Contributor – Lesley Hodge

It was 2007. The boom was hot. Jobs were plentiful. As a Bachelor of Science in Nursing (BScN) student, I got a job as a Nursing Attendant (NA) in long term care. The unit had about 80 residents, and the floor plan was so lengthy that I recall one RN there used a segway to mobilize. Even though I was young, my legs would ache by the end of the shift. It was hardly worth the extra steps to the break room. Many other NAs mentored me, and to my surprise, they did not always provide quality care. They were tired. Understaffed. 

It was 2009. I was in my first or second year of my undergraduate education. A student colleague of mine was pregnant. She dropped out of the BScN program. I don’t know if she was able to come back for further education, and I don’t believe she would have had the option to transfer her credits that she earned in the BScN to any other nursing program. What if she wanted to pause her education to focus on her family, while still working in health care as a Licensed Practical Nurse (LPN) or Health Care Aide (HCA)? 

It was 2012. I finished my undergraduate BScN degree and would soon apply for a scholarship to pursue a Master of Nursing (MN) degree. Because I had the privilege of entering (and finishing) the BScN program to become an RN, I had a stepping stone which has allowed me to earn an MN. In 2017, I married and in the years that followed, had three children. I am now able to pursue a PhD in Nursing because of the stepping stones the BScN allowed me to further my education.  

In 2023, I read about a unique community initiative which supported locals with funding to pursue HCA credentials (Town of Drayton Valley, 2023). This funding opportunity in unstable economic times is outstanding. But, I can’t help but think—the credits of these HCA students probably won’t easily transfer to LPN programs, much less BScN programs. If the economy is taking a nosedive, can the structures of nursing education provide some support too? As I’ve argued before, nurses too are ecologically shaped by the schools of nursing and employment organizations (Hodge & Raymond, 2023). 

So Where Can One Step?

In Alberta, Canada where I live, there are some stepping stones. But these stones seem a bit precarious: 

• From HCA to LPN, Norquest (2023a) offers HCA’s a “laddering” opportunity. After one has 500 hours of work experience, they can request a “prior learning assessment and recognition” to receive some transfer credit into the LPN program (Norquest, 2023b). 
• The Alberta government (2023) summed up the nursing program transferring that is currently possible. From what I can see, there is no opportunity for someone to stop two years into a BScN and get any transfer credits towards an LPN certification. 

Note: Where I live, HCA is used interchangeably with NA (Alberta Health Services, 2023).  

Are We Practicing What We Preach? 

We care about healthy aging, yet what about those HCAs, whose bodies tire but their heart is still in the job. I think about my former NA colleagues, who’ve gained tacit and bedside knowledge but grew tired at the physical demands of their job.

We advocate for mothers, but what about mothers who also are responsible for nursing care? I wonder about my former student colleague, who started a family a little earlier than graduating the BScN program. 

Theoretical Connection 

I sought feedback about this draft post from Drs. Chinn and Fawcett, whose work has immensely shaped my thinking. They pointed me in the direction of Nye and colleagues (2022; 2023) Theory of Norm-Criticism for Nursing Education. The theoretical connection I see here is that structural barriers in nursing education reinforce inherent cultural hierarchies within nursing and existing structural barriers beyond nursing. An example illustrates this idea. A socioeconomically marginalized individual might only be able to afford to pursue entry level credentials (e.g. HCA) rather than a higher level of education (e.g. BScN). This limited entry point serves to entrap one within a social class and limit upward mobility. Are there ways to flatten power structures within nursing education and across schools of nursing that would make seamless progression through the ranks more feasible, and normative? 

Concluding Thoughts (and Questions)

Often, it’s better to understand something before suggesting changes. I welcome any insights about why there are not more seamless stepping stones in nursing education, or if there may be some efforts I may be unaware of. These stepping stones seem especially important in the healthcare industry—where there are crushing pressures and short staffing issues globally (Buchan et al., 2022; Baumann et al., 2023), and in a female dominated profession—where women still face patriarchy, and sexism. 

With further conversations, collaborations, and intentionality, it seems there could be a “stop, start, pause” model in nursing education, where learners have the opportunity to do just that. Maybe those stepping stones could turn into a bridge. Why aren’t schools of nursing more connected? Have efforts towards professionalism led to silos in nursing education? What questions ought we ask? Where do we start? 

References

Alberta Government. (2023). Nursing Programs. https://transferalberta.alberta.ca/post-secondary-admission/nursing-programs/ 

Alberta Health Services. (2023). Health Care Aide (HCA). https://www.albertahealthservices.ca/info/Page8636.aspx

Baumann, A., & Crea-Arsenio, M. (2023). The crisis in the nursing labour market: Canadian policy perspectives. Healthcare (Basel, Switzerland), 11(13), 1954. https://doi.org/10.3390/healthcare11131954 

Buchan J., Catton H., Shaffer F. A. (2022). Sustain and retain in 2022 and beyond. https://www.icn.ch/node/1463 

Hodge, L., & Raymond, C. (2023). Code poverty: An adaptation of the social-ecological model to inform a more strategic direction toward nursing advocacy. Nursing inquiry, 30(1), e12511. https://doi.org/10.1111/nin.12511 

Norquest. (2023a). Health Care Aide. https://www.norquest.ca/programs-and-courses/programs/health-care-aide/future-education.aspx 

Norquest. (2023b). Prior learning assessment and recognition. https://www.norquest.ca/applying-to-norquest/transcripts-and-transfers/prior-learning-assessment-and-recognition.aspx

Nye, C. M., Tengelin, E., & Somayaji, D. (2022). Theory of norm-criticism for nursing education. https://nursology.net/nurse-theories/theory-of-norm-criticism-for-nursing-education/

Nye, C. M., Somayaji, D., & Tengelin, E. (2023). Developing a theory of norm-criticism in nursing education. Advances in Nursing Science, 46(2), E66-E79. https://doi-org/10.1097/ANS.0000000000000440 

Sergei, A . (2018). Wheel on gray surface in closeup photography. https://unsplash.com/photos/wheel-on-gray-surface-in-closeup-photography-idNH4KGVh1Q 

Town of Drayton Valley. (2023). About: Helping local learners achieve their academic goals. https://www.draytonvalley.ca/zft-about/ 

About Lesley Hodge

Positionality statement: 

I’m a mother of three kids who (alongside my husband) are perhaps the best thing that has ever happened to me. I can’t imagine being a mother with fewer options. I hailed from relative poverty and with a bit of luck, I managed to break and escape the cycle. Meditation is my jam. I love to learn, write, connect, walk, and think!