Math requirement for RNs?

[llg]

I have a question for both practicing RNs and students alike:

It's come to my attention recently that some nursing schools are on longer verifying that their students can do basic 4th grade math. By that I mean add, subtract, multiply, and divide without using a calculator. They assume that calculators will always be available and that therefore, nurses don't need to know how to do basic calculations anymore and don't have anything in their curriculum that requires students to do those things. In fact, they are aware that some of their students definitely can NOT do those basic calculations when they involve fractions and/or decimals. Also, the TEAS test now allows applicants to use calculators: so they are not testing those skills, either.

To me, that seems like a safety issue. There might come a time when a calculator is not available.

1. What do you all think?

2. Students ... are you competent adding, subtracting, multiplying, and dividing fractions and decimals?

3. Practicing nurses ... are there any times you need to use basic calculation in your work (without a calculator)? Can you give me some examples?

4. Is anybody verifying those skills in orientation anymore? (med tests without calculators, etc.)

Thanks,

llg

[KelRN215, BSN, RN]

I specifically remember the following example being given in my Pharmacology class in college:

Mr Jones needs to take 100 mg of X medication. Medication is available in 25 mg pills. How many pills do you administer?

Half the class immediately knew the answer was 4, the other half had no idea where we got that answer from. I couldn't believe I was in college (at a nationally ranked University, nonetheless) with people who couldn't divide 100 by 25 in their heads.

Calculators are typically readily available but I do recall a time in a code situation where I caught another nurse's error. We had a child who was seizing, the MD called for "0.1 of ativan." I was handed a syringe with 0.2 mL of ativan to push. Ativan IV is 2 mg/mL so what I was handed was 0.4 mg. That was problem #1. Problem #2 was that when the MD called out "0.1 of Ativan", he meant 0.1 mg/kg.

[Julius Seizure]

To add to the coming troubles I see ...

Some school systems are no longer teaching/requiring cursive writing (hand writing, script, etc.). Students are graduating high school without being able to write in cursive and only a minimal ability to read it. Everything in their schools are printed in block letters. I've read that history professors and other social sciences are concerned because their students can't read documents that aren't in block print -- diaries, hand-written letters, etc.

The school district that my niece and nephew attend is such a school. As teenagers, we discovered they couldn't sign their names in cursive -- only in block print. We have since insisted they learn to read and write cursive on their own so that they will have the ability as adults.

Does this relate to concerns about their ability to be nurses in some way, or are you just concerned about the education system in general?

[Julius Seizure]

It's extremely scary that schools are doing this. A nurse needs to be able to look at an order and figure out the dosage from the vial by just looking at it.

But why? Because that's how school and nursing has always been? Nurses used to have to count the drops in the IV chamber while looking at their watch to adjust the infusion rate. I'm glad that's changed.

If the med is something like Ativan 2mg/ml, and you are supposed to administer 4 mg....I don't mind my nurse doing that in her head. I also don't mind if she uses a calculator, as long as she gets my dose correct.

But its its something like Epi 1:10,000, administer 0.1mg/kg or Dopamine 400mcg/250ml, run infusion at 5 mcg/kg/min...

....in those cases, I hope my child's nurse IS checking her math with a calculator, honestly.

[37changes, ASN, RN]

Thanks for this thread. This has motivated me to continue "brushing up" with the math and algebra programs I have available at home. (We homeschooled the kids for seven years.)

But to answer the one poster who cannot imagine this happening ~ I can tell you this:

I am about to be in an ADN program which does not require algebra. I am completing the one math requirement right now -- called "Quantitative Reasoning" -- and we use calculators for *everything*. I also used the calculator for the TEAS exam, and scored 100% on that section. Could I have done it without a calculator? Sure. I graduated high school 20 years ago and so, I am not a part of this new generation of schooling. But I don't believe for a second that I would have gotten 100% on it.

[Julius Seizure]

Calculators are typically readily available but I do recall a time in a code situation where I caught another nurse's error. We had a child who was seizing, the MD called for "0.1 of ativan." I was handed a syringe with 0.2 mL of ativan to push. Ativan IV is 2 mg/mL so what I was handed was 0.4 mg. That was problem #1. Problem #2 was that when the MD called out "0.1 of Ativan", he meant 0.1 mg/kg.

Kel, does your place of work use code sheets? (Printed out papers with the dosage/volume of emergency drugs based on the patients weight)

[pro-student]

When I was in nursing school, we had a med calculation test in every clinical course and had to pass with 90% and no calculator. This included old fashioned drip rate calculations. One of the instructors was pushing for the pass rate to be 100% cogently arguing that a nurse with a 10% error rate in med calculations is a ticking time bomb.

I don't think the argument should be about whether or not calculators will be avaialable in clinical settings. It's about being well-educated professionals. What's next, I don't need to know how to spell basic words because I have spell check? I don't need to know right from left because I can write it on my hand? I don't need to know how to tie my shoes if I only wear Velcro?

The math that is required for nursing practice is very basic indeed. Far below the level that should be expected of a college grad. I hope that any nurse who ever cares for me or anyone I care about (or anyone at all for that matter) can do that kind of math in his or her sleep. We are not a credible profession if we can't meet even that low of a standard.

[djh123]

An engineer cousin and I have both talked about stuff like this. The problem with people who totally rely on calculators is that at least *some* of them may blindly take whatever answer the calculator says, whereas I (and my cousin) - and hopefully most of us - kind of have that little voice in the back of your head saying 'does that make SENSE?' (the result, that is). If you don't have that little 'math conscience', blindly taking what a calculator says when you hit a wrong # can obviously be dangerous.

[AJJKRN]

I'm trying to imagine a moment in time where a calculator wouldn't be available in this day and age. Beyond an EMP blast or maybe a war zone where the batteries on every cellphone of every person was dead at once.. I'm drawing a blank here.

I do cringe when I think of the impossible and acute weather conditions that in the past have caused utter destruction and chaos like hurricane Katrina and the Joplin Missouri tornado...

[chare]

Kel, does your place of work use code sheets? (Printed out papers with the dosage/volume of emergency drugs based on the patients weight)

We do. We have a standardized code sheet throughout the children's hospital, as well as a binder on every code cart with each of the individual code sheets, and this type error still occurs.

[CCU BSN RN]

I got tested every semester at nursing school on basic conversions and what I deemed '5th grade math'. Needed an 80% I think, maybe a 90%. Simple function calculators were allowed if I recall. Students still failed and needed remediation before they could pass it EVERY TIME. Not only did they fail once, they failed 8 times, once per semester. Not only did they not know it, they never learned it, except to regurgitate for a testing retake after remediation with a professor.

Examples from my practice:

1. At a code blue, MD running it wanted a vasopressin drip, we had 2 vials, 40units each. I called pharmacy, they told me a vaso drip is 200 units in 250cc normal saline. I only had 2 vials x 40 units= 80 units total. I figured out that I could put the 80 units in a 100cc bag of NS to hang until the patient could be transferred to CCU and a bag ordered from pharmacy. I did not have a calculator out, I was drawing up and mixing and labeling meds in a code situation; my hands were busy elsewhere. I verbally checked my math with another nurse in the room who I knew was at least moderately okay at math and logical reasoning.

2. Eyeballing weights for weight-based medications, most notably vasopressors. Now, with a patient in ICU and a smart pump , their weight is on the bed, which they're in, and it get programmed into a smart pump to calculate the precise dosage for me. Stellar. No math needed, you're right. Wait, though, that sounded a little too textbook.

The patient is being admitted from another hospital because they're too unstable to be treated at previous hospital. Come to your CCU via ambulance with a Paramedic or the flight deck with a nurse. Come on meds from another hospital that are a different concentration. Stopping them until the MD sees the patient, puts in the order, pharmacy verifies, mixes, and sends the med would kill the patient. You need a weight. You eyeball it or root through documentation. You do the math based on their weight and dosage and figure out how many cc/h to set the pump for. Smart pumps don't work without your institution's correct concentrations of meds programmed in, so that's out. A simple calculator on your phone saves you, but creates the possibility for huge error as well, so you have to think about your answer in the context of your knowledge to make sure it seems like a valid dose. You again run it by a friend to double check your rough math. If you're really ahead of the game you pre-plan the dosages for your next titration(s) in either direction and get them checked now too, but you probably don't have time.

So, I think you not only need some basic math and logical reasoning skills, I also think you need to be able to use them under pressure, and know your peer group's math skills too, because if you ask the wrong person to check your math, you could make a fatal error. I think there should be a standard math test included in the NCLEX and that failing that should mean you fail the entire test itself. I find the concept of nurses having trouble with 5th grade math very troubling, though to some extent I find any adult of average intelligence having trouble with 5th grade math very troubling, so my barometer may be off.

[KelRN215, BSN, RN]

Kel, does your place of work use code sheets? (Printed out papers with the dosage/volume of emergency drugs based on the patients weight)

This was many years ago, I left inpatient care 5 years ago, but those were only posted at the patient's bedside in the NICU. We had them on the code cart but we usually weren't cracking the code cart for seizures unless the patient stopped breathing. We had seizure kids with the standard seizure meds for status epilepticus in our Pyxis.

[PMFB-RN, RN]

I'm trying to imagine a moment in time where a calculator wouldn't be available in this day and age. Beyond an EMP blast or maybe a war zone where the batteries on every cellphone of every person was dead at once.. I'm drawing a blank here.

Often unable to use them on the helicopter when doing critical care transport. The vibration damages them and they fail at the worst time. Also it can be difficult to get the numbers punched in accurately during flight. We do our calculations on a dry erase board.