Nursing’s Mean Girls

If you are a nurse in the United States you probably have heard about the “mean girls”. They are a group of good old girl nurses that have reigned terror over the profession for many years. They are the ones that so narrowly defined nursing theory as to make it somewhat useless in our interdisciplinary healthcare world. They are the ones that narrowly defined admissions in a way that has forced many universities to go to blinded holistic admissions to avoid all manner of bias. They are the ones that have controlled our professional organizations in a way that doesn’t allow dissenting views or any views not consistent with the good old girls’ perspective even when the evidence is against them. And, they are the ones that control our journals and seem to think that protecting nursing is more important than integrity and evidence. In short, they are bullies.

We will not be able to remain the most trusted profession if we don’t clean up our own house. We need to take a thorough look at our educational standards. It is time for nursing to have its own Flexner report and it should not be managed by our professional organizations who have consistently shown they are unwilling to make difficult decisions or stand up to for-profit universities that are widely known to be diploma mills. Sadly, to compete many nursing programs have lowered standards to compete. Let me give a few examples.

  • DNP Scholarly Projects started out as rigorous work. Many were well-designed quality assurance projects, some were qualitative research, and others were small quantitative research projects. Now, much of what is produced is less than the Master’s Thesis that used to be required.
  • RN-BSN programs are often not equivalent to BSN programs at the same university. The best programs are still excellent, but many have turned into diploma mills. We all know it, but we keep silent.
  • Simulation was supposed to be based on a well-designed and rigorous study that showed how it can be equally effective to clinical experience. Yet, we went from rigorous simulation to universities using online modules and calling it simulation. When students do not do well the solution doesn’t seem to be to change the didactic content but to change the simulation to something less complicated.
  • Online courses when well done are useful to some students, but many are poorly done with no significant didactic content and excessive discussion boards that are barely reviewed.
  • Clinicals are getting harder and harder to find. This isn’t the fault of the education system, but rather the hospitals that not only limit access but limit what students can do and then wonder why they can’t manage a full load of patients on day one.
  • How we count clinical hours is not standardized. A credit hour of clinical range from 30-75 hours. Clinical can be hands-on with patients, shadowing a nurse, simulation either high or low fidelity, online simulation, or even writing a paper about clinical or another topic.
  • Ped, OB, and psych are now optional or electives at some schools with zero clinical in those areas.
  • Medication calculations are now considered a high-stakes test by some and there have been some who have proposed to much emphasis is placed on it. Yet we just saw a nurse convicted for a medication error. The FDA gets over 100,000 reports of medication errors a year. The right dose, at the right time, to the right patient is as basic as it gets.

Maybe the Carnegie Foundation will be willing to fund nursing to do a similar process and if they will not then we need to establish a coalition of the willing.

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