Crash Course?! Thoughts on RN education - page 6

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

  1. by   fronkey bean
    Quote from jjjoy
    I see your point. At what point did you feel you had enough knowledge and experience to be able to quickly recognize specific medical conditions and to know the precise info to give a doc to get the right order? Was your nursing school program one of the more clinically intense programs that had you taking on the kind of responsibilities that working nurses have? Have you had the opportunity to work with recent new grads from different programs? Do you think they are ready to for the job? By accrediting the schools and granting licenses, the BON has deemed all new grads as "ready" to start work as nurses.



    I had a good working knowledge of pathophysiology when I left school so that when I saw something that deviated from the norm I could recognize it and and call the physician w/ pertinent info. I was coached in this for a 6 wk orientation and then put out there on my own and in 13 years have never had a complaint that I didn't call when I should have or that I called when I didn't need to.

    Quote from jjjoy
    Absolutely! There's no way to substitute for the knowledge and skills that come from experience.

    I just know that I was frustrated with the way my program, and I'm assuming several other programs, taught the didactic portion of class. Why did each assignment feel like reading a hundred pages in a reference book? Because my med-surg book WAS written like a reference book. And that's fine, but you don't read to UNDERSTAND from a reference book. You read the reference book to get the facts, then you apply knowledge you already have from other sources to see how you can use that information caring for a patient.

    It would seem more important to make sure students have a strong foundation in recognizing and dealing with symptoms, and knowing and understanding pathophys, pharmacology and the like, as opposed to reeling off the symptoms,lab values and treatments of a ton of specific conditions they may not encounter. If there were more time to learn, then fine, study them all. But since time is limited, something has to give.

    In practice, the nurse will either already know the diagnosis from the chart or will have to run the symptoms by the MD to get a diagnosis. Whether or not the nurse has a good idea of what the MD will say isn't as important as the nurse recognizing when an MD needs to be called. With experience and practice, the nurse WILL be able to predict what an MD will order. But with just two short years of training, not all of which is hospital-based nursing, and the current situation where students often don't get the amount and kind of first hand clinical experience to that would truly break them in professionally, a basic nursing education can only cover so much ground.

    I'm wondering if it still might work if nursing education if there were less breadth of the possible health conditions a nurse may come across, in order to free time to really learn how to be a nurse. If they have that down, it's okay with the nurse gets a patient with a condition he/she isn't very familiar with - that's what reference books are for.

    Maybe highlight a couple of diseases from each system and then assign students to apply their nursing knowledge to a couple of other diseases from that system, pointing them to reliable reference sources. Finally, quickly review the longer list of the conditions usually covered on that system. As graduates, students will have at least heard of most conditions and they will be well prepared to use available references and resources to create a plan of care and to understand the short explanation of the disease in the reference book and be able to teach their patient about it.
    I run into a similar argument from my daughter when she wants to just answer the lesson questions by skimming through the assignment to find the answer w/o actually reading the assignment. The problem is that you learn isolated facts out of context and you don't develop an overall familiarity w/ the subject matter. Of course you are not going to remember all of it, if you could you would have gotten a 100 on every test (assuming you didn't), but when you were done you hopefully had a working knowledge of the normal physiologic processes of whatever body system you were covering and also the pathophysiology. This should put you ahead of the curve when it comes to knowledge gained by experience too. If you already have the knowledge that some nurses have after a few years of experience then it seems to me you would always be a little ahead. It probably evens out after 10-20 years but shouldn't we start as prepared as possible to meet the needs of the patient and facilitate our physician colleagues to do the same?
  2. by   fronkey bean
    Quote from SMK1
    As a student approaching graduation, I kind of disagree with this. I think the not breathing, found unconscious "code" type situations are things we would know how to handle because we won't be alone making decisions. It would be scary but you know what to do. Person isn't breathing, do ABC's call a code initiate CPR and the calvary comes to rescue you! The issue that I see as a big issue is that hours prior to the arrest the signs of it coming may have been caught by a more experienced person. There is no replacement for experience when it comes to assessment. This is what makes me nervous. We do 2 clinical days per week 8-9 hours. Which is decent, but it could be more. Getting out there and seeing what a real live patient with ____ disease looks like is so important. The education is vitally important as well but the two must go hand in hand for the concepts to really come together.
    I agree w/ you in part but I think even a new nurse should be able to recognize subtle signs that something is different w/ her patient and have enough knowledge to investigate further and consult other people. How many times have those of us in ICU reviewed NN and seen a trend developing that, if it had been caught and treated earlier, might have averted the code?
  3. by   jjjoy
    Quote from fronkey bean
    I agree w/ you in part but I think even a new nurse should be able to recognize subtle signs that something is different w/ her patient and have enough knowledge to investigate further and consult other people. How many times have those of us in ICU reviewed NN and seen a trend developing that, if it had been caught and treated earlier, might have averted the code?
    First you say a new nurse should be able to recognize subtle changes and then you note that it's not uncommon to find that such signs were not recognized by experienced nurses you work with.

    Yes, ideally all new grads would be well-prepared... but they aren't. Just like there are practicing nurses who don't seem to make the grade. The question is whether those who show deficits have had their chance and shouldn't be nurses there or if they just need additional education and training. You probably don't treat newbies poorly, but too many experienced nurses give newbies a hard time for not being able to "hit the ground running" and to know things right off the cuff - which, given the way many programs are run these days, isn't a realistic expectation.
    Last edit by jjjoy on Oct 9, '07
  4. by   jjjoy
    Quote from fronkey bean
    I run into a similar argument from my daughter when she wants to just answer the lesson questions by skimming through the assignment to find the answer w/o actually reading the assignment. The problem is that you learn isolated facts out of context and you don't develop an overall familiarity w/ the subject matter.
    I completely agree! That's why I didn't like the way the nursing texts were structured. They focused on each condition separately. 3-4 pages with a short pathophys section, a list of signs and symptoms, a paragraph or two on diagnostics and treatments and finally a section devoted to nursing care. Was I to seriously memorize all of that for every condition we covered? I didn't just want to memorize, I wanted to understand, to see the relationship between the symptoms, the lab values, the mechanisms by which the treatments worked... but with as much as we had to cover, there was never time to ask questions in lecture. And the text didn't integrate the material that way. Yes, we all need to be able to teach ourselves things, but I don't think many would argue that nursing should be a self-study course.

    Just in case you have the impression that I think nursing school should be easier, let me clarify that I don't think that! I earned very good marks in nursing school as well as my other subjects, including the sciences and AP classes in high school. I spent many a weekend throughout school in the library. I'm no slacker when it comes to studying.

    I just felt that for all of the hard work that nursing school was, I didn't feel like the learning objectives were clear. What were we to do with those thousands of pages of info we covered in the med-surg booK? With the 3-4 pages of hundreds of disease summaries? Study it for the exams? Well, yes, of course. But remember, it's NCLEX-style exams... so really, skimming worked just fine for test preparation. What were were supposed to come out knowing? How to provide nursing care for those patients, presumably... well, I could write a darn thorough nursing care plan and apply nursing diagnoses!! But that doesn't mean I know what to do without careful referencing and doublechecking... things which practicing nurses don't have much time for.

    I'm still clarifying my thoughts on this. That's why I started the thread. That's for participating!
  5. by   smk1
    Quote from fronkey bean
    I agree w/ you in part but I think even a new nurse should be able to recognize subtle signs that something is different w/ her patient and have enough knowledge to investigate further and consult other people. How many times have those of us in ICU reviewed NN and seen a trend developing that, if it had been caught and treated earlier, might have averted the code?
    But this just illustrates my point. If this is happening with experienced nurses then how much more so is the risk that a new grad is going to miss something, or be unsure of what they are seeing. What is obvious to someone with a lot of experience is not ncessarily obvious to those with little. Clear objective data is not as hard to miss MAP falling significantly, clear change in mentation, Large BP changes, breathing difficulty etc... it is the little things that don't seem to mean much on their own, but for someone with experience that can easily put it all together, well the devil is in the details. We will hopefully all get there but it is scary to think of the time it is going to take.
  6. by   scooterRN52
    Quote from jjjoy
    Absolutely! There's no way to substitute for the knowledge and skills that come from experience.

    I just know that I was frustrated with the way my program, and I'm assuming several other programs, taught the didactic portion of class. Why did each assignment feel like reading a hundred pages in a reference book? Because my med-surg book WAS written like a reference book. And that's fine, but you don't read to UNDERSTAND from a reference book. You read the reference book to get the facts, then you apply knowledge you already have from other sources to see how you can use that information caring for a patient.

    It would seem more important to make sure students have a strong foundation in recognizing and dealing with symptoms, and knowing and understanding pathophys, pharmacology and the like, as opposed to reeling off the symptoms,lab values and treatments of a ton of specific conditions they may not encounter. If there were more time to learn, then fine, study them all. But since time is limited, something has to give.

    In practice, the nurse will either already know the diagnosis from the chart or will have to run the symptoms by the MD to get a diagnosis. Whether or not the nurse has a good idea of what the MD will say isn't as important as the nurse recognizing when an MD needs to be called. With experience and practice, the nurse WILL be able to predict what an MD will order. But with just two short years of training, not all of which is hospital-based nursing, and the current situation where students often don't get the amount and kind of first hand clinical experience to that would truly break them in professionally, a basic nursing education can only cover so much ground.

    I'm wondering if it still might work if nursing education if there were less breadth of the possible health conditions a nurse may come across, in order to free time to really learn how to be a nurse. If they have that down, it's okay with the nurse gets a patient with a condition he/she isn't very familiar with - that's what reference books are for.

    Maybe highlight a couple of diseases from each system and then assign students to apply their nursing knowledge to a couple of other diseases from that system, pointing them to reliable reference sources. Finally, quickly review the longer list of the conditions usually covered on that system. As graduates, students will have at least heard of most conditions and they will be well prepared to use available references and resources to create a plan of care and to understand the short explanation of the disease in the reference book and be able to teach their patient about it.
    I think a nrsg. student should be able to apply some of their knowledge when they graduate. When they first take care of patients they should know what is nomal. If they see something that deviates from the norm they need to call the Doctor. They should collect all of the data first; symptoms, labs that are abnormal,
    etc.
    A new nurse is not expected to know everything, but she should be smart enough to seek the assistance of a more experienced nurse.It takes years of experience to learn and be able to recognize a disease process and know what should be done, but it helps to know your A&P and understand pathophysiology.
    Last edit by scooterRN52 on Oct 9, '07
  7. by   nanacarol
    When I was in nursing school, I probably felt as you do, however, I now realize the positive impact all that information and repetitive lectures and plan of care writing have served me well. I am able to assess a patient on admission and develop my own differential diagnosis, set a true working plan of care, I was introduced to the concept that my assessment ability was only as valuable as my ability to get the patient involved in the plan. Pharmacology was a critical course for me and I believe for any nurse, because I am able to use the symptom review I learned by repetition many, many times I can, at a glance identify existing and potential medication issues. I read your statement and I came away feeling that your personal expectations were centered around "being prepared" to be a functioning nurse, that doesn't happen and even if school became an arena where the emphasis was on the tasks the perform, those are not what make us nurses, they are merely tasks. We must be prepared to think critically and we must be taught to take the information we gather and analyse it so we have a premise "before" we call the physician. The instructor is trying to get the student to that point via repetitive reading and regurgitating the information with an eye for differences, those subtle, gut utterances. When you get to that point you have arrived on the first platform of the nursing profession. As you traverse the upper levels of academia you will be introduce to broader ideas and concepts, through it all you will be encouraged that the beginning "grunt" work was worth it. nanacarol
  8. by   nanacarol
    References are always our ally. No matter what level we are on the reference drawer is to be accessed. nanacarol
  9. by   nanacarol
    The lack in the education of nursing is a result of the nursing education system. A system where many of the instructors are novices themselves and have a mandate to move students as quickly as possible through the system so the professional impartation is missing. Nursing administrators are correct, we graduate nursing student who simply demonstrated the can pass the NCLEX. These are not real nurses they are task performers. They are not professionals they are license holders. I don't wish to offend anyone, but the truth is the truth. nanacarol
  10. by   kellyskitties
    OK, first I got to get this off my chest. Most of the fields of nursing you listed are bedside nurses. Unless you are in community health, home health, legal nurse consultant, doctor's office etc you ARE a bedside nurse. I believe in med surg and I don't think we are "stereotypical."

    Now, that being said, on my med surg floor when things are bad nurses float. We get psych nurses, OB nurses, ICU nurses etc. They come to us to help out and we go to their departments to help them out. We usually baby them when they come our way so they will want to come back. But they need a little knowledge about the other floors even if it's just to recognize what's going on around them so they can be more helpful.

    Second, on med-surg I have had overflow from every other floor. I have taken care of a miscarrying OB patient that was passing a fetal demise. I have had psych patients on suicide watch that are waiting on a bed in psych. I have had a patient waiting to transfer to ICU who we started ICU meds on to save their life even though they were not in ICU. Diabetics may also be pregnant or schizophrenic. Pregnant women may have gall bladder disease or could fracture their leg. No floor is exclusive. We see it all everywhere eventually.

    Thirdly, I have come to believe the broad spectrum of education given to nursing students gets them into uncomfortable zones and makes them reason. Even if you never again have to locate a fundus (and I can say I have had to since we have had a fetal demise patient a few times to care for) you had to learn the process. Get out of your comfort zone.

    Stick to it. It's worth it. In the end you'll see you needed more knowledge. Unless you manage to land a private duty job with a kid with one oddly uncomplicated disease and that job holds you until retirement - the broader spectrum will serve you best.
  11. by   jjjoy
    You make a good point about nursing school forcing students to work in areas that they wouldn't choose to since they might end up with patients (either through floating or overflow from another unit) that they don't usually care for on their unit.

    My issue is that with only 2 years to cover all nursing content (one year for accelerated programs!) is it really possible to adequately cover all that is required?

    Yes, nursing school graduates do manage somehow but so many struggle the first year out and who knows how many give up. I don't expect the transition from student to professional to be seamless or easy. I just wonder if perhaps there are other effective ways to approach to teaching nursing.

    At a bare minimum, what does a new nurse need to be able to do? I would think it would be recognize symptoms of distress and emergent crises, to know when to call for help and what interventions the nurse should implement in such situations.

    Outside of emergencies, nurses also need to be able to recognize and document any deviations from normal (in other words, assessment skills). They need to learn how to take care of various symptoms, whether through independent action or by doctor's order. They need to learn how to prioritize the importance and severity of different symptoms (can it wait an hour? should the doctor be contacted? etc)

    Nurses administer meds, carry out invasive procedures and work with open wounds, so they need training in safe medication administration and sterile and clean technique.

    Nurses are at the front-line of prevention and control of complications - so they need to know about skin breakdown, pressure sores, thromboembolism, infection, and the like. Preventive measures, early symptoms, treatments.

    Since nurses are responsible for basic personal care as well they also need training in feeding, toileting, and bathing patients with functional limitations.

    Finally, the nurse needs a basic foundation in human physiology, pathophysiology, pharmacology, and human development. With that, the nurse can turn to any reference (colleagues, books, P&P manuals, etc) and get the information needed to take care of just about any patient, whether or not the particular condition in question was studied in school.
  12. by   Cecileno1
    I agree with everything you've said about nursing education. I was surprised that someone other than myself found nursing education to be a crash course. I thought this was only something that happened in my country (in the Caribbean) where we do four years work in three years and at the end of each year you feel as though you do not know enough about anything you have done that year. At the end of the course you wonder if you know enough to actually manage a patient and you are almost afraid to give care. Something needs to be done to restructure these courses because like you, I see no reason to try to learn everything one time especially diseases that you may never come in contact with or are very rare.
    Last edit by Cecileno1 on Oct 11, '07
  13. by   doe9181
    I think it would be a great idea to make it mandatory for students to particpate in an externship or internship. My school always notified us of possible opportunities that were available but not everyone wanted to do it. I never had the opportunity because I had to take a summer class to catch up on my prerequisites. I was also afraid to quit my very flexible job as a pharmacy tech. I could work as little as 4 hours in a day if I wanted. If an externship was mandatory then I would of had no choice and I would of probably benefited a bit more from that experience. I know my classmated that took advantage of the opportunity had a bit more knowledge than the rest of us and a better idea what areas they were interested in. I strongly encourage any students out there reading this to take advantage of any externship/internship programs that are offered to you. Even if you don't get paid, the knowledge and experience alone are valuable. I wish I had. I don't think my role transition class at the end was long enough to teach me half the things I needed to know. When I first strated I felt like a deer in headlights at times.:uhoh21:

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