There are more than 100 different specialties in nursing, providing nurses with a variety of career options to pursue. In this episode, APU’s Dr. Bjorn Mercer talks to Assistant Dean and nurse Dr. Stacey Malinowski about her career path and the numerous ways students can pursue a nursing education. Learn about what questions to ask when pursuing a nursing education including acceptance of transfer credits, accreditation, online course options, and more.
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Dr. Bjorn Mercer: Hello. My name is Dr. Bjorn Mercer and today we’re talking to Stacey Malinowski, Assistant Dean in the School of Health Sciences. And today we’re talking about nursing education. Welcome, Stacey.
Stacey Malinowski: Hi, thanks for having me.
Dr. Bjorn Mercer: Absolutely wonderful topic of conversation. There’s so many different ways to attain your nursing education. So what entry ways into nursing are there for those who want to become a nurse?
Stacey Malinowski: Well, that’s a great question. And there are a ton of different ways which sometimes can add to a little bit of confusion when it comes to, how can I become a nurse? Right now, there’s several different pathways you can come in as a nurse with an associate’s degree. This would be a two-year program that you take at a community college.
They still have in some parts of the country what’s known as a diploma program, and diploma nursing programs are usually offered in conjunction with a healthcare organization. So you do all of your nursing courses and you do have some general education courses like your sciences that you would get during that type of program, and you would come out with what they call a nursing diploma. Then you can go to a four-year degree program and get out with a bachelor’s degree and enter the nursing profession that way.
And now they even have a master’s entry-level nursing, which is typically referred to as a clinical nurse leader program. So when you’re trying to decide, “Okay, I want to be a nurse. What’s the best way for me to get started?” I say, look at the time that you are willing to invest. Look at the schools near you, see what programs they have to offer and see what the trends are in your state as far as nursing education.
For example, I am in the state of Maryland. There is a national push for nurses to enter with bachelor’s degrees. However, in Maryland, you can still go to an associate’s degree program, but the expectation is that you will get your bachelor’s degree very quickly after earning your associate’s. So you want to have an idea of what the trends are in your area.
Dr. Bjorn Mercer: And that segues perfectly to the next question: What is the benefit to nurses to pursuing higher education beyond their initial nursing degree? So, for example, with the associate’s or the RN, I should say.
Stacey Malinowski: Yes. Perfect. So I know and have known many wonderful, wonderful nurses that have never chosen to go back to school beyond their diploma or beyond their associate’s degree, and they make fantastic direct care nurses and you cannot beat their level of expertise they have from being at the bedside for so long.
Now in nursing, I looked the other day, there’s over 100 different specialties in nursing. So, I think one of the benefits to pursuing further nursing education is it can help you move into some of these different specialty areas.
For example, many healthcare organizations, if you want to get into nursing management, you have to have at least a bachelor’s, if not a master’s degree. So, you might be interested becoming a nurse practitioner or a different level of care provider, you’re going to need advanced degrees for that.
So, going back to school can really help you be more competitive as you search for different specialty positions in nursing, and just help overall increase your knowledge of the nursing profession. When we go back to school, we learn more about research, evidence-based practice, different quality-improvement methodologies. And there is research that shows that hospitals that have a more educated nursing workforce actually have greater patient rescue rates.
Dr. Bjorn Mercer: And that’s wonderful because one of the great things about research is that hospitals around the country and clinics are always doing research, how to improve, how to make everything better, how to make patient care better. If someone is interested in going to nursing school or going back to school, what research should they do to determine the best path?
Stacey Malinowski: Great question. I’m going to say the first thing is, what do you want to be when you grow up? What is it in nursing that you want to do? If you decide, for example, you’re going to go back for your bachelor’s degree, as an associate’s degree nurse, there are many, many programs that have what we call RN to BSN programs. They’re completer programs to help you get that bachelor’s, and they are offered online, they’re offered on the ground. So, see what’s in your area and see what works for you.
There’s online programs that have five-week classes, eight-week classes, traditional semesters. So, you want to look at what’s going to fit in with your lifestyle. So I would recommend contacting different schools, finding out one, how many transfer credits you’re going to get, so you can see how many more classes you need to take, and how much is that going to cost you.
Another important consideration at the bachelor’s level going back to school is, is that program accredited? Do they have specialty nursing accreditation? If they don’t, you may not be eligible for financial aid or some other federal programs. So making sure that they have that seal of approval that they’ve been accredited. So, at the bachelor’s level, really it’s going to be more, what fits your lifestyle, what can you afford, and what’s going to work for you.
When you start to get in the master’s, you really want to research different universities that have the programs that you are interested in. Do you want to be a nurse leader? Do you want to be a nurse educator or a nurse researcher? That’s where the different specialty tracks start to come in.
So, it’s important to have a strong idea of where you’re going to know which program will be the best fit. And, again, if you know you want to be a nurse leader, check into several different schools. What’s it going to cost you? How long is it going to take you to finish? And what is the format like? Is it going to fit with your schedule?
Dr. Bjorn Mercer: And that’s great. And I remember my mom was a nurse for her entire career. And so she was an RN and then she stayed in a private practice for decades and she loved it and it suited her well. Can I ask you what your path was as a nurse? What did you start out in? What did you change to, and how you kind of came to that decision?
Stacey Malinowski: Sure. So, my decision was fairly easy. Actually, I started off wanting to be a teacher, and as I was in the military and trying to save up for time and money for college, I found myself I had gotten ill and ended up needing medical care and was released from military service and I had these amazing nurses. And I’m like, you know what? I want to be a nurse. I want to be a nurse because these nurses, they taught me so much about what was going on. I’m like, I can still help people because I wanted to be a teacher to help people.
So, I already had two years of college and I switched to the local community college because I could get my degree the fastest there. And that was what I did. And I kind of saw the writing on the wall and this was 20-some years ago, where they were going to be preferring bachelor’s degrees.
So I then decided, I’m just going to do this now. And I enrolled in an RN to BSN program. And in another year, I had my bachelor’s degree. I was very happy with that. Loved taking care of patients and was very happy working in the ICU doing that. And I was helping nursing students who were coming in for clinical, and I was back to that teacher thing. “Man, I really love working with these nursing students. This is a lot of fun, loved precepting new grads.”
So, I chose to get my master’s in nursing education. It’s actually a dual masters in nursing education and in healthcare leadership. I was still working at the hospital. I got into staff development, started working as a clinical instructor on the side at the community college and just really loved working in staff development and helping the other nurses find their path back to school.
And then I realized that if I ever wanted to go full-time in academics, I needed my doctoral degree. And so that was my last step in my journey. And once I completed my doctoral degree, I transitioned full-time into nursing education and never regretted it. Nursing has been just a wonderful profession. I’m actually about to go back to the bedside just on an as-needed basis just to help with some of the COVID surge in the area. But I never regret having gone back to school and kept taking that next step, next step, so I could be exactly where I wanted to be.
Dr. Bjorn Mercer: Can you say a few words on nursing leadership. Because nursing and healthcare is different than other fields because not only do you have to deal with the staff, other nurses, other healthcare workers, but you have to deal with their emotions. And these staff have to help and treat patients who sometimes die. That’s emotionally very difficult for people. Can you say a few words about what it’s like as a leader to help support your staff with that issue?
Stacey Malinowski: Well, I think self-care, and the nurse leader really needs to promote self-care amongst the staff because even a good day in the hospital is a very busy, stressful day. We do, in certain areas, you do see a lot of death. Some is expected, some is not. And giving the nurses an avenue, not only for self-care, but an avenue to talk, to debrief on these situations as they occur, I think, is very important. So creating a support system.
I know where I’ve worked, the best managers I’ve had after critical incidents we may have, she was there, she was there on the floor. She was there talking to the nurses. She had the chaplain there. She had people from the ethics team there. There was just always support. You always felt as though you had someone you could talk to. And so I think that’s what’s really important as a nurse leader, is that being present and being there, as opposed to being in your office, which is hard because healthcare, it’s a business. There’s data, there’s quality, there’s measures that we have to keep up with that can often conflict with the human side of what we need to do every day. So being a nurse manager is a very, very busy and I think often thankless job.
Dr. Bjorn Mercer: And that totally makes sense. Unfortunately, it can be very thankless, but always connecting with that human side of being a nurse and with patients is always so important. And this leads us to the next question is, what is the difference between an advanced practice nurse and a registered nurse?
Stacey Malinowski: That’s a good question. An advanced practice nurse is actually a protected title for those that have received advanced education and have sat for national certification as a nurse practitioner, nurse anesthetist, nurse midwife, a clinical nurse specialist. So, they’ve all gotten their master’s degree and they’ve taken a national certification test.
Nurses that go and get a master’s degree in nursing education or another specialty, they may have advanced nursing education, but they are not considered an advanced practice nurse, a big distinguishing qualifier to make.
Another question I get asked a lot is what’s the difference between a nurse practitioner and a physician’s assistant. And I think that’s important too, and I think where you live in the country depends more of what you’ll see.
And a nurse practitioner is somebody who has a minimum of a master’s degree. They’ve received 500 clinical training hours in a specialty area. So maybe it’s geriatrics. Maybe it’s family or pediatrics. And then they sit and take the national test. Nurse practitioners in some states can practice independently. They do not have to practice under a physician, and they can write your prescriptions. They can see you and treat you for a variety of diseases that they’ve been trained to that’s within their scope of practice.
Physician’s assistants, they often attend additional training. I believe it’s upwards of 2,000 practice hours that they receive as part of their education through physician assistance programs. However, I don’t believe that in any states that they can practice independently. So you’ll see them practicing with physicians.
Dr. Bjorn Mercer: And I love that you brought up physician’s assistants and nurse practitioners because, in reality, most people don’t need to go see a doctor every time for the regular checkup to make sure everything’s fine, X, Y, and Z. They’re great, and they’re absolutely wonderful. But again, for most people, seeing a PA or a nurse practitioner is all we need and it could really help us get back on track and having that healthy life and also just to make sure that we have those yearly or however it is, maintenance visits to make sure that our body is also behaving if that makes sense.
Stacey Malinowski: Yeah. Absolutely. And we have such a shortage of healthcare providers, and physician’s assistants and nurse practitioners are just such a wonderful addition to the healthcare team to help us see patients and help patients get the treatment. Can they treat, diagnose everything? No, but they certainly have the tools and skills to refer and to get you to the appropriate level of care when needed. But they see patients all day in and out and they develop quite an expertise themselves.
Dr. Bjorn Mercer: And that leads us to the last question. Have you seen any impact on admissions to nursing schools due to COVID? And in what way has nursing education been affected overall?
Stacey Malinowski: Yeah. So, unfortunately, that’s another area that COVID has affected. The good news is that applications to nursing programs across the country are up, which is wonderful. However, because of COVID, we have a shortage of faculty. A lot of faculty have retired. Not only that, we have had, understandably so, a lot of difficulty in placing nursing students in clinical sites to do their clinical rotations because yeah, hospitals and healthcare organizations are limiting who comes in. We’re starting to see people get more back in there and letting the students in, which is great, but it kind of has definitely slowed down the pipeline just a little bit.
So, nursing education, you have a lot of your initial nursing licensure programs, like your associate’s degree programs they had to transition completely to online. They had to incorporate a lot of simulation. So I do think we’re going to see, for a short time, a group of nurses that are going to come through where a lot of their practice was simulation, which simulation is great. But I do wonder the person-to-person connection. I wonder about the interpersonal skills, how those might be changed in the students that had to rely so heavily on simulation while they were in their nursing program.
Dr. Bjorn Mercer: And that’s a great question, because it’s hard to know. The one thing, my wife is an occupational therapist and having worked through COVID, it’s been very difficult. So all nursing professionals have had a really tough time over the last two years. And it’s not to say that everybody in the country hasn’t had a hard time, but especially nurses and especially healthcare professionals were having to treat COVID patients, having to treat everybody else, having to be essentially on the front line and for the vast majority of them, getting COVID themselves because of their profession. And it’s quite a toll, and it’s interesting because I remember when I was teaching 20 years ago, there was a nursing shortage and it’s somewhat endemic. And how can we overcome that nursing shortage?
Stacey Malinowski: I don’t think we ever will. I think in 20 years, we would still be talking about it. The population’s booming and there just aren’t enough nurses to take care of patients because we have expanded in our technology so much that patients are living so much longer than what they used to, which is again, another great problem to have that patients are living a really, really long time because we can manage their healthcare needs.
However, that requires more people to manage those healthcare needs. So I would love to see there be more consistency in the nursing profession and how we’re bringing people in. I know there’s a big push in a lot of bachelor’s only, bachelor’s degree only. I think as a profession, we need to remember how well our diploma and associate nurses have served us over all of these years. And I think it would be a shame to take away that pathway as an entry level to our profession because they do a tremendous job. So I think we really need to find more streamlined processes, ways to get people in and working at the bedside.
Dr. Bjorn Mercer: Education, just speaking holistically, is great. Getting a bachelor’s degree is very advantageous, but four years is a long time for people and sometimes people need a quicker path. And so, say the CNA or the RN, depending on the state where you are, are absolutely wonderful paths because then when people oftentimes will take that two years or however long it takes, sometimes shorter, to get that education and then job, they’ll continue it, of course, because then they’ll see how the upsides of getting their bachelor’s or whatever can really benefit themselves and their family. And so, I completely agree that more education is always good, but it shouldn’t limit access to people getting out there and helping their fellow humans with such an important job such as nursing.
Stacey Malinowski: And I think too, there needs to be more education to the public, those that are interested in becoming nurses. Maybe we need to start in high schools and really start talking and having these discussions earlier. Because there are so many really great federal programs out there to help assist pay with nursing school, there are state-level programs.
And I will share that my bachelor’s, my master’s and my doctoral degree were all paid for by my state because I was able to apply for grants and funds and then provide my service back to my state. So there are a lot of ways out there. I just don’t know that students know where to find them.
Dr. Bjorn Mercer: And that totally makes sense. A portion of my wife’s master’s was WICHE, which is a Western organization. It’s a conglomeration of western states in the U.S., which was able to pay for a part of it. Not all of it, unfortunately, but a part of it. But, like you said, there are a lot of programs out there and depending on your state, some states have a worse shortage than others, but there are ways to get funding, if not all, partial, which is always helpful.
Stacey Malinowski: Yeah. I agree. And also using the military as an avenue, too. Military medicine and nursing is very exciting, at least for me. And I enjoyed being a part of that later on, when I went back into the Army Reserve Nurse Corps. I think we almost need more mentoring. Nurses need to mentor the young to help them find their way into the profession, help them see that this is something that you can do relatively low cost. It doesn’t have to be something that you have to come out with all these expensive student loans, because I think people are getting savvier and people are, why should I have all these tens and thousands of dollars of student loans for my career? They don’t want to start out that way.
Dr. Bjorn Mercer: Exactly. And I 100% agree. And as someone who’s always taught at the college level my entire career, I think college education is great for everyone, but you don’t have to get all these degrees and all this education to have a great life and a fulfilling career and to really help people. You need to find the job that works for you, and nursing I always say is absolutely wonderful, of course. I saw my mom be a nurse her entire career. It is the foundation of all healthcare, from my perspective. Doctors are great. Therapists are great, my wife’s a therapist, but nothing happens without nurses. And so absolutely wonderful conversation. Any final word, Stacey?
Stacey Malinowski: No. Just I encourage anybody who’s ever even considered maybe becoming a nurse, really look into it, find a nurse and talk to them because there are so many ways in the profession, over a hundred different specialties. There’s so many things that you can do. So once you become a nurse, you can stay a nurse for your entire career.
Dr. Bjorn Mercer: Absolutely wonderful. And today we’re speaking with Stacey Malinowski about nursing education. And of course, my name is Dr. Bjorn Mercer. And thank you for listening.