Barrier to Entry
I’m about to get myself in big trouble here. In another excerpt from what is rapidly becoming a book-length project on choosing nursing vs. medicine, I’m going to try to tackle part of nursing’s image problem. Hold onto your hats.
Here’s a quote from a reader of this blog:
“I have done a semester of an RN program, but I’m starting to have an identity crisis. If I worked harder in the past, I would have been going to medical school today.”
What this person is really saying is: “Doctors are better educated than nurses. So if I’m smart and good in school, I should be doctor. If I don’t work hard or get good grades, I should be a nurse.” First of all, the term “better educated” is fairly meaningless. By “better educated” do you mean smarter? Good nurses are smart, and I know plenty of dim doctors. By “better educated” do you mean “spent more time training?” Time in training gets you more experience, not more education necessarily. By “better educated” do you mean “spent more time in school”? I spent a whole year sitting in Calculus and never learned a darn thing. Yes, doctors have more education, of a scientific and medical nature. That’s why they get to make medical decisions.
What the writer might really mean by “better educated”, “better” being a value judgement in this case, is “superior”. Herein lies one of the core sources of nursing’s image problem and it’s tendency towards defensiveness: the assumption that “Doctors are superior to nurses because they are smarter and better educated.” This is what people who say “You’re really smart. You should go to medical school” are really implying. I hope by now you know that I think that the decision to go into nursing or medicine lies in what you want the focus of your care for people to be, and not how smart or educated you are or want to seem. But the the assumption that doctors are smarter than nurses persists, in large part because of the barrier to entry.
Let’s compare the academic bar set for various degree programs.
Admission requirements for a typical ADN program:
1. Be high school graduate or have passed the high school equivalency GED (General Educational Development) Test.
2. Have a high school grade point average (GPA) of at least 2.5.
3. Have completed one-year courses in high school algebra, biology and chemistry with “C-” or higher in each.
4. Have a negative 7-panel urine drug screen and complete a criminal background check. Students will not be allowed to enter the program until cleared by GRCC police.
5. Score at least 75% on the HESI test. This test assesses knowledge in reading, vocabulary, grammar, and math.
Admission to the BSN programs typically require:
1. High School GPA of 3.00 or higher (on a 4.00 scale)
2. ACT score – 20 or higher or SAT score (CR+M) – 930 or higher
Here are the entrance requirements for a typical state medical school:
1. High school diploma with average science GPA of 3.7 and total GPA of 3.8
2. College degree with all the required science and math courses (grades of C or below don’t constitute completion of any any course), average GPA 3.7
3. MCAT scores of at least 27
The existence of an entry point into nursing that does not require a college degree, or even a high school diploma, really, and that only requires the student to barely pass their coursework, pulls professional nursing into the realm of being more of a job or a trade than a career, requiring more brawn than brains. An ADN-prepared nurse might be a great nurse and a smart person, but such a low barrier to entry fuels the assumption that nurses are not smart. Nursing policy makers would really like to make a college degree a requirement, but there is also a strong argument being made that removing the ADN as an option will discourage people from becoming nurses at all. Professional nursing will have to decide whether it wants to maintain this inclusivity at the expense of image and credibility.
Medicine, of course, has an incredibly high barrier to entry, both in terms of time, money, and academic ability. Notice I don’t say intelligence. Medical school is more about persistence than smarts. But to become a doctor you have to perform at a very high level for a very long time from a very young age. And it’s very expensive. It almost seems designed to discourage people from becoming doctors. The resources, both external and internal, required to actually complete such a road are beyond what most people think they can come up with. This lends to medicine a mystique and unreachability that results in a superior image.
I’m not saying that nursing should require everyone to have a PhD. Nor am I in any way saying that doctors are smarter than nurses. Nor am I saying that ADN-prepared nurses aren’t good nurses. I’m saying that the standards set by educators and administrators in any field should reflect the image that field wants to portray.