[cardiacRN2006]

Originally Posted by llg

Thanks, elkpark. I certainly harbor no ill will towards any individual either -- and I wish the original poster all the best. In fact, I was struck by her comment that she is struggling with the basic things like diet trays and wheelchairs. Yes, each hospital's equipment and procedures are a little different, but a new grad should be familiar enough with these things to adjust quickly. It's not the hospital's role to have to go back and teach Nursing 101. That foundation should be established in school.

I happen to live in a community in which there have been several new RN programs established -- and in which old programs have expanded beyond their capacity to do a good job. For example, a local respectable ADN program has recently expanded beyond the number that they can find pediatric faculty for. Their solution? Graduate a cohort with NO peds inpatient clinicals! Another program has graduated several classes in which students only got 1 or 2 of the specialty rotations -- either peds, or OB, or psych -- but not all of them. We have a local trade school that spends most of its very limited clinical time doing "observations" because they are not in any one place long enough to get sufficiently competent to actually do any care -- and their faculty are not qualified to supervise complex inpatient care.

Based on what I see locally and what I read on allnurses -- there are a lot of programs that are now not actually teaching nursing. Instead, they have turned into test prep centers. They take the students' money ... give them the bare minimum legally required courses to sit for the NCLEX ... and then focus on test prep so that they can keep their NCLEX pass rates high enough to stay open. Students are going to these programs (and paying big bucks) because they don't want to invest the time to get a proper education. Being properly educated as a professional nurse requires many hours of practice and that is inconvenient and expensive. So ... they pick the quickest program with the fewest requirements -- the test prep programs.

Then the hospitals are stuck with RN's who never really learned how to be nurses -- and the staff nurses and unit leadership get blamed when these new grads struggle through orientation and decide to leave.

Instead of offering a real, long-term solution to the nursing shortage ...these "fast tracks" are making the problems worse by adding to the burden at the unit level and costing everyone lots of time, energy, and money that could be better-spent.

Wow, wow, and wow! This is it! So very, very well said!

[jjjoy]

Originally Posted by llg

Based on what I see locally and what I read on allnurses -- there are a lot of programs that are now not actually teaching nursing. Instead, they have turned into test prep centers. They take the students' money ... give them the bare minimum legally required courses to sit for the NCLEX ... and then focus on test prep so that they can keep their NCLEX pass rates high enough to stay open. Students are going to these programs (and paying big bucks) because they don't want to invest the time to get a proper education. Being properly educated as a professional nurse requires many hours of practice and that is inconvenient and expensive. So ... they pick the quickest program with the fewest requirements -- the test prep programs.

I wouldn't only place blame on the students. The fact that such programs exist is a problem as well. Often the accelerated programs are offered by big name schools with overall shining reputations, so potential students figure that they wouldn't offer such a stream-lined program if it wouldn't be sufficient for entry-level practice. I went to a traditional BSN program with 2 years of nursing coursework and still didn't feel it provided a strong clinical foundation. Looking back at how we rushed through thousands of pages of nursing texts, I now realize that our lectures & texts were to meet the NLN educational content requirements. And looking back at those strange mulitple choice test questions that didn't seem to really reflect lecture or text materials I realized they were written to approximate the NCLEX. We had the required hours of clinical time, but I remember being worried about the ability to check off the pages of clinical skills because we had so few chances to practice many of those skills.

I think a big part of the problem with the development of nursing as profession has been it's strenuous efforts to make it appear more academic than it need be. The nursing profession has traditionally been a skill-based one. Of course, you must use you mind as well in the application of those skills. But so does any professional. Carpenters don't just mindlessly saw and hammer. But they don't insist on a unique theory for carpentry or a language to differentiate carpentry from construction. You can study carpentry as a profession and measure it's influence on the construction industry without getting a PhD in carpentry.

Another more recent issue is liability. Hospitals, staff nurses, clinical instructors, and schools don't want to take on too much liability for students. I think that may be another reason clinicals have become pared back. And then as others have noted, there's a demand to educate more nurses but available clinical time for students is limited. More students can mean less clinical time as schools compete for clinical space. The high per student cost of clinical instructors also creates limitations as groups of 8-10 students must share the clinical instructors and patients and staff on any particular unit.

Anyway, I'm off on an tangent. I'm not sure what the answer is to the current nursing education conundrum. How prepared should new graduates be? I'm not sure who should be responsible for that. MDs don't graduate ready to "hit the ground running." They get paid (albeit a relatively low amount) for their first years of practice. Many nursing schools now explicitly say that a new grad isn't expected to "hit the ground running." But many hospitals don't seem to be in agreement in regard to the minimum required skills for a new nurse. What to do?

[elkpark]

Originally Posted by jjjoy

I wouldn't only place blame on the students.

I just want to be very clear that I don't place ANY blame on the students -- I see them as victims in all of this. It is the professionals and educators who bear the reponsibility to not mislead potential students into believing that they are enrolling in an educational program that will provide them with a good, basic preparation in their chosen field. It's not the students' job to know what they need in a basic nursing education and make sure they get it ...

llg, I don't understand how the programs you're talking about can stay in business -- what about your BON? I know every state is different, but in my state, the BON educational consultants are very active about surveying nursing programs and making sure that they meet the minimum requirements. Clinical sites have to be surveyed and approved to be used as clinical sites, you have to show the BON that you're providing the minimum required clinical experiences in all the required specialty areas, and you have to provide documentation that all your faculty meet the minimum requirements. Do things work differently in your state?

[janfrn]

Originally Posted by llg

I happen to live in a community in which there have been several new RN programs established -- and in which old programs have expanded beyond their capacity to do a good job. For example, a local respectable ADN program has recently expanded beyond the number that they can find pediatric faculty for. Their solution? Graduate a cohort with NO peds inpatient clinicals! Another program has graduated several classes in which students only got 1 or 2 of the specialty rotations -- either peds, or OB, or psych -- but not all of them. We have a local trade school that spends most of its very limited clinical time doing "observations" because they are not in any one place long enough to get sufficiently competent to actually do any care -- and their faculty are not qualified to supervise complex inpatient care.

That's exactly what's happening here. It's really frightening to think that the people the BONs exist to protect are basically being defrauded not only by the nursing education world, but also by those BONs who are permitting these programs to proliferate and their graduates to become registered.

Originally Posted by llg

Based on what I see locally and what I read on allnurses -- there are a lot of programs that are now not actually teaching nursing. Instead, they have turned into test prep centers. They take the students' money ... give them the bare minimum legally required courses to sit for the NCLEX ... and then focus on test prep so that they can keep their NCLEX pass rates high enough to stay open. Students are going to these programs (and paying big bucks) because they don't want to invest the time to get a proper education. Being properly educated as a professional nurse requires many hours of practice and that is inconvenient and expensive. So ... they pick the quickest program with the fewest requirements -- the test prep programs.

Ditto! That describes what our university nursing programs have become. Besides that, you should read some of the Canadian forum threads, especially those we've moved to the International forum about foreign-educated nurses wanting a fast-track to licensure in Canada.

Originally Posted by llg

Then the hospitals are stuck with RN's who never really learned how to be nurses -- and the staff nurses and unit leadership get blamed when these new grads struggle through orientation and decide to leave.

Instead of offering a real, long-term solution to the nursing shortage ...these "fast tracks" are making the problems worse by adding to the burden at the unit level and costing everyone lots of time, energy, and money that could be better-spent.

I had the opportunity to spend a night shift overseeing a nursing student who is doing his senior practicum in our PICU. He had already worked a half dozen or so 12 hour shifts with one of our other nurses. I was amazed at the gaps in his knowledge and his clinical skills, even basic things. Then a few shifts later I got report from him; his primary preceptor was in the room but took no interest in what he was telling me. I had major egg on my face more than once that day because there were things that hadn't been passed on in report that should have been. I found an antibiotic order that had been transcribed and actioned by the day nurse at 1835 the preceeding evening, but no evidence that the med had been given. I found it mixed in with the meds for the other patient in the room. AND there were RSI drugs drawn up for my patient sitting on the supply cart in the room that were only labeled with what was in the syringes, and not who they were drawn up for or when they'd been drawn up. Basic nursing! I spent more than an hour filling out incident reports.

[Valerie Salva]

Originally Posted by llg

Thanks, elkpark. I certainly harbor no ill will towards any individual either -- and I wish the original poster all the best. In fact, I was struck by her comment that she is struggling with the basic things like diet trays and wheelchairs. Yes, each hospital's equipment and procedures are a little different, but a new grad should be familiar enough with these things to adjust quickly. It's not the hospital's role to have to go back and teach Nursing 101. That foundation should be established in school.

I happen to live in a community in which there have been several new RN programs established -- and in which old programs have expanded beyond their capacity to do a good job. For example, a local respectable ADN program has recently expanded beyond the number that they can find pediatric faculty for. Their solution? Graduate a cohort with NO peds inpatient clinicals! Another program has graduated several classes in which students only got 1 or 2 of the specialty rotations -- either peds, or OB, or psych -- but not all of them. We have a local trade school that spends most of its very limited clinical time doing "observations" because they are not in any one place long enough to get sufficiently competent to actually do any care -- and their faculty are not qualified to supervise complex inpatient care.

Based on what I see locally and what I read on allnurses -- there are a lot of programs that are now not actually teaching nursing. Instead, they have turned into test prep centers. They take the students' money ... give them the bare minimum legally required courses to sit for the NCLEX ... and then focus on test prep so that they can keep their NCLEX pass rates high enough to stay open. Students are going to these programs (and paying big bucks) because they don't want to invest the time to get a proper education. Being properly educated as a professional nurse requires many hours of practice and that is inconvenient and expensive. So ... they pick the quickest program with the fewest requirements -- the test prep programs.

Then the hospitals are stuck with RN's who never really learned how to be nurses -- and the staff nurses and unit leadership get blamed when these new grads struggle through orientation and decide to leave.

Instead of offering a real, long-term solution to the nursing shortage ...these "fast tracks" are making the problems worse by adding to the burden at the unit level and costing everyone lots of time, energy, and money that could be better-spent.

I agree.
Also, it used to be that a graduate could take the NCLEX only three times. If they failed a third time, they had to repeat their nursing program, or at least complete some type of remedial education.

Now, graduates can apparently flunk and retake the test endlessly.

Putting on my flame proof-scrubs here-
If graduates find that they are repeatedly failing the NCLEX, this indicates a problem- and it's not that the test is "too hard."

I am also dismayed at the number of incoherent posts written by nursing students. In the past, people with such poor basic grammar and writing skills would not have made it into a nursing program.

[multicollinearity]

Originally Posted by Valerie Salva

I am also dismayed at the number of incoherent posts written by nursing students. In the past, people with such poor basic grammar and writing skills would not have made it into a nursing program.

I think this may have to do with the 'text-messaging' generation. Their constant texting has affected their grammar and writing skills.

[SoundofMusic]

Wow, I think and hope that my OP began a good discussion here. And I think a lot of you ARE onto something.

I do feel coming from a 2nd degree program, that our clinical time was very minimal, that I did NOT learn much of the basics, that theories and academics were stressed, and that I came out of it just not knowing a whole lot about how to be a floor type nurse. I think much of this is really accurate.

And exactly, you cannot place blame on students for this at all. How could or would we know what we were supposed to be learning?

(But I do take issue with whomever said many can't write or write incohrently. Many of my colleagues in the 2nd degree program were talented writers and also held degrees in many different disciplines -- accounting, business, history -- you name it. Some at the master's level. I myself have a degree in journalism, so writing was always the easy part for me.

Now the younger, way younger generation in their early 20's -- that might be a different story.)

I do want to report that since our floor preceptor came on (sort of an overseer to my preceptor), things are much better. She's holding our preceptors accountable, and I find things are just going much smoother and I can get a few more straight answers.

But, you all are right -- we probably don't come out of school with enough training -- don't know what the answer is. However, I did do 5,000 practice questions from Aug to Oct '07 to pass the NCLEX.

[cardiacRN2006]

Originally Posted by Valerie Salva

I am also dismayed at the number of incoherent posts written by nursing students. In the past, people with such poor basic grammar and writing skills would not have made it into a nursing program.

I'm glad to know I'm not the only one who noticed that on this board. Text-messaging generation or not, some of the posts are downright illegible.

I mean, some of the students don't even know how to spell drug names! That has nothing to do with text messaging....

[llg]

Originally Posted by SoundofMusic

Wow, I think and hope that my OP began a good discussion here. And I think a lot of you ARE onto something.
.

I want to compliment you, SoundofMusic for your attitude within this thread. Some people may have taken offense at some of my comments -- and taken them personally. But you have engaged us all in a great conversation and helped us avoid a flame war in the process. You sound like a very caring, conscientious person with an open mind who wants to learn. I would be happy to work with someone like you.

Now ... back to the ugly issues we are trying to deal with.

About closing bad programs. Have you tried to actually do that elkpark? It's not easy in any state -- though it may be harder in mine than in yours. I don't know. There are a lot of considerations. How do you prove that it should be closed when there is not minimum standard for their NCLEX pass rate? What if their NCLEX pass rate is actually OK because they do so much test prep and don't let people take boards until they pass HESI? What if the program in question is a state school that focuses on the education of minorities and students from underpriveledged backgrounds? What if the program is the local community college that has thousands and thousands of alumni? etc. etc. etc.

I had a private meeting with one of the State Board inspectors. They know that some of these programs are weak -- but can not do anything until a violation can be proven that is so bad that the public will support the BON in taking action. Until then, we wait and hope that the schools improve themselves. So far, that's not happening.

As for blaming the students ... I don't blame all the students. I think most students are pretty clueless when it comes to picking a school. However, I read an awful lot of posts on allnurses.com that say things like, "I'm looking for the quickest route to becoming an RN." .... and ... "C=RN" .... and .... "Just choose the quickest, cheapest ADN program you can find and let your hospital pay for you to go back and get your BSN." "I have kids and don't have time to do all those clinicals." .... and "I already have a BS in something else and don't want to spend a any more time in school than I have to." ... "I've already spent 2 years in school with another major and I don't want to spend any more time or money than necessary to get my basic RN." "I want to finish as quick as possible so that I can get on to grad school as soon as possible." etc. etc. etc. Yes, those students have to bear some of the responsibility for the fact that they end up with poor educations.

[aeauooo]

I had a great RN1 orientation: Harborview Medical Center in Seattle.

HMC is not some hoity-toity suburban hospital either - it's the county hospital and level 1 trauma center - the kind of place that when you tell people you work at there they have instant respect for you. "Whoa! Dude, you work at Harborview?!"

They told us when we started that if we survived our first summer at Harborview, we'd "made it," then the nursing ed department made sure we survived.