In order to perform the duties of a Registered Nurse (RN for short), one must attain certain criteria. Included in this criteria is attending an accredited and recognized Nursing School. The school/college can be public (CUNY/SUNY), private, online or in person. It is generally a two year diploma (ASN) or a four year degree (BSN), and once you have completed the rigorous curriculum, you should ideally be ready to take your licensing exam- the NCLEX, administered by Pearson Vue. This exam is the determining factor of whether or not you are a Registered Nurse or just a nursing school graduate. The RN license and registration are mailed to the home and this individual is now eligible to begin employment as a Registered Nurse!

            Personally, I disagree with the idea that the NCLEX licensing exam should be given intermittently, in order for nurses to maintain their licensure. Not all people are excellent test takers- some have the knowledge but lack the practical skill set or being RN’s, while others may be fantastic RN’s but don’t test easily. Also, we should take into account that the RN working in Labor and Delivery for the last five, ten or twenty years is most likely not current or up-to-date with Med- Surge or Oncology or Geriatric nursing practices.

            Alternatively, I feel that allowing RN’s to renew their licensure with proof of attaining a predetermined amount of Continuing Education (CE) credits would be a better solution. There is a vast amount of ongoing research as well as a massive amount of published research, and actual in person seminars that provide current up-to-date information and evidence based practices. These CE’s and CE seminars are more beneficial than just going in and taking an exam. The scope of nursing is so vast and extends so far that many nurses would be at risk for losing their licensure if this NCLEX Re-examination to maintain licensure were implemented. Consider the School RN’s or those in specialties or those doing insurance claims from behind a desk! I do agree that some form of requirement to maintain licensure needs to be implemented but insisting that RN’s retake the NCLEX would not be my route of choice.

There are three learning domains: Cognitive, Practical and Affective. Cognitive learning involves knowledge, facts, thinking, information. The cognitive domain refers to intellect. It involves thought, recall, decision making, and drawing conclusions. In this domain the patient uses previous experiences, prior knowledge, and perceptions to give meaning to new information or to alter prior thought perceptions. The Community Nurse can make use of the patient’s cognitive abilities when information is given to the patient or to his/her caregivers about the disease process, disease management, medications/ treatments and there adverse reactions, and even relocation/transfer processes. The patient utilizes their cognitive domain to process the information being given, ask questions, and make decisions. The goal is to ensure that patient’s are making informed decisions about their health care.

Practical learning involves applying your knowledge to a situation. It can also be referred to as psychomotor learning. Similar to practical courses in school, the name suggests “hands-on” learning. This learning domain involves learning physical skills or tasks. The patient can be taught a task or skill using a step by step method. Examples of practical learning could include teaching the patient how to self-inject insulin, take their blood glucose utilizing a glucometer, or monitoring their blood pressure utilizing a blood pressure machine.

They should be allowed the opportunity for  “hands-on”practice under the supervision of an appropriate healthcare provider such as a doctor or a nurse. Depending on the Community Nurses qualifications and skill set, the Community Nurse could also supervise the patient performing a return demonstration. The healthcare provider would then assess the patient’s proficiency of the skill.

Affective learning, which is very rarely reached by many healthcare providers, involves the patient and their feelings about what they have just learned. This particular domain includes the patient and at times even the patients’ caregiver’s, attitudes, feelings, beliefs, and opinions. Health care providers often ignore this domain, usually unintentionally.

However its imperative to reach out to this specific aspect of patient teaching. It is extremely effortless to hand out a pre-printed teaching pamphlet or article or guideline off of the computer/ internet. This is more so than not becoming the standard in most healthcare institutions.  Generally, the kind of material being handed to the patient or caregiver is often intended to be utilized as a checklist to aide or reinforce prior teaching. These pamphlets or “checklists” are useful in assisting the healthcare provider to remember pertinent facts to be covered while performing the teaching to the patient. It is there for reference and then it is given to the patient for their future reference. These pamphlets or handouts almost never take into account the affective domain of learning.

The most important requirement to learning about a patient’s affective learning domain and their readiness to learn, would be to develop a therapeutic relationship with the patient. This would include a relationship based on trust and caring. Patients are very keen and can sense when healthcare providers are genuine and sincere in their actions and words. Building this relationship early on is vital to paving the foundation to a patient’s readiness to learn.

When one takes the time to develop and build up a therapeutic relationship, both the patient and the caregivers or family have an increased confidence in the information being provided. It is vital to always approach the patient with respect and encourage and urge their expression of thoughts, questions and feelings.