Failing the next Generation of grads

mattsmom81 · Mar 12, 2002

Interesting points, Zhakrin. :)

I attended a 3 year diploma RN program and graduated in 1981. My instructors were nurses and doctors: it was a large teaching hospital and I received an excellent education with 2 years of university prereq's including all sciences (we bussed to the university but lived in hospital dorms, working as paid techs in house when we wished and gaining OJT)

I was functioning as teamleader in my senior year and was competent as a RN upon graduation. Diploma programs give, IMHO, the best possible education to prepare nursing students for the 'real' world, but have fallen victim to the NLN's position that BSN is entry level education for the nursing professional. This is unfortunate as I feel a great deal has been lost.

An ideal nursing program IMO will combine essentials of the BSN education with the practicality of the diploma schools. New grads today are floundering, needing support from staff nurses who are already overstretched and overwhelmed from short staffing and poor working conditions. We need to revamp current nursing education and rethink our goals before we lose more nurses, IMO.

New grad 'internship' programs are one way facilities are dealing with the problem, but in a way I feel they let the nursing schools 'off the hook' here.

What's everybody else think?

dstout-rn · Mar 12, 2002

I think that my BSN program should have had more hands on time. I worked while I was in school and had a better grip on patient care than my fellow nursing students who just went to school and made dean's list. As an entry level nurse I can understand having theory that is needed to have an understanding of the skill and to begin critical thinking, however the leadership, research and a few other hours of class were not necessary. The most patients I ever had at one time in nursing school was two how realistic is that. But since I had been working as ER tech I had learned organization and time management skills. Now according to my school I was a bad student because I was working well I had to eat. But I think working in the hospital/LTC environment helps you to have a realistic understanding of how the system works vs. having it spoon fed from a nursing instructor who hasn't seen a patient at the bedside in YEARS!!!!

Just my opinion:roll

jaelle · Mar 12, 2002

Another topic that directly relates to this discussion is what happens when the ADN programs around the country fall prey to the new admissions guidelines. In the class I graduated with, there were students that missed as much clinical time as they attended, and failed more than the alloted number of academic tests....but those students graduated with the rest of us that followed the rules, and worked our butts off.

When I asked the Head of our Nursing department why this was happening....she replied that with the new discrimination laws...they didn't dare refuse to accept anyone that applied, or to wash out a student who was obviously not academically oriented to Nursing. Is that scary or what? Out of 40 students who graduated with me, 27 of them failed to pass state boards. Some of them of course retook the test...and passed the second time. 15 of them had to take the test a third and fourth time, and out of those 15 students that failed 8 of them never did pass.

I understand that state boards are supposed to be the great leveler, but that is simply terrifying to me personally.

Also...our instructors, four in our freshman year, and four in our sophmore year were for the most part clinic nurses or not involved at all in any aspect of nursing rather than teaching. We had one instructor who was going to school herself for her NP. She was the best instructor we had. Granted...the college I'm speaking of did stiffen their standards after my class graduated, but good grief!

I must agree that stricter standards must be implemented in the hiring of Nursing instructors. As we all know book knowlege is wonderful....but it doesn't replace actual experience.

Ann

estiger · Mar 12, 2002

I think part of what they teach you in nursing school is how to think about things. The pathophysiology and disease process helps to understand how and why we do what we do. Essential to effectively performing. Especially in the higher acuity areas. If all you need to learn was how to do tasks then you wouldnt really ever need classroom work. The courts these days are holding nurses responsible to what we do even when ordered by a physician. Theories may seem boring and useless but it is training us how to think about what we are doing.

fergus51 · Mar 12, 2002

My program had more clinical time than the diploma program, so I felt I had enough hands on time. Those theoretical courses that you mentioned like research are very valuable. First off, how do you know if that appeals to you if you are never exposed to it? And leadership and communications courses are a HUGE benefit if you put an effort into using them!! And personally, I think tasks are overrated. You can teach a monkey how to do a task. The job of a nursing program should be to encourage students to be able to think critically and theoretically. That is the only way they will be able to adapt to the changes that will no doubt occur over their career. New grads tend to be obsessed with tasks and think that is the end all and be all, but the way you were taught how to do them will probably be wrong in 10 years. My program doesn't even teach how to landmark for the dorsogluteal muscle anymore, because it is considered to be clinically unsafe to give injections there.

I do agree that nursing students get beat down through the program and that should decrease a lot! (Not stop all together, because I think some people need it to get past thinking they already have the answers for everything. I know I did)

grouchy · Mar 12, 2002

Zhakrin,

You made some excellent points. I was distressed to read Fergus's reply that "tasks are overrated:you can train a monkey to do tasks". Sadly, this is just a blunter version of what the clinical instructors in my BSN program told us when we complained about inadequate practical orientation. I think this kind of disrespect for actual hands-on work has corrupted and weakened nursing. We've bought into the media hype that you're noone unless you are a member of the upper class. Working class people are almost invisible and real work is perceived as an unskilled embarassment,something a "monkey" can do, instead of a valuable service to society.

I think that just as minorities fight against "invisible"racism, and may even "internalize" the prejudices of the majority as self-hatred, nurses are caught in a struggle over class and economic prejudice, which is rarely even discussed in this country. Some of the underlying assumptions of this prejudice are: hands-on work = "unskilled" manual labor = blue collar/working class = not important or not deserving of dignity. To some extent, the embrace of nursing theory by nursing educators ( at least to the extent that it detracts from preparing competent graduates ) reflects this kind of internalized prejudice, or self-hatred. They strive to be accepted as professionals by abandoning the core of nursing practice

I think we need to realize that our hands-on skills are as deserving of respect as those of a surgeon, or a woodworker handcrafting Shaker furniture. And to realize that blue-collar jobs are also skilled jobs requiring intelligence. (Do you want your car repaired by a 'trained monkey'). I like the Shaker crafts'man' analogy because every detail of Shaker furniture expresses their beliefs and values. Thats part of what makes it so special. Similarly, our hands-on nursing practice should reflect our nursing theory, including our values. I think that by taking the time to teach and to learn how to give a shot or do wound care correctly, we show our patients that we value them, and we show them that we are true professionals.

dstout-rn · Mar 13, 2002

Well said Grouchy!!!

Zhakrin · Mar 13, 2002

Very well said Grouchy and you raised ideas that I had not thought about.

I believe that a more balanced approach is needed with practical skills given high or at least equal priority. I was a medic and I sought out very good clinicals. I also work as a clinical assisant and nursing intern so my skills will be great upon graduation (not to mention having to repeat a clinical experience where I was more of a teacher to the other students than the one assigned).

What I hate is that look from staff when you say you a new grad. They look at you lke you know nothing and unfortunately thats oftens the case with the grads we are currently producing. Oh they can quote roy or tell you about Watson's theories, but often they have never given an IM or a enema. They have little experience with IVs. The current program where I will graduate is structured so that if a demented student wants they do not have to even see a patient after the 2nd (of 4) year. They can do administrative clinicals. Even if thats their professional choice, do we really want managers, DON or future educators with no bedside or frontline nursing experience?

The number of letters after a professors name is less important to me that the number of years of experience they carry under their belts.

I would rather have a nurse with 20 years bedside/frontline experience teaching me that a nurse with a PhD in Astrophysics and has not seen a patient in the last 10 years.

estiger · Mar 13, 2002

I absolutely agree that the hands on part is as important as the theory part of nursing. In the bsn program I attended many of the instructors that taught the clinicals were still working in the field. Many of the instructors that taught classroom were phd's without a whole lot of clinical exp. I felt like this was ideal on learning the 2 facets of nursing.

fergus51 · Mar 13, 2002

Whoa grouchy! I don't mean to sound like an elitist. I just felt that my program had enough hands on, and new grads will learn more practical skills in their first year on the job than they ever could in school anyways. School just gives a foundation. I am not trying to compare blue collar workers to monkeys. I am trying to say that the skills will come a lot easier than the thinking.

I should mention I was equally task obsessed as a student because I was also told about the poor quality of new grads now a days. All the older nurses made it seem like they spent their whole schooling doing skills. Then I talked to one and found out that is a big lie. When my aunt graduated from nursing school from a real hands on program, they did spend most of their time on the floor, but her hospital didn't even allow patients with epidurals out of ICU and maternity patients stayed in for 5 days post-partum. So was her program any better than mine when te acuity was much more in my training than in hers? And that was a hands on hospital program! It's like the stories about the fish you catch, it tends to get exagerated.

I think more focus needs to be put on mentoring and precepting new grads when they do graduate so they get proficient at tasks quickly and stop worrying about them. No program will ever make new grads completely ready to practice. They need help and support in that first year.

grouchy · Mar 13, 2002

Good points Fergus! I don't mean to flame you. I just thought your comment could be symbolic of an unconcious attitude that hasn't helped nursing. In your case it may not be. I'm going by my own experiences. And, unfortunately, I was one of those unskilled BSN grads everyone complains about. I, and my fellow students, were very upset and angry regarding our lack of clinical preparation and some of us met as a group with the clinical instructors to voice our complaints. They blew us off with a much nicer version of your comment, and told us we'd learn on the job. It doesn't bother me that you made this remark in a chat room. It's the way that the attitude I described shapes nursing education that bothers me. When nursing instructors don't feel that basic nursing skills are important enough to teach, something is seriously wrong. And when you see and read that this is not limited to one school, you have to wonder why this is happening. My argument is that unconcious, unresolved struggles regarding class and economic status have led nursing leaders and educators to devalue manual skills. I think that the very nurses who are leading the way in attempting to professionalize and raise the status of nursing have unconciously bought into society's prejudices about nursing. In doing so, they have created nursing education programs that add to the problems nurses face. A generation of BSN grads who are learning basic skills the public expects us to have on the job will help erode the public's confidence and trust in nurses, hurting our attempts to be recognized as professionals.