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]

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

You mean you never had to do one patient scenario or pretend to be in a patient care situation as a Paramedic student? I seriously would have thought you would get a chance to simulate some patient care situations with an instructor given you the scenario or having you come up with one for the class. They even have national EMS competitions based on scenarios and these teams practice by having others role play for them. They also have people trying to come up with other situations to role play. This is also done for community disaster team training.

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

Respiratory Therapists, Radiology and Lab also bill and are not part of the room charge. If a nurse does a respiratory treatment it is placed as a general nursing or room charge because you probably will not be in the room solely with that patient for 15 - 30 minutes to meet the guidelines for a therapy.

Of course all of these professions also had to increase their education level to maintain compliance for reimbursement status.

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.

If you had read my posts, you would have noticed I differentiated between those who are open to education and those who become task fixated which can also due to their mentoring situation and work environment. There are some places that will never advance regardless of education because "this is the way we've always done it" keeps getting passed down. And as the sentiment with some on the forum, the ADN has been good enough for the past 4 decades and should still be good enough. Times are changing.

As far as education, if the nursing program has a long list of prequisites which are heavy in the sciences, maths and English, the student may spend at least one year taking those classes. Why not just take a couple more classes and get the BSN? Wouldn't that be more effective for the long run?

The problems some BSN programs have encountered is placing their students with nurses who have an attitude toward education and believe all BSN students are stupid. How well do you think those clinicals go for the nursing students? Just the few comments on here I would not want a BSN student placed with that person. The inflated education comments from PFMB-RN would probably not make any BSN student comfortable. Regardless of how good you are, your emotions and attitude will eventually show. If you read through some of the different threads on this forum you will see a variety of opinions about advanced education and nurses. Many believe the person automatically becomes less a nurse if they get an education and the statements about those who have MSNs or Ph.D.s are not a good reflection of a profession that wants respect.

Your statement about "all BSNs at my workplace", I refer you back to my post and notice I said the RNs in most of our units (critical care, transplant, ECMO etc) are BSNs.

When I mentioned posters and skits, I was talking about the assignments nursing school students are given, not patient education.

Those assignments later become patient and staff education. You might think this is stupid also but to maintain our unit ladder status, each of us must give a little educational inservice to our co-workers, including doctors (Residents and attendings) which can be a visual of some type. Generally we resort to a poster rather than trying to set up a lot of electronic equipment. So some of those "silly things" you did in school never go away and you will find they can be educational with practical uses. As far as skits, we go out to the med-surg floors to practice Rapid Response and Code scenarios all the time to keep everyone up to date on equipment and skills. I can play a dead patient now even better than I could in college...provided I can lay on the bed and not the floor. We also have drills for missing babies where someone sticks a doll in their backpack or we have a staff member play a confused person wondering the halls.

[Altra, BSN, RN]

I cannot speak for the poster who originally mentioned "skits". I would make a distinction between role-playing scenarios which teach patient care such as Grey Gull describes, and assignments that some students are required to complete including songs and other cutesy/campy arts & crafts projects that certainly do nothing the elevate the image of professional nursing.

I am tired of nursing educational activities which refer to "jewels" or "pearls" of knowledge and include accompanying graphics which would be more appropriate for an elementary school audience. I am also tired of nursing educational activities which include drawings for prizes such as a spa day, a designer handbag, or other feminine, non-professionally associated items.

In my fantasy world, students would utilize group work experiences to prepare professionally-oriented presentations such as they will be required to do in their future professional lives, and "prizes" would at least be professionally oriented such as memberships in local chapters of nursing organizations, or subscriptions to journals.

[metal_m0nk, BSN, RN]

You learn something new every day...I was also unaware that a member alone could feel or exhibit suspicion.

I think I've got this concept map thing DOWN though...

[GreyGull]

I cannot speak for the poster who originally mentioned "skits". I would make a distinction between role-playing scenarios which teach patient care such as Grey Gull describes, and assignments that some students are required to complete including songs and other cutesy/campy arts & crafts projects that certainly do nothing the elevate the image of professional nursing.

I am tired of nursing educational activities which refer to "jewels" or "pearls" of knowledge and include accompanying graphics which would be more appropriate for an elementary school audience. I am also tired of nursing educational activities which include drawings for prizes such as a spa day, a designer handbag, or other feminine, non-professionally associated items.

In my fantasy world, students would utilize group work experiences to prepare professionally-oriented presentations such as they will be required to do in their future professional lives, and "prizes" would at least be professionally oriented such as memberships in local chapters of nursing organizations, or subscriptions to journals.

We definitely went to different colleges. We sing cutesy songs or have spa days. Designer handbags? My advisor never told me about those perks when I was choosing a college. I went to a state university which was no nonsense.

[PMFB-RN, RN]

You mean you never had to do one patient scenario or pretend to be in a patient care situation as a Paramedic student? I seriously would have thought you would get a chance to simulate some patient care situations with an instructor given you the scenario or having you come up with one for the class. They even have national EMS competitions based on scenarios and these teams practice by having others role play for them. They also have people trying to come up with other situations to role play. This is also done for community disaster team training.

*** Yep, we did all that, but not a single skit.

[nursel56]

You learn something new every day...I was also unaware that a member alone could feel or exhibit suspicion.

I think I've got this concept map thing DOWN though...

Nursel56 wants to give Triquee designer handbag and autonomous peni--- oh OK let's not go there--- big fat kudo for being creative, clever and perhaps even =gasp= making Grey Gull's point (sort of) about the implementation of different strategies to adapt to the learning styles, with eye toward possibility of congnitive deficits, of the persons one wishes to impart the concepts to! Whether that concept map works with those who it may have been directed toward remains to be seen.

[jjjoy, LPN]

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.

I agree that assessing communication deficits and creating action plans are important skills. I don't see that it relates to whether or not one supports BSN-for-entry or the idea that I tossed out there, do away with one-size-fits-all RN licensure and instead have specific licensure for various nursing specialties.

There isn't just one standard teaching credential that pre-school teachers and college professors both need to earn before specializing. Nursing foundations, like teaching foundations, can still be taught in all nursing programs, whether training up acute care, hospital nurses or community/organizational nurses (just possible examples).

[jjjoy, LPN]

PS no skits in my nursing program; I would've appreciated some well-coordinated role-play, but given how rushed and, well, unhelpful, most lectures were (let's try to cover 300 pages of text in 2 hours-so no questions, no real-world examples!), I suspect any attempts at role-play probably would not have have gone well anyway.

[lifelearningrn, BSN, RN]

I haven't read this whole thread but it seems like a lot of folks would like to see less theory classes and more hands on clinical work.

I think this attitude is why so many people treat nurses like technical workers and not professionals. Personally, I don't just want to know HOW, I also want to know WHY.

[AOx1]

Things I would love to see change in nursing education and nursing, from the perspective of a nurse educator:

1. Fund programs adequately, including scholarships for students that have the intelligence, but not the means to become nurses. Just as nursing in general is understaffed, so is nursing education. Many of us carry the workload of two people, but more educators are not hired. Also, supplies are often begged/borrowed from local hospitals. When programs are not adequately funded, you begin to find yourself saying things like "Well, we don't actually use 'equipment x' at my facility, but..." and are stuck with outdated equipment. And yes, I do write grants, in addition to all my other responsibilities, with little support.

2. Raise salaries: many of my new graduates make more than I do when you consider the hours I put into my work. I do laugh when people ask if I like holidays/weekends/evenings off. I wouldn't know. I am too busy grading, preparing lectures and activities to benefit my students while also caring for my family, pursuing my doctorate, and working in the clinical setting. Oh, and don't forget research and grant writing!

3. Consider alternate ways for clinical practice: for example, partnerships between hospitals and schools in which the hospital provides a staff member that knows the floor well and enjoys teaching. Several agencies have done this successfully where a nurse educator pairs with a staff member to ensure that the students know the "ins and outs" of that floor while still maintaining consistency with the overall program goals. Also, precepted and simulation hours are strictly limited in some states.

4. Educators should teach essential content. There are millions of "nice to know" things we could teach, but what will keep the patients safe?

5. Stricter admission standards in some cases. I don't believe it is fair to accept an academically unprepared student. It will only cause heartbreak for the student and take time away from those students who are prepared. Also, I would love to see all schools implement a program for students who need extra help. I wish I could tutor each struggling student one on one, but I can't be every place at all times.

6. In a few rare cases, students feel that they are entitled and buying the "right" to a degree. As I said, this is rare, but it is also scary. I don't think this is "fixable" per se, but there is nothing like having a student write "I don't think I should have to read for class. You should just tell me everything I need to know" on an evaluation.

7. We need some standardization so that a student who chooses to transfer can attend another school without starting from scratch.

8. A climate that is respectful of ALL nurses would be fantastic. I know we all feel frustrations at some point, and I've made the mistake of becoming angry at the bureaucracy myself, but I am SO TIRED of reading bashing on this board. It seems anyone in management, education, or with a doctorate is seen as an easy target for ridicule, and we seem to find it acceptable. Last I checked, this board was called allnurses.com, which means that ALL NURSES, whether in management, education, or any other specialty, and future nurses such as students, should be welcomed here. We will all disagree, and I don't mind a joke at my expense, but I am tired of seeing my chosen specialty being characterized as "not real nursing" or for "those who can't do." I have the letters RN behind my name also.

9. I hope those that gripe are politically active and active in the community. Otherwise, it's just whining. We need people who are politically active and willing to serve on school's community advisory. I find it interesting that many people have an opinion, but few are willing to really dig in to find an implement potential solutions. To those with some of these wonderful ideas, please find yourself a local nursing school and offer to serve on the community advising board.

10. Be willing to participate in research. What parts of the curriculum actually contribute to success and which parts are extraneous?

11. Be a willing teacher. I have two clinical groups. One facility has the most wonderful nurses; we have a fantastic relationship, and they are welcoming to our students and to me as an instructor. Our students fight to work at that facility. The other facility has 1 wonderful floor and 1 floor where the nurses are rude to students and to each other. Nobody wants to work on the floor where the majority of the nurses are hateful. In this economy, I recognize things are tough, but we all have a responsibility to help the next generation of nurses for the safety of our patients.

12. Address those nurses (whether nurse educators or staff nurses) who are cruel and angry and GET THEM OUT! Nursing has no place for this type of nurse. This type of nastiness seems to be accepted in our profession. It shouldn't be. These people should be counseled on their behavior, and if it does not change, document it and follow facility protocol for firing them.

[JaneyW]

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

Actually, we have a lot of men in our program and they are some of the better skit participants. There was a young man portraying a menopausal woman in a skit that hit all of the symptoms in a very memorable way that I think all his classmates will remember well forever.

[PMFB-RN, RN]

Actually, we have a lot of men in our program and they are some of the better skit participants. There was a young man portraying a menopausal woman in a skit that hit all of the symptoms in a very memorable way that I think all his classmates will remember well forever.

*** Oh I am not saying we aren't good at them. And those where college students, not nurses.