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“Titles have no meaning; it’s the competencies that matter,” said a nurse on an Internet mailing list the other day. That sums up the battle going on in nursing now about whether it’s education or experience that really counts. Those who don’t want to see the bachelor’s degree become the minimum requirement to be a registered nurse argue that “mere pieces of paper”—four-year college degrees—don’t say a thing about someone’s expertise. They say that nurses should be judged solely by what they can do, ideally by regularly proving they are competent at a litany of skills laid out by fellow nurses. What these nurses don’t realize is how that minimizes what nursing is all about. No other profession would allow its skills and abilities to be reduced to a series of measurable activities. Can you imagine an attorney allowing the act of taking a deposition to be whittled down to steps? “First, you subpoena the witness, set a date, and schedule a court reporter. Then, you prepare a series of questions.” Never. That’s because lawyers and society widely understand that the act of taking a deposition is far more complicated than the sum of its parts. It involves mental agility and analysis that cannot be easily tested or measured. And nursing is really no different. Sure, you can check whether I can start an IV or listen to lung sounds or defibrillate a patient. But how would you measure my ability to spur the will to live in a discouraged patient or to encourage a father to become more involved in his wife’s labor experience? How would you write a “competency statement” about my ability to support a family through weeks of dealing with a dying child? There are those in nursing who put a lot of stock in step-by-step experience, who say that every nurse should have to be a nursing assistant, then an LVN, then a two-year nurse. They’re locked in the early-20th century notion that the only way you can learn is skill by skill. The truth is, however, that a lot can be learned in college, too. And as important as all the skills are, a foundation of a broad education in the sciences and humanities is what nurses most need. That’s the kind of education that really teaches critical thinking and without that kind of background, nurses will forever be limited and stuck in a skills-based curriculum. Skills will always be important in nursing, just as they are for physicians, teachers, and professionals in virtually every other field. But measurable skills aren’t everything. The other fallacy about this “competency-based-practice” way of thinking is that it assumes health care isn’t going to change in the next few years, that all the skills nurses use in hospitals and home health will be in demand forever, just as they are now. But most experts say that nurses are becoming chronic-care coaches, and that the vast majority of us will be helping people deal with the challenges of long-term conditions. Nursing may soon be done mostly by phone and computer, checking on patients’ blood sugar, blood pressure, heart rhythm, and tidal volume, for example, and then telling them what to do about it. If nurses have a broad education, they’ll be infinitely adaptable to the big changes that are sure to occur in the next 20 years. If they have only AA degrees and are encouraged to learn mostly by experience, they may not be able to provide the skills that will be needed. To the nurse in the chat room who said titles have no meaning, I say I’d rather start a 21st century career with a great and comprehensive education than without it. Barbara
Bronson Gray, MN, RN |