- Email: [email protected]
To the editor:
To the editor: The place of experience in graduate level nursing education: A time for discussion and debate Teri L. Hernandez, RN, MS
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s a recent graduate with a Master of Science degree in nursing, I offer this testimony of the commencement of my career in graduate school. I entered my Master of Science program after seven years of clinical nursing experience. My memory is clear: nervous, anticipatory, and ambitious optimism about how I may fit into the future of our great discipline. Yet, when I entered my first class, I was met with a situation that was unexpected and disappointing. Nearly half of my classmates had no work experience as nurses, and some had not taken their NCLEX certification boards. I thought to myself, “Could this be true at the graduate level?” When I finished my baccalaureate program in 1994, our class in my Master’s program was told to acquire a minimum of two years’ experience in nursing before returning to graduate school. And although that first class in my Master’s program was a good learning experience, we spent the semester in a frustrating battle of discussions between those of us who were experienced nurses versus those of us who were not. This was a resounding theme throughout my Master’s program. A search of the literature reveals dominating discussion over the point of entry into nursing practice, the shortage of nurses and nursing faculty, and the consequent need to provide more options in doctoral preparation to fill the needed nursing roles in our future. Nurses are no longer required to gain experience as a nurse before beginning Master’s level or even Doctoral level education in nursing; no one appears to be discussing this issue. Therefore, I raise the subject myself, asking us all to truly reflect on the question, “Where is the place of clinical
experience at the graduate nursing education level?” This paper will present both sides of the issue, and a contention that fundamental nursing experience is foundational to an advanced role in our discipline.
THE CHANGING FACE OF NURSING DICTATES A CHANGE IN OUR EDUCATIONAL STRUCTURE Porter-O’Grady1 described nursing in the 21st century as moving out of the hospital, and he predicts that nursing as we now know it will disappear. Consequently, he described a shift in the nursing role, stating, “Most nursing activity will be in facilitating access, interpreting information, advising and guiding consumers in sorting through increasing complex health therapeutic choices, educating the consumer for the use and application of new therapies, and partnering with the consumer . . .” To adjust to this shift and the shortage of nurses in advanced roles, Anderson2 contended that the entry level to nursing should be a post-Baccalaureate degree. He further stated, “We must emulate other disciplines that do not require years of experience prior to pursuing graduate study.”3 Therefore, the changing face of nursing combined with the looming nursing shortage highlights the need to recruit nurses with different backgrounds to our discipline. The shift in focus away from hospital care would make hospitalbased clinical experience less relevant in this new health care environment.
IS ADVANCED-LEVEL NURSING PRACTICE TRULY EXPERT? Benner,4 in her seminal work, “From Novice to Expert,” described the progression of nurses’ skill level on a continuum from novice to expert, contending that nurses develop both clinical expertise and their ethical/ moral and aesthetic sense of knowing through practicing, or being, a nurse. She stated that “Memorizing characteristics and features of a diagnostic category from a textbook . . . is not the same as recognizing when and how these characteristics manifest themselves in particular patients . . . this clinical discernment must be learned in practice.” Norris5 voiced that we are “diluting the skill level” of our advanced practice nurses in allowing nurses to enter into graduate study without
Teri L. Hernandez is a Clinical Research Nurse in Division of Endocrinology, Metabolism, and Diabetes, and an Instructor in the School of Nursing at the University of Colorado at Denver and Health Sciences Center, Denver, Colorado. Reprint requests: Terri Lynn Hernandez, RN, MS, Instructor and Clinical Research Nurse, PhD Student, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado at Denver and Health Sciences Center, PO Box 6511, MS8106, Aurora, CO 88045. Email: [email protected] Nurs Outlook 2006;54:8-9. 0029-6554/06/$–see front matter Copyright © 2006 Mosby, Inc. All rights reserved. doi:10.1016/j.outlook.2005.08.003
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clinical experience. She observed that nurses who complete their basic nursing program and immediately transition into an advanced practice role have difficulty adjusting because they are still developing basic nursing skills while trying to function at a higher level. She expressed concern that the reputation of advanced practice nurses may be in jeopardy. The question, then, becomes one that is fundamental: Can we expect novice nurses to function in expert, advanced-level roles?
A CALL TO ACQUIRE A FUNDAMENTAL NURSING IDENTITY BEFORE PURSUING GRADUATE EDUCATION Years ago, my earliest independent nursing role was as a medical– oncology nurse. The first week on the job was revealing and terrifying because, although I had my Baccalaureate degree behind me, I realized that I had not yet learned how to be a nurse. Consequently, my first years of nursing were much as Benner described as I moved from amateur to highly skilled. Beyond the task-oriented skills I learned in even that first year, I built a fundamental nursing identity that is still with me today as I pursue my PhD. I believe the disharmony in my Master’s-level courses was not specific to my school and was created by a lack of nursing identity in the students who had not yet had the opportunity to form one. I did not fault these individuals. Instead, I found myself wishing they could experience the essence of nursing before trying to embark on graduatelevel discussions and nursing applications with those of us who had been in the discipline for some time. My fellow colleagues, I urge you to discuss and
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debate this serious concern in our nursing discipline. The public has an expectation that an advanced-practice nurse truly be an expert in his or her practice, and that a doctorally-prepared nurse be an experienced member of the discipline. Although nursing is changing due to the fast pace of technology, the nursing shortage, and the dynamics of the health care system, I would urge us to reflect back on how each of us developed our own nursing identity. It did not happen under the safety net of a preceptor, and it did not happen during our undergraduate education. “Experience” does not have to be hospital based, but should refer to the transformation that takes place as one moves through the phases of novice to expert, or even novice to intermediate, regardless of setting. As leaders in our discipline, we have a responsibility to prepare all of our nurses for the complexities of our health care environment. It is imperative that nurses develop a sense of nursing identity through experience being a nurse before embarking in graduate study. In doing so, we will have more to offer the discipline, and we will strengthen our ranks as we move into this new century of nursing knowledge discovery. REFERENCES 1. Porter-O’Grady T. Profound change: 21st century nursing. Nurs Outlook 2001;49:182-6. 2. Anderson CA. The time is now. Nurs Outlook 2000;48:257-8. 3. Anderson CA. Moving on. Nurs Outlook 2003;51:1-2. 4. Benner PE. From novice to expert. Upper Saddle River (NJ): Prentice-Hall, Inc; 2001. 5. Norris D. Evaluation of RN experience requirement needed for APRN role. Conn Nurs News 2004;3:xx-xx.
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s a recent graduate with a Master of Science degree in nursing, I offer this testimony of the commencement of my career in graduate school. I entered my Master of Science program after seven years of clinical nursing experience. My memory is clear: nervous, anticipatory, and ambitious optimism about how I may fit into the future of our great discipline. Yet, when I entered my first class, I was met with a situation that was unexpected and disappointing. Nearly half of my classmates had no work experience as nurses, and some had not taken their NCLEX certification boards. I thought to myself, “Could this be true at the graduate level?” When I finished my baccalaureate program in 1994, our class in my Master’s program was told to acquire a minimum of two years’ experience in nursing before returning to graduate school. And although that first class in my Master’s program was a good learning experience, we spent the semester in a frustrating battle of discussions between those of us who were experienced nurses versus those of us who were not. This was a resounding theme throughout my Master’s program. A search of the literature reveals dominating discussion over the point of entry into nursing practice, the shortage of nurses and nursing faculty, and the consequent need to provide more options in doctoral preparation to fill the needed nursing roles in our future. Nurses are no longer required to gain experience as a nurse before beginning Master’s level or even Doctoral level education in nursing; no one appears to be discussing this issue. Therefore, I raise the subject myself, asking us all to truly reflect on the question, “Where is the place of clinical
experience at the graduate nursing education level?” This paper will present both sides of the issue, and a contention that fundamental nursing experience is foundational to an advanced role in our discipline.
THE CHANGING FACE OF NURSING DICTATES A CHANGE IN OUR EDUCATIONAL STRUCTURE Porter-O’Grady1 described nursing in the 21st century as moving out of the hospital, and he predicts that nursing as we now know it will disappear. Consequently, he described a shift in the nursing role, stating, “Most nursing activity will be in facilitating access, interpreting information, advising and guiding consumers in sorting through increasing complex health therapeutic choices, educating the consumer for the use and application of new therapies, and partnering with the consumer . . .” To adjust to this shift and the shortage of nurses in advanced roles, Anderson2 contended that the entry level to nursing should be a post-Baccalaureate degree. He further stated, “We must emulate other disciplines that do not require years of experience prior to pursuing graduate study.”3 Therefore, the changing face of nursing combined with the looming nursing shortage highlights the need to recruit nurses with different backgrounds to our discipline. The shift in focus away from hospital care would make hospitalbased clinical experience less relevant in this new health care environment.
IS ADVANCED-LEVEL NURSING PRACTICE TRULY EXPERT? Benner,4 in her seminal work, “From Novice to Expert,” described the progression of nurses’ skill level on a continuum from novice to expert, contending that nurses develop both clinical expertise and their ethical/ moral and aesthetic sense of knowing through practicing, or being, a nurse. She stated that “Memorizing characteristics and features of a diagnostic category from a textbook . . . is not the same as recognizing when and how these characteristics manifest themselves in particular patients . . . this clinical discernment must be learned in practice.” Norris5 voiced that we are “diluting the skill level” of our advanced practice nurses in allowing nurses to enter into graduate study without
Teri L. Hernandez is a Clinical Research Nurse in Division of Endocrinology, Metabolism, and Diabetes, and an Instructor in the School of Nursing at the University of Colorado at Denver and Health Sciences Center, Denver, Colorado. Reprint requests: Terri Lynn Hernandez, RN, MS, Instructor and Clinical Research Nurse, PhD Student, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado at Denver and Health Sciences Center, PO Box 6511, MS8106, Aurora, CO 88045. Email: [email protected] Nurs Outlook 2006;54:8-9. 0029-6554/06/$–see front matter Copyright © 2006 Mosby, Inc. All rights reserved. doi:10.1016/j.outlook.2005.08.003
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clinical experience. She observed that nurses who complete their basic nursing program and immediately transition into an advanced practice role have difficulty adjusting because they are still developing basic nursing skills while trying to function at a higher level. She expressed concern that the reputation of advanced practice nurses may be in jeopardy. The question, then, becomes one that is fundamental: Can we expect novice nurses to function in expert, advanced-level roles?
A CALL TO ACQUIRE A FUNDAMENTAL NURSING IDENTITY BEFORE PURSUING GRADUATE EDUCATION Years ago, my earliest independent nursing role was as a medical– oncology nurse. The first week on the job was revealing and terrifying because, although I had my Baccalaureate degree behind me, I realized that I had not yet learned how to be a nurse. Consequently, my first years of nursing were much as Benner described as I moved from amateur to highly skilled. Beyond the task-oriented skills I learned in even that first year, I built a fundamental nursing identity that is still with me today as I pursue my PhD. I believe the disharmony in my Master’s-level courses was not specific to my school and was created by a lack of nursing identity in the students who had not yet had the opportunity to form one. I did not fault these individuals. Instead, I found myself wishing they could experience the essence of nursing before trying to embark on graduatelevel discussions and nursing applications with those of us who had been in the discipline for some time. My fellow colleagues, I urge you to discuss and
J
debate this serious concern in our nursing discipline. The public has an expectation that an advanced-practice nurse truly be an expert in his or her practice, and that a doctorally-prepared nurse be an experienced member of the discipline. Although nursing is changing due to the fast pace of technology, the nursing shortage, and the dynamics of the health care system, I would urge us to reflect back on how each of us developed our own nursing identity. It did not happen under the safety net of a preceptor, and it did not happen during our undergraduate education. “Experience” does not have to be hospital based, but should refer to the transformation that takes place as one moves through the phases of novice to expert, or even novice to intermediate, regardless of setting. As leaders in our discipline, we have a responsibility to prepare all of our nurses for the complexities of our health care environment. It is imperative that nurses develop a sense of nursing identity through experience being a nurse before embarking in graduate study. In doing so, we will have more to offer the discipline, and we will strengthen our ranks as we move into this new century of nursing knowledge discovery. REFERENCES 1. Porter-O’Grady T. Profound change: 21st century nursing. Nurs Outlook 2001;49:182-6. 2. Anderson CA. The time is now. Nurs Outlook 2000;48:257-8. 3. Anderson CA. Moving on. Nurs Outlook 2003;51:1-2. 4. Benner PE. From novice to expert. Upper Saddle River (NJ): Prentice-Hall, Inc; 2001. 5. Norris D. Evaluation of RN experience requirement needed for APRN role. Conn Nurs News 2004;3:xx-xx.
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