When I went to nursing school, back in the dark ages, I had all I could do to earn my Associates Degree. I took three years of pre-requisite courses, and two years of full time nursing courses, which included two to three lecture days a week, and bi weekly clinical rotations, along with whatever other ridiculous shenanigans they drummed up for us, like taking blood pressures at the mall or giving flu shots on the campus green to whomever was foolish enough to accept, this in the name of community nursing. While this was all going down, I was also working full time, since I am fortunate enough to be an independent woman, and unfortunate enough to not have ever won the lottery or inherited a swimming pool full of money. One of my most painful memories in life is waking up at 0330 in the dead of winter to bundle up my two tiny kids, and drive them an hour to my sisters house, so she could watch them (hey! it was free!) while I went to clinical and work. I’d drop them off, and then drive the hour to the hospital, where I’d park down the street (student parking was offsite, and the shuttle didn’t start til long after we were expected to show up), and trundle up to the front doors in my squeaky white shoes and painfully thin student nurse scrubs, eyes burning from the cold and exhaustion, to arrive on the floor at 0645, ready for huddle with my fellow students/sufferers, under the meticulous and unforgiving eye of our instructor, whom I believe learned all she knew from the devil himself. After a full shift of screwing up and trying not to cry about it, I’d hustle out of the hospital, using the long walk back to my car to contemplate the sweet peace of death, and then race over to my own LNA job, for a solid eight hours of the most brutal kind of work imaginable in this field (if you’ve never been an LNA, you’ve missed out on this right of passage). Then, finally, it was home to throw together updates for my care plan due the next morning at 0645. This shizzam was no joke. It went on like this, in one way or another, for years, so when it finally, blissfully ended, and I tasted the sweet freedom of not wanting to throw myself in the ocean every day, I was in no kind of hurry to go back.
I knew, because I had heard from my veteran nurse mentors, that I should start working on my bachelors degree right away. What I didn’t understand at first, that I do now, is that earning your BSN is essentially the difference between nursing as a profession and nursing on a technical level. This, in my opinion, is a really grey area, since I would consider my scope and understanding at this point to be developed on a much more usable, realistic level than that of a freshly minted BSN grad straight off the commencement line. On paper, they have earned substantially more credits and credentials than I have, but, if shit were going down, like a code or a belligerent detoxer looking for trouble, expecting them to handle it based on a degree alone would be unfair and unsafe, a real set up for disaster. When push comes to shove, and lets face it, as floor or staff nurses on the front lines in the hospital, push is doing much more than its fair share of shoving, I want the AD nurse with ten years of experience in my corner before I would expect the one year BSN grad to take charge. Give them five years, ten years, and yes, there’s a more comparable level of understanding. Most of the stuff we need to do to really, really run the show, you can’t learn in school, no matter how long you go or how intensive your training, or how high your degree. No one in school tells you how to phrase your request for an order to get exactly what’s safest for the patient, i.e., exactly what you want. No class is going to teach you that if a patient really, really needs a foley, its better to ask for forgiveness than permission. And certainly no where, no how, is anyone ever going to tell you about the “nurse dose”. No degree of any kind is a better teacher than experience.
So the question though still remains, why am I going to go back to school now, after all this time, when I am happily employed and doing a damn good job without it? The National Advisory Council on Nurse Education and Practice recommends that, because of the increasingly complex demands and ever changing landscape of todays healthcare environment, at least two thirds of the nursing workforce be educated with a BSN or higher. I couldn’t tell you what difference that higher education would make, since I don’t have it. But the demand for specialized nursing, such as clinical nurse leaders, nurse practitioners, and advanced practice specialty nurses, is growing at a rate that far outpaces the available talent, so someone has to go get that BSN. The US Bureau of Labor Statistics indicate that nursing, specifically registered nursing, is the field set to have the largest job growth between 2008 and 2018 (a fact you can verify on their website just like I did, if you are so inclined), and also to experience the largest shortage, by just over 250,000 able bodies shy of the number needed to meet the healthcare demands of our increasingly sick population. With this in mind, does it matter if I have my ADN or my BSN, so long as I can recognize a patient who is on the verge of physical crisis and act accordingly, as well as provide quality care for a variety of conditions in a fast paced environment? Is it ok to be happy right where I am? Am I not fulfilling a social obligation unlikely to see an end? In other words, is my role as a less educated but more experienced nurse not equally valuable?
I could solve this problem like I solve most of the ones in my life, and ignore it til it goes away. But if I really give it some thought, the best reason for me to continue my education would be to set an example. For the younger nurses, the newer nurses. The LNA’s and the techs considering nursing. To show them that continuing to learn and grow and develop as a professional is just as important as showing up every day and doing the job you already are good at. To validate the importance of what they have done, rather than trivializing it with the attitude that it doesn’t make a difference. The field is ever changing, and the requirements, the protocol, all of it will be different, and we can either go with it, or risk being “that nurse”, the one on the unit who’s been there since they poured the cement for the foundation, who has a bunch of dusty stories about the “old days”, (“when I was a new nurse, we didn’t have real needles, we had to whittle our own! We had glass bottles for everything, and when they broke you saved the glass to cut things because we didn’t have scissors either! We calculated our drip rate on an abacus!”). I actually like these stories, but I also know that we do ourselves a disservice by refusing to adapt, because its our own research and innovations that create the change we see. The autonomous nature of nursing means that we drive our own scope, we shape what it is now and what it will be in the future. We owe it to ourselves, and those who follow after us, to be as equipped as possible to handle what lies ahead. Now make no mistake, I don’t want to go back to school. Not even for a second. Nothing would please me less than that. But will I do it? In all likelihood,yes. Because I appreciate the greater good of what I do enough to tough it out. Because being a nurse means doing what needs to be done, regardless of whether or not its pleasant, or fun, or even a little bit easy.
If you really think about it, the individual pieces of our job can downright blow. I mean, does anyone look forward to an enema? “Oh boy, I hope I get to take a bath in poop water tonight!” Or putting in a catheter? “You know what would make this day brighter? A trip into a cavernous vagina!” Or placing an IV in a patient with no veins? “Well, since I’m not doing anything else, I guess I’ll poke this guy with a needle to see how long it takes him to get pissed off and punch me!” Nope. It’s a no to all of that. It’s the reasoning behind these agonizing little tasks that makes them worth doing though. And the same is true of earning the BSN. In no way will it be enjoyable. But in the end, its worth the doing, isn’t it?
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