September 4, 2006, 12:46 pm

And While We’re On the Subject….


Death by Constipation.

Sounds like a James Bond movie.

I wonder who would sing the theme?

Instead of “Live and Let Die” it could be “Strain and Let Go”.

Or maybe: “The Ex-Lax Who Loved Me.”

According to this learned document, nearly 75% of all illness can be traced to constipation.

In fact, did you know that constipation causes diabetes?

Well, blow me over! We don’t need metformin or insulin, we need Milk of Magnesia or the biggie: GoLytely!

I’ll be right back, I have to call the ADA!

All these deaths and diabilities.

All cured by: lubrication!

Wow – rectal WD40.

I wonder if Tom Cruise is anti-laxative.

Of all the people who could use one…


Labor Day morning.

Starbucks. House Blend. Venti. Room for cream.

Sam Cooke’s Greatest Hits on the speakers.

Man, it doesn’t get any better than this!


A comment on this recent post started me thinking about the other side of nursing education.

One of my commentors, an RN (who blogs about her experiences as an RN whose spouse suffers from multiple myeloma) began her comment with this sentence:

“I apologize for being one of those nurses with all the initials after her name…”

Uh oh.

Not the impression I was trying to give regarding higher education within the profession.


All comments come into my email and in my response to my fellow nursing blogger, I mentioned that I didn’t want anyone to feel they had to apologize for their education, but that I just didn’t want to have to of defend my lack of letters!

We need nurses who have BSNs, MSNs and PhDs. We need nursing instructors and leaders in the profession.

And we need them badly.

They are responsible for producing the bedside nurses that make up the bulk of our profession.

To do that well, they need to have the theory, the background and the gift of teaching/leadership.


I have the utmost respect for those nurses who chose an upper level degree, whether they choose it as their entry-level or work their way up as they practice.

I work with a PhD candidate in the ER who fascinates me with her knowledge of areas of nursing that I would never think of exploring. She provides a perspective of nursing that gets me excited to be doing what I do.

She does it not for the money, I doubt academia pays anywhere near what bedside nursing does and that is what she is doing now. Bedside nursing.

She loves the theory of nursing.

And it almost makes me want to go back for a BSN! So you know her enthusiasm is infectious!

And she gave me her entire Cherry Ames collection, so, basically she just rocks anyway!


But what these nursing leaders do not understand is that everytime they advocate for the BSN to be the entry level of nursing, they put down me and every other ADN graduate, even as people clamor to enroll in ADN programs.

I might not be able to discuss five different theories of nursing, but I can tell you about Sister Calista Roy’s adaptation model.

I may not know anything about leadership qualities or how to be a good manager, but I can advocate for my patient.

No, I have not written a thesis on the history of the nursing diagnosis, but I can work my butt off for twelve hours and actually place my hands on patients and make an immediate difference in how they feel.

I don’t sit at a desk, in fact I often work up to ten hours without a single break, but I can tell you more about how a patient is responding than anyone sitting in a suit in their office.

Those basic tasks of care are hiding the most important aspect of nursing, the nursing assessment. Seeing and responding to subtle changes in temperament, nutritional status and knowing what they mean.

Seeing lab results and understanding what they represent.

Not finding fancy ways to document them.


Oh, I can write very pretty nursing plans using nursing diagnoses.

You could frame my care plans and put them on the wall.

I’ve gotten more compliments in three decades than I can count.

And all it means is that I can write legibly and spit out what all the accreditation bodies want to see.

They don’t affect my patient care at all because they aren’t written or designed with the actual NURSE and PATIENT in mind.

They are written because someone who probably hasn’t been anywhere near an actual patient in years has decided that nursing must mimic other professions instead of blazing a trail as the unique profession it truly is.


So don’t tell me that the BSN should be the entry level into nursing.

It insults me and negates almost 30 years of professional practice to “technical” status.

In our profession you can begin with an ADN.

Hell, for that matter you could begin from a diploma program if they hadn’t made those obsolete.

Get the nurses at the bedside doing what 99% of all nurses do!

And maybe, for oh, say, one month out of the year, those who sit happily in their offices should be required to get back to the bedside and re-connect with what they are supposed to be promoting and advancing.


I respect those who have chosen to advance in their nursing education.

I have chosen to advance mine at the bedside.

With my ADN.

And all I’m asking is for a little respect…

Just a little bit.


  • Teresa

    September 4, 2006 at 4:25 pm

    Kim, I do respect you more than a little bit,and all nurses at all levels of education. Clinical experience is the best education there is. There are several universities that have established faculty practices where nursing faculty are employed taking care of real patients. Examples: Medical College of GA, Johns Hopkins Schoolof Nursing, University of South Carolina, and University of MI. They have websites.

    FYI, I don’t have an office and I don’t wear a suit…I have a desk in a work practice is 100% clinical. I document using the SOAP model…no nursing diagnoses. I entirely agree with your assessment of those.

    My daughter will be starting an ADN program next fall. (Waiting list) I have never told her that she needs to get a BSN. I applaud her decision. I love nursing and I hope she will, too, and she’ll have my respect as well.

  • Kim

    September 4, 2006 at 5:07 pm

    Hi Teresa!

    I knew you respected all of us, that second post was triggered by our emails over the first post when I thought I was giving advanced practice nurses the short shrift.

    I certainly wasn’t talking about you when I discussed the “office-bound” nurse.

    I just wanted to give to you credit for stimulating me to write the second post (which started out concilliatory and got ranty and the end!)

    I was hoping to get across that I had respect for those who DID have higher educations and that nursing needed them just as much as bedside nurses, but they had to stay in touch with what happens at the bedside (or clinic, or home care).

    I hope that came across somewhat….

    Frankly, there is no difference between any of us where I work.

  • Teresa

    September 4, 2006 at 5:18 pm

    Thanks Kim, and that did come across

  • Jen

    September 4, 2006 at 6:34 pm

    Absolutely nothing wrong with ADN! I don’t think that it’s the degree you hold, rather years of experience, and patient outcomes show much more about a nurse’s practice than the degree they hold.

    My ADN cardiac instructor didn’t even have ACLS, and lord knows how long it’s been since she was at the bedside. I’m precepting a BSN GN that didn’t start one IV in 4 years of nursing school. I work with an awesome MSN nurse in the ER, yep she’s at bedside.

    It’s wonderful for nurses to get advanced degrees!! We need more nursing instructors (that keep their foot at bedside).

    I’d like to pursue my BSN or even more, however I can’t afford it on my ADN salary. Note: my pay wouldn’t change even with a BSN.

  • Sid Schwab

    September 4, 2006 at 7:14 pm

    Regarding constipation. You may recall I posted here about a near-fatal case of it….

  • Janet

    September 4, 2006 at 8:27 pm

    Once again. . . .AMEN, Kim!
    I’m a DIPLOMA nurse. I won’t even begin to tell you about all the crap I’ve been handed over the past 30 years about being “only a diploma nurse.” I’ve had still-wet-behind-the-ears new BSN’s tell me I wasn’t qualified to be a “real nurse” and that I didn’t have the appropriate education to be effective in “the contemporary healthcare environment.” But who did they call when they needed help or were stuck with a procedure they were unfamiliar with?

    Anyone who has the guts to go for an advanced degree deserves respect and has my admiration. Yes, we need more nurses with advanced degrees but that does not give anyone the right to look down their noses at those of us who have stuck with the basics.

  • Mother Jones RN

    September 4, 2006 at 9:28 pm

    I respect anyone who wants to go for a degree, but like Janet, I’m a diploma nurse that is tired of the alphabet soup crowd telling me I’m not qualified to be a “professional” nurse. It’s funny that some people are offended by our anger. I dare say they would be angry, too, if they were subjected to the same type of crap we take because of our educational background.

    I’ve learned more about nursing working on the floor than any PhD, FAAN could learn out of a book. Kim, thanks for talking about this subject so we can all put our cards on the table.

  • noran

    September 4, 2006 at 11:27 pm

    For our profession to be taken seriously, we need a standard educational platform/requirements. What use is a BSN, if if is 2 years liberal arts and 2 years years. To me–that is an ADN to me. Experience makes the nurse and experience in the best teacher. I attended a 2+2 program at Purduein the early 80’s. You got your ADN,and as an RN, you went on for your BSN. Having your own RN, gave you more reign during clinicals. Now in my area a non-nurse with a BS, can take an 18 month program, and get a MSN–what is that!!!????!! I have my MSN–I work the bedside, 12 hour shifts in the ER–learning new things daily. I also have been a diabetic instructor, an office nurse, ortho/rheum. educator, med/surg nurse, PACU nurse, and guest lecturer with Purdue Biology dept. Nursing allows you to do so many things.
    We need a standard foundation for our profession to grow on–we just do not have it, and doubt we ever will. In the late 1980’s, for my MSN program I had to do a presentationon something I fet strongly about. That month the ANA ran ads in all the nursing journal–2 pager–nure at the bedside taking care of her patient with sure care and devotion. The caption read that if you want to provide the best care for your patient, getyour BSN. It being 20 years ago, my memory might not be too exact with the wording–but that was the jest of it. I was so upset!!!! I got on my soapbox and did my presentation that experience makes the nurse, not the letters behind the name. Some of the best nurses I have had the honor to work bedside were diploma graduates. I attended one of the very first seminars on nursing diagnosis at St. Elizabeth’s–a diploma school and the speaker was the top in the nation on the topic. Today’s programs lack the clinical hours–again we need a standardized program.
    I was told by my boss, when I was ortho/rheum educator–that ifI hadmy BSN,I would understand things better and see things her way. She was just finishing her BSN, and never spent a day working at the bedside. I replied I had my BSN, and was actively working onmy MSN–and maybe if she got her hands dirty, she would understand where I was coming from. Well, Idid not hold that position long, and that MSN class, was the only B I got.
    Sorry for the rant, but after 24 years as anurse, and with letters after my name–I still feel the same, even more stronly than ever.

  • Susan

    September 5, 2006 at 7:25 am

    I understand that a nurse with an ADN can be very well-qualified, but I hope you realize that not all BSNs are imbeciles.

    Enough of the BSN-bashing! Can’t we all just get along?

  • marachne

    September 5, 2006 at 10:35 am

    BSNs can be snotty about their degrees. Old nurses eat their young (I’ve heard people say “Oh BSN, that stands for “Bull S**t Nurse”). None of it helps the profession. Interesting that a librarian talks about the issues of professional respect. What do these two professions have in common? A perception of being “women’s jobs.”

    As women we have a lot of prejudice to overcome.

    As women and nurses, we have a lot of baggage about inferiority to deal with.

    We have a history, as a profession, of the apprentice model. How do we combine time-tested and useful way of leaning that with a more academic approach so that we glean the most from both? How do we honor the experiential knowledge, not to mention that “knowing” that comes from having being a (good, observant, caring) nurse for years, and also be open to the skills and knowlege that a broader education brings? And I’m sorry, but there ARE things you learn in a BS program that are of value to the profession and the job of nursing.

    I know there are some things that you only learn by doing, and the most highest trained nurse will not provide good direct care without learning how to do it by doing it…and being open to new ideas, new new evidence-based techniques requires you at least be open to the fact that we are in a dynamic field that changes as the knowledge base grows (“We’ve always done it that way” is NOT a good reason to use a particular technique)

    I’m a direct care nurse — I wipe butts, I turn, and suction, and give bed baths to my dying patients. I hold their hands and stroke their foreheads and provide a shoulder and an ear and hugs and reassurance to their families who may, or may not be ready to accept that they are going to loose someone near and dear to them.

    And I’m in a PhD program. Why? Because at my age I know I can’t do direct care for as long as I know I’m going to have to work. Because I love to teach, and the faculty shortage is worse than the nursing shortage. Because I know that as a nurse, I bring a very particular clinical knowledge and perspective to research that can only make the care we provide our patients better. Because as a geriatrician, I am bound and determined to get everyone to realize that all nursing (ok, except maybe L&D and Peds) is geriatric nursing and am determined to get geriatric training integrated into nursing curriculum.

    The voice of the nursing profession needs to be heard by the research community. Our holistic approach means that we look at the whole person: mind, body, family system, community setting–all the things that affect health and disease.

    We also need to be heard in the policy community and, sad to say, those politicians look at those letters and give the people with them more credence.

    At the risk of showing my feminist colors, I see the kind of snarking that goes on between nurses as a typical example of “divide and conquer” been so effective marginalized groups oppressed. Keep us at each other’s throats so that we don’t use those energies to both move the profession forward and improve the care we provide.

    There really is room in the tent for everyone. Just leave your attitude at the door.

  • Kim

    September 5, 2006 at 1:09 pm


    Great response!!! That is exactly what I was trying to say only much better!

    And again, this was written because I’m tired of having to defend my lack of “letters”, not because someone else decides to get a higher degree.

    Notice that I work with a PhD candidate who does all that I do, but has a great wealth of knowledge she is willing to share!


  • marachne

    September 5, 2006 at 1:49 pm


    I did notice you’re working with a PhD candidate, and I “got it,” that you don’t have anything against nurses with more education — I think most of us are just looking for colleages who will work with us, respect our skills and knowlege and share their own.

    I agree that there is a problem in nurse leadership not recognizing the reality of the world. For a case in point, look at the move to change AP nurses from masters-prepared to doctorally prepared. While I can see some benefit, what it does is make that degree less accessible and more expensive, which then affects how care is distributed and delivered.

    Rural areas have the worst part of the nursing shortage. In some (many)rural areas, NPs are providing most of the primary care. In some rural areas ADN programs are the only programs available for nursing. We know that the way to get people to work in rural areas is to train the people who live there. Take away the smaller, more affordable programs, and who will take care of that already underserved population?

    As I said before, we need to be working together and celebrating what we all bring rather than stirring up ferment and division.

    Thanks for starting/continuing with such an important discussion.

  • Annemiek

    September 6, 2006 at 12:15 pm

    We do need the nurses that move on to higher education, but that does not make the bedside nurse less valuable. I have 20 years of experience, and have a diploma, but you just keep on learning, even if I don’t have the letters behind the name.
    To Noran; I took some nursing classes at Purdue and worked at St Elizabeth too (’86-’89), where I learned so much!

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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