A Career In Nursing Essay
Throughout the history of nursing, training of those entering the field has varied from rudimentary to extensive. In the 19th century, training for nurses was minimal and there was no set curriculum (Nursing Timeline of Historical Events, 2014). With the nursing focus shifted from caring for the sick and dying, to caring for ill people and providing preventative care for well people, the training for nurses has also changed. This discussion will focus on the differences in competencies of nurses who obtain an Associate Degree in Nursing (ADN), or a Baccalaureate degree or Bachelors of Science Nursing (BSN). There will also be discussion of a scenario in which a BSN prepared nurse’s clinical decision-making may differ from an ADN prepared nurse.
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In the 1950’s, Mildred Montag created the two-year degree program with the idea in mind that students could complete this program sooner than a BSN program, thus improving the nursing shortage in the United States.
Dr. Montag envisioned a new subset of nurses, a “technical nurse,” with a two-year degree, rather than a “professional nurse” who would assist the baccalaureate prepared nurse in providing care for patients (Matthias, 2010). The introduction of various paths toward a nursing career has since introduced confusion regarding the minimum entry-level requirements for credentials as a professional nurse (Cresia, 2011).
In 1965, the American Nurses Association published a paper recommending that the minimum degree for entry-level Registered Nurses be a baccalaureate degree (Taylor, 2008). Dr. Montag’s vision of all professional nurses obtaining a baccalaureate degree has not yet come to fruition, as, according the Heath Resources and Services Administration, only fifty-five percent of working Registered Nurses hold at least a baccalaureate degree (Fact Sheet: Creating a More Highly Qualified Nursing Workforce,
2013).
The differences in competencies of nurses prepared at the associate level versus the baccalaureate level can be difficult to pinpoint. Ideally, all who are able to practice as Registered Nurses have a standard level of knowledge to keep their patients safe. The curriculum for both programs vary in that many ADN programs focus on technical skills, and BSN programs delve more into theory and evidence based practice for patient care (Taylor, 2008). Both degree levels are able to sit for the NCLEX-RN exam, which is the minimum level of competency of a nurse entering into the professional nursing work environment. There is usually no difference between either degree in the pay and working conditions, and the associate level degree is obtained faster, therefore making that path toward becoming a registered nurse an attractive route to many second career students (Taylor, 2008). According to the Grand Canyon University College of Nursing Philosophy (2011), a baccalaureate prepared nurse practices within his or her scope using critical thinking, communication and assessment to provide care, to teach and to lead their patients to better health. All nurses prepared to sit for the NCLEX-RN exam are trained to practice using these tools, however baccalaureate prepared nurses expand on these, and pull from their knowledge of research to use evidenced-based practice in treating their patients. The educational background of a nurse influences patient perception, as well. According to Taylor (2008), 76% of respondents believe that nurses should hold a four year degree or higher. It can be said that many patients do not understand, nor could they appreciate, the differences in the education of associate degree prepared nurses and baccalaureate prepared nurses (Taylor, 2008). Patients are mainly concerned with receiving the best possible care from well-educated health care staff.
The following is a clinical scenario in which the actions of a BSN prepared nurse and an ADN prepared nurse are paralleled. In a busy critical care unit, an ADN prepared nurse receives report on her patients for the day from the off-going nurse. One of his patients is a 73-year-old male with an indwelling urinary catheter, a central line and an endotracheal tube. This patient’s last three axillary temperatures have been gradually increasing, and the off-going nurse has given him rectal Tylenol for the temperature spikes. Upon the ADN nurse’s assessment, he notes that the temperature has maintained since the last nurse administered Tylenol. He notes the finding in his medical record documentation, and informs the attending physician of the temperature spike during rounds. He goes about his day providing care to both patients, consistently monitoring the temperature of his 73-year-old patient until the end of his shift.
At 7pm that evening, the ADN nurse gives report to the nurse coming on for the night shift. This nurse is a BSN prepared nurse who, after receiving report, completes her patient assessments. She checks the medical record documentation to ensure endotracheal tube suctioning and mouth care have been completed for the 73-year-old patient. She also checks the length of time that the indwelling catheter has been in place. She takes these measures because she knows that evidenced-based practice shows that endotracheal tubes and indwelling catheters create paths of entry for bacteria that may be causing this patient’s infection. She calls the attending physician to notify him of the still elevated temperature, and she asks for an order for blood cultures to be drawn to check for infection of the central line. The BSN prepared nurses training, in theory, helps him or her to pull from their knowledge of research and evidenced based practice to “see more than what is in front of them” in caring for patients.
In closing, continuing education should be a priority for all nurses, no matter the degree level. All nurses must do their part in maintaining a workforce of nurses who are well educated and informed of the most up to date practices to keep patients safe.
References
Creasia, J., & Friberg, E. (2011). Historical Development of Professional
Nursing in the United States. Conceptual Foundations: The Bridge to Professional Nursing Practice. St. Louis, MO: Elsevier.
Fact Sheet: Creating a More Highly Qualified Nursing Workforce. (2013).
American Association of Colleges of Nursing. Retrieved from http://www.aacn.nche.edu/media-relations/NursingWorkforce.pdf
Grand Canyon University. (2011). Grand Canyon University College of Nursing
Philosophy. Retrieved from https://lc-ugrad1.gcu.edu/learningPlatform/user/users.html?operation=loggedIn#/learningPlatform/loudBooks/loudbooks.html?operation=landingPage&
Matthias, A. (2010). The intersection of the history of associate degree nursing and "BSN in 10": Three visible paths. Teaching and Learning in Nursing, 5, 39-43. Retrieved July 31, 2014, from http://www.sciencedirect.com.library.gcu.edu:2048/science/article/pii/S1557308709000833
Nursing Timeline of Historical Events. (2014). [Graphic illustrations and slides].
Retrieved from http://lc.gcumedia.com/zwebassets/courseMaterialPages/nrs430V_timeline.php
Taylor, D. (2008). Should the entry into nursing practice be the baccalaureate degree?. AORN Journal, 87(3), 611.
In the 1950’s, Mildred Montag created the two-year degree program with the idea in mind that students could complete this program sooner than a BSN program, thus improving the nursing shortage in the United States.
Dr. Montag envisioned a new subset of nurses, a “technical nurse,” with a two-year degree, rather than a “professional nurse” who would assist the baccalaureate prepared nurse in providing care for patients (Matthias, 2010). The introduction of various paths toward a nursing career has since introduced confusion regarding the minimum entry-level requirements for credentials as a professional nurse (Cresia, 2011).
In 1965, the American Nurses Association published a paper recommending that the minimum degree for entry-level Registered Nurses be a baccalaureate degree (Taylor, 2008). Dr. Montag’s vision of all professional nurses obtaining a baccalaureate degree has not yet come to fruition, as, according the Heath Resources and Services Administration, only fifty-five percent of working Registered Nurses hold at least a baccalaureate degree (Fact Sheet: Creating a More Highly Qualified Nursing Workforce,
2013).
The differences in competencies of nurses prepared at the associate level versus the baccalaureate level can be difficult to pinpoint. Ideally, all who are able to practice as Registered Nurses have a standard level of knowledge to keep their patients safe. The curriculum for both programs vary in that many ADN programs focus on technical skills, and BSN programs delve more into theory and evidence based practice for patient care (Taylor, 2008). Both degree levels are able to sit for the NCLEX-RN exam, which is the minimum level of competency of a nurse entering into the professional nursing work environment. There is usually no difference between either degree in the pay and working conditions, and the associate level degree is obtained faster, therefore making that path toward becoming a registered nurse an attractive route to many second career students (Taylor, 2008). According to the Grand Canyon University College of Nursing Philosophy (2011), a baccalaureate prepared nurse practices within his or her scope using critical thinking, communication and assessment to provide care, to teach and to lead their patients to better health. All nurses prepared to sit for the NCLEX-RN exam are trained to practice using these tools, however baccalaureate prepared nurses expand on these, and pull from their knowledge of research to use evidenced-based practice in treating their patients. The educational background of a nurse influences patient perception, as well. According to Taylor (2008), 76% of respondents believe that nurses should hold a four year degree or higher. It can be said that many patients do not understand, nor could they appreciate, the differences in the education of associate degree prepared nurses and baccalaureate prepared nurses (Taylor, 2008). Patients are mainly concerned with receiving the best possible care from well-educated health care staff.
The following is a clinical scenario in which the actions of a BSN prepared nurse and an ADN prepared nurse are paralleled. In a busy critical care unit, an ADN prepared nurse receives report on her patients for the day from the off-going nurse. One of his patients is a 73-year-old male with an indwelling urinary catheter, a central line and an endotracheal tube. This patient’s last three axillary temperatures have been gradually increasing, and the off-going nurse has given him rectal Tylenol for the temperature spikes. Upon the ADN nurse’s assessment, he notes that the temperature has maintained since the last nurse administered Tylenol. He notes the finding in his medical record documentation, and informs the attending physician of the temperature spike during rounds. He goes about his day providing care to both patients, consistently monitoring the temperature of his 73-year-old patient until the end of his shift.
At 7pm that evening, the ADN nurse gives report to the nurse coming on for the night shift. This nurse is a BSN prepared nurse who, after receiving report, completes her patient assessments. She checks the medical record documentation to ensure endotracheal tube suctioning and mouth care have been completed for the 73-year-old patient. She also checks the length of time that the indwelling catheter has been in place. She takes these measures because she knows that evidenced-based practice shows that endotracheal tubes and indwelling catheters create paths of entry for bacteria that may be causing this patient’s infection. She calls the attending physician to notify him of the still elevated temperature, and she asks for an order for blood cultures to be drawn to check for infection of the central line. The BSN prepared nurses training, in theory, helps him or her to pull from their knowledge of research and evidenced based practice to “see more than what is in front of them” in caring for patients.
In closing, continuing education should be a priority for all nurses, no matter the degree level. All nurses must do their part in maintaining a workforce of nurses who are well educated and informed of the most up to date practices to keep patients safe.
References
Creasia, J., & Friberg, E. (2011). Historical Development of Professional
Nursing in the United States. Conceptual Foundations: The Bridge to Professional Nursing Practice. St. Louis, MO: Elsevier.
Fact Sheet: Creating a More Highly Qualified Nursing Workforce. (2013).
American Association of Colleges of Nursing. Retrieved from http://www.aacn.nche.edu/media-relations/NursingWorkforce.pdf
Grand Canyon University. (2011). Grand Canyon University College of Nursing
Philosophy. Retrieved from https://lc-ugrad1.gcu.edu/learningPlatform/user/users.html?operation=loggedIn#/learningPlatform/loudBooks/loudbooks.html?operation=landingPage&
Matthias, A. (2010). The intersection of the history of associate degree nursing and "BSN in 10": Three visible paths. Teaching and Learning in Nursing, 5, 39-43. Retrieved July 31, 2014, from http://www.sciencedirect.com.library.gcu.edu:2048/science/article/pii/S1557308709000833
Nursing Timeline of Historical Events. (2014). [Graphic illustrations and slides].
Retrieved from http://lc.gcumedia.com/zwebassets/courseMaterialPages/nrs430V_timeline.php
Taylor, D. (2008). Should the entry into nursing practice be the baccalaureate degree?. AORN Journal, 87(3), 611.