A time to reform nursing education?

[nyteshade]

After reading some very interesting posts around here lately in regards to "fluff" being taught in nursing school, I wonder if it is time to reform nursing education.

I feel we could do without the nursing diagnosis. I understand they can help a student group and rank interventions for a disease process (dare I say that?), but there are better ways to help a student understand this concept. I am not against throwing out holistic nursing practices, but we really could do without the fluff. Why is it that many new grads can't "put it together" Maybe, because fluff doesn't cross over into real-world nursing practice?

I realize that nursing schools are geared towards passing the NCLEX, and that will never change. People in the nursing adovacy groups want nursing to be a profession, no problem with that, but our hands-on skills are being "outsourced" by RTs, techs, therapists, etc. We are "losing" our skills. Nursing students are graduating and have never even put in a foley. What's happening?

I'd like to know what experienced nurses, novices, instructors and new grads feel should be included, or tossed out of the nursing curriculum. Who knows, maybe reform will come?

[AOx1]

Basically, it's a case of those who can do and those who can't teach. Nursing instructors are often so high in their ivory towers that they have NO clue of what it is like to work on the floor. Don't even start me on how little the BScN instructors know about the scope of an LPN in my province.

This is an incredibly rude and broad generalization. I work 40 hours a week as an educator, 12 hours weekly in the ICU, full time ICU in summers, and am a full time doctoral student. I have no free time. I do this to ensure that what I teach is clinically relevant and current. My students deserve the best. Nursing education is one of the most thankless jobs, and I am as tired of that worn out phrase "those who can, do..." as I am of "all nurses eat their young."

Trite sayings and insults improve nothing. Honest dialogue and inquiry can change things. It's too bad you prefer the former.

It makes me sad, honestly. I thought this would be a great thread to read; I have really enjoyed all the constructive comments others have made. I simply do not understand why it is acceptable to insult an entire group of nursing colleagues. It would be met with outrage if I said "Specialty 'x' is for those who can't handle real nursing," but it is acceptable to say all nurse educators "can't do?"

[14togo]

Livetolearn You are absolutely correct. The Staff Development Education nurses I work with are all part time practitioners in addition to their SDE duties. It helps them keep current with their clinical skills. The comment from Fiona59 is while broad and not a little unfair, it is not wholly inaccurate. There are clinical instructors (more than a few) whose only real clinical experience was their practicums. They chose the education route post-BSN and are somewhat "out of touch".

Having said that, the problem of clinical unpreparedness large begins in the academic arena. It is widely known as the 'Theory to Practice Gap" and it has been recognized since as far back as 1937. Dr. H. Baum, a Canadian doctor who was assigned to assess nursing education in Canada stated: “It is what is seen on the wards which sticks and it is a great pity the instruction of nurses is not at present based on that fact.” In order to begin to influence nursing care, a restructuring of formal nursing curricula is necessary. The difficulty of trying to develop a clinical curriculum based on academic theory that must be successfully combined with clinical skills training and practical know-how is huge with so many mitigating factors.

In many university programs clinical faculty and educators are often distanced from development of curriculum. Therefore, they are hard pressed to incorporate relevant material to practice situations. And as has been stated many time throughout this thread it is the lack of of relevant clinical practice that seems to precipitate the real or perceived notion of clinical unreadiness to practice. Through a practice driven approach, educators and students can re-evaluate curriculum and can offer opportunities to revise curriculum to meet common goals of systematic change. It is very difficult sometimes to reach out across the span of the abstract to the concrete. As long as power struggles occur in academia as to what philosophical bent should be adopted and, equally important, how it should be taught, nursing will continue to have an appreciable spread between what is and what should be. Off the soap box now. ta

[CuriousMe]

why do people post stuff like this and never post the name of their school ?

if your school is great, don't you think others would benefit in knowing the name ?

Because this is anonymous board and some programs are small enough that posting your school is akin to posting identifying information.

[CuriousMe]

All this talk about skills is fine, but we just had 6 hiring managers come and speak at my school. Each one said that they're far more concerned about a new grad's ability to critically think (which you can only do if you understand all the why's....which is why all that theory is taught). They each explained that they don't care how many IV's you have or haven't put in, and certainly don't care about how many foley's you've put in, as they want them used as little as possible.....physical skills are physical skills, with enough repetition, anyone can learn them. They felt that they could teach any physical skills that were needed....they wanted us to have all that theoretical information and the ability to synthesize it so that we could critically think.

That being said, my BS program has over 1,300 clinical hours (I forgot the actual number) which includes our 6 month preceptorship (25 - 30 hours a week) before graduation.

[klone, MSN, RN]

why do people post stuff like this and never post the name of their school ?

if your school is great, don't you think others would benefit in knowing the name ?

Because they want to maintain anonymity on the internet?

[nursel56]

. . . .All those "fluff" classes, the electives, statistics, whatever it may be may seem really useless while you are taking them. But I've found that I really appreciate my well-rounded education from my previous degree, where my curriculum was centered around humanities and journalism.

I agree with this! Anthropology, Sociology, Statistics, and Philosophy are not "fluff" to me. Even Art History can be useful for learning about other cultures before photography, and nothing screams "psych issue" like The Garden of Earthly Delights by Hieronymus Bosch. "Fluff" to me is a class that has a low return for time invested. Not-fluff can turn into fluff if it's dumbed down too much, though. But that's a whole 'nuther thread topic. I am shocked, shocked at the amount of poster-making, water and flour map making and papier mâché projects assigned in today's senior high and general ed requirements in colleges these days. Signed, old fuddy-duddy.:)

[GreyGull]

I agree with this! Anthropology, Sociology, Statistics, and Philosophy are not "fluff" to me. Even Art History can be useful for learning about other cultures before photography,

Many of these so called "fluff" classes are still based on the 3 "Rs"; Reading, Writing and Arithmetic. Those in the visual or creative arts serve a purpose to stimulate the mind which is also part of the critical thinking process. When you do assessments, you utilize all of your senses. For any daily activity, you utilize all of your senses. The liberal arts aide in assessing and channeling one's thought processes into communication and assist in problem solving. The arts can train someone to be more observant to details. Maybe that sounds a little philosophical to some but education is complex. Whether you like it or not your brain is getting some benefit from those "fluff" classes.

You can have a choice of having college be just like grammar school with Reading 1, Reading 2, Reading 3 or you can stimulate someone's interest through an American literature class. The alternative could also be to go back to the tech school way and have all of the text books written at 8th or 10th grade levels. Documentation would a challenge and even now it seems some write at less than a 6th grade level.

The internet and texting hasn't helped either.

[JenniferSews]

My ADN had no "fluff" courses. It was the bare bones makings of a good nurse, with 700 clinical hours in 2 years. But I couldn't help notice the difference in my clinical rotations over time. My second semester I was given a single patient and was responsible for every portion of care, from med administration to bed bath. The only thing that needed signing off with a nurse was a narcotic. But I knew very well I would have to give a solid reason for every med I gave during my shift, plus the action, interaction and contraindications and I was ready at a moment's notice to verbalize all that. But by my fourth semester I wasn't allowed to give a Tylenol without approval from my preceptor standing by my side, scanning in and signing off the med. My vitals were double checked by a cna and my every move was monitored. Focus of what was important moved from being prepared for clinicals to doing well on the killer tests mainly because clinical instructors were too overburdened to be as hard nosed as they had been. The application value of those classroom tests is still up for debate imho.

Not that there should be any room for error in school, but we were never given the chance to even think about what we were doing by 4th semester. That one clinical instructor knew what and why we were doing things based on her experience, but since she had 5 other students tapping their feet to give their am meds without being late, she only had time to click through and sign off. She never had time to question us on the meds, or the patient diagnosis, or the reasons we may have had to hold those meds. It seems to me it should have been the other way around, with newer students being monitored much more closely.

But with hospitals being more and more conscious of the legal ramifications of every move they make, it's harder and harder to train students and even give them any patient contact.

[thomlewis3]

I have work in the ER as an RN now for ten year and never once have had a reason to use a Nursing Diagnosis it and age old idea that all those people with a PHD in nursing use to justify there existence. Also a waste of time. WE need to take care of our patients the government, JACO, and all the other regulatory boards and bodies all ready cause a mountain of paperwork. This archaic practice just add more to the pile.

[Spikey9001, BSN, RN]

Tagging this to read later.

[netglow, ASN, RN]

I think the word "fluff" in relation to actual nursing coursework means all the time spent on "therapeutic communication" and "anything NANDA". Huge focus loss.

Too much time is spent dancing around the elephant in the room. Sure it's important to know how to communicate, but the main focus in nursing edu should be on pathophysiology/A&P/Pharmacology and your skillset of assessment/intervention as part of a team: you and physician, you and ancillary staff. Simply, "what do I have here, what am I going to do about it".

[nyteshade, BSN]

This is an incredibly rude and broad generalization. I work 40 hours a week as an educator, 12 hours weekly in the ICU, full time ICU in summers, and am a full time doctoral student. I have no free time. I do this to ensure that what I teach is clinically relevant and current. My students deserve the best. Nursing education is one of the most thankless jobs, and I am as tired of that worn out phrase "those who can, do..." as I am of "all nurses eat their young."

Trite sayings and insults improve nothing. Honest dialogue and inquiry can change things. It's too bad you prefer the former.

It makes me sad, honestly. I thought this would be a great thread to read; I have really enjoyed all the constructive comments others have made. I simply do not understand why it is acceptable to insult an entire group of nursing colleagues. It would be met with outrage if I said "Specialty 'x' is for those who can't handle real nursing," but it is acceptable to say all nurse educators "can't do?"

Thank you for being an nursing educator! I have had wonderful nursing instructors that I will never forget, and I strive to be like them in my own practice. I agree that nursing as a whole needs to let go of tired sayings, and beliefs.