Which of the following ICU nurses would you want caring for you, presuming that all provide good emotional support?
* One who instills normal saline into your tracheostomy before suctioning.
* One who keeps you supine while on ventilation.
* One who lets your family visit only for the 10 minutes permitted every hour.
I'm hoping you'll say "none of the above." All of these nurses are using practices that are not evidence based and are out-of-date-even unsafe.
In this issue we report troubling findings of a study of the educational mobility of nurses: evidently, some nurses believe their work requires no additional education beyond that of their original nursing program. James William Bevill, Jr., MSN, RN, and colleagues from the North Carolina Center for Nursing report on their analysis of two cohorts of graduates of North Carolina nursing schools who maintained active state licenses during a 20-year study period: graduates of diploma, associate-degree, and baccalaureate programs in 1983-84 (3,384 graduates) and 1993-94 (5,341 graduates). Fewer than 20% of those graduates pursued higher degrees, and fewer than 6% acquired a master's degree or doctorate. The authors discuss these findings in terms of the supply of nursing faculty, but I see implications for practice, as well (see page 60).
As I wrote in July 2006 (Editorial, "Mentored by an LPN"), I have long been a proponent of the many routes of entry into nursing practice. I've argued that nursing has the best educational ladder of any profession, one that other professions should emulate, particularly since public funding for degree programs can't keep pace with increases in tuition and fees. According to a report by the College Board in October 2006, the average tuition and fees of four-year public colleges increased by 35% over the past five years. The 2006-07 average annual cost was $5,836 for a four-year public university and $22,218 for a private university.
Bevill and colleagues didn't have access to data on why more nurses didn't pursue higher degrees, and clearly more research in this area is needed. But the North Carolina data have reinforced my belief that, while we should keep our educational ladder, we should also
* require a baccalaureate for professional practice after a specific period, such as 10 years, as is being proposed by New York and some other states, and push for public funding of loans, scholarships, and tuition reimbursement by employers.
* build in substantive workplace rewards for nurses who pursue master's degrees. In her new book, AfterShock: What to Do When the Doctor Gives You-or Someone You Love-a Devastating Diagnosis, social psychologist Jessie Gruman, PhD, draws upon her own experience as a patient and says, "Clinical nurse specialists have become an important fixture of many hospital units, and they are pure gold." We must do more to enable nurses to become advanced practice nurses.
Supporting the evidence of Bevill and colleagues are the random reader surveys we do at AJN. While most respondents say that AJN is an excellent journal, some say that they will not renew their subscriptions because they "don't have time to read nursing journals." How can a nurse not read at least one nursing journal? Woul you go to a physician who didn't have time to read medical journals?
This is not about whether one individual nurse is better than another. It's about whether we believe more education will benefit nurses, patients, and society. How can you believe otherwise? Every other health care profession has raised its educational requirements for practice. Why shouldn't nursing follow suit? Care and the science behind it have become much too complex for nurses to refuse to continue their education.