March 14, 2009, 8:26 pm

The Future of Nursing Education: Do I Detect Ageism?

ImageChef.comDo you know how much it costs to be a major Nascar sponsor?

Around $25 million!

No, I didn’t hit the jackpot in Reno, but it would be pretty cool to actually sponsor a driver!

I could always go half-sies with Budweiser over Kasey Kahne and call it….

“EmergiBud”!

It’s a Nascar-free weekend; they take a “brake” (get it?) after five weeks.

Unfortunately I do not, and I’m having withdrawls.

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yearthreelogo4

Calling all nurses! Don’t forget Change of Shift is here on March 19th! Hit that contact button up top and send in your submission, the theme is….wait for it….Nursing! I know you have been writing up a storm, so share it with your colleagues!

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You should have been there when I realized I could obtain a PhD in Nursing without getting a Master’s degree first.

I was thrilled.

There is nothing wrong with having an MSN, it’s just that my personal goal is a doctorate, specifically a PhD.

Well, nursing is full of debates and the BSN-to-PhD is apparently one of them.

*****

I came across an editorial from a 2003 edition of the American Journal of Nursing discussing the BSN-to-PhD degree program.

The writer, Editor-in-Chief Diana J. Mason, PhD, RN, FAAN doesn’t think it’s a good idea.

Sigh.

Well, let’s look at why.

*****

Ms. Mason recounts a time in her career when she accepted a position teaching pediatrics.  She had never practiced pediatrics and did not know much about the specialty. She notes that, “I felt like an imposter.”  She vowed to never teach outside her area of expertise and to maintain a nursing practice while teaching.

Sounds good.  Now what has that got to do with BSN-to-PhD programs?

Ms. Mason is concerned that utilizing a direct BSN-to-PhD program would produce nurses with minimal clinical experience teaching at the beside and having nursing clinical instructors without clinical background teaching clinical skills is not a good thing.

Agreed.

*****

But here’s where she goes off track.  I quote from the editorial (emphasis mine):

Nursing faculty tend to get an associate’s or bachelor’s degree first and practice for several years before returning to school for a master’s degree. They then practice for several years more as advanced practice nurses before completing the doctorate through part-time study—particularly if they have families who need their salaries. According to the AACN, by the time they are ready to enter tenure-track professorships, they are, on average, 46.2 years old and have only about two decades in which to teach.

Is it me, or is there a hint of ageism here?

What is wrong with teaching for “only” two decades?  What is wrong with not starting the teaching portion of a career until the average age of 46.2?

If a clinically competent teaching force is the goal, what is wrong with this? Am I missing something? You have nurses who have decades of experience on the floors/units with the nursing students. Not to mention that not all MSNs practice as nurse practitioners; some of them begin teaching with the Master’s degree.

*****

Let me answer some of Ms. Mason’s questions, from a personal standpoint.

  • “What would nurse educators prepared via the BSN-to-PhD route really know about clinical nursing practice?”

Ms. Mason assumes that a BSN-to-PhD candidate goes straight through their education with nothing but their basic nursing clinical rotations as experience.  Not all BSN-to-PhD candidates are newbies.  Some of us, in fact, will have four decades of clinical experience before we even get to the PhD program.

  • “How could they teach the subtleties of hands-on care that are apparent to an experienced nurse—how to know simply by looking at a patient that his condition is deteriorating? Or how to motivate a postoperative patient to get out of bed for the first time?”

By using exactly what Ms. Mason is worried they won’t have – hands on experience.  The intuition that allows a nurse to know  patient is deteriorating comes from exactly that, experience.  You can teach the theory, you can teach the clinical. You cannot teach intuition, but you can impart what you have learned from your intuition over the years and that is often more practical than anything that comes out of a book.

  • “Would generations of student nurses really benefit from three or four decades of teaching from a nurse who’s not at a proficient or expert level of practice?”

No.  But they would certainly benefit from two decades of teaching from a nurse that has four decades of clinical experience.

And finally, a response to this comment in the editorial:

Proponents note that not all faculty must teach clinical courses; instead, they argue, some faculty spend much of their time conducting research. But researchers who haven’t practiced are unlikely to investigate the concerns that are important to practice.

Try telling that to the Nurse Researchers from the Magnet hospitals I met in Reno this week, who work with the bedside clinical nurses in conducting research that is precisely directed at concerns important to practice.

*****

I have yet to see a BSN-to-PhD program that will accept any nurse who has not made a mark in the profession.  Please correct me if I am wrong, but anyone can apply with clinical experience, it is the nurse who can demonstrate something “extra” that gets accepted.

God willing, I have something “extra” to demonstrate.

*****

Assuming I am accepted into a BSN-to-PhD program in the fall of 2010, I will be 53 years old when I start and 57 when I finish.  I will have, by the end of that time, 37 years of clinical experience at the bedside.

I intend to do research, and I intend to teach.  And I do not intend to retire.  So, if I put in my “two decades” of teaching/research I’ll be 77.  If I put in three decades I’ll be 87.

Why on earth would an experienced nursing workforce who chooses to use their experience for the good of the up-and-coming generation of nurses, be considered a detriment because of their age?

The answer to Ms. Mason’s dilemma is simple: BSN-to-PhD programs should not accept nurses without at least a decade of hands on experience.  Better to have a nurse educator with experience who only teaches “two decades” as opposed to a nurse educator who can teach “three or four decades” with minimal experience.

March 9, 2009, 7:03 pm

Reflections from ENA: “Stop Counting Crayons, Start Drawing Pictures”

reno2I woke up early this morning, having changed my flight.

With the exception of a few glances out my hotel window, I had been incommunicado with the outside world for four days.

I had packed my sweatshirt, figuring I’d go from the shuttle to the airport to the plane and wouldn’t need it.

The casino was quiet. Not too many people up and about at 0630 on a Monday morning.

I checked out, headed for the revolving door and this is what awaited me outside!

A pristine blanket of snow, soft flurries falling sideways and dead silence.

Whoa.

I stood outside for as long as I could stand it and let myself get snowed on.

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mark

The title of this post comes from a story told by this man, Mark Scharenbroich.

Mark gave the keynote speech at the ENA Leadership Conference.

You can hear the original story right here on Mark’s site NiceBike.com.  I suggest you listen because it’s hilarious.

And profound.

My take on it is a little different than what Mark spoke of in his keynote. But not much.

Oh, and hey, Mark?  Nice bike.  Very nice bike.

*****

My attendance at the ENA Leadership Conference confirmed one thing.

No way in hell am I cut out to be a manager.

Never. Nada. Not gonna do it. Don’t wanna do it. Never have wanted to do it. Never will want to do it. Don’t have the personality for it. Don’t have the stomach for it.

And I sure as heck don’t have the skills for it.

But thank goodness for the nurses who do.

*****

As far as my managers go, I haven’t always been the easiest staff nurse to deal with. What? You thought I was the perfect nurse?

Well, you just keep on thinking that!

The reality of it is that sometimes my attitude really sucks.

It may come as a shock (not), but I gripe. A lot. Not necessarily to my manager, but being rather, um, verbal, the whole world knows exactly how I feel when I feel it and why I’m feeling it.

And griping begets griping. Before you know it, I’m ten times more ticked off than when I started, my blood pressure is sky high, I’m ready to quit (again) at 0700 and my co-workers are aren’t exactly uplifted.  Sometimes we feed off each other and have a regular group gripe session that lasts throughout the night.

On those shifts you would think we work in the depths of hell.

*****

The truth is I don’t work in the depths of hell.

Here is where the crayons come in.

My department is like a very nice, brand new box of 8 Crayola crayons and at times it seems all I do is gripe that it doesn’t contain Cyan, Burnt Sienna, Magenta or Periwinkle.

If I stopped bemoaning what we don’t have and appreciated the primary colors we are able to provide, I’d be a lot less frustrated and my patients a lot more happy.

(And my co-workers very relieved!)

You can buck the system without getting anywhere or you can work within the system to accomplish what you want to accomplish.

It’s time to stop counting crayons and start drawing the best pictures I can with the colors at my disposal.

March 7, 2009, 9:06 pm

Standing On Top of the World With ENA President Bill Briggs

billThe man never sleeps.

He says he does; I don’t believe it.

Meet William (Bill) Briggs,RN,MSN,CEN,FAEN, the current President of the Emergency Nurses Association.

Oh, he is also the Trauma Program Manager at Tufts University (Boston).

And he is a per diem staff nurse at Lowell General Hospital.

And he is a member of the Metro Boston Critical Incident Stress Management Team.

And he teaches TNCC and ENPC.

Geeze! I gripe when I have to work an extra four hours……

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Bill was kind enough to sit down with me at the end of a busy Saturday and talk a bit about himself and about emergency nursing.

I had a blast.

*****

Some people are born to be emergency nurses.  Bill was destined for the emergency department.  He wanted to be an EMT so badly that he took classes when he was seventeen so he could jump into the role on his 18th birthday.

He graduated from nursing school ready to hit the code room running!

Unfortunately, back in the late 70’s, you just about had to wait for someone to die before there would be an opening in ER.  Bill filled his time with gaining experience in med/surg and critical care, detouring to Saudi Arabia where he wound up managing the ER in a brand new, state-of-the-art hospital!

Bill’s been involved with ENA for so long it wasn’t even ENA when he joined, it was the “Emergency Department Nurses Association”.

Circa 1978.

Now he’s the president, and the professional organization for emergency nurses boasts a national roster of 36, 500 members.

*****

There is a standing joke in ENA that if you get up to go to the bathroom during a local meeting, you’ll be appointed state president by the time you come back.

Around 1985, after being back in the states and involved again with his local chapter, Bill “came back from the bathroom” (so-to-speak) as the Massachusetts State TNCC Coordinator.  (Okay, he actually volunteered to do it, but the thought of getting an assignment while you’re in the bathroom was too funny for me to pass up!)

*****

We often think of our managers and leaders as not being “hands on” or not really being involved in patient care.  Bill repeated a theme I heard often this weekend: that as a nurse leader/manager he could affect patient care on a more global scale, having much more influence than he could at the bedside.

But, two times a month, Bill dons the scrubs of a staff nurse and walks the talk in his per diem job at Lowell General, keeping himself connected to the patients and the staff nurse perspective.  “It’s just in me,” he notes.

And by the end of a Sunday PM shift in triage, he is more than ready to shift back into the leadership role!

*****

This year, the ENA put a call out for committee members.  Eighty positions were available.  Over four hundred applications were received. It’s an organization record.

Bill believes that the surge in interest comes because the issues being studied are extremely important to ER nurses everywhere: crowding/boarding (the #1 issue for ER nurses), psychiatric care in the ED and workplace violence, to name just a few.

*****

Emergency nursing requires passion for the work, passion that can become depleted as we get caught up in the day-to-day minutiae of patient care or management obligations, putting us in danger of burn-out.

That’s where the ENA comes in.

By attending local meetings (or national conferences!) and networking with colleagues, we are able to reconnect with that passion.

And Bill Briggs is passionate about emergency nursing.

It’s contagious.  One meeting, and I felt re-energized.  Many, many thanks to Bill for taking the time to sit and talk with me and to Tony Phelps for arranging the interview.

(I still don’t believe he ever sleeps…..)

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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