Some days ago I was assigned a nursing student from a university to follow me in the care of one of my ICU patients and give certain meds under supervision. I've done this before and I'm always surprised at how easy they have it. The instructors, when they come by, are very nice, helpful, and never expect them to know anything. For instance, she was asked how many units of insulin the patient should get, and she hesitated a second and then seemed to venture a guess. The instructor teasingly called her out on it. A guess? In my day, if I hadn't been prepared with an answer, let alone tried to guess on a medication as important as insulin, I would've had my head stuck on a pike in front of my school as a warning to students forever.
Like 57% of nurses in the US, I was prepared by a community college and received an associate's degree in nursing. So tell me: do you think I will learn anything more about taking care of sick human beings by completing a bachelor's degree in nursing with her university? Because I could. The school is associated with my hospital and will get paid by my hospital if I go there.
No one in nursing acadème or nursing administration comes out and says that an associate's degree is not enough to be a nurse. But they do fixate on the idea that it's not enough to be considered a professional. Not enough to be considered independent or autonomous. Not enough, in other words, to compete with physicians. Going back at least to the 1980s, nurses have been trying to get out from under the paternalism of physician-led healthcare. The general public thinks we're just order-followers, med-passers, and scalpel-hander-overs, and we're still trying to shake that image. For some reason, we think the only way to shake it is with academics. So there are countless RN-to-BSN programs out there, and our hospital system will gladly pay for us to go through them—so I can't really complain that they want us to do it.
Okay, yes I can.
It's kind of silly. My degree is a two-year degree. The four years at a university school are typically divided between two years of general education and two years of formal nursing. In other words, it's a two year degree. But, they say, a university program also includes coursework on research, community health, ethics, and nursing theories. So did mine. So what's the formal difference? A formal degree. Something that academics and administrators can point to. But probably not anything that's going to help you in the care of sick human beings—in bedside care.
The irony is that at the same time we ADN nurses are encouraged to get our BSN, we're also told we don't need a BSN to be good nurses, and that the BSN program is not going to teach us very much we don't already know. They might as well say: it's basically pointless, or it only helps a little, but more importantly it achieves some ulterior goal aside from improving you as a nurse. Goals like being able to say you have more BSN-prepared nurses for your Magnet award application.
The reality is that a nurse doesn't need a higher-level liberal arts education in order to be a nurse. That doesn't make us unprofessional. There's a science to nursing, but there's also an art; there's a logic to nursing, but there's also a knack. We don't like to admit that we're basically like car mechanics, but we are. We know can interpret pulmonary measurements and blood gases, but we can also just eyeball a patient and have a good idea if they'll fly or crash when taken off the ventilator. How different is that from a mechanic who knows how a catalytic converter works but also knows whether a knocking sound is benign or bad? The idea that an academically-prepared professional must fix your body but mere 'skilled labor' can fix your car is absurd. The difference is the degree of knowledge, not the category. Whether you're a car mechanic, a nurse, or a neurosurgeon, you're basically exercising your knowledge as you do tasks. This includes physicians. Physicians are not artists or philosophers. They're task-oriented like everyone else.
What does this have to do with my BSN? Well, since physicians are in the same ballgame as the rest of us, and not an elite group of Ph.D.s, I don't see the need to compete with them academically as long as I can achieve my goals in patient care. I've never met a resident or physician who cares what degree I have. They care about my license and expertise.
But I'll go for it. I'm open to learning new things. It's a stepping-stone to advanced practice, and I don't have to pay for it. But I still kinda worry about the efficiency and efficacy of this: in five years, will it matter than I spent this much time and effort away from my family to do this? Will I think I wasted my time? Most likely there's no increase in pay or status. Am I just submitting to some outdated dream of nurses who abandoned patient care for academic politicizing? I don't know. I just hope this effort helps me more than it helps them.