Crash Course?! Thoughts on RN education

luvmy3kids · Sep 14, 2007

And this is the table of contents for a Med-Surg book (Mosby). It's possible to cover all of the topics in one or two individual courses but not in any kind of depth. One might think this was for an entire year of nursing education.
Section One: Concepts in Nursing Practice
1. Nursing Practice Today
2. Health Disparities
3. Culturally Competent Care
4. Health History and Physical Examination
5. Patient and Family Teaching
6. Older Adults
7. Community-Based Nursing and Home Care
8. Complementary and Alternative Therapies
9. Stress and Stress Management—NEW!
10. Pain
11. Palliative and End-of-Life Care
12. Addictive Behaviors
Section Two: Pathophysiologic Mechanisms of Disease
13. Inflammation and Wound Healing
14. Genetics, Altered Immune Responses, and Transplantation
15. Infection and Human Immunodeficiency Virus Infection--NEW!
16. Cancer
17. Fluid, Electrolyte, and Acid-Base Imbalance
Section Three: Perioperative Care
18. Nursing Management: Preoperative Care
19. Nursing Management: Intraoperative Care
20. Nursing Management: Postoperative Care
Section Four: Problems Related to Altered Sensory Input
21. Nursing Assessment: Visual and Auditory Systems
22. Nursing Management: Visual and Auditory Problems
23. Nursing Assessment: Integumentary System
24. Nursing Management: Integumentary Problems
25. Nursing Management: Burns
Section Five: Problems of Oxygenation: Ventilation
26. Nursing Assessment: Respiratory System
27. Nursing Management: Upper Respiratory Problems
28. Nursing Management: Lower Respiratory Problems
29. Nursing Management: Obstructive Pulmonary Diseases
Section Six: Problems of Oxygenation: Transport
30. Nursing Assessment: Hematologic System
31. Nursing Management: Hematologic Proble
Section Seven: Problems of Oxygenation: Perfusion
32. Nursing Assessment: Cardiovascular System
33. Nursing Management: Hypertension
34. Nursing Management: Coronary Artery Disease and Acute Coronary Syndrome
35. Nursing Management: Heart Failure
36. Nursing Management: Dysrhythmias
37. Nursing Management: Inflammatory and Structural Heart Disorders
38. Nursing Management: Vascular Disorders
Section Eight: Problems of Ingestion, Digestion, Absorption, and Elimination
39. Nursing Assessment: Gastrointestinal System
40. Nursing Management: Nutritional Problems
41. Nursing Management: Obesity—NEW!
42. Nursing Management: Upper Gastrointestinal Problems
43. Nursing Management: Lower Gastrointestinal Problems
44. Nursing Management: Liver, Pancreas, and Biliary Problems
Section Nine: Problems of Urinary Function
45. Nursing Assessment: Urinary System
46. Nursing Management: Renal and Urologic Problems
47. Nursing Mgmt.: Acute Renal Failure and Chronic Kidney Disease
Section Ten: Problems Related to Regulatory and Reproductive Mechanisms
48. Nursing Assessment: Endocrine System
49. Nursing Management: Diabetes Mellitus
50. Nursing Management: Endocrine Problems
51. Nursing Assessment: Reproductive System
52. Nursing Management: Breast Disorders
53. Nursing Management: Sexually Transmitted Diseases
54. Nursing Management: Female Reproductive Problems
55. Nursing Management: Male Reproductive Problem
Section Eleven: Problems Related to Movement and Coordination
56. Nursing Assessment: Nervous System
57. Nursing Management: Acute Intracranial Problems
58. Nursing Management: Stroke
59. Nursing Management: Chronic Neurologic Problems
60. Nursing Management: Alzheimer’s Disease and Dementia
61. Nursing Management: Peripheral Nerve and Spinal Cord Problems
62. Nursing Assessment: Musculoskeletal System
63. Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery
64. Nursing Management: Musculoskeletal Problems
65. Nursing Management: Arthritis and Connective Tissue Diseases
Section Twelve: Nursing Care in Specialized Settings
66. Nursing Management: Critical Care
67. Nursing Management: Shock, SIRS, and Multiple Organ Dysfunction Syndrome
68. Nursing Management: Respiratory Failure and Acute Respiratory Distress Syndrome
69. Nursing Management: Emergency and Disaster Nursing

I think I just had a stroke!!! :lol_hitti

Lisa CCU RN, RN · Sep 14, 2007

I'm just curious here... wondering what your nursing school experience was like and how it compares to nursing programs today. I don't want to assume one way or another. Did you guys have the same two inch thick texts? Surgical nursing, maternity nursing, etc? Were you assigned hundreds of pages a reading each week in each text? Did you have the same ridiculously vague nursing exam questions? Were lectures essentially a rehash of the readings with no time for questions or elaboration? (Since the texts were essentially already summaries of disease processes and treatments, lectures couldn't really summarize it any more than that). If so, were you satisfied with that?
Don't you mean 3 inches!?

I agree, I always wished we had time to discuss the material we were learning or to ask questions, but not only did this make my classmates mad when people did this, but even during our three hour class, we STILL didn't have enough time.
Some programs today do have strong clinical components but from what I've read here, it seems many do not... often due to liability concerns, I'd imagine, as well as the lack of strong clinical instructors. Students care for no more than 2 patients for much of the time and have to wait around for the instructor to do tasks. Students also often have a hard time coming across enough opportunities to practice skills for all the students. They might have only done one foley catheter and set up a chest tube set once during their entire education.

This is true also. I hate how we are not allowed to do IV pushes without our instructor. I am really scared because itf it were not for me being such a bookworm, I'd never have realized the importance of certain aspects of IV therapy. In our next to last clinical, my instructor touched on this a little, so I began to realize how many things could go wrong. I will be looking up every med for compatibilty.

I really liked OB, but we were not allowed to touch their pumps at all. And then in ICU rotation, I had no clue what titrating involved! I figured it out by the end, but they were very vague to me.

It is also very frustrating to have to wait all the time on instructors.

RNperdiem, RN · Sep 14, 2007

If something has to be learned, it can be learned. You should see the textbooks medical students have to learn from.

A complete education includes all systems. Would you want a doctor with no experience in all areas? It is called being well rounded. There is no reason nurses shouldn't be too. Perhaps the change needed is to extend nursing education since the amount of material to learn has increased; I mean more clinical time especially.

I still consult my texts and other books even after 9 years as a nurse. Learning never stops and does not have to be in a classroom.

jjjoy, LPN · Sep 14, 2007

If something has to be learned, it can be learned. You should see the textbooks medical students have to learn from.
A complete education includes all systems. Learning never stops and does not have to be in a classroom.

I agree! It's just that despite covering all that nursing school material, I didn't feel that I *learned* much. From bio, anat/phs, I knew the systems pretty well going in. In nursing school, I had to cram lists of s/s and tx of a bunch of conditions into my head with just the most basic explanation of the pathophys and no realistic examples or context.

The nursing care made sense as it tended to repeat... assess for fluid retention/dehydration, assess for changes in mental status, assess for pain, etc... but the specifics of each of every condition we covered... not! Maybe as nurses, we don't need to *KNOW* those things so well. Maybe the most basic introduction is enough. In that case, why make it seem as if students should be able to reel off the list of symptoms for this or that disease?

Diaphoresis, clamminess, nausea, anorexia... all of these symptoms indicate something's wrong and nurses need to know how to recognize them and what to do about them (besides just "notify doctor.") But nurses aren't in the business of diagnosing. With enough experience, the nurse will be able to recognize symptom patterns and predict what the doctor will diagnose and treat. But new grads shouldn't be expected to function at that level.

Maybe nursing school was more like studying long lists of long vocab words for the SATs. I kept expecting something more like a lit course or comp course where we'd see and use the vocab - not just be given more lists to study. But maybe we only needed to be familiar enough with the vocab to recognize it, not use it. For me, making up flashcards and memorizing never worked well. It would help me pass a multiple choices (hmm, I seem to remember a word like this one meaning something like that) but I still wouldn't be able to use it in a sentence. Thus, I didn't feel I *really knew* it. That's how nursing school felt in some (not all!) respects.

espritjolieRN · Sep 16, 2007

I agree! It's just that despite covering all that nursing school material, I didn't feel that I *learned* much.

I know exactly what you mean. I felt exactly the same way when I graduated. Then I started working and I realized that I had learned a lot more than I thought I had.

For example: I would walk into a patient's room and listened to their MD explain their condition and realize that I completely understood everything he was saying, we had touched on all of it in school. I was then able to clarify what he was talking about to the patient later when he asked me questions. I would take an admission, understand their diagnosis, know why their labs looked the way they did, understand what the possible complications were, know what to monitor for... and feel, blessedly, somewhat competent. (Of course, I usually couldn't start their IV to save my life...)

Here's what I think is the most important thing though... learning doesn't mean that you have instant recall, instant knowledge, that it's all in your head and you're never going to forget it. It means that you took the time while in school to learn something complicated, created the associated neuroconnections and filed it away. The next time you need to "re-learn" it, you will open up your reference, read through it, and it will all kind of click together very quickly and nicely in your head. Because you already spent the time getting it in there.

Really. I questioned all this too, but it does have value.

fronkey bean · Sep 16, 2007

JJ, It sounds like what you want is a return to hospital based diploma nursing programs. While these did prepare a nurse to be very competent in one area, they left little room for professional growth after graduation. A professional education requires that you learn many things that may not be immediatly applicable but broaden your scope of knowledege so that you will be aware of different techniques and situations that may apply to something you could potentially encounter. I have never worked a day in L&D and don't want to, but when I got a fresh post-partum pt in my ICU I had the knowledge base to know to check her fundus and lochia along w/ her B/P.

Knowledege, even if unused, is never wasted.

purplemania, BSN, RN · Sep 16, 2007

the problem is, your license is generic. You are able to practice any field of nursing. That is good in that you may change directions of your career without having to return to school, as they do in some countries. But the drawback is there is SO MUCH to learn. That is why I personally advocate BSN as entry level to RN. No flames please. It is my opinion, not a demand.

sharona97, BSN, RN · Sep 16, 2007

Dear Purplemania,

I'm confused with the word generic. r u telling LPN/LVN/ADN that because they can go anywhere to work and hone their skills, that there is a problem with that? Don't BSN's have a choice of what field of nursing they might apply themselves to? Does that constitue having a "generic BSN license"?

Secondly,for many,many yeas LPN?RN's have been doing just that, working and honing their skill level. There is more material to learn these days at all levels of nursing;furthermore, RN/s and LPN's are aware of this and they continue with CEU's as mandated. Wich then in turn gives knowledge a piece at a time.

I see it like this, if a BSN nurse prefers managment versus thedirect care patient assist aspect there is nothing wrong with that choice. It does not make the BSN any lesser if they go into teaching or research or writing. RN's have gone into teaching. I do understand that their are different levels of the nursing plateau as far as job placements. Can't this be considered a choice of the RN or LPN to be happy with their position? I would think it would be a better team approach, rather than the generic post.

elkpark · Sep 16, 2007

JJ, It sounds like what you want is a return to hospital based diploma nursing programs. While these did prepare a nurse to be very competent in one area, they left little room for professional growth after graduation. A professional education requires that you learn many things that may not be immediatly applicable but broaden your scope of knowledege so that you will be aware of different techniques and situations that may apply to something you could potentially encounter. I have never worked a day in L&D and don't want to, but when I got a fresh post-partum pt in my ICU I had the knowledge base to know to check her fundus and lochia along w/ her B/P.
Knowledege, even if unused, is never wasted.

I'm puzzled by your characterization of diploma programs. When I graduated from a hospital-based diploma program in the mid-'80s, I graduated prepared to "hit the ground running" and practice as a Registered Nurse from day one, which I can certainly not say for graduates today. I don't understand what is meant by being prepared to be "very competent in one area" -- my school prided itself on the fact that its graduates could be dropped down anywhere nursing was happening, and we could do the job. As for "progressional" education, I got a much better education in critical thinking & problem solving, managment, ethics, legal issues, professionalism, etc., in my original diploma program than I did in the BSN completion program I later attended, or the new graduates I encounter these days have gotten. The school encouraged us from day one to consider the diploma a starting point, not a terminal degree, and to plan on continuing our education beyond basic licensure. Many of my classmates (and myself) have gone on to take graduate degrees and practice in a wide variety of advanced practice roles and specialty areas. Frankly, the longer I've been out of nursing school and the more I've seen, the more I appreciate what an excellent nursing education I got. I've taught in ADN and BSN programs since then, and am shocked at how little nursing students learn about nursing now, compared to what we learned back in the "bad old days" that everyone in nursing loves to badmouth now.

I find it extremely ironic that, as time passes, the more there is to know in nursing, and the more accountability and responsibility nurses bear in their practices, the less we are teaching nursing students. One of Florence Nightingale's main contributions to nursing was to establish it as an academic discipline, to be taught in educational settings instead of through "on the job training" -- and yet, for the last couple decades or so, we've been teaching less and less nursing to students and are, more or less, reverting back to OTJ training. (Nursing administrators and educators in hospitals will tell you openly that they don't expect new grads to know anything about nursing -- they expect to have to teach them everything they need to know to function on a floor.) There are many areas in which I feel the larger nursing community has "thrown the baby out with the bathwater," and nursing education is certainly one of them.

Indy, LPN, LVN · Sep 17, 2007

The purpose I saw in my ADN education was to give me a foundation to do two things: pass the NCLEX and start working. That's all.

Now the thing about a foundation is, it needs to be under the whole house. If your house foundation goes under all the rooms but the bathroom, trust me and don't take a bath in it. There's a lot of varied content and it all needs to be more specific to feel like it's useful in a nursing education. And you are not expected to know the drugs to expect with every disease you come across. But if you have the basic pathophysiology in mind with new cases, you'll be looking in the right direction, and when you do look up the new drugs, you'll have "aha" moments and real learning will happen.

My current boss went to nursing school overseas and graduated as an ICU nurse. Now that's specialty education. And I can see the value in it just from watching her work... or can I? She's been practicing a lot longer than I have, and maybe her performance is topnotch from all those years of experience.

jjjoy, LPN · Sep 17, 2007

One of Florence Nightingale's main contributions to nursing was to establish it as an academic discipline, to be taught in educational settings instead of through "on the job training" -- and yet, for the last couple decades or so, we've been teaching less and less nursing to students and are, more or less, reverting back to OTJ training. (Nursing administrators and educators in hospitals will tell you openly that they don't expect new grads to know anything about nursing -- they expect to have to teach them everything they need to know to function on a floor.)

It is rather interesting that OTJ training is so necessary for many new RN grads these days. I wouldn't ascribe that to schools teaching less... again, check out how many different conditions are covered in just one or two courses! There is just an awful lot to know! So the issue I suppose I'm grappling with here is "How much of what information is *enough* for an entry-level RN?" I don't have a clear answer.

There are many other questions that come up in thinking about this. What *should* an RN know and be trained in, regardless of their eventual job? Most RN programs still focus on inpatient, bedside care. Is that experience an integral part of being an RN? Should any graduated RN be able to minimally function on an inpatient unit? If so, what is considered minimally functional? Doesn't blindly administer medications? Yes. Can handle a full load of patients? Not necessarily.

Some might argue that RNs don't necessarily need strong inpatients skills depending on what kind of nursing role they eventually plan to take up. If one argues that, then should there be different educational tracts that focus on inpatient care versus other kinds of nursing?

For now, it seems that employers are having to "fill in the gap" by offering extended preceptorships and guidance for new nurses. And maybe that's a fine model. Any new nurse would need some extra support and guidance regardless. The amount and type needed will vary depending on what skills and experience new grads bring with them from school.

jjjoy, LPN · Sep 17, 2007

You always have a lot of questions about the status qo and I like that about you. I almost never agree with your conclusions, but nevertheless I really appreciate someone who looks at a situation and questions the value of a certain way of doing things and wonders if there is a better way of doing it.

I appreciate your feedback. My *conclusions* are incredibly tentative and I recognize that there are likely reasons out there that would show why somethings are done one way and not another. Still, if I don't put my thoughts out there, I won't further my understanding, even if it turns out that my thoughts eventually come full circle. I appreciate your (and others') willingness to engage in discussion and your respectful demeanor even in disagreement.