another associate degree and a bachelorsdegree. Once I obtained my BSN I went on to graduate school. I am proudto 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 dont 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.