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

[C0SM0]

I'm currently in an ADN program. College Algebra was required before even applying to nursing school, then we had to take a math test in first semester which we were required to score 100% before being allowed onto a clinical site. Math questions are also on every single exam we take throughout nursing school. The questions are similar to this:

The physician writes an order for Diazepam 10 mg IV to be given now. You have in supply 5 mg/2 ml. The drug book says to give 5 ml per minute. How many ml(s) would you give? Over how many minutes would you infuse the dose?

Yes, we are allowed to use calculators. We live in a time where calculators are readily available so I see no problem with it. If I were a patient, I'd rather my nurse use a calculator instead of just doing it in their head.

[klmartin08]

For most nursing programs algebra is a prereq to get in. Often only an a/b grade is acceptable, at least in this area.

[SouthpawRN]

Pre-calculus was required for the BSN program I am in with a minimum passing grade of a B. We have med math exams every semester, you must pass in 2 tries with 95% or better (missing 1) or you are kicked out of the program....

HESI 2 now tests English and Math skills if the program uses it.

[AnxietyMaven, BSN, RN]

All if the BSN programs in my area/state required statistics. You have to have a decent understanding of what you're doing or you won't know what formula to use, or how to use it. We also had to have 4 hours of general chemistry.

[Skippingtowork]

I'm a dinosaur, not having practiced in a hospital setting for almost 20 years. But I vividly recall some train-wreck deliveries where we had to estimate weight of a critically ill newborn, calculate doses and draw up code meds based upon that estimate. In one case, the delivery took place on the way into the hospital with no scale in sight, in another case, the room was so poorly designed and set-up, the scale was there, but completely inaccessible. Mental math saved those days.

How do you use math to guess at a baby's weight? Calculate meds, yes, but the scale thing lost me.

[AnnieOaklyRN, BSN, RN, EMT-P]

Honestly, I am pretty sure most nurses can do basic math; however using a calculator to do that for us decreases human error and speeds up the process, thus being safer and more efficient than doing it by hand!

Would you rather your nurse (who is both human and prone to error) do it all manually or the calculator?

Annie

[llg, PhD, RN]

Honestly, I am pretty sure most nurses can do basic math; however using a calculator to do that for us decreases human error and speeds up the process, thus being safer and more efficient than doing it by hand!

Would you rather your nurse (who is both human and prone to error) do it all manually or the calculator?

Annie

I don't think you fully understand the original question. We all agree that nurses can (and should) use calculators most of the time. That's not at question. The question is: Should nurses have the ability to do those basic calculations by hand? Is it OK if a nurse does not know how to multiply and divide fractions and decimals?

Some of us believe a nurse should know how to do it -- just in case he/she needs to do it by hand in an unusual situation. Others believe it doesn't matter if the nurse can do it or not because there will always be a calculator available or someone else around who knows how to do the calculations.

[PANYNP]

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.

Re drip rates - if you travel as a volunteer on a health care mission trip, which many nurses do, to Central America or rural Africa, you will find yourself counting drops.

[MelodyNelson, LVN]

I have co-workers that cannot do basic medical math. For example there was a med, and we were supposed to give 5 mg. The pills came in 2 mg. Right on the label, it said to give 2.5 pills. This co-worker kept arguing that the label was wrong, but she did not know how many pills to give. I tried to explain how to work out the math, she did not get it. I finally broke down, and I drew dots on a piece of paper. "One dot equals one MG, so each pill is worth 2 dots. So, 2 dots from the first pill, another 2 dots for the second pill, and since we are cutting the last pill in half, you only have one dot! Now count the dots... one, two, three, four five! So, 2 and one half pills, make 5 mg" She was still confused but gave the med anyway. She also cannot figure out the volume of a medication, for example insulin. In our software (CERNER), we have to enter the units AND the volume. So... 2 units = 0.02 mL, 30 units = 0.3 mL That is WAY above her math skills. I would hope the NCLEX would weed out people like that, but it does not.

[readyforthehesi]

Also, while I haven't taken the TEAS yet, I did take the HESI. A very basic calculator was provided, but if you didn't know your conversions or how to approach the problem, it was useless. The questions weren't things like "what's 1.37 + 5.28". They were more like "what's 5 1/5 divided by 6 3/7". If you don't know how to set up your problems, it didn't really matter if a calculator was available or not.

That's exactly right, Jen. It's pointless to have a calculator if you don't know how to actually use it. A lot of students that I have tutored and have continued to become nurses, always have a calculator handy at work.

However, a calculator is just to ensure mistakes aren't made...miscalculations are more likely to happen if you are doing it in your head or by paper. I don't think nursing schools are skipping the math literacy basics.

Many nursing schools are very difficult to get into and almost all of them require some kind of admissions assessment test like HESI A2 or TEAS V, which covers basic adding, multiplying, dividing, subtracting fractions, decimals, ratios, proportions, etc.

And they're not just number problems, they are actual word problems in which you have to use critical thinking. So what if we use calculators during a test or in real life. It's a tool that can actually save a life to ensure the correct dose or whatever other medical measurement is the correct one.

[WKShadowNP, DNP, APRN]

I agree even though I am terrible at basic math! I Googled my "problem" once to see if anybody has discovered that people have a learning disability with math, similar to dyslexia. No one has, gosh darn it!

Yet I got A's in chemistry, balanced equations like a pro! I can easily calculate doctor ordered 250 mg, it comes in 725 mg per ml, or doctor ordered 25 mcg, it comes 50 mcg per ml in a 2 ml vial.

But if you gave me a basic math test dividing and multiplying decimals and fractions......I think I'd eventually figure it out but it would be painful for me to do and I'm sure painful for you to watch.

It's called dyscalculia.

Oh, see, someone beat me to it.

Look up dyscalculia.

[WKShadowNP, DNP, APRN]

Or how about people just too lazy to learn math formulas?

We plot our own strips at the beginning of the shift, and I use the basic computer calculator to get the square root of the R-R so I can calculate the QTc. I had one of my coworkers sitting next to me when I did it the other day, and she went, "Wow, you actually know how to do the math behind that?! I just plug the R-R and QT into this app in my phone."

...Really? It's not like remembering to find the R-R, take the square root, and divide the QT by the square root of the R-R is rocket science. I thought that was a little scary. Anybody who works with monitored patients ought to know how to find the QTc. Pretty sure it's actually more time consuming to get your phone out, open the app, and type in those two numbers than to just use the desktop calculator.

I do think we should be able to do basic algebra. I've had a dosage calculation test during orientation at three out of the four jobs I've had as a RN, which I fully support.

I am trying to wean one of my patients off of opioids and I manually plotted out his total doses in equianalgesia from PO and IV meds, then converted using the paper conversion chart, divided it, manually, and got a new dose of his PO opoids to get him off of IV meds.

The doc I ran it by to see if I was on the right track was impressed. He uses an app.

And this patient is one of the few who was not reluctant to come off of the IV "D."