Illustration by Malcolm Garris/PhotoDisc
Illustration by
Malcolm Garris/PhotoDisc
What's
different
about differentiated practice?
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June 7 , 1998 Have you heard the term differentiated practice? Some think it’s the carrot that will finally inspire more nurses to get their bachelor’s degrees. Others say it’s just a caste system. A dedicated and diverse group of nursing leaders, working through the California Strategic Planning Committee for Nursing (CSPCN), has proposed giving different roles, responsibilities, and salaries to nurses depending on whether they hold an AA or a bachelor’s degree, and on their experience and competence. The overall goal is laudable: encourage nurses to seek higher education and put nurses in roles where they can best apply their education and experience. But the catch is that the plan just perpetuates one of nursing’s biggest problems: We don’t share a common educational base. The model wants hospitals and other employers to pay nurses based on all the skills, education, and experience they bring to the job. That’s great, but it doesn’t go far enough. It doesn’t say the bachelor’s degree is so valuable that every nurse should get it. All entry-level nurses should have equal status and standing in the eyes of the patient, the public, and the hospital. The only way to achieve that is to have one educational level for entry into the practice of nursing. No other profession has created a two-tiered system, and nursing’s current model won’t work for the future. Different job descriptions for AA and BSN nurses won’t work. At least 70 percent of the nurses in the state have graduated from community college programs. Already some hospitals are offering sign-on bonuses of up to $8,000 just to get a specialty nurse. Are hospitals really going to turn an experienced, talented specialist away as they wait for a nurse with a bachelor’s degree? Theoretically, it could make sense. Practically, it cannot. Differentiated practice could create new tensions within the profession as, nurse by nurse, that complex equation of education, competence, and experience lands on a salary grid. How will a nurse who’s new to ICU but with three years in med/surg and a bachelor’s degree compare to a diploma nurse with 10 years in pediatrics? The answer is to have one basic educational requirement. No matter how much you may like the idea of two-year nursing education, it’s a myth. In fact, it’s taking AA nursing students up to three and even four years to get the prerequisites and all the classes they need to graduate. Just the waiting lists to begin nursing school at some community colleges are 500 students deep. With distance learning and the Internet, education is not about years anymore, anyway. It’s about material mastered, courses completed, and competency. It wouldn’t have to take massive, expensive restructuring of California’s higher education system in nursing to make the switch. For example, Arizona has been offering baccalaureates at community colleges through Northern Arizona University’s 2 + 2 program. After students complete two years at one of the 12 community colleges in the program, they officially transfer to the university. But instead of changing campuses, they keep on attending classes at the community college site. State university faculty teach about 20 percent of the classes, using video conferencing. It costs Arizona $2,000 less to educate a student under this model than it would if the student went to the state university campuses. One NurseWeek reader recently wrote us to say that patients don’t care what kind of degree we all have; they just want good care. That may be true. But patients expect nurses to figure out what kind of education we need now and will need in the future. Teachers have done it. Occupational and physical therapists have done it. Librarians have done it. Social workers have done it. Nurses can, too. We’ve been fussing over this issue for years, but we don’t have much more time to argue. As the nursing shortage intensifies, pressure to quickly prepare nurses will inevitably mount. Nursing’s challenge is to explain to the state Legislature how to best fund nursing education over the next 25 years. Should we perpetuate the current community college system or adapt it for the future? Imagine it’s the year 2015. Just about every field—from sales to law enforcement to computer repair—demands the bachelor’s degree. Is the amount of knowledge and skill needed to be a nurse really less than in all these other jobs? If we want the next generation of nurses to have bachelor’s degrees, we’ve got to decide that now. What do you think? Barbara
Bronson Gray, MN, RN |
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