Why Did I Choose this Path?

Group of nurses, Base Hospital #45
Group of nurses, Base Hospital #45 (Photo credit: The Library of Virginia)

Many times, I’ve had cause to question just what the heck I was thinking when I decided to work full-time nights as a hospital CNA while going to nursing school.  I stumble/limp into lecture after a shift, feebly clutching a giant latte, hoping to stay awake for most of the lecture.  I would be lost during this second year without my trusty digital recorder, although I’m currently avoiding becoming the class bee-yotch (no, I will not post all the lectures so the rest of you can leech off my effort – the nice guy who did that for y’all last term failed out, so I’m leery of following in his steps).  Yes, health insurance is a nice thing to have, but I still question my choices – especially when my grades are not on a par with those of those that don’t work (except at school, which is hard work enough).

So the other night at work, one of my nurses asked me to help her student RN (from a distinguished local BSN program) with a bed bath on a vented patient.  The experience went well, as I like to teach (although I have a hard time keeping my hands in my pockets so the person learning actually has time to learn).  The student was careful, and seemed to treat the experience seriously.

So where was the problem?  The student said that she had taken a CNA class, but that she never really wanted to do “that kind of work.”  (‘Scuse me? I mean, I didn’t know that the work many choose as a long-term career was on a par with pole dancing, or something.  No disrespect meant to the dancers out there. . .I’ve seen your tax returns, ladies, and you sure have to spend a lot on shoes.  Noamsayne?)  I bit back on my hair-trigger response, and asked the student what she meant (because I prefer not to second-guess people).  The student said “well, they are such different jobs, and the CNA job doesn’t really have that much to do with the RN role, so I didn’t want to get confused.”

Fair enough – I’ve sometimes had difficulty trying to step beyond the CNA mindset at my own clinical shifts – which is task-based, because it has to be, or you’ll drown/cry after every shift/get fired.  But it’s not impossible, as evidenced by the many RNs I work with who were CNAs first.  

I would argue that students should not be allowed into nursing school until they have worked in some clinical situation – medical assistant, EMT, ED tech, CNA, assisted living aide, whatever – because the practical experience gained is invaluable.  As a grunt, one is in a unique position to observe and learn in many situations – particularly in critical care or the ED.  I’ve been a helper/fly on the wall during codes, new admissions, transfers, road trips to CT, etc.  Each experience has taught me things I need to know as a nurse, in any situation where I find myself after graduation.

I asked one of my coworkers if lack of clinical experience and skill displayed by this BSN student, compared to the students in my community college ADN program, was typical in our geographic area.  She responded that in her experience, that was generally the case, if the student had not worked in the medical field before.  I have heard – not just from this coworker, but also from others, that BSN programs prioritize teaching the leadership aspects of nursing over skill development, telling their students “you’ll learn your skills on the job.”

I wonder to what extent this has contributed to the woes new graduate nurses experience when trying to get jobs in the current tight nursing job market?  Is nursing education shooting itself in the foot in the effort to “professionalize” nursing?  The statistics would seem to indicate that BSN program graduates are successful in being hired.  Are the educators attempting to shift clinical training back to the hospitals, where nurses used to be educated and trained, not colleges and universities?

Even though this student’s opinion of the value of CNA work caused me to have an indignant knee-jerk reaction, I am glad she shared it, because it’s helped me do some thinking about the future of nursing education in this country.




5 thoughts on “Why Did I Choose this Path?

  1. IMHO, nursing’s been shooting itself in the foot for 50 years. Maybe longer. Nursing has always been a profession, and there’s nothing wrong with getting it and us the respect deserved. But ignoring skills for theory is how physicians in the Middle Ages wound up behind the surgeons in their hierarchy, where they remain to this day.
    The day nursing decides to step up, and teach theory AND practice hand in hand, to every level of nursing student as appropriate, is the day it’ll get better, and better treated, not to mention become more effective for patients, which is the only excuse for a profession.
    And yes, you’re correct, lack of experience as an EMT, CNA, etc. should be a bar to nursing school admittance. It would also weed out a lot of can’t-cut-its, and let the ones who’ve proven they not only want in, but have some bare aptitutde for the job, into those impacted seats in every nursing program coast to coast.

    The average time for a BSN nurse to catch up to the clinical skills of a new ADN is two years, or more. I base that not on when they *think* they know what they’re doing, but on when everyone else working with them thinks they do.
    And to compound the problem, a lot of BSN grads end up getting shoved into charge and higher management before they’ve really gotten their head and their hands around the skills needed for bedside nursing in any specialty, and we get incompetent nurses who can’t nurse yet, newly thrust into the position of now being incompetent nurse supervisors who can’t manage, because once again the gap between school theory and clinical application takes months to years to bridge, if you even have an aptitude for it. Many people simply don’t and can’t manage well (because adding letters after your name doesn’t guarantee anything but a history of good study habits and attendance), and their own shortcomings cripple them from doing anything well, ever. The mediocre because they suck, they know it, and the insecurity makes them use poor management and leadership techniques to overcompensate for their insecurities; and for the truly awful because they have no clue that they have no clue, and their first wake-up is when half of a shift quits en masse. And some fortunate few find their way, and get the hang of things.

    The ultimate penalty is that of directors of nursing, the ratio of good/mediocre/awful is almost exactly 1:1:1.

    Patients don’t arrive on our units with 4 choices tattooed on their chests.
    The biggest problem with using mere education absent sufficient practical experience to determine competency or “professionalism” is that it creates a lot of people who can answer multiple choice questions really well (and think that merits special recognition), but real life patient care at any level is generally fill-in-the-blanks and essay questions.

    Kudos for tackling nursing school and clinical care as a CNA at the same time. Hard tasks in education generally make things easier in application. There are no letter grades once you graduate. It’s pass/fail, and for your patients, it may even be pass/die.So the most important thing you can learn in school, and while you’re working, is to recognize how much you don’t know, and demonstrate good judgement in getting help from someone who does know.

    When you someday become everybody’s go-to nurse more often than not, then you’re truly doing the job at the level of professionalism it deserves. After nearly twenty years, I’m there a lot, but there’s always room for improvement.

    1. Thank you for your thoughts. . .I hadn’t been aware of the history behind the surgeon/physician hierarchy, but that explains quite a bit. To some extent, I wonder if RN-BSN programs aren’t degree mills satisfying the Magnet and ANA demand for baccalareate-prepared nurses.

      I guess higher education itself is a business, and needs growth to sustain itself, like any business. In part, I decided on the ADN path (which in total – including prerequisites – has cost me about $5,000 out-of-pocket, thank you scholarships) after contrasting it with a $200,000 BSN degree (assuming 4 years attendance at your average private school).

      Wonder why we have a looming “education finance bubble” on the horizon. . .?

      1. Magnet and ANA are EXACTLY the self-greasing axle driving the RN to BSN phenom.
        Nursing is really big on “evidenced-based practice”, right up until you ask them why BSN rates of approaching 100% are so necessary, when ADN programs produce 2/3rds of all nurses, and twice as fast, and why therefore patients aren’t dropping like flies.

        It’s worse: government tuition programs are what turned a $40,000 BSN into a $200,000 BSN in 20 years. Who benefits? Well, let’s see if nursing salaries since 1985 have climbed as fast as nursing instructor salaries since 1985. My sense is, not just no, but hell no. And so many public and private institutions have nosed into the trough ofgovernment financial aid, now the ITT/Bryman-type of trade schools are looking to replicate their own versions of (NLN accredited!) slices of the tuition pie too.

        If the .gov stopped financing college completely next week, tuition at most private 4 yr. colleges would be back down to $10K/yr. in 12 months, because otherwise, they couldn’t attract enough people to pay for it.

        Get your ADN, get your job, and then let your employer(s) reimbursement benefits pay the tuition for a BSN, or anything else.

  2. I just found your blog.. lots to catch up on.. I am just starting cna classes.. last week anyway…and when I’m done with that, hope to get a night job as a cna while I go to nursing school.. glad I’m not the only crazy lol. we are required to have our cna before starting the rn program.. so it just goes to say we get the experience.. I think it makes us better nurses.. and yes I thought that “cna work was below me” but as I get more into it, I see that it is all a part of the big picture. it’s all hard work but rewarding, right?

    1. Looking back on the whole process as I prepare to enter my final term of nursing school, I am glad I chose to work as a CNA first. I think the experiences I’ve had at all levels of care (sub-acute, long-term acute care, and acute care) all have given me what I needed to make sure that this was the field for me, and to be the best developing nurse I could be. Good luck with your educational path, I am sure you are starting off on the right foot!

C'mon - out with it! You know you have an opinion - share it here!

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s