Are more nursing degrees too much?

diploma-mortarIn 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?

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Comments

  1. I don’t believe that a Doctorate of Nursing is a necessity at this time. At least with the curriculum that it entails. I want more clinical information and hands on training, not more research and another “project” to do. Dear God! The thesis was enough. I want to know the most advanced techniques and the most updated information in order to care for my patients that I already have now. I can’t afford to take a hiatus to go back to a full time curriculum in order to advance a career in which I can’t yet use for independent practice or more money. The BSN has supposed to be the norm as an entry level but it still has not happened. I also think that the BSN needs to include way more clinical education rather than all of the theory.

  2. lipodoc says:

    I couldn’t agree more!! I think all of medical education should probably have two tracks – a clinical track with a much greater focus on technical pearls, and a research or academic track with more emphasis on theory. And I think your point about ever more advanced curricula in the absence of increased re-imbursement for that education is very valid as well.

  3. Steve says:

    How many RN’s are REALLY interested in a Ph.D in Nursing? Where is the financial payoff for all of that money spent to get that level of education? Hell, at this point in my life (I’m 49), I’m not seeing any financial payoff to spending several thousand dollars for a BSN. (I have a B.A in a un-related liberal arts area and an A.D in Nursing) I think the entire discussion of Ph.D nurses is another symptom of the “Balkanization” of nursing that already exists: ADN, Diploma Nurses, LVN’s, LPN’s, BSN’s. As a profession, we have more divisions and disagreements than a bunch of catty soriorties.

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  4. Shannon says:

    First off why would anyone not want a profession to have terminal degree? How many PhD.s in Nursing do you know? I promise you that I would not begin to say”Why do Surgeon’s need Critical Care Fellowships?” My God stay in the OR and don’t try to take care of patients in the ICU, leave that for the Pulmonary Critical Care specialists. That is just wrong I am grateful that you chose to advance your training. I am grateful for any further education you get because you can teach others what you have learned. You are a better physician at the bedside for it. Our profession is still evolving. A few hundred years back physicians did not have to go to college to call themselves a Medical Doctor. We need our Nurse scientist whose specialty is researching nursing interventions that help change our practice and healthcare. Most evidence -based nursing interventions are not done by Associate degree nurses, LPN’s, BSN’s or even Master’s prepared nurses. It is our doctorate prepared nurses who are doing the research. Most did not get their doctorates on-line. Look at reducing ventilator acquired pneumonias in the ICU. Those researched nursing interventions are saving lives and reducing LOS in the ICU and guess what they were proven effective by RN’s who have PhDs in nursing. They headed up this research. That is just one reason why we should be proud as nurses that we have those calibar scientists in our field. Those nurses are not epidemiologist or microbiologist, although they had to know a great deal about both fields. There are many types of doctorates in nursing just like there are many specialties among physicians. Why would you even debate this? Sorry it is offending to me that you are not in my field but feel you can make comments on how my profession should handle it’s research. It would be like me writng a blog saying Plastic Surgeons should be the only MD’s doing liposuction. I don’t know enough about the training to make an informed opinion. No nurse on the floor or MD should question why a PhD. in Nursing is needed. If we took all the research away that those individuals have done more patients would be dying, period. That it something to be proud of. Yes our education is evolving and changing and frustrating at times that is what healthcare is about.

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