Hello everyone,

CNAs have to demonstrate their skills. Pilots have to demonstrate their skills. Same with cosmetologists.

Why don't nurses?

What the rationale behind not including a demonstration of basic skills as part of the licensure process?

Are you in favor of a demonstration or not? Why?

A professor of mine once said that the reason why the board exam does not include demonstrated skills is 1. to streamline the process and 2. one can reasonably assume that the applicant becomes competent during the clinical hours a LVN or RN student has to complete under a supervision of a nursing professor.

Well, ideally, yes but....

So what do you think?

P. S. I am a pretty new Allnurses poster so I apologize if this has been discussed ad nauseam.

Actually, I don't think it has been discussed much. I'm not sure how I feel about this but will be looking forward to what others have to say.

Cannot think of one state board exam that historically included a clinical skills component.

Your professor is quite correct. When diploma programs dominated nursing education students learned the skills of the profession via the apprenticeship system, that is working on the floors, literally in some cases.

When nursing education began to move out of hospitals and or included nursing arts as part of the course work one began to see nursing labs/classrooms where students would practice nursing skills supplementing clinical time.

Added to the above most if not all nursing programs, diploma, AAS, ADN and BSN have separate exams and or other ways of grading students on their nursing lab and clinical work. In short by the time one graduates a student nurse is *supposed* to have learned a core set of nursing arts and skills along with the rest of nursing education. Putting all that theory and pratical skills together on the floor is what orientation and the first several months post graduation is for; connecting the dots as it were.

That is how things are supposed to go in theory, but for various reasons many nursing programs seem to be cutting back on clinical exposure and or lab work; the result is graduate nurses that cannot "nurse". That is they have little to no practical knowledge of the core skills hospitals expect of a nurse, and quite frankly many are getting tired of having to teach such things on their dime. How to hang a bag, start an IV, drop a tube, insert a Foley and so forth.

I have to agree that schools should return to focusing on having good strong skills. I feel like I heard the same lectures about leadership in my LVN, my RN and my BSN programs. And it was all fluff and nothingness. I would have MUCH rather had additional ER and ICU training exposure.

I still feel like I have to spent a lot of time now off studying and trying to absorb info that would have been easier for me had it been presented in nursing school.

I do think the skills competency should be left to the schools though, they just need to reinforce it more.

I think the skills competencies that would be required to truly assess each nurse during boards would take so much excessive time it would truly slow down the process of boards and renewals.

Well I graduated as an ADN able to do most of the basic skills, thankfully. Because no one was going to teach me in the real world these days. But I guess if you'd have to choose, you might want a graduate nurse who had never done a foley insertion but knew the steps by heart, the reasons you might need a foley inserted, the possible effects of said foley, what to look for before, after and during the procedure, the reason why sterile technique was so crucial, how often the foley should be changed, etc. A skill like foley insertion can be learned easily by most people with enough repetition and a good instructor. But if you don't understand all the other things that go along with the skill and can't consider the implications critically, you are missing the main point of nursing. That is what I think they are attempting to test with the NCLEX. Whether they are doing so successfully or not is up for debate.

I feel like I heard the same lectures about leadership in my LVN, my RN and my BSN programs. And it was all fluff and nothingness. I would have MUCH rather had additional ER and ICU training exposure.

:up::up:

I applied for a BSN program and I KNOW I will hear about autocratic, laissez faire, self-actualization, Maslow, freezing and unfreezing, go into denial, get angry, bargain with my teachers, get depressed... and accept it long enough to regurgitate onto a Scantron.

Seriously, I would love an entire rotation dedicated to the ICU, ER or some other specialty that was touched on for a mere few days to a week during my program.

You didn't pass your clinical part of class without passing the skills- so if you got to boards, you were considered safe w/skills.

Also, with a computer- there is no need to hire nurses to start the test. For a skills portion, they'd have to have actual nursing instructors doing it- plus it's not %100 objective.

It is simply not feasible from the standpoint of time to conduct hands-on testing of every candidate. It is also highly unlikely that a panel of nationwide "experts" could ever agree on the proper methods of performing basic nursing skills. Heck, we sometimes can't even get two co-workers in the same unit to agree on how best to (fill in the blank).

Some states do so with CNAs (not all do), but CNA certification is based upon standards which vary widely from state to state.

Ultimately, NCLEX is designed to identify candidates who possess the knowledge to practice safely as an entry level nurse. No entry level nurse should be performing skills without supervision and feedback, something that a one-time skills test can't possibly replace.

:up::up:

I applied for a BSN program and I KNOW I will hear about autocratic, laissez faire, self-actualization, Maslow, freezing and unfreezing, go into denial, get angry, bargain with my teachers, get depressed... and accept it long enough to regurgitate onto a Scantron.

Seriously, I would love an entire rotation dedicated to the ICU, ER or some other specialty that was touched on for a mere few days to a week during my program.

All nursing school does is teach you how to not kill someone on purpose, and give a BASIC overview of any specialty. The majority of nurses are not in critical care areas.... so, they're not given more time. If there are 40 students in the class (divided among the rotations), and 20 end up in med-surg, 5 go to OB, 3 go to pedi, 1 goes to NICU, 3 go to psych, 5 go to an office, 8 go to SNF/LTC, 3 go to ER , and the last 2 go to ICU of some sort- it's not hard to see where the need is for getting people through school.

:)

I think that the answer is fairly simple. Because you can not pass a nursing program without passing a clinical skills component, the NCLEX only needs to test on the knowledge stuff. At least that's the rationale that I can come up with, and it's probably close to correct.

Other certification/licensure programs require both written and practical exams in order to receive a License to practice in that field. Doing this takes at least 2 days. One day for written, one day for practical exams and the scheduling between the practical exams would have to be VERY tightly controlled due to the sheer number of people that need to be tested.

One certification exam does this in a stressful way (and it does induce a lot of stress) by pulling examinees out of the written exam and straight into the practicals and releasing back to the written exam immediately afterward. You can be pulled right away or at any time prior to the completion of the exam and you don't choose when you get pulled away. Each examinee is escorted to and from the practical exam area so there are no opportunities to cheat by utilizing outside resources to look up answers while in transit between those areas.

That takes time. Also, given that the NCLEX is adaptive, and number of questions vary, it is much more difficult to determine when to pull an examinee out of the exam room.

I don't know why they don't, but I am glad they don't...

My state exam for EMT-B included several skill stations, plus the written test, plus a 6 week wait for results. It was an ALL day affair, and required many examiners, and I tested in a rural county. I remember it as far more stressful than the NCLEX-RN.

My diploma program affords me an entire term of critical care/management. I just spent 4 weeks managing up to 4 patients (functioning as the RN), and another 4 weeks in Neuro ICU, CCU, CSU, and STU functioning as the RN. I am happy to have the experience. I am certain I could effectively complete a skills competency demo. I realize there is much more than just skills, don't get me wrong. We do our fair fair share of theory and art.

The NCLEX is not a test that measures whether or not you have the clinical skills to be a nurse; you'll get that evaluation when you go to work and you have to pass and have documented that you met all of the institution's clinical competencies. Many hospitals will even have written and demonstration tests during an orientation/internship.

The NCLEX is a test that measures the safety of your decision-making. It's is a test to protect the public, not to measure your skill. Sure, it will ask you important questions to evaluate your risk of harming a patient while performing skills, but they don't care if you can follow steps 1-10 exactly, as long as you can do it safely. It's a judgement test, not a skill test. They want to know if you can identify the patient who is most in trouble, or the medicine that carries the most risk-potential. If they ask a question about skills, it's more to hone in on where the risk is and what your judgement would be as a nurse in a situation where your decision will have an impact on that risk somehow.

I have often wondered though, why it's not something they do as an exit exam from nursing school. My school has a beautiful, top of the line simulation lab. We often use it during clinical rotations, at least once or twice, to simulate high-risk scenarios or common clinical skills. I even wrote a paper on how I think part of the exit exam from the program should be passing an individual simulated scenario.