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Letters to the Editor – January 2009


Why not a bachelor’s degree in 10?
I agree that advanced education for RNs should be mandated, as described in “BSN in Ten” in the November issue. I don’t agree, however, with the narrow focus of the mandated degree, the Bachelor of Science in Nursing (BSN). Nursing is an art as well as a science.
I earned a Bachelor of Arts degree before I entered an associate degree RN program. I tried but failed to achieve my BSN. Later, I completed my Masters degree in Public Administration, which allowed me to move into a nurse-manager position and positively affect patient outcomes.
Many roles are available to nurses today, and a science background isn’t the best preparation for all of them. The requirement should be that RNs attain any baccalaureate degree within 10 years. By mandating the BSN, all we are doing is turning out square pegs for holes with an infinite variety of shapes.
Ken Wolski, MPA, RN
Trenton, NJ

From Today’s Forum
Yes, Yes, Yes. BSN should have been the entry level years ago. Nurses are essentially the patient-care team leaders, yet other professions require more education and training. Physical therapists, occupational therapists, respiratory therapists, and pharmacists all have increased educational requirements. But nurses continue to be offended by the thought that needing more education means they aren’t good nurses. We need to move past that mindset and progress as a profession or be left behind.

Inappropriate reflex testing?
In the November issue, the author of “Urinary incontinence: No one should suffer in silence” says the neurologic exam should include checking for anal wink (in response to a light scratch of the perineal skin lateral to the anus) and bulbocavernosus reflex (similar anal contraction in response to a light squeeze of the clitoris or glans penis). Neither I nor my colleagues have ever heard of these reflexes. We don’t see why they are necessary when assessing a patient with urinary incontinence or how their presence or absence would affect patient care. We believe that eliciting these reflexes would be uncomfortable for the patient and nurse and could lead to a sexual harassment lawsuit.
Name withheld by request
St. Louis, MO

Author’s response: These tests are used to assess pudendal nerve transmission and sacral reflex (S2-S4) integrity. Certainly, more sophisticated tests such as electromyography are available to assess for neurologic or myopathic damage that may contribute to urinary incontinence. However, eliciting the anal wink and bulbocavernosus reflexes can mean avoiding costly, more invasive tests. The absence of these reflexes, though not diagnostically definitive, may suggest further testing is needed to rule out spinal cord pathology that could contribute to urinary or fecal incontinence, such as lumbar sacral cord lesions or cauda equina syndrome.
Numerous reputable sources discuss the importance of and methods for testing these reflexes during a urologic assessment, including these three:
• DuBeau CE. Clinical presentation and diagnosis of urinary incontinence. Accessed December 9, 2008.
• Gray M. Assessment and management of urinary incontinence. Nurse Pract. 2005;30(7):32-43.
• Toglia MR. Voiding dysfunction and urinary retention: lower urinary tract disorders. In Weber AM, Brubaker L, Schaffer J, Toglia MR, eds. Office Urogynecology: Practical Therapies in Obstetrics & Gynecology. New York, NY: McGraw Hill Professional; 2004:111-133.
Vicki Y. Johnson, PhD, RN
Assistant Professor
The University of Alabama School of Nursing at Birmingham

Nurse-to-nurse abuse: Learned behavior
I agree with Dr. Durkin’s comments in “Novice nurses: Leading the way against nurse abuse” in the October issue’s Letters to the Editor. I’d like to add that abuse in the workplace is deeply rooted in the way nurses are socialized into nursing under faculty mentors who themselves are abusive to students.
As a nurse educator for more than 3 decades, I have been privileged to work with and be a part of shaping our young nurses. However, I am very aware of and outraged by the way our precious students are disrespected, verbally abused, dismissed, and targeted for failure—all under the guise of curricula and high standards. No wonder nurses are abusive in the workplace; they are simply playing out what they learned from some of our respected colleagues.
Esther Graber Bankert, PhD, RN
Marcy, NY

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