By State Representative Sharon Cooper (R) HD 41
Everyone, since we’ll all be patients eventually, needs to pay attention to the most lobbied issue before the Georgia Legislature. SB 49 eliminates the Georgia Board of Nurses’ (GBON) authority to maintain Georgia’s standards for registered nurses (RNs). Excelsior College, a non-traditional New York program, the only nursing program in the United States with no supervised clinical training[1], is pushing this bill.
In recent years, non-traditional (online) nursing schools have become increasingly popular. Other online programs include clinical training that meet the standards established by GBON. Excelsior College has repeatedly refused the GBON’s requests that they include clinical training. The school relies solely on online, self-study modules and a two day assessment of a student’s clinical skills. Obstetrics and mental illness assessments are not included. The school claims their students need no clinical training because the students have experience as Emergency Medical Technicians, Respiratory Technicians, Licensed Practical Nurses, Military Corpsman or other in “clinically oriented health care fields.”
While I have great respect for the men and women working in each of the areas above, they each have competency in a very specific healthcare area. None cover the breadth or depth of skills that are required for registered nursing. For example, respiratory technicians are adept at caring for patients with breathing problems, but are totally unprepared for the responsibility of caring for an entire surgical unit with post-op patients of every description. For this reason, GBON requires several months of clinical training for every nursing student to ensure they receive clinical training in all patient settings in which RNs practice.
Sadly, the Georgia Nurses Association (GNA), which only represents about 3% of the state’s RNs, is supporting SB 49. The GNA administers the two day clinical test for Excelsior students from all over the country. This has become a major funding source for the association, since students pay $1900 to take the test and many fail the first time.
Supporters of SB 49 say Georgia’s nursing shortage is reason to rush passage of this bill. With 110,000 RNs in Georgia, perhaps the question should be, “why are RNs choosing not to work?” According to one national study, 1 in 5 RNs quit within their first year. Hospital patients are sicker now than they have ever been, causing many novice RNs to report feeling overwhelmed managing multiple patients and making critical decisions without sufficient support. Flooding the system with less experienced graduates will only make matters worse. One Excelsior graduate was such an imposition to his supervisors they requested he, “not return to the unit because he places excessive demands on staff time due his lack of fundamental knowledge of the nursing process.” Two major health systems in North Carolina do not hire new Excelsior graduates for this reason and for concerns for patient safety.
For similar reasons other states are questioning the lack of clinical training in Excelsior College’s nursing program. For example, one graduate attempted to catheterize a man who could not urinate. Being untrained in the technique, he inflated the catheter balloon in the man’s urethra instead of his bladder. To make matters worse, he then pulled out the catheter, balloon inflated, causing the man to experience excruciating pain and excessive bleeding. Another graduate could not place an IV in the patients’ vein so he just pushed the fluids into the patients’ surrounding skin. Examples such as these have led many states to consider or establish additional licensing requirements for Excelsior graduates. Some states evaluate Excelsior graduates on an individual basis, while others will only license Excelsior graduates who have worked as RNs in other states.
Try to imagine yourself as a hospitalized patient; if you believe it is important for nursing student to have supervised clinical practice in their nursing education programs before they become RNs, please take the time to call or email the Governor, the Lieutenant Governor, Speaker Glenn Richardson, and all the members of the Health & Human Services Committee, log onto Georgia.gov for all of the contact information. There is a place for non-traditional programs in educating nurses, but before we whole heartedly adopt a radically different approach, we need to carefully study the issue. I do not believe that even the author of SB 49, who is a dentist, would want a dental assistant to take online courses, a two day test, and receive a license to be a dentist.
Representative Sharon Cooper, RN, MSN
Chairman, Health & Human Services Committee
Georgia House of Representatives
[1] National Council of State Board of Nursing