Thursday, October 14, 2010

Rench's Nursing: Degrees & Research

My name is Nurse Rench, and I understand there were some concerns about my initial Elementary Nursing 101 lecture. I will try not to be so colorful this time.

We are surrounded by sickness and death worming its ways through the bloated bellies of the Baby Boom generation, which may now be our collective doom. 40% of nurses are currently over the age of fifty, with fewer people entering the field before thirty. Nurses will begin retiring at record numbers in 2012, just as the population is increasingly in need of their services. You can use this to your advantage, if you are willing to put in the work.

You should be aware of hierarchy. The lowly nurse's aide can walk in off the street and gain employment. A Certified Nurse's Aid receives a few months' worth of basic training, but is still at an entry level disadvantage against experienced uncertified aides, with a slightly higher eventual pay grade.

The Licensed Practical Nurse is subject to a rigorous year long accredited program, bringing with it a much greater amount of responsibility and broader skill set. After passing the National Council Licensing Examination for LPNs, they earn nearly twice as much as an experienced CNA. They provide basic direct technical care to clients under the supervision of a Registered Nurse.

A general RN will assess client's conditions, draft a care plan, and monitor its effectiveness. They graduate through diploma, associates, or bachelor's degrees, often studying within a hospital setting to accrue a wealth of clinical experience before actually serving as RNs. In fact, the American Nurses Association has resolved that an associates should only grant entry to technical nursing practice (AN,) with the baccalaureate a minimum for professional practice (RN.) As a straight shot, a bachelor of science in nursing takes four years, although a person who already has another bachelor's can piggyback it to pass through a 12-18 month accelerated program. From there, a master's takes a year-and-a-half or two.

Continuing education is necessary for expanding your knowledge base, progressing in your career, and keeping abreast of scientific, technological, and legal changes applicable to your field. Most employers compel their staff to attend in-service education relevant to their practice. Often, the state will mandate the need to spend 15-30 hours in CE to renew your license every few years, but you might also use it as an opportunity to work toward specialization.

A Nurse Educator like myself requires a PhD and brings down $50-75,000 a year. The Nurse Researcher is your overeducated academic, requiring a doctorate to make $60-75,000 annually. A Nurse Administrator is in management, which demands at least a bachelors and about 80K. A Clinical Nurse Specialist provides direct client care, acts as an educator, manages, consults and researches in their specific area of expertise to the tune of $75-90K a year. An RN certified by the American College of Nurse Midwives handles pre-and-postnatal care, manages delivers, and other duties often associated with the OB/GYN for a high five. Surprisingly, a Nurse Practitioner, who's practically a doctor these days, can expect the same. A Nurse Anesthetist can earn in the low-to-mid six figures for their work, but it is a boring, empty job with brief moments of enormous intensity when things go awry. The sky's the limit for a Nurse Entrepreneur, but it requires an advanced degree and business savvy.

All nurses are expected by the ANA to include research as part of their standards of professional performance, with emphasis on evidence-based practice (EBP) to substantiate their clinical decisions. The two major approaches to investigating diverse phenomena are quantitative (left brain hard data) and qualitative (subjective, anecdotal responses.) The human subjects of this research must be afforded their full rights as sentient beings. They include the rights of self-determination, full disclosure, privacy & confidentiality, as well as the most important, the right not to be harmed.

There are four criteria to determine the value of researching a question or problem. The first is significance, as in uncovering the biographical details of New Bloods left out of the Skybox trading card set because they were created in Batman-related titles to which Fleer had already been awarded the license. None of those characters mattered, most are dead, and few mourn their passing.

The second criteria is researchability, which proves that no one researched a dictionary before drafting the criteria. You may ask "What if god was one of us-- just a slob like one of us-- a stranger on the bus trying to make his way home?" However, the question lacks specificity, as there are thousands of documented deities active within the universe, and the scope of most nursing does not include the mystical arts.

The third criteria is feasibility, as in launching a study into the Silver Age mating habits of Martians. While elements of various ages of Kryptonian mating manifest to this day across the multiverse, good luck getting a grant to investigate Martian continuity buried under the three Crisis-level universe-spanning reboots.

The final criteria is the researcher's own interest, as they will rely on their obsession to drive them to fully pursue their studies. Perhaps you are an expert on the Red Tornado, but do you truly have the willpower to make it to Will Power and successfully complete a thesis on Primal Force?

The quantitative researcher must address their dependent variable, which is the subject they wish to explain or predict; and the independent variable, the catalyst that influences the activity of the subject. For instance, let's say one's purpose was to analyze the illness of DC Comics from the mid-90s. You might define the purpose of the study with the Jewish maxim "never again," then you must review the literature (Xenobrood, Extreme Justice, etc.) You must formulate a research hypothesis like "Zero Hour was mostly just an excuse to launch a bunch of shoddy titles and tidy up a bit of continuity in as lucrative a manner as possible." Your dependent variable might be #0 issues, and the independent variable would probably be the speculator market. From there, a research design must be settled upon; a population needs to be sampled; empirical data collected, verified and analyzed; and the conclusions shared.

Conversely, the qualitative researcher collects narrative data through interviews and observations which they transcribe and organize to construct conclusions. For instance, phenomenology might set aside sections of readers who had or had not read Campbell or Moorecock in determining their influence on how Hawkman fans felt about the eternal hero gestalt incarnation. Ethnology might look into the difference in responses between hetero-and-homosexual readers to the Legion of Super-Heroes reboot. Grounded theory might address whether people were ecstatic or merely content when Jared Stevens was stabbed to death by his own dagger of Fate.

That is all for today.


Tom Hartley said...

Brilliant. You are on your way to becoming the Alan Moore of super-hero bloggers.

Diabolu Frank said...

I wasn't sure about these indulgent semi-educational materials, so that's heartening. :)

LissBirds said...

If being compared to Alan Moore is a compliment, then I agree. :)

I'd like to see how that Silver Age mating habits of Martians study goes. I'd imagine your sample space is pretty small, though.

And what's with this trend of pushing RN's into a four-year degree? I really disagree with over-academization, if there is a such a word, for a practical, hands on profession. Do you really need four years of nursing classes, or are they throwing in liberal arts classes and theoretical stuff just to take up your time? Colleges need to stop sucking money out of their students while telling them they "need" this degree or that to be successful. Sorry for the rant, but higher ed and all its messed up priorities is a big pet peeve of mine.

Diabolu Frank said...

The thing with nursing is that there's a push from all sides for upward mobility. Nurses basically want the prestige and money of doctors, who are over-educated specialists and in too short a supply to meet societal needs. At the same time, someone still has to be willing to wipe butts and deal with the mundane realities of compromised health, which can only be foisted on family/home caregivers so much. LPNs get caught in the middle, because you need to be qualified for a lot of common procedures, but are clearly overqualified as an RN. Hospitals want to use LPNs and low level RNs as CNAs, forcing RNs to degree up whether they want to or not, often specializing just like doctors.

The thing about colleges is that somebody has to actually build the things and pave the roads to reach them. I expect we'll see a return to emphasis on and destigmatizing of vocational training in the relatively near future.

LissBirds said...

That's true for my friend, who's been an RN with an associate's working at a hospital for years, who suddenly wants to go back and get her four year degree either because she wants more pay or doesn't feel adequate. I can understand technology changes a little bit from year-to-year, but there's nothing a little on-site training couldn't cover. The human contact is the most important part of nursing, in my opinion, becuase they can connect with a patient in a way that doctors can't.

I was always an advocate of trade schools. I couldn't stand library science graduate courses because the assumption was always that a good school librarian should produce a student who goes on to a four-year degree and who is a reader. First of all, not everyone has to read, and second of all, not everyone needs a four-year degree. Since librarians have a superiority complex, I argued in my classes which would you rather have: all the libraries in the world cease to work, or all the toilets in the world cease to work. Screw books, I want a working toilet. The fact that the professors had their heads so far up their own rears was bad enough, but the fact that the students just sat there and accepted everything without questioning it was worse. I'd rather learn through my own experiences. I live in a so-called progressive state where librarians get all sorts of state funding, yet it's not even a state law for a school to have a school nurse, and many private school's don't have one.