Aahhh - The Good Ole Nursing Diploma Days

I so remember the first days of my nursing education at the Misericordia Hospital in Edmonton - it was a mix of high anxiety and excitement as I entered the nursing school and started out on a new journey. The anxiety was related to a lot of the normal baggage one brings from their upbringing that, for people who know my background, there were a few challenges. But it was also due to taking a huge leap of faith into a career path and profession that I only understood from the outside through nurses I had observed and admired. And from what I had seen of nurses, the knowledge and skill and life saving interventions suddenly seemed like something beyond my capabilities - I definitely felt a lot of insecurity and deep-seeded self doubt beaten into me from childhood. I intentionally selected the Misericordia program as it was a 3-year program, rather than than the usual 2 1/2 years that most other institutions had (except for the baccalaureate program at the University of Alberta and, at the time, I felt it was beyond my academic abilities). I figured that it would take me additional time to be a competent nurse. On the other hand, the excitement was finally doing something I wanted to do and not what I had been programmed to think I should be - a farmer or a tradesperson. Don’t get me wrong…there is nothing wrong with either of those but it was just not me. It was nursing where I could finally break free of the farm and my rural roots to be my own person. And to discover my potential.

As I was to discover, the diploma program at the Misericordia was more than just a nursing education program - it was a community that still carried the legacy of the nuns who founded the hospital and had values that focused on individuals and family. This would become evident from the overall sense of belonging and cohesion between the various departments and staffing on the units where there generally was good camaraderie and respectful relationships between most people - of course, there were a few exceptions to this and a few challenging personalities to navigate. Some of the nurses on the units had been there since graduation topping off the seniority list with 35+ years of service and many nurses who came from other programs or countries would stay to serve out the rest of their careers. The nursing school was tucked in behind the hospital within a 10-story tower, of which 9 floors were dedicated to student residences staffed with “house moms” and regular housekeeping staff. While not all students opted to stay here (I did for my first year), the combined residence and education facility with the large Red Room lounge and gymnasium was a hub where students learned and socialized together, supported each other, celebrated together, and also grieved together. For me and many others, this communal arrangement facilitated our success in the program and forged many long, enduring friendships.  

Besides adapting to the rigors of serious academia, my time at the Misericordia would also be a transition for me to become a more social being because throughout junior and senior high school I had been an outsider, a misfit. I had grown up being pretty reserved and awkward in social settings - something I would eventually shed through my nursing education. And that is one thing I can say about my nursing education…it was transformational on so many levels, instilling confidence and an ability to express one’s self. However, a person really had no choice - learning and transforming was a matter of survival. There was an expectation to learn, to know your stuff, and to demonstrate competent application of skills and knowledge. There certainly was not the handholding and spoon feeding that current nursing programs have evolved into that cater to a culture of entitlement for many students or an unwillingness to do the work required of a professional program. While not all of our instructors were perfect, there was a fairly strong respect for them and there was not the dynamics of online character assignation towards them with anonymous comments or getting parents involved because of bad grades. Social media has certainly played a big part in this but so has a general loss of accountability or sense of responsibility for one’s own behaviour and actions - I have both observed and experienced this in my last decade of teaching. 

Also throughout the last two decades I have observed a general lack of courage and/or fear by many instructors to counter this trend, plus academic systems that accommodate to the point some graduates do not have the capacity to function in healthcare settings. To be clear, I am a firm supporter of reasonable accommodations to support learning and I believe that students are entitled to quality education; but the reality is not everyone is cut out to be a nurse be it due to academic performance or a fit for the person. Yet many students now get through their program, pass a registration exam that has a surprisingly low threshold (something like 60% - same as the pass mark in most nursing programs), and then go into practice impacting quality of care, patient safety, and the standings of the nursing profession. When I entered the Misericordia program, I knew I would test myself as to whether I could or should be a nurse and, as I will share in a future post, I almost walked away from the program by the end of the first year. Not because of grades or ability but, rather, due to an instructor who seemed to have it in for male students. By the end of our program only 69 of 90 students completed the program and graduated and, of these, six of us were men (we started with eight).

From Day 1, the expectations were set on academic and professional performance. This included a requirement of attendance (not showing up as a matter of personal choice was not an option), meeting the grade threshold, clinical skills ability (each skill practiced and tested before heading to a unit), professional comportment, and even meeting the standards of the school-issued student uniform…cap and all. And it was a full academic schedule with classes and labs three days per week and then two days of clinical practice on the units. The visionary leaders of the program were already anticipating the day nursing would become degree entry-to-practice, so five of the courses we would take were taught by faculty from the University of Alberta and this would count towards credit for a post-RN baccalaureate degree after diploma completion. 

I encountered some very wonderful and supportive instructors and mentors during my diploma nursing program. The most memorable was in my second year postpartum rotation when, before having to do my first postnatal assessment, the instructor checked in with how I was feeling about the situation prior to seeing my patient. I was highly nervous bordering on terrified because, although I had worked hard to be prepared, this was a super intimate interaction with a patient who had just given birth - way out of my comfort range and experience. The instructor’s caring approach and genuine desire to support me put me at ease prior to going in the room; this helped when things did not go completely as planned. My attempt to protect the patient’s modesty went awry when, at the point of doing a fundal check, the patient (trying to be helpful, I think) whipped her hospital Johnny gown over her head leaving her starkers on the bed. I could not conceal my surprise/shock with the process going off completely off script but I managed to thoroughly complete my assessment. The instructor debriefed me immediately afterwards with, what I detected, was a sense of bemusement whilst genuinely inquiring how I felt about the procedure and reassuring me that, despite the unanticipated revealing, I had acted professionally and had done a great job with my assessment. It was one of several times that I truly felt being well-supported as a student but also valued as an individual, especially as a male in such an unique and foreign learning experience.

While we were “only” hospital diploma graduates, when the time came we were more than prepared to transition into the role of a professional nurse. This was because we needed to know our craft and did what was necessary to pass our school exams, demonstrate our clinical abilities, and then pass the national profession exam (four components over two days!). I think that everyone did pass on the first writing when the time came, but not all who started the program finished - some lost to academic performance, some to clinical performance, a few to life circumstances, and a few leaving because they just did not find nursing a fit. And all of these reasons are OK, in my opinion - life happens and sometimes nursing is not the right path. Those who crossed the stage were prepared to a standard and quality to ensure safe, competent patient care…the rest of the work to follow this through was now resting on our own accountability, professional responsibility, and integrity. Most of us would then move on to work on units that still had cultures of solid nursing practice, quality care, and a spirit of cohesion amongst the staff.

I fear, however, that the standard and quality of nursing education and graduates has been truly compromised for a variety of reasons, not least of which some academic institutions treat education like a widget assembly line - something that does not serve practice professions very well. I will explore this and other factors impacting the education of knowledgeable, safe, and competent nursing graduates in upcoming posts. But, for now, I wax nostalgia on the good ole days of nursing education.