This summer, as part of an ongoing educational exchange programme, I was privileged to be one of 12 nursing students from Glasgow Caledonian University awarded a travel scholarship to attend California State University, Long Beach (CSULB).
As nursing education varies state-to-state across the US, the similarities and differences I encountered are based on Californian nursing education. In the US, there are two routes to becoming a registered nurse, both of which have to pass the National Council Licensure Examination (NCLEX) to gain a nursing license.
“I found it fascinating, the amount of pre-education students must undertake”
These are the associate’s degree in nursing (ADN) and the bachelor of science in nursing (BSN). From what we were told they are trying to phase out the ADN route in California, and many ADNs struggle to find employment unless they are completing a conversion to BSN.
I found this particularly interesting, especially when England have done the reverse through the introduction of the nursing associate role.
In California, to apply for nursing school, there are pre-requisite college courses students must complete in quantitative reasoning (statistics), oral communication, critical thinking, human anatomy and physiology, microbiology and chemistry.
Then there are co-requisite courses in psychology, sociology, pharmacology, pathophysiology and nutrition that must be completed throughout the programme. I found it fascinating, the amount of pre-education students must undertake and think it would undoubtedly have been beneficial and something I would have liked.
Potentially, it could also free up time for other learning in our UK nursing programmes, which have to cover some of their pre-requisites. However, when we are already struggling with nursing recruitment, is this something that would put people off applying?
Whereas in the UK we specialise in our chosen field from the outset, all nurses in the US are general trained.
Their five-semester BSN course, which takes four years to complete, includes modules in advanced medical-surgical, labour and delivery, critical care, psychiatric health, paediatric, community health, research and leadership. In their final semester, they then have a preceptorship module where they choose the area they would like to specialise in.
While I think it is essential all fields have knowledge of each other, I do think it benefits us to specialise early on in our education. There is only so much you can learn, and it is essential we join the register fully equipped to meet our patient’s or client’s specific needs. Interestingly, this was a sentiment shared by a significant number of the American students we met, who wished they had this opportunity.
Another difference is the number of practice hours needed to join the register. In the UK, all nursing students must complete 2,300 hours under the supervision of a registered nurse mentor to be signed-off and enter the Nursing and Midwifery Council (NMC) register. At CSULB, students only complete 1,125 hours.
Most surprisingly, only 180 of these are supervised by a registered nurse, during their final preceptorship module. The remaining hours are supervised by a faculty member. Throughout the programme, students attend wards in groups of 10, each taking care of one patient who they have made up a care plan for the day before, once weekly in the first semester, then twice weekly for the remainder.
While there is some argument around 2,300 hours being too much, I have found a sustained period on clinical placements to be where I have done much of my learning. Of course, this is supplemented by prior learning in class; however, I am sure I would not feel confident to nurse having worked for a sustained period of only 180 hours with patients in a clinical setting.
The health status of a patient can change so much in one shift, let alone in the day between students meeting a patient and writing a care plan for the following day. However, one benefit of having faculty members supervise may be that it helps students to retain supernumerary status; an identified problem that occurs in the UK.
In the lectures we attended, such as evidence-based practice, much of the learning was similar. However, their programme seems to be designed to pass the NCLEX. This examination is very similar to the UK Clinical Aptitude Test (UKCAT) that UK students must pass to gain a place on a medical degree programme. Therefore, nursing in the US seems to be much more diagnostic and clinically focused.
”We can, and should, learn and grow from each other by sharing best practice, benefitting the communities we serve”
While I can see the benefit in this, particularly as the nursing role develops and advances, it does make me question whether this shifts away from the unique function and agency of the nurse. I think Virginia Henderson (1966) perfectly defines this as: “to assist the individual, sick or well, in performance of those activities contributing to health or its recovery (or peaceful death) that he/she would perform unaided if he/she had the necessary strength, will or knowledge.”
The most important thing I have taken from my visit is the importance of global nursing. We can, and should, learn and grow from each other by sharing best practice, benefitting the communities we serve. And this once in a lifetime opportunity has left me with much to reflect on, which will help me throughout the remainder of my degree and influence my future nursing career.
My advice to other nursing students is if you have the opportunity to travel to another country and experience nursing there, apply and embrace it.