Old School vs. New School Learning

I recently read some passages from Etienne Wenger’s “Communities of Practice”. I found Wenger’s writing and social theory of learning very thought provoking. I find I can easily relate to and identify with Wegner’s ideas. Perhaps one of the reasons behind this easy familiarity is that I am a perpetual student. I have literally been participating in formal education for over 28 years,  12 of which have been undergraduate studies. I feel that my last four years of undergraduate nursing school has transformed me as a person. Nursing has changed my way of thinking. As a result, it is through a nurse’s lens that I examine Wenger’s theories.

A lens can be understood as   “One’s own culture provides the “lens” through which we view the world; the “logic”… by which we order it; the “grammar” … by which it makes sense. In other words, culture is central to what we see, how we make sense of what we see, and how we express ourselves.”(PBS,1997)

A nurse’s lens is how I see and understand my role and experiences as a health care provider.  My  nurse’s lens helps me comprehend the station of a nurse from the perspective of a female in a traditionally male dominated environment. Furthermore, this viewpoint impacts how I view my rights as an employee of an institution; how I interact with my patients, their families, my co-workers and superiors.

I found Wenger’s ideas about the two main axes of intellectual traditions fascinating. It reminded me of the two vastly different ways nursing has been taught over the years, and the tension that still exist between them. Wenger states that “theories of social structure” give an acknowledged importance to institutions, accepted norms and rules. As a result, our culture places greater value on knowledge that has been attained  in a formal setting. For example, a degree or certificate from a recognized institution would carry more value than knowledge that has been acquired though the experience of  an individual. Whereas, the “theories of situational experience” places the greatest value on the “dynamic of everyday existence, improvisation, coordination and interactional choreography…They mostly address the interactive relations of people with their environment” (Wenger p. 12) In this theory, personal experience is viewed as valuable learning.

As Wenger describes these two theories, I feel he is describing oil and water and their inability to mix. Sadly, this has been my experience in regards to learning in the nursing world. Not too long ago nursing evolved from a two year program to a four year bachelor’s degree. The profession of nursing used to be taught exclusively in the hospital. Becoming a certified registered nurse required two years of hands-on clinical training as well as examinations for certification. The classes were small, predominantly made up of female students, and taught by female registered nurses. It was not uncommon for these teachers to be nuns. During this two year program the students were continuously learning and practicing nursing skills, while simultaneously caring for sick patients.

In today’s world, to become a registered nurse, one needs four years of undergraduate nursing education. Unfortunately, the majority of this learning is theory, with very little patient interaction. Only a small percentage of the degree is dedicated to in-hospital, hands-on patient care. From my personal experience, this theory-centered higher learning leaves a novice nurse feeling overwhelmed and completely uneducated in regards to patient care. This may seem like an exaggerated  situation, but this sentiment is common among novice RN’s. So much so, that there are hundreds,  if not thousands, of scientific journals and  laymans’ blogs  discussing it. This has made me question why nursing school was taken out of the hospital?

I also wonder where the shame attached to being hospital educated came from? Many nurses who have participated in the two year registered nurse certification program, regard it as a thing of embarrassment. I have often overheard seasoned nurses commenting, that they “only have their RN’s”. Yet, in my experience, these coworkers are some of the best nurses I have come across.  Their knowledge in regards to wound care, intravenous management and critical thinking is vast and rich, yet their education is trivialized. This is reflected in their lower salary allotment in comparison to university educated nurses. Furthermore, nurses who are hospital educated are not employed in preceptor roles for nursing students. I feel that this is a reflection of our society’s educational elitism. It is this kind of elitism that is causing shortages for student nurses looking for crucial in-hospital training preceptors. In fact, this crisis is not just a national problem, but a global one.

“Educating the next generation of qualified nurses in sufficient numbers is paramount to addressing the current nursing shortage. However, the current educational infrastructure in nursing schools inhibits workforce growth. While schools are struggling with such barriers as limited classroom space, insufficient clinical sites, and overall budget constraints, it is the shortage of nurse faculty that is the major obstacle to increasing student capacity. If not addressed, the shortage of nurse educators will continue to hinder further progress in reversing the national nursing shortage.” (Guillen, 2010, pg 3.)

To use Wenger’s words, university BSCN programs are denying  “agency or knowledgeability to individual actors”, by placing little or no value on RN certified educators (Wenger p. 12). Could we as a society be cutting off our nose to spite our face?

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8 Comments

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8 responses to “Old School vs. New School Learning

  1. Allie,
    I really enjoyed reading your blog and totally agree with your point about taking the training of nurses out of the hospitals. My daughter is an RN, and I remember the phone calls I would receive when she first started her career in nursing. She too is now taking her Masters so she can progress in her career. She had her four years of education from St.F.X.U. which included time on the floors of various hospitals, but it would be short periods of time and certainly didn’t add up to two years on the floor. The transition from school to the workforce is a difficult move for most people but when you are dealing with making decisions that effect a person’s life you need that hands on experience that comes from being in the work environment to go with the theory you learn in the classroom. As well you have to see and learn how to deal with the stress involved with working on the floor you can’t learn that from a book. That you learn from the “Old-timers” as Wenger calls them. Thank you for what you do in a much needed and undervalued profession.

  2. Hey Allie,

    I enjoyed reading your blog and getting a look at things through your ‘nursing lens’. Your appreciation for the ‘old-timers’ who may not have been trained in the classrooms but carry with the a fountain of knowledge from their hands on training was great to see . It saddens me to think that these nurses believe that they are “just RN’s”, not seeming placing value the years of experience they have. The fact that these RN’s are not being compensated monetarily for their experience & expertise could also be making them feel undervalued.
    I know nothing about the nursing field except for what I have heard from a close friend that was going through the BSCN program while I was taking my Dip. of DH. And as you and I both know from that program the hands on experience is key to making better clinicians. Hopefully those in positions of power in the nursing field will soon consider the research available and see that the old way of hands on teaching were great and incorporate it into the curriculum for future BSCN students. One can hope and dream!!! I admire nurses, I could never do all that you folks do, in my opinion none of you are paid enough!

  3. Hi Allie,

    I enjoyed reading your blog for a couple reasons. My roomie is a nurse and I’ve learned just how skillful she and her colleagues are, and have to be, to maintain high standards of patient care and accountability. I like the idea of apprenticeship learning because it works with my philosophy of making learning meaningful. You can have all the theory you can gather crammed into your head but will likely not fully fathom the implications of applying, or not applying, this knowledge in the ‘real world.’ It’s the difference between reading about how to climb a mountain and actually climbing it.

    Our society is trapped in the clenches of justifying every decision we make with such extraordinary precision that we almost fear the value of experience because it can’t always be tangibly measured. It results in self- and societal marginalization that, ultimately, is leading us toward educational elitism. I suppose putting a stop to this elitism is another hurdle to add to our list of things-to-do as adult educators.

  4. Hi there,
    I too enjoyed your post and could not agree more with your comments. My mom and I were just discussing this issue recently about the layers of nursing roles in the hospital and health care system. For example, Personal Care Workers, Continuing Care Assistants, Licensed Practical Nurses, Registered Nurses, etc. It seems there are a vast array of layers and qualifications overlapping to nursing patients today. It also seems that new roles have been created to force people into categories and differentiate them enough to justify lower pay and more work. Nurses overall are worked too hard, but I can’t help but notice how those lower on the totem pole tend to do some of the hardest work and receive the lowest pay. Much of the training they have received during a 2-year diploma program is comparable to the older nursing schools that prepared nurses to be RNs, but today are no longer considered adequate to become a “full” nurse (sorry I couldn’t think of a more appropriate term)..
    The justification for education seems to be the underlying rationale but perhaps it is not always the best indicator of ability, skill and knowledge. We have become consumed with being a knowledge-based economy and place the utmost value on credentials, that perhaps we have lost our ability to value hands-on experience and applied learning.
    Please don’t get me wrong, I am a believer in education but one that embraces both informal and formalized training. I believe that “old-timers” have a critical base of knowledge and skill that can be shared with “new-comers” via shared work roles, shadowing, training and mentoring. Perhaps our systems of education (whether it is nurses, teachers, tradespeople, etc.) would benefit if we could bridge the division of old versus new and try some blended learning strategies that integrate the best of both methods.

  5. Hi Allie,

    I agree with you; nursing has changed you as a person (I was and still am witness to this). I feel it did the same for me as well. I think the class that was key for me was on social economic status. It had a huge impact. Nursing has had a major effect on the way we both view issues. I personally feel we examine and discuss the question, why? When why is asked repeatedly, it typically prevents victim blaming and allows other possible perspectives to be open for examination.

    A topic you examined was the discourse between BScN vs. RN programs. I question if the change over from the diploma to the degree program was a money grab. Experiential learning to me as a learner is better than theory. However, there should be balance. The pay differential you discussed; is so minimal that over 30 years (or 780 pays) it will eventually pay for the principal cost of the undergrad degree. Never the less it is still there and nurses are aware of it. It is a pink elephant in the room.

    The politics that hide behind the initials are another story. Their effect on a nurse’s career is drastic. BScN nurses not only get paid more, they qualify for promotions diploma RN’s do not. As you said this closes doors to great nurses for teaching experiences and other opportunities. Another related issue worth mentioning is Masters of Nursing. Acceptance alone into masters of nursing offers teaching positions, promotions and other perks within the healthcare field. Diploma RN’s are excluded, as they would have to complete a post RN Bachelor’s degree and then masters. There is politics in our profession based on initials and parchment not experience, skill or ability.

  6. Hi Allie,
    While reading your blog I could easily relate to your story. Nuclear Medicine was also a two year NSCC program followed by on the job training. Overtime it grew to a three year diploma with an option to perform a fourth year to obtain a degree. I was the first graduating class (2008) that it was a mandatory four year degree from Dalhousie. My four year degree did consist of both classes to learn theory and clinical experiences. I am constantly hearing the argument you are making of the importance of experience. Then on the other hand I am hear the need for furthering education to gain professional recognition.

    I firmly believe that although experience is extremely important the importance of furthering education can not be overlooked. From my experience the degree program gave me opportunities’ and experiences I would not have been able to obtain in a 2 year program. For instance I was able to take electives in research, critical thinking, health law, management and health promotion. The degree allowed me to develop a better understanding of the bigger picture in health care and also opened other opportunities for me in the future while at the same time allowing me to learn and practice patient care skills.

    In a professional context, in the past it was seen as difficult to obtain
    professional status and recognition from other professionals without making the program a degree program. In many instances I heard “we need to follow the nurses” or “ look at the recognition nurse gained by requiring degrees”. In many ways I think we moved to a degree program to gain professional recognition and status because experience is not always respected. But where does it end? I think that is the difficult part. In the past you needed a degree to be in management or educator positions. Now you need a degree for entry to practice and a Masters to pursue management or education positions. What’s next?

    In the workplace it is sometimes difficult to see the benefit of higher education over experience. In my work place the majority of the time decisions based on promotions, pay increases or educational opportunities’ are usually given first to individuals with seniority not on what education you have o do not have or what continuing professional development you participate in.

    In my opinion higher education is important but it’s hard to find a balance between producing highly educated professionals and over educated professionals.

    Melissa

  7. Hi Allie,
    Great post! I appreciate your nursing perspective and have heard this type of elitism reflected in other parts of our health care system. I have read about issues of home-birthing in NS. Such as attacking the safety of using a midwife or duala, or the implication that they lacked the expertise necessary to handle even a regular uncomplicated birth. I agree that this is likely a symptom of our commodification of education. Whereby, the value is in proving that you have the right piece of paper as opposed to the right type of knowledge.

    Cheers,
    Chris

  8. Hi Allie,
    It sounds to me like the old nursing program was very efficient and successful at producing competent well-trained nurses. It is not fair that those who have graduated from the two-year program feel shame because they have had less time spent on theory. Most often I find I learn more rapidly when I am actually doing something as opposed to reading about it. I found this blog entry very interesting as I can relate it back to my experience as a nutrition student. I have been in university for six years now and have all the theory I need behind me to be a competent dietitian but little to no hands on experience. I have very little experience in a hospital setting and my only interactions with clients have been while job shadowing a dietitian. Next year I will be starting a dietetic internship with Capital Health where I will finally get the hands on experience I need but I too believe that nutrition students should be given more opportunities for hands on learning in university. I am nervous and anxious to be thrown into the hospital setting next year but at the same time extremely excited. I know the internship will provide me with all the tools and skills needed to become a successful dietitian however I would be less anxious about the experience if I had been exposed to more in university.
    Andrea

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