Loretta A. Murphy
I have been a nurse since 1976 – 37 years. I graduated from a diploma school program.
This is not a new argument. We were clearly told then – over 3 decades ago – that we would need a BSN to practice as a professional nurse at some point in the future. At the point I graduated, there were 3 levels of entry to professional nurse practice that permitted you to take boards – diploma, associate degree, and bachelor’s degree. There may have even been (at that time – I can’t quite recall anymore) a grandfather clause that allowed LPN’s to take boards.
Anyway, I received a few college level credits through my nursing school – 9 to be exact. Ha. Big deal. I began taking college courses the year I graduated. It took me, working full time and raising a family, until 1992 to finally complete my degree. There were some jobs that didn’t offer college reimbursement at that time, and sometimes I could pay for a course, sometimes not. Sometimes, working shift work or because I was in a management or leadership position, I was simply too busy to fit in a course. I finally put the push on towards the end, went full time and worked part time. I graduated cum laude with a 3.6 cum and immediately started working on my MSN. I obtained my MSN in Community Health as a Clinical Nurse Specialist in 1999 with a 3.8 cum. Let me add that my initial choice for a masters was in psych nursing but the college I was accepted to closed its graduate degree in psych and there were only 2 schools in our state with a psych program, both too far away for me to go to because of my kids.
In 1997, in the middle of my MSN, I made a hard career choice and decided to leave psych and become a certified school nurse (through the state system – I needed to take additional course work to qualify for the certification). At the time I left psych, I was at the top of my field. I had been a director of several mental health programs by then and had pretty much achieved expertise in every facet of psych nursing practice. It was a painful decision but necessary. Following successful completion of my school nurse certification, I then returned to my master’s program. Prior to this, when I worked in psych, I was an ANA Certified Psych Nurse Generalist from 1984 to 2004. I had to eventually give this up when I switched specialties because I no longer had enough hours of clinical practice to maintain it.
To make a long story short, I am an expert in two fields – psych and community health nursing. I worked 25 years in psych and then switched fields – I’m entering my 13th as a certified school nurse.
Do not fool yourselves into thinking this is a competency issue or a practice issue. Do not allow yourselves to get caught up in the I’m a better nurse than you because I have a college degree or I have better clinical skills because I’m an AD nurse. This issue is bigger than all of that. This is about level of entry into professional practice and about the validation of our nursing profession.
Some of you may be too young to realize it, but all the other health professions have a bachelor’s as entry level. Some now have a masters. Physical therapy has moved to a doctorate. I have been around long enough clinically to remember when nurses did it all. OT, MSW, PT, ST, RT, PA’s, etc are all fairly new professions but they have all passed us out in prestige and salary as well as professional reputation in the eyes of the public. Why? Because nursing continues to shoot itself in the foot arguing about entry level of practice. We’re been arguing this battle since way back in the 1950’s. We have allowed the colleges and “nursing leaders” of private organizations like the ANA to dictate to us about our highest levels of nursing and what they “need” to have to get “certified” and licensed as advanced practices nurses while allowing the cornerstone of our practice to erode into a muddy mess of initials that no one in the public understands. Do you know why?
Well, this is my theory and since I’ve been through the education ringer and have the debt to prove it, I’ll tell you. Nurses are a lucrative source of consistent income to colleges, providers of workshops and CEU’s, and to the certification process. It isn’t enough to get a masters in nursing. Oh no, you’ve got to get a masters in a “specialty” in order to become “certified” and unless you’re certified, you can’t sit for the exam. If you can’t sit for the exam, you can’t apply for your state advanced practice license. Then of course, even if you’ve jumped through all those hoops, if you decide to switch specialties, guess what? You’ve got to get another masters or another “certificate” to the tune of thousands of more dollars.
Over kill? You bet.
And yet, this same group of educators and nursing leaders can’t find it within themselves to find a way to come up with a standard for entry level to our profession?
Why? Because it isn’t in the best interest of the colleges or the certification folks or the people who run the continuing education workshops.
Do you know that when a social worker graduates from a master’s program, they graduate with a generic master’s in social work. They then sit for their exam and become licensed. If they switch specialties, guess what? They switch specialties and use their social work skills and professional judgement in supplementing their knowledge base. They do not have to go get another masters in a specific field of social work. The same goes for Occupational Therapy, PT, and ST, and Physician Assistants. Also, be aware of this – in both OT and PT, the professional standards place anyone with a bachelor’s degree as an “assistant”. They must still take licensure exams but they must work under a professional, licensed OT or PT.
Nursing is the only professional occupation that is allowing all of these private interests to dictate to us the scope and direction of our specialty. And colleagues, it is all about money.
Yes, a BSN is a must, if only to stop the madness that all of you are going through trying to predict how and what to do about a degree. All of you should not even be debating this question. It was answered and answered well a long time before most of you even graduated from high school and before some of you were even born.
We need to stop letting nursing be used as a feeder for colleges and private nursing organizations and businesses so they can keep their bank accounts solvent. I am a firm believer in education and expert practice, but in these times of economic struggle, I am absolutely against pressuring nurses to constantly be going to school. It is important we police ourselves and keep our professional skills updated and knowledge base current but it is ludicrous to keep nurses running the maze their entire career.
Do yourselves a favor. First off, begin lobbying for BSN as your entry level. In the long run, all of you will save money and it will go a long way towards your professional stability. It will also insure that nursing will not become a technical field. We cannot allow that to happen, but trust me, it will if we are not careful and begin to chart our own professional course. These are troubled times.
Secondly, speak out against the overspecialization of our most educated nurses. Constantly running to college to get “more” education is just plain not necessary. There are only about 13% of the nurses in the US with an MSN or Doctorate in Nursing. There are about 50% who have BSN’s. Check out these other statistics at http://nursingworld.org/NursingbytheNumbersFactSheet.aspx
These are the “entry” level salaries for the following professions: Social work: 61,957 PT: $76,310 OT: 73,271 Nursing: $50,000 Physicians Assistant:$86,410. See any patterns of interest here?
I don’t want to burst anybody’s bubble, but there are too many people who are NOT nurses making decisions for nurses about what nurses need educationally. There is way too much corporate influence. It’s big business and nurses – or their employers via continuing education benefits – have the capital. Until we take the bull by the horns and make the decisions for ourselves, we are going to keep eating each other alive, each trying to prove that their level of education is the best. And those who are benefiting financially from it are laughing all the way to the bank.
College isn’t getting any cheaper. The best way to get a degree is to get it now – not over a 5 or 10 year period. It is way to expensive and the cost increases substantially every year.
Trust me, it is beyond the question of what entry level of nursing is the “best”. We need to take a clue from the other health care professions and govern ourselves. We need to stop arguing and being defensive. We need a standard for entry level practice and a clearly defined pathway to advanced nursing practice. We need to stop running the gauntlet – we work in the oldest, most needed, and most demanding health care profession that exists and yet we are allowing ourselves to fall behind in the world of health care professionals. And to make things worse, it is causing all of us undue stress as well as massive amounts of time and money trying to keep up.
Why am I telling you all this? Because I will be retiring in five or so more years as will be a great many other baby boomer nurses like myself. About 30 percent of today’s working nurses are over the age of 50, and more than half of them
could retire in the next 10 years. I am proud of my profession and my contributions to it. I do not want to see it eroded to a technical profession nor do I want to see nursing take a back seat to physicians or physician assistants. Nursing will never be rivaled in what we do for the world but we must be a viable profession in order to continue to do what we do.
It shouldn’t be this difficult. A BSN for entry level practice is not only the right thing to do; it is the best thing to do.