Letters not printed
I’ve got a pretty good track record in getting letters to the editor published – if I say so myself. Every now and then I send a letter that I think is particularly important, especially when it is correcting misinformation, doesn’t seem to make the “cut”. When this happens I sometimes decide to post it on my blog, and this is what I’ve done with a copy of the letter to the editor that I sent in response to an Pasadena Star News editorial piece they published on the nursing education and nursing shortage challenge. Though overall the article made a valiant attempt to present solutions, I also found at least one glaring error and many of the same old-same old problems and solutions that the nursing talking heads have been nattering about for almost as long as I’ve been a registered nurse. However, the Pasadena Star News paper letter to the editor person felt that my response was too long to print and after he suggested that I might want to consider editing it down and “tightening” it up I should resend it, which I did. Alas, neither letter has been published to date. So below you’ll find both versions of my letter to the editor the first is the original followed by the much revised and edited down version of the second submission.
September 22, 2008
Letters to the Editor
Pasadena Star News
Pasadena, CA
Re: “Make room for nurses”
Dear Editor:
Your paper’s effort to address the layered and complicated issues surrounding our Nation’s nursing shortage and nursing education dilemma is commendable; but unfortunately like so many well-intentioned individuals and groups before you, your efforts fell short and your editorial also provided erroneous information.
The Associate-prepared RN does not receive a certificate but receives an Associate Degree of Science in Nursing. The three recognized pathways to an RN licensure are as follows the Associate-prepared (often referred to as the two-year degree), the Diploma-nurse (often referred to as the three-year program) and the Bachelor-prepared (often referred to as the four-year degree). All three pathways require that their candidates take the same licensure exam, the N.C.L.E.X.-RN, and once this exam is passed that individual is then eligible for licensure, assuming they meet the state other licensure pre-requisites.
An LVN, though a nurse, is not a RN and not one of the three pathways to an RN licensure. The LVN licensure has its own scope of practice, is a separate educational and licensure pathway, and in California is regulated by its own nursing board. The LVN can be and is recognized as part of the nursing career ladder, and many excellent RNs, nursing leaders and educators have begun their career as either a LVN or LPN, before moving up the career ladder to advance training, degrees and licensure.
Many external factors impact our nursing education pipeline, some of which you noted in your article. However your editorial failed to address issues such as the low student to instructor ratio which is mandated (in some cases as low as 8:1) which often makes colleges and universities hesitant to launch, expand or maintain nursing programs. The high attrition rate that is often found in our nursing schools, contributing factors are due in great part to poorly prepared students specifically in areas of science, math and yes English-language skills and a lottery system that is still being used in many of our community college nursing programs. A study published in 2001/2002 found that key indicators of success in a nursing program were directly linked to the prospective nursing students’ comprehension and at least B grade in Math, Science and English-language, and when you keep in mind that nursing is a science/math focused skill and that the language of medicine/nursing in this country is English these outcomes make sense. Senator Scott sponsored legislation that would have replaced the lottery system as it applied to nursing programs with a system that focused on these key indicators, but unfortunately the final bill was substantially water-down leaving the use of the lottery system up to each individual community college When a nursing class has a high attrition rate then that can translate into empty seats for the remainder of that “student year”. Nursing programs are also plagued by a great deal of “individuality” which often makes transferring from one nursing program to another problematic. Not to mention that the average nursing school educator can make more money as a staff nurse with less overall responsibility than as a teacher.
All these issues place a strain on our nursing pipeline, and while these problems are being addressed, all too often it is being addressed piece-meal with very little county, state or nation-wide coordination. Nursing also needs to find a way to integrate RNs who hold advance degrees that are not in nursing but in related fields into the nursing education pipeline, these nurses could serve to help ameliorate our current educator crisis. Currently, there is a push for nurses to go immediately from the B.S.N. to the M.S.N. and then on to the Ph.D. or Doctorate in Nursing degree in order to fill the nursing educator gap, but one has to wonder if this push which ignores extensive clinical (or real-world) experience for theoretical and didactic may have on the skills of the student they teach. And though “book smarts” are all well and good there is something to be said for the nurse who can translate what they’ve learned from the book into the real-world of bedside nursing.
Though as your editorial so quaintly noted that both Cal State Long Beach and Cal State Fullerton B.S.N. program are a mere six-semesters in length, it doesn’t always translate into six uninterrupted semesters. Many nursing students face roadblocks in taking required courses simply due to the lack of qualified teachers and these roadblocks translate into a delay that could and often does lengthen the time to graduation, and let’s not forget just because one graduates from one of these three pathways does not a RN make, because that graduate must then pass their N.C.L.E.X.-RN exam. Luckily in California our schools maintain a respectable 88% passage rate, which means most of our graduates then are eligible for licensure.
As someone who has written extensively on the issue of the nursing shortage and an outspoken advocate for nursing I have called on a “Flexner-like” study of our nation’s nursing programs. In the early 1900s our Nation’s medical schools and the very structure of medicine received an overhaul of sorts in the form of a nation-wide study that is often referred to as the Flexner-study. This study provided a framework from which all medical schools now design their program around which has allowed for a maximization of available “seats” in medical schools, the facilitation of transfers within and outside school systems all the while maintaining a high level of quality. I think nursing, too, could benefit from a similar review. This does not necessarily mean that I think nursing should be forced to adopt the same study tool, but perhaps nursing could use a top to bottom review from a core group of experts that could then provide recommendations on everything from what the entry-level of nursing should be to how we should structure the complete nursing career ladder, to how to design our nursing programs to maximize the available and often limited seats and so forth.
October 3, 2008
Letters to the Editor
Pasadena Star News
Pasadena, CA
Re: “Make room for nurses”
Dear Editor:
Your paper’s effort to address the layered and complicated issues surrounding our Nation’s nursing shortage and nursing education dilemma is commendable; but unfortunately like so many well-intentioned individuals and groups before you, your efforts fell short and your editorial also provided erroneous information.
Two most noticeable mistakes in your editorial are: the Associate-prepared RN does not receive a certificate but receives an Associate Degree of Science in Nursing. An LVN, though a nurse, is not a RN and not one of the three pathways to an RN licensure. The LVN licensure has its own scope of practice, is a separate educational and licensure pathway, and in California is regulated by its own nursing board. The LVN can be and is recognized as part of the nursing career ladder, and many excellent RNs, nursing leaders and educators have begun their career as either a LVN or LPN, before moving up the career ladder to advance training, degrees and licensure.
Many external factors impact our nursing education pipeline, some of which you noted in your article. However your editorial failed to address issues such as the low student to instructor ratio which is mandated (in some cases as low as 8:1) which often makes colleges and universities hesitant to launch, expand or maintain nursing programs. Many of our nursing schools have a high attrition rate; contributing factors are due in great part to poorly prepared students specifically in areas of science, math and yes English-language skills. Nursing programs are also plagued by a great deal of “individuality” which often makes transferring from one nursing program to another problematic. Not to mention that the average nursing school educator can make more money as a staff nurse. These are just a few of the issues that place a strain on our nursing pipeline, and while these problems are partially addressed, all too often they’re being addressed piece-meal with very little county, state or nation-wide coordination.
Thursday, October 30th, 2008
