What constitutes flunking out?

rebelwaclause, ASN, RN · Oct 5, 2002

Same as RNConnie post #4

CoreyB · Oct 5, 2002

First off Roland, I hope we can all agree that if it were not for Bush Sr, the chances are Jr wouldn't be President. Now I agree that sometimes there are forces other than grades or personal "merit" effect achievement or advancement, but I don't think that is something that should be endorsed.

Now I am not in CRNA school yet, so I have no idea how difficult it will be. Perhaps when I get there and I am overwhelmed by the volume and rigor of the course work I'll change my mind. However right now I think there is something to be said for pushing people to their limits. It teaches people what they're made of and ultimately instills confidence in those that survive. Having spent time in the service I know there are certain jobs that require people who are capable of thinking on their feet and who respond well to pressure, rather than crumbling under it. It seems to me that being a Nurse Anesthetist requires these skills. I realize that responding to the pressure of pt mgmt in the OR maybe different than the pressures of the class room. But looking at this from the pt's point of view, who would you want providing your care? the nurse that stuggled academically or the nurse that a excelled (and by excel I mean met the standards required). It may seem harsh that failing one exam in a course would doom the student to a "C", but one failure in judgment in the OR will doom the pt to much worse than a bad grade and possible change in career goals.

Roland · Oct 5, 2002

errors in process as opposed to the grades which the nurse or doctor earned in school. Has there ever been any studies which prove a correlation with low grades and poor performence on the job in nursing? It's something that is taken at face value much like the old adage to drink at least eight glasses of water per day (which was recently exposed as unfounded in the popular press). I think this is ESPCIALLY the case when you are talking about an isolated "C" or two.

We need to be intellectually honest and call it what it REALLY is. That is to say a method of distributing scarce resources in this case available CRNA jobs. In addition, the desire to limit supply of CRNA's entering the job market by CRNA interest groups probably also plays a role. It's no secret that the AMA has actively lobbied congress to limit the availibility of internships for doctors in the past (I remember hearing an NPR segment on this issue last year entitled something like "why doctors want to cut funding for training doctors"). In fact once I become a CRNA (God willing) I will join in that fight to limit supply. Basic economics tells us that price or in this case salary varies inversely with the supply (graduating CRNA's entering the job market) and the availibility of substitutes (MDA assistents for instance). The only difference is that I will not be circumspect in stating my motives. Thus, I will proudly declare that yes I want relatively few CRNA's to graduate because this benefits me and my family. Kevin does make a good point in that most other graduate programs have the same guidelines with regard to getting "C's". My reply is that those programs are equally mistaken. In the early 19th century 80% of scientists believed in spontanious generation they too were mistaken.

I just hate intellectual elites wrapping themselves within the protective cloke of their ivory towers and then lording their presumed superiority over others. While such an attitude probably doesn't apply to anyone on this board, it does pervade many of our institutions of higher learning. Like politicians they seem to have forgotten whom it is that they serve which is first and foremost the best interests of their customers.

Also, I would like to assert that while it probably IS true that "W" wouldn't be President without the help of his father this is also true of virtually all politicians. Most have powerful families that place them in a position to one day aspire to higher office. As I stated above even if Al Gore was President you would still have someone who was helped greatly by his family AND perhaps more relevantly who was a "B" and "C" student in college.

WntrMute2 · Oct 5, 2002

I believe that most if not all graduate programs have higher standards for each grade and a grade of B is the usual passing grade. Those at my school, who are in the business of producing those new graduates claim the university sets those standards no one else. We should check masters in arts standards for instance.

Gardengal · Oct 5, 2002

In my original BSN program (21 years ago) a C was a passing grade, and anything below was not accepted. Like others-the scale was higher than the old 70% C, 80%B, etc...Ours was A=94-100, B=88-94%, C=82-87%, everything below would have to be retaken in order to continue in the program. Many of the students I speak with tell me that they follow a similar grading scale today.

MICU RN · Oct 5, 2002

I agree with your post Roland, especially concerning controlling the influx of new grads. I have noticed how whenever there is any kind of nursing shortage in bedside nursing that the nursing schools at the undergrad level want to flood the market. There has to be a balance and we should not over supply it at every chance. One of the things I like about the AANA is that they appear to be more organized and powerful at protecting their profession. I realize there is only about 25,000 members, but that includes almost all the active crna's. Just think if reg nursing was that united. Sadly, I don't see it happening in my working career, therefore, I am trying to become crna as soon as I can. I don't want to insult anyone, but I think there is a direct correlation with the % of males in the crna profession and how organized they are and how well they are compensated. As opposed to what is going on in bedside nursing, where it is still 90 something % female. RN's at the bedside need to stand up an expect better pay, respect and work conditions. And get away from this mentality "we are nurses because we really care about the patients" well, as I have posted before , most healthcare workers also care about their patients, nurses do not have a monopoloy on this, but they don't base their rational for a profession soley on the premise that they really care about their patients. We as nurses need to promote all the other services we provide. we also need to remind people that we are college graduates who have went through rigorous training to become RN's. In addition, think about the fact that in some smaller hospitals the ceo's who run them have just udergrad. business degrees; I had friends in my nursing class who said that nursing school at the undergrad level was harder than the MBA programs they attended. What is wrong with this picture? So next time admin. expects the RN to also do the aid work, think about it. this should piss you off instead of just accepting it and saying something " we will do because we really care".

WntrMute2 · Oct 5, 2002

In response to the comment regarding "aid work", consider that the last time nurses allowed others to take over the personal care aspect of nursing there was suddenly a glut of unneeded nurses. The role of nursing should be expansive so there is a bigger demand. That is frequently just as important as limiting supply. If the shortage of skilled workers gets too small others will displace the remaining ones. Consider that state law is the only thing requiring certification for RNs. If the supply dries up, hospitals may petition the state legeslators to repeal state liscensure and allow hospitals to train and credential their own "nurses". Same thing in anesthesia could happen if the supply of providers drops below some critical level. There is no law that provides for protection of the monopoly (dinopoly) of MDAs and CRNAs to administer anesthesia.

MICU RN · Oct 5, 2002

Wntrmute:

You have a good point in regards to the supply and demand of nursing as well all healthcare providers. However, concerning aid work, I do feel that hospitals could commit to providing more nurse's aids and therefore allowing the nurses to focus more on the tech. aspects of patient care, especially in the critical care areas. Now of course part of the commitment will be a willingness to pay aids better and train them better. But why do this? The admin. can just dump in on the nurses and they know they will do it. And would you willing to do aid work once you are out there providing anesh?

Roland · Oct 5, 2002

the supply getting "too low" ties into what I said about the availibility of substitutes. At some threshold health care providers might seek to obtain substitutes for CRNA's. CRNA's should seek to obtain the type of "legislative" protection that pharmacists have. Namely, without the license of the pharmacist the drug store literally shuts down (or conversely cannot open in the first place). It would be nice if there were "hard" legislation which basically said "no MDA or CRNA no anesthesia". In a similar manner nursing organizations should seek state or federal level legislation that mandates licensure for as many patient care activities as is possible.

I say this as an aspiring nurse and CRNA NOT as a conservative or libertarian. While I don't necessarily believe this to be the best public policy, it IS the course of action which will lead to the highest rate of conpensation for this profession. Unless, of course such tactics cause the increase in the price of health care to rise TOO much. In that case the big substitute which would spell a permanent end to the party would be nationalized health care. That would be unfortunate for both nurses AND the general public. Perhaps fighting nationalized health care is the one issue which could garner united support from almost all nursing AND doctor interest groups!

CoreyB · Oct 5, 2002

I disagree with the "allocation of scarce goods and resources" arguement. The allocation or admission to crna school takes place based on undergraduate performance and ICU experience. While a C or 2 in undergrad certainly won't help, I have read a few post right hear from people who have said they recovered from much worse.

Even if all those who are admitted to CRNA school completed it there would still be a shortage of anesthesia providers. I don't know the percentage of people who fail to graduate CRNA school, but 97% of those admitted to med school complete it and I would think the numbers are comparable.

Failing students is not the way CRNA school limit the number of future CRNAs. They do so by limitting the number of available seats in the program. I think it is rather cynical to suggest that educators are failing students out of a concern for job security. I am not saying that the AANA doesn't want to limit the number of practicing CRNAs. I am just saying failing students already admitted to CRNA programs isn't the method they use.

In regard to the perceived lack of correlation between grades in school and performance in the work force, I don't think there is a right answer. Schools have to establish a method to assess who will be a safe provider of anesthesia and who won't. If you have another method to determine who is more likely to make "errors in process", I'd be interested in hearing it.

I haven't run into very many intellectual elites, save acouple of docs at work (so maybe I don't understand where you are coming from), but I just don't see the problem in setting the bar at a certain level and saying anyone who achieves this level passes.

As for the politicians, I don't think Clinton had any family connections, and wasn't he a Rhodes' scholar at Oxford?

Roland · Oct 6, 2002

that correlates to having good grades and making on your own then give me the "C" student any day. If I was "in charge" of the CRNA school system I would still give grades. However, a "C" would mean average not failing. Those who scored D's or F's would indeed have to retake any classes they failed, I might even "suspend" their progress until they scored acceptible grades depending upon the subject matter involved. This might have the impact of placing the student in a position of graduating a class behind, but they wouldn't be eliminated from the program. In addition, all graduates of "my" program would have to pass a rigorous cumulative final which would have both written, and practical elements. There would be no limit on the number of times you could take the "final" exam but you would need to score at least a "C" to pass.

Keep in mind that it is possible to write an examination so easy that almost anyone who extended even a minimum of effort might score an "A". Conversely, it is also possible to make exams so difficult that even Albert Einstein, Stephen Hawkins, and Enrico Fermi working as a team with nearly unlimited time and access to their notes would fail. Having said that I think you are correct in your assertion that the primary way in which CRNA's limit supply is via availible school openings and in controling how many institutions can become accreditated. However, any school which will expel you for two "C's" is in my opinion displaying the attitude to which I alluded above.

kmchugh · Oct 6, 2002

I want to go back to something Roland said earlier. "If anything they should consider refunding my money should I not sufficiently grasp the material or at least let me retake the class at a discount.

I once took a PADI diving course from a local dive shop and this was their policy in the event I didn't pass the certification test. "

In passing, Roland mentioned that there might be a difference between a PADI course and a CRNA program. This bothered me, but until this morning, when I gave it some thought, I figured out why.

As Roland said, there is a vast difference between a dive certification course and any Master's program. For one, the time committment. As far as I know, there are no PADI programs that require two years full time for initial dive certification. Generally, most folks can be taught sufficient information, in an easily remembered format, to pass such a course. The rare few who can't and end up having money refunded probably don't hurt the dive shop too much. How much are we talking here, $1000? A CRNA program, on the other hand, can run as much as $5000 a semester. A university simply could not afford to refund that kind of money after a failure.

Part of the reason the interview process is so strenuous is to try to weed out those with less committment. Also, it gives the university an opportunity to try to weed out those who have the drive, but not the talent to be a CRNA. After making it through that far, if the student fails, unless a large percentage of his/her classmates fail, the failure can be fairly blamed on the student.

All of life is a risk. Had I failed out two weeks prior to graduation, I still would have been an RN, with CRNA school debts. That's the risk I took enrolling in the program, and knew that up front.

I guess in the final analysis, I have to disagree with Roland. A university cannot afford to reimburse students who fail. If the failure can fairly be said to be the student's fault, then the student bears the responsibility for that failure. A reimbursement policy would put the university in the position of having to pressure program directors to pass students. Knowing this, some students might find themselves under less pressure, and push themselves less to learn necessary material. The end result is the graduation of less profecient practitioners. This holds up for CRNA's, physicians, or any other profession out there.

The CRNA programs are difficult because they have to be. They must teach a large amount of difficult material in a specified period of time. Their responsibility is to teach the material, and to set clear standards for the student. Meeting those standards is, and must be, the full responsibility of the student. To much is at stake to reduce program requirements.

Kevin McHugh, CRNA