She Gets It Right, She Gets It Wrong

For reasons best known to itself, the CMAJ tries to flog the long dead horse of nursing credentials. Should nurses have their degrees?

The correct answer is well, duh.


While Canadian advocates of the change say degree nurses are better prepared for the challenges of an increasingly complex healthcare system, critics worry that phasing out diploma programs entirely may have exacerbated the nation’s shortage of registered nurses.

New Brunswick has never regretted its 1998 decision to become one of the first provinces in Canada to require a baccalaureate degree for entry to practice in nursing, says Margaret Dykeman, professor of nursing at the University of New Brunswick in Fredericton.

“Let’s not romanticize what the diploma program did. Bottom line, we ran a hospital and got a half decent education while doing it, but it was more luck and practice than knowledge,” says Dykeman, who originally trained for a nursing diploma before returning to school to pursue a doctorate. “The primary onus for the student should be to learn, not to fill the gap when a hospital isn’t adequately staffed.”

According to the Canadian Nurses Association website, “the knowledge, skills and personal attributes that today’s health system demands of its registered nurses can only be gained through broad-based baccalaureate nursing programs.” It also cites a study that indicates there was a 5% decrease in risk of patient death for every 10% increase in the proportion of hospital registered nurses holding degrees (JAMA 2003;290[12]:1617-23).

So far so good. This Margaret Dykeman is my kind of nurse: articulate, smart, ready to defend the profession and so on. But then she starts spouting, well, horse pucks:

My diploma course never talked about outcomes, the patient just got better or died,” says Dykeman. “Today, we have to prepare students to think critically, tackle higher workloads, deal with advanced procedures and technologies, push policy and advocate for the patient, in addition to the basic bedside care we were trained for in the past.”


“In the 1980s, my physician told me I had to get out of nursing, and I remember someone telling me, ‘You can’t do anything else, you’re a nurse’,” says Dykeman. “The difference a degree makes it that it opens doors beyond bags, beds and bedpans.”

Ugh. Can you possibly get more condescending to the 86.5% of us who work in the front lines and do bedside nursing? Or to those of us with their degrees who like bedside nursing just fine? Or to the multitudes of diploma RNs who have just been told that their practice is crap? I’m not sure. I think Margaret Dykeson pretty well nails it.

Either provide leadership to all nurses — not just the ones who occupy teaching or managerial positions — or shut up.

Or am I being too sensitive?


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  1. #1 by Maha on Saturday 02 January 2010 - 1814

    Not being overly sensitive. Yes bed pans and poop suck but that doesn’t mean bedside nursing is crap. Its the basis for all higher nursing as well. If you don’t know what happens at the bedside and the patients aren’t being looked after, what’s the point of teaching, leadership and policy making? There’s no one there to implement the new learning at the bedside.

    I hope that made sense – I just get a little upset when I get told that being so close with patients is somehow demeaning to oneself.

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