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?

[GreyGull]

The big issue is knowing how to assess for a communication deficit and create a plan of action. Sometimes patient who is aphasic or even locked in gets placed in a noncommunicative category and forgotten. This becomes obvious in how the patient is cared for and any attempts at even offering communication alternatives are neglected. That is were the lack of education about the communication process as well as disease/injury are evident.

Sidenote: Have you read the book or seen the movie, "The Diving Bell and the Butterfly"? It gives a good insight as how some take communication for granted and what the patient who can not communicate is thinking.

Right now the current ADN + a few more "fluff" or science classes should be the very lowest amount of education for the RN. Anything less than that and an LPN/LVN should be considered. The minimal sciences and math are barely adequate. Actually, in some programs, they are not adequate for even the most minimal entry level positions.

The Therapist programs I posted earlier have the same minimal standards regardless of what they do which is why I posted programs on different coasts. Some might argue that a Masters for OT is overkill but few would now give up their education and create a lesser level professional except for the "assistant". They like their status with CMS and have gained respect from the physicians and other educated professionals from other disciplines. Even the Respiratory Therapists have moved on and up in the past few years but that may not be enough in their profession which is also reimbursement dependent. To appeal to CMS they petitioned with a Bill for professional recognition with a Bachelors degree. By the time their Associates degree became the minimum, they were already pushing for the RT employees to get their Bachelors. They know RTs are lagging behind the other allied health professions.

Medicine has arrived at a point where just the bare minimum is no longer good enough.

[PMFB-RN, RN]

I thought my school was the only crazy one! I graduate in two weeks and one of my final projects includes a book report and a skit about the book. Yeah, that's going to make me a better nurse...

*** That's why we need more men in nursing. More men = less skits.

[CuriousMe]

*** That's why we need more men in nursing. More men = less skits.

Not at my school....in the past three years we've only had one opportunity to do a skit (we could do a PowerPoint, Skit, etc)

The only group that chose a skit, was all male.

[PMFB-RN, RN]

After reading some of the posts here it is easy to see why nursing is being referred to as a trade and not a profession. Right now the entry level RN is near the bottom of the list for the least educated of the health care professions. I would say it is barely surviving in the category "profession" and will soon be back as officially a "trade" listing.

*** How many of those other health care profession must punch a time clock like most RNs and factory workers are required to do? Given the extremely high level of supervision RNs must work under compared to other health professions who seem to mostly work with very low levels of supervision. In my hospital each unit has a charge nurse, and assistant nurse manager, a nurse manager, and of course there is the house supervisor. Compare this to, say OTs who are usually the only OT in the house and expected to work unsupervised.

I would say we are very definitely in the "skilled trade" category, just lower paid than other skilled trades like plumbers.

[PMFB-RN, RN]

Not at my school....in the past three years we've only had one opportunity to do a skit (we could do a PowerPoint, Skit, etc)

The only group that chose a skit, was all male.

*** Ya but those guys wheren't nurses, they where college students. When half or more of the nursing instructors, managers etc are males skits will go away.

[CuriousMe]

*** Ya but those guys wheren't nurses, they where college students. When half or more of the nursing instructors, managers etc are males skits will go away.

They were male nursing students who when given the choice, chose to do a skit to present information (and were the only ones in the class who do choose a skit).

I get that if there were more of you around, there would be no skits. I disagree that your entire gender necessarily agrees with you.

[GreyGull]

*** That's why we need more men in nursing. More men = less skits.

It you ever take an EMT or Paramedic course or train with FFs you will do a lot of skits for various patient situations as homework and classroom projects. These are all male dominant professions with mostly male instructors. Some call them scenarios or information projects but when the students have to come up with them and demonstrate with others in class, they are "skits".

If anybody takes one of the defense classes that is now being offered for health care professionals across the country, you may do a lot of presentations and demonstrations over and over for different situations.

[GreyGull]

*** How many of those other health care profession must punch a time clock like most RNs and factory workers are required to do? Given the extremely high level of supervision RNs must work under compared to other health professions who seem to mostly work with very low levels of supervision. In my hospital each unit has a charge nurse, and assistant nurse manager, a nurse manager, and of course there is the house supervisor. Compare this to, say OTs who are usually the only OT in the house and expected to work unsupervised.

I would say we are very definitely in the "skilled trade" category, just lower paid than other skilled trades like plumbers.

If an OT, SLP or PT work in a hospital they are punching a clock and are reporting to a supervisor over many services and operating under some medical director.

Don't home health and school nurses work unsupervised? Because of the structure of supervision, does that mean you should be less educated? Aren't RNs responsible for supervising others as well such as patients, CNAs and ER Techs?

As far the pay, that depends on where you live. There are areas where you definitely can not say a nurse is a minimum wage earner. But then again if the industry standard only wants a 2 year college degree for entry level, what do you expect and what do you think are the expectations of policy makers when they are dealing with someone who only has two years of education. Look at the education requirements a grade school teacher must have and their pay is not that great either. Teaching kids also comes with responsibility.

[PMFB-RN, RN]

If an OT, SLP or PT work in a hospital they are punching a clock and are reporting to a supervisor over many services and operating under some medical director.

*** Where I work those professions bill for their services. They are not part of the room charge like nurses are.

Don't home health and school nurses work unsupervised?

*** Sure. I was careful to say "most".

Because of the structure of supervision, does that mean you should be less educated?

*** It means nurses are not seen as independent practitioners.

As far the pay, that depends on where you live. There are areas where you definitely can not say a nurse is a minimum wage earner.

**** I certainly never said anything about nurses being minimum wage earners. I said paid less than skilled tradesmen. Think plumber, not burger flipper.

But then again if the industry standard only wants a 2 year college degree for entry level, what do you expect and what do you think are the expectations of policy makers when they are dealing with someone who only has two years of education.

*** Nurses with BSNs or MSN don't get paid any more, or if they do it's some tiny, insignificant amount. If the higher levels of education where valued they would get paid more.

Look at the education requirements a grade school teacher must have and their pay is not that great either. Teaching kids also comes with responsibility

*** Their educations requirements are like the nurses educations requirements in that they are not actually needed to do their job.

In my view nursing suffers from an inferiority complex. I see evidence of this in the absurd DNP requirement for NPs. Pure degree inflation.

[PMFB-RN, RN]

It you ever take an EMT or Paramedic course or train with FFs you will do a lot of skits .

*** I was a paramedic and never was a skit to be seen in my program. I saw my first one in nursing school.

[eyeball]

This is an interesting post...I am in week four of orientation to a busy telemetry floor. It's my first job out of nursing school. I am being repeatedly reminded on many levels that Nursing School does not equal Nursing and I'm beginning to wonder about the value of my program in preparing me for real world nursing. Like many posters my program had an extremely high pass rate on the NCLEX. I feel well prepared in theory of pathophysiological processes, medications and basic CNA skills: bathing, turning, etc. Beyond that, I still feel weak with heart and lung sounds and I realize that at no time in my education did I have the experience of listening to abnormal heart and lung sounds under the guidance of a teacher. My CI's were way too busy to do much with me other than observe my medication administration, look over my assessment on the computer, and guide me doing a few (and I mean few) random interventions. I like the idea of one-on-one preceptoring in nursing school as well as more time spent shadowing real nurses doing real world nursing.

Another thing that is hard for me is the reality that in nursing school we are taught proscribed ways of doing things but that in the real world nurses need to cut corners in their practice in order to get the day's work done. Everyone admits they do this and my problem is in knowing the difference between safe corner cutting and what becomes corner cutting that can compromise safety. I've already had a few disturbing experiences on the floor that leave me feeling anxious and unsure about what really is "the right way."

[nursel56]

QUOTE PMFB RN Don't home health and school nurses work unsupervised?

They do! And I'm an L V N, which makes me, in Grey Gull's estimation, about 2 pebbles shy of a granite block in the brainiac department.

Grey Gull, I think you've created an artificial gap between ADN nurses and BSN and up nurses by ascribing to them negative characteristics that go beyond the issue of formal education. I think it's insulting to imply that without at least a BSN would see the nurse flipping the patient back and forth and jamming a catheter up his unsuspecting member . Can a member suspect something not-so-good is afoot? Sorry. Ahem, anyway, I honestly think you're underestimating them by a large degree.

The other issues I picked up from your posts is that you feel that a nurse coming out of a 2 year program would be less open to change and less flexible about changing established practices and resistant to innovation. That describes a characteristic of personality, and intellectual curiosity is not dependent on years in school. In the olden days, continuing education was assumed to be what a nurse or doctor does as a matter of course, and nurses happily learned and avoided killing people for decades before mandatory CEUs.

You mentioned that all the RNs at your workplace have their BSNs and are therefore wonderful mentors and communicators. There are reams of complaints here about preceptors, and I'm pretty sure it hasn't been connected to their highest level of education in nursing. Same for the patient education issue. When I mentioned posters and skits, I was talking about the assignments nursing school students are given, not patient education.

Last point- I agree that OT, PT and SLP are growing in professionalism by leaps and bounds. My daughter is in a PT program that requires 6 years of study. She's specializing in kinesthesiology with emphasis in sports injuries.