Crash Course?! Thoughts on RN education - page 3
To me, nursing school often felt like a series of crash courses, one in each specialty area. Dozens of disease processes and conditions were covered each lecture, with no time for questions,... Read More
Sep 18, '07Quote from deeDawnteeI agree that nursing school does sometimes function as a weeder and I think some weeding out is reasonable.My take on nursing school is a little different. I see nursing school as a series of hurdles designed to weed people out... I think when you graduate from nursing school and have passed NCLEX you have cleared a thousand different hurdles. Now you can go out there and learn to be a nurse.
I suppose my contention in this thread is with the second half of your statement... "now you can go out there and learn to be a nurse." Because when you graduate you ARE a full-fledged RN, not a junior RN or a probationary RN or the like. And in some places, the new nurse is given a full-load with full responsibilities in just a few months (sometimes after just a few shifts such as in some LTC facilities).
There is still a fairly pervasive assumption even among nurses, that anyone who is an RN should be able to handle acute care. Many experienced nurses and hiring personnel out there expect nurses to be farther along on their learning trajectory than many new grads are. And new grads are too often criticized whether openly or through inference and body language, that they ought to know more, be faster, etc.
If the RN is truly more of a license to learn (and then practice) as opposed to a license to practice what has already been learned (in school, not discounting the fact that one must continually be learning beyond formal education), then maybe the different kinds of nurses should be more formally acknowledged. I can imagine some kind of unique nurse classification for nurses who have 'proven' their skills in an area of nursing. Once the newbie has 'survived' for a certain amount of work hours (such as the equivalent of year of full-time work), then the nurse moves from being *just* an RN, to an official "ACRN" Acute Care RN, or whatever labelling that formally distinguishes RNs who haven't 'proven' their bedside skills from those who have. Some RNs might never become ACRNs (or whatever) if they never chose or try to work in acute care. And thus, any RN coming into acute care as *just* an RN won't be expected to be "up to speed" or to "hit the ground running" or the like. Of course, those RNs with extra skills or talent would be fully functioning sooner than others, but just as with school, all would have to put in XX amount of hours to move up in status to ACRN (or whatever you might call it).
This is how it tends to work informally now. The new grad needs that "at least one year of med-surg under their belt to hone their skills" ... and if they don't for whatever reason some nurses don't consider them to be "real" nurses. So with some kind of official ACRN status, nurses could talk about being an ACRN or some other kind of RN (PHN, school nurse, occ health nurse, etc).
Again, just thoughts...Last edit by jjjoy on Sep 18, '07
Sep 18, '07I may need to read the entire thread when I am a little less brain-dead. (It has been an insane week so far, and it is not over yet!)
Initial thoughts. . . . .
I can't comment on other nursing programs, as I only attended mine. However, I believe here in the US, we are generally educated as "generalists". We know a little about a lotta stuff. In my program, we did a "Basics" course, (bed baths, bed making, assessments, and the basics of meds). Followed by "med-surg", then either psyche or ob or peds. During senior year we started with either critical care or leadership (during which we began to take a full load of patients on a floor, usually 4-5) oh, and I almost forgot "community nursing", followed by "capstone" which was basically a preceptorship, where we moved into the RN role.
We had the most "hands on" time in the basics, med surg, icu, and leadership settings. I think the philosophy of our program was that most nurses move into these roles initially. Clinical time in OB and Peds was quite limited. This was explained to us as these areas being "specialties" that the majority of the graduates would not enter. We still had some great experiences in both peds and ob, but we rotated through clinics, support groups for teen mothers, etc. not just the hospital setting. From talking to other people who graduated from different programs, I think we got a much broader look at those specialties.
I can't say specifically, but I believe in some other countries, (the UK, I believe) nurses choose their specialty in university. Although I think that may provide for a broader education in that area, I am really glad that I didn't have to make a decision about my specialty before graduation. I took a job because it was a great opportunity, not realizing that I was finding my passion in the process. I would never have chosen the route I did had I been asked initially.
Sep 20, '07Quote from elkparkNo insult intended to diploma nurses. What I meant was they were designed to train you to be a bedside nurse and, while you may hve received great management, research, case management skills, etc. from your program that is not generally true. In addition, I think any nurse that works at the bedside long enough will pick up a lot of knowledge. There are great backyard mechanics who have been taught to work on cars by other backyard mechanics who can keep a car running that no-one thought had a prayer of cranking. Then there are mechanics who have received hours of special training and instruction on how to work on various engine parts and have been certified as experts. They both know how to work on a car but I know which one I want working on my porshe (If I had a Porshe that is).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.
That sounds stuck up and I don't mean it to, but I really do think that the more education a nurse has the better nurse s/he will be in the long run, even if they are a little clumsy w/ proceedures for a little while.
Quote from AriesbsnWhat can I say, you had a horrible peds/ob experience.fronky bean,
I have a BSN. My school lumped Peds and OB together into one course. I had a whopping 5 days of clinicals (30 hours total). Of those 5 days, I had 2 experiences to try and feel a fundus. I wouldn't know the feel of a fundus from the feel of Adam's house cat. I would never have taken a fresh post partum patient when I worked in ICU. I don't know enough to even come close to providing safe care.
Sep 20, '07What can I say, you had a horrible peds/ob experience.
But the original topic is RN education in general. I'm wondering if it would be more important for the nursing students to prove that they can look up and utilize information than to have them try to cover, even if just cursorily, just about every condition they might come across. I can see the point that having studied at one time, the next time you come across it it makes sense more quickly. But on such a basic level, it's not about making sense, it's just about memorizing. And the reality is that nursing students don't memorize every last thing out of those big texts. You have to pick and choose what to focus on. So why not focus more thoroughly on the conditions that nurses are most likely to see instead of making it seem that the student should know every last detail of every last disease covered? Why not have class time be utilized to interact and discuss situations nurses come across and the kind of choices and judgments they will have to make instead of having a lecturer rush through dozens of conditions so that they can say it was 'taught' even though there was no time for discussion, questions, or practical application?
I'm sure some schools and instructors out there are better at presenting their material and doing more than just rehashing the text, but from what I've read here, it sounds like my program wasn't an exception.
Sep 20, '07Interesting. After spending my first 2 years in nursing in a large teaching hospital, and learning right alongside interns and residents, I am of the opinion that the trend toward extended orientations/preceptorships/nurse residencies/whatever label you wish to use should absolutely continue. Instead of focusing on how much can be crammed into basic nursing education and whether or not it's "enough", why not recognize the reality that clinical practice is developed over time? No one would dream of turning an intern who passed the medical licensing exam 6 weeks ago loose on 6 or more patients without supervision -- why is it exactly that this is expected of new nurses?
I would also like to say that I whole-heartedly agree w/elkpark's post above re: diploma programs. My diploma school experience reflects much of what was stated in that post, even though our respective diploma experiences took place 2 decades apart.
Sep 20, '07Quote from MLOSI agree that such programs are a benefit and should be encouraged.I am of the opinion that the trend toward extended orientations/preceptorships/nurse residencies/whatever label you wish to use should absolutely continue.
Sep 20, '07I also thought that I walked away with too little skills and too much information. I didn't have much clinical time in school, maybe one or two days a week, and most of the time, it was not for the entire shift. I was very nervous to work in med-surg because of that.
Sep 20, '07Quote from pagandeva2000My clinicals were a joke.I also thought that I walked away with too little skills and too much information. I didn't have much clinical time in school, maybe one or two days a week, and most of the time, it was not for the entire shift. I was very nervous to work in med-surg because of that.
I completely agree with this.
Sep 21, '07Quote from SuesquatchMy clinicals were a joke.
I completely agree with this.
I think my clinical experience was such a waste of time that I was glad when the instructors used to cancel out as much as they did. I used that time to study what would be on the next exam and NCLEX. In most cases, clinicals did not prepare a nurse in my opinion because they do not prepare you for dealing with a real load of patients independently because the student is either babysat or just placed on their own with one or two patients (if the clinical instructor is exceptionally lazy). I really could have done without them.
Sep 21, '07Well that's scary to hear that some clinicals were cancelled. What did they have a dentist appt or something? Our program has clinicals QWEEKEND BETWEEN 3 SITES,then also 2 days during the week closer at the end of the program.
Does the NCLEX focus more on theory then or do they have random equal amounts of questions on clinical application? Just curious.
Sep 21, '07Quote from sharona97I find it hard to say what NCLEX is for people since each exam is individualized. I did not have any skill oriented questions on my exam, thank goodness, but, I did have CD ROMS to watch and remembered the labs just in case. Didn't matter for me anyway, because most of my NCLEX questions focused on neuro and digestive disorders as well as infection control and co-horting. I leaned on theory and good guessing for those.Well that's scary to hear that some clinicals were cancelled. What did they have a dentist appt or something? Our program has clinicals QWEEKEND BETWEEN 3 SITES,then also 2 days during the week closer at the end of the program.
Does the NCLEX focus more on theory then or do they have random equal amounts of questions on clinical application? Just curious.
Sep 21, '07Quote from purplemaniathis is one of the reasons why the EU and some parts of Aus have different registrations for different branchesthe 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.
in the Uk we have 4 nursing Branches pre-reg (adult, child, mental health, learning disabilities) specialist community and public health nurses as post basic registration (generally adult nurses by first registration ) and midwifery as a seperate profession by regulated by the same regulator
the dutch and some ofthe scandinavian countres have sort of nurse anaesthetists and Nurse advanced practitioner Ambulance providers as post basic registrations
the EU requires 2300 hours of practical placement experience for first registration
in our third (final year) we were expected to be able to manage a decent patient load with minimal support ( often we were placed on 28- 30 bed units which were genrally staffed with 3 RNs on days and 2 at night ( plus 2or 3 HCA on days and 1 at night ) and would generally take responsbility for 6 or 7 patients OR ended up looking after the level1 critical care patient(s) (level 1 = needs more nursing input for not sick enough for High dependency - 2 = single system organ support, NIV, or really really high levels of nursing input, 3 = intensive care invasive vent and/or multi system organ support)Last edit by ZippyGBR on Sep 21, '07
Sep 23, '07I agree there is a great deal of information poured into the nursing student and very few opportunity for return demonstration in the clinical site, however, the information is given the way it is so that the practitioner is prepared to begin developing critical thinking skills. No you may not care for patients with each of the conditions you covered in class but you have a starting point for narrowing the signs and symptoms to get to a clearer differential dx. For those just starting out, you will always need to refer back to the "manual" patients are different and present with the same diseases with different presentations. Our education (initial) is just to prepare us to begin our practice, to certify, after NCLEX that we are competent to recognize general patient presentations related to groups of conditions.
It is true, the more you think you know, the more you realize how little you really know.