Tuesday, March 18, 2014


Talk Them Out Of...

Every so often you hear something in a meeting that makes you stop short, because it so neatly encapsulates a difficult truth.  That happened yesterday.  Someone who works here mentioned that her job is to “talk students out of Nursing.”  

She was exaggerating, of course, but substantially correct.  Sometimes talking students out of something is one of the most valuable things we can do.

In the case of Nursing, the issue isn’t the academic ability of the students.  That tends to sort itself out without much external nudging.  The issue is mostly the students’ ignorance of alternatives.  For many students, especially those in the first generation to attend college, the only health-related jobs they can picture are doctors and nurses.  Nursing seems like the more accessible of the two, so they set that as a goal.

Which is great, as far as it goes.  But there are only so many clinical spots for nursing students, and only so many jobs for nurses.  And plenty of other well-paying jobs in the health field are far less crowded.  The trick is in getting that information to students early enough that the cost of switching goals is minimal.  We’ve institutionalized that over the past few years through an advising-intensive program, through which students are introduced to other jobs in the allied health fields..  We turn away fewer students from nursing than we once did, because more of them have found other routes.  (Nutrition and Human Services have proven popular alternatives.)  And our pass rate on the NCLEX has improved, because the right students are finding their way into the right roles.  In this case, simply presenting other options was enough.

I faced a more challenging version of this dilemma recently when a colleague reported that she was considering going for her Ph.D. in political science.  I have a general policy of warning people away from doctorates in liberal arts fields, given the mostly dismal prospects if you aren’t coming from one of the top ten or so programs in a given discipline.  (As a Rutgers political theory Ph.D., and former freeway flier, I know of which I speak.) I did my standard “what the hell are you thinking?” spiel, but she actually had pretty compelling reasons and a clear sense of where it fit in her career path.  I even agreed to write a letter of recommendation for her, which is the first time I’ve ever done that for a poli sci doctorate program. Whether that will extend my time in purgatory remains to be seen.

Talking students (or colleagues) out of a path is a tricky business.  If the issue is raw ability, the right path is clear.  It became painfully obvious early in life that I would never be the third baseman for the Orioles; nobody had to bother to tell me in so many words.  And sometimes the issues are clear cut in other ways, whether involving criminal records, citizenship status, or other legal matters.  Those have the virtue of being relatively objective.  

The harder question involves warning capable students away from crowded or declining fields.  Educators as a group prefer to encourage, rather than discourage -- it’s what we do.  And some students will beat the odds, even in difficult fields.  Even well-intended warnings are founded on a sort of epistemological arrogance.  We don’t know who’s going to beat the odds.  But if we have a better sense of the odds than the students do, I’m thinking we’re on solid ethical ground in sharing what we know with them, and in helping them find other appealing options.  

And if they still insist on the longshot, well, they’re adults.  Sometimes they know things we don’t.

Wise and worldly readers, is there a more elegant way to handle warning students about longshots?

I don't know if there's a "more elegant" way to warn students against what we feel to be a mistaken choice. It's best to be upfront about one's position but also add the qualifier that the student should ask others.

The arrogance can go both ways. It's not only the professor warning against grad school, it can also be the professor urging grad school on the student because the professor supposedly knows best. I remember as an undergrad (and after) having a rather distorted view of the advice any professor gave me so that I followed it mostly blindly and eventually made choices (e.g., grad school) that I realize at the time were mistaken. Don't get me wrong....I made my decisions and am responsible for them (and things have so far turned out pretty good...but I still think my decision to get a PHD was the wrong one at the time and for the reasons I so decided).

If someone asks me whether to go to grad school, I tell them my default response to any such question is "don't go" and if someone wants to go, they have to start with the position that it's a bad idea and then prove to themselves it's not a bad idea. I then also reassure them that they ought to ask a lot of people, not just me, and that if some of the people they ask act as if they have the absolute right answer, then they should take that advice with a large grain of salt.

The 'presenting alternatives" method is best (although often not sufficient; then the academic requirements kick in). It's also interesting to think what would happen if high school counselors would do the same: fewer underprepared new students who flunk out, more who take a more realistic path thru a certificate program or work for a while and gain maturity until they are prepared to handle the stress of remediating themselves for an academic 2-year program.
Total agreement in theory. It's fairly easy to say to the under-performing high school student that they should consider another field. Entrance requirements for certain programs solve that issue nicely. Although, if someone has the ability, nursing is the last field I would talk them out of. Everything I'm reading shows that it's the field to be in. Maybe not making as much money out of the gate as 10 years ago but much more reliable than other fields. The problem lies in the nasty catch-22 of "we need more nurses and more slots in nursing programs but we don't have anyone to teach them". (And by the by, we aren't going to pay those nurse educators enough to entice them away from the hospital.)

I would caution that whatever we do say, don't pitch it as "the easier program". We all know nursing can be pretty demanding but if you aren't good with the interpersonal then a counseling related field like human services is going to be hard for you too. I couldn't hack the math and science (in addition to getting squeemish with blood and needles), so nursing wasn't for me. However, human services was and it was easy. I know it wasn't for others.
Near the end of my undergrad, I perused job postings and talked to a few people I'd met about their jobs and what's required to do their job. My decision to do my Ph.D. (still in the process of completing) rested on the knowledge that the jobs I wanted to be in 10-20 years from now either recommended or required a Ph.D. It helped me make an informed choice.

Further help my education choices was that my school, and several in the area, have started launching hr-free and prof-free career nights. It's several former grad students 5-20 years in the future talking about how their career evolved. That has proven to be extremely useful in realizing what grad school can do for you outside of academia. Admittedly, this has been more on the side of validating my choices rather than making my choices, but seeing such an event prior to joining grad school would have been useful. Such career nights might help talk students out of the more identifiable fields and into other streams they might enjoy more.

My thought is to recommend students to look at jobs, whether at postings or career nights, and see where they possibly see themselves.
It's not our job to talk students into our out of, but to let them make informed decisions. Caveat: I'm in the sciences, where there are still a few more jobs than the humanities, but it's still pretty dismal here.

That said, when my students ask for guidance, I ask what they want to do, where they want to be. I give them the stats (and readings) on the stats re: academic jobs. I tell them about the experience of grad school, good and bad. I suggest they seek counsel from other faculty as well.

But in the end, it's their choice. If they choose it, I will write them letters and do anything I can to help them be successful.
As an adjunct professor in the humanities looking to make a career change, I very much wish that at least someone had taken a shot at "talking me out of" getting a PhD. From where I was at I was just blind to the poor prospects and institutional pressures that academia would later offer. A few professors half-heartily suggested delay and one talked me out of poli sci (but not a related field).

The closest anyone came was (during graduate school) when I heard comments about how you "shouldn't do this unless you really can't imagine yourself doing anything else." I think what they meant was that only those with a singular passion should do this. But passion's not enough and telling someone who has spent all of their remembered life in school to make a decision based on what they can or can't imagine isn't very useful advice. I would have much rather someone sat down with me to (a) show me the numbers, which even then were bleak and (b) helped me get in touch with people who could help me identify worthwhile alternatives.

Unfortunately, I have found that most academics I have encountered are too focused on their own path to success to have paid enough attention to the huge numbers of the equally qualified who are unsuccessful. Their blind spot turned into my blind spot and I have 10 years down (for me) a poor path to show for it. It was my path and ultimately my responsibility. But I wish I'd encountered someone willing to seriously try to talk me out of it.
Dean Dad, we have a shortage of nurses here in the Upper Midwest--send them out here! We can't begin to keep up with the demand.
Richard--The economist in me wants to know...

We (allegedly) have a shortage of nurses in the Chicago metropolitan area. But wages/salaries of nurses there are not rising very quickly. (As near as I can tell, in fact, both weekly earnings and annual earnings--in nominal, not in inflation adjusted, terms--have been flat since about 2009.)

What's happening to earnings of nurses in the upper Midwest (Minnesota? Wisconsin? The UP?)
Hey Doc! As you probably know, the deep numbers vary enormously based on location, even within a given state. Here in Wisconsin, the city of Madison (which has three major hospitals, a jillion clinics for both general and specialized medicine, and at least five very large geriatric facilities), pay is relatively high and has been rising. On the other hand, because the city is home to three nursing schools (the UW, Edgewood College, and Madison College), supply of brand-new nurses outstrips demand. You don't have to go very far out of the urban areas, though, to find demand outstripping supply, a situation also true of certain teaching specialties (special education, in particular). Nevertheless, in the rural areas, salaries are lower and have not risen for some time. I am not a healthcare labor economist (my father was, though, before retirement), but I have seen enough now that think there are several reasons for this:

1. Healthcare is apparently unprofitable (or not profitable enough...) in rural areas. We are seeing rapid consolidation of healthcare companies--Aurora, based in Illinois, is growing rapidly here--and they are closing clinics and hospitals in the rural areas while, at the same time, opening them in the urban areas. There are some areas in the state in which one hospital is serving multiple counties, and even urgent care clinics are difficult to locate.

2. The rise of nurse-on-call telephone and live chat services seems to be cutting down on jobs for general practice nurses by handling triage for the worrying-but-normal complaints that have always taken up a large percentage of office visits.

3. As with new teachers, the power differential between the rural healthcare companies and newly minted nurses is such that new nurses are at a disadvantage in job negotiations. For example, nursing jobs in Madison advertise a starting salary (these days, at one of the three hospitals, an RN with 1 year of experience is looking at about $38 an hour). Rural jobs don't list a salary, but ask for the applicant's "salary requirements" instead. Salaries are much lower in rural areas, sometimes below $30 an hour.

So, although it would seem to be a buyer's market for rural nurses, there are in fact chronic shortages. From time to time the state has had programs to encourage nurses (and doctors and veterinarians) to locate in rural areas by forgiving their student loans if they stay for a certain number of years, etc., but as far as I know those programs have never had much effect.

It's an interesting example of how economics works in the real world. In this case, high supply of labor (urban) is linked to high and rising salaries, whereas low supply of labor (rural) is linked to low, stagnant salaries.
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