In October, at the Blogworld Expo I had the privilege of hearing “Nurse Ratched” who blogs at her site Nurse Ratched’s Place speak on a panel. The most fascinating thing she discussed (at least to me) was a phenomenon she noted of nurses always undercutting other nurses. She had written a blog post about it entitled “nurses eat their young” and she felt it was the most pressing issue facing the nursing community today.
Her main focus was the ever-increasing pressure to further your nursing degree. She remarked that when she started out, a two year plan after high-school earned you a white starched cap and the ability to care for sick patients on hospital wards. You were a “nurse”, you had a uniform and everybody understood your position in the hospital But then came the split between “real nurses” aka RNs and licensed nurses aka LVN/LPN. Then the pressure for a bachelor’s degree. Then a masters and finally now, a movement towards a doctorate in nursing science – a doctor of nursing!
As an “old school” nurse her concern was focused on how inadequate she and her fellows (with many decades experience!) were being made to feel by the insistence that their education was insufficient. I can’t help but agree and wonder whence comes all this spiraling degree obsession. Because I’ll let you in on a little secret: I feel like it kind of demeans the value of my education, too.
Currently there are masters of nursing programs across the U.S. that prepare people with basic nursing training to perform advanced skills – anesthesia (CRNA), baby delivering (nurse midwifery) and primary care (nurse practitioner). And I can certainly understand maybe three levels of differentiation such as LVN (for floor or office nurses perhaps), RN (for more critical levels of care such as ICU or ER) and masters for people who will be assuming a primary role in the therapeutic care of patients without constant/immediate supervision. This progression would allow the choice of length of time spent in school, the amount of responsibility a person is willing to assume and degree of specialization.
But a doctor of nursing? What would that really mean? What extra clinical skills would be taught that are not currently encompassed by the masters programs? There is no evidence in the litterature that the current masters programs are inadequate, so why the push for another level?
Since a lot of nursing masters programs consist of a lot of online training and non-standardized clinicals in non-academic settings, I also wonder if this really meets the advanced qualifications of a doctorate. There are NO doctor of medicine programs that can be completed online, no clinical training that can be done outside of an academic program and there’s always the little matter of clinical training after school – residency. Four years of full-time school (there aren’t any part-time med schools, either) then 3 to 10 years of additional full-time (80+ hours/week) training afterwards to earn the title of “doctor.” I’m sorry but 2-3 classes per semester, taken online over the course of several years should not imply the same depth and breadth of training implied by a doctorate.
But what about nursing research you might say. Well what about it? What is specific to advanced nurse-performed research that is not covered by a more traditional doctorate. You want to do bench research? Get a PhD in molecular biology. Want to do epidemiology or population studies? Then get advanced degrees in statistics or anthropology or genetics or whatever other specific thing is of interest. If you want to be a DON, go get a business administration degree.
But I think it demeans the training of and care by the LVNs on the floor of a hospital to say that you need to have almost a decade of training to take care of patients. Is there really a problem with the nurse structure in healthcare or do we need to re-vamp the entire system?