Nursie poo, I don’t really want to be just a nurse, I wish to practice medicine (yes a real statement from a nursing student) Hmm, then go to medical school. See APRN’s are not about the practice of medicine, we are about the advanced practice of nursing. I know we don’t use them as much like that in the hospital or primary care, but that is what an APRN does. While I am not a floor nurse, Nurse Case Manager, Public health nurse, or primary care nurse anymore, I am still capable of being that nurse in addition to my ability to provide advanced care to my patients.  As an APRN, you should be able to draw on that knowledge much more than what you learned in NP school. You must really be a nurse to be an APRN (or any advanced degree nurse for that matter).

I was talking to Karen (who ironically is an excellent nurse with a stellar nursing history that shines in comparison to mine, and no she does not have I want to see your manager hair) She too has seen this phenomenon first hand as well and is always taken aback by this rush to advanced practice. I ran this past her, like I did when I was on the floor with her.

Well, I have never been known to be all warm and fuzzy (ok a little, but don’t tell), but this will make a few (more) nurses hate me, I am sure.  I am sure that the local nursing schools will as well, but I am safe as they tend to sit in their ivory tower and feel like they are too good to associate with all of us regular Nurses or APRN’s. It’s not jealousy or any kind of rivalry, someone at these schools didn’t “wrong” me, it’s just a fact. Every nursing school has similar hang-ups.

Nursing schools could really give a damn less what you think. Yep, you read right, they could freaking care about who they produce as nurses as long as the almighty nursing board pass rate stays high. They argue that they are providing quality by artificially raising the percentage required to pass a course (which most schools put around an 83% cumulative score in classes. It is merely a shell game, and, in the end, they want you to keep going to school and paying their salaries. So, they push more and more education before nurses have any experience being a nurse.

The local nursing schools, University of Utah, Westminster College, Weber State, and of course, every for-profit school in the valley (there are a ton, big money in nursing ya know) are just pushing out quantity over quality. This is true of most any school in the country, but I have seen it first hand from those schools.

I have precepted students from all these programs (precepting is when a student is assigned to working nurse for a shift), and while they were competent students and seemed to know the book, they were misguided by their instructors in the fact they should immediately pursue an advanced degree. I had a student tell me one day that she had already been accepted into the Doctor of Nursing Practice program before she had even completed her baccalaureate. She wanted to be an NP but didn’t wish to and almost refused to do front line care as a nurse. She is who greeted me with that opening line of this blog today (well all except the nursie poo part).

What the hell is wrong in these schools to just move a nursing student forward into advanced practice without experience. This is not a liberal art degree where you can go to school from high school to Doctorate with little or no experience. Nursing is trench warfare. It is a daily battle of organization, prioritization, critical thinking, and skill. These skills do not happen overnight, and in fact, times, they take years to develop. No offense to liberal arts majors, but nursing and medicine are life and death and should not be practiced by a professional student.

Many nurses never move on from being a staff nurse. They are happy to do their job day to day, enjoy it, and excel. These are some of the most exceptional nurses I know, and some of them only have an Associate’s degree (scandal don’t tell them in the ivory tower).

There are way too damn APRN’s that skip being a nurse to move on to an advanced degree, even if it is not to become an APRN. Stop! While any capable nurse should continue their education, you should do it at a measured pace that allows your experience to compliment your degree. By skipping the experience, you rob nursing of your “in the trench time” where you develop not only your baseline skills, but you develop your knowledge and intuition (things needed more than a snappy hair doo as a nurse or the ability to do your nails on a night shift).

When I was a new nurse and so confident that they had taught me everything I needed to know in school, I had an experienced nurse tell me how wrong that was. Tina told me one morning, “none of this will make any sense, no matter how much you learned in class or how much you learned in clinical.”

“The first 2-3 years, you will have an idea of care once the diagnosis is made,” She said. “At that point, you may be able to parrot what needs to be done, however, you will still need help.”

I am sure I looked downtrodden to have my ego deflated in short order like that, but she also told me, “one day at about 5 years of nursing, say, it will just click.” “Everything you have learned and done will be automatic, and you will be shocked.”

She wasn’t wrong. I knew the book knew how to take instructions from other nurses very well, but when it came to know something was going wrong with the patient, I usually picked up on it as they were in crisis. Then one day, about 5 years later, I was working in a completely different hospital, and my gut hit me smack dab in the brain, and I knew I had a patient in trouble long before they started. After that, I got better and realized what differential diagnostics were and why things were the way they are.

I want more nurses like Karen (the nurse, not the “I need to see your manager”) and Tina their progression through nursing has followed a degree with years of practice.

Remember to be the kind of person your dog and your mom hope you are.