A time to reform nursing education? - page 5

by nyteshade

10,711 Views | 115 Comments

After reading some very interesting posts around here lately in regards to "fluff" being taught in nursing school, I wonder if it is time to reform nursing education. I feel we could do without the nursing diagnosis. I... Read More


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    Quote from grandmawrinkle
    I don't understand this statement. A baccalaureate degree in nursing does not have one enroll in the science prerequisites that are required for application to medical school (although one could probably squeeze them into one's electives if one was really motivated), nor does a BSN prepare you to sit for the MCAT, and why should it? Most nurses don't want to apply to medical school. If the curriculum was changed to include these prerequisites, what would be thrown out? My assumption is that you are suggesting that the "fluff" coursework should be tossed and replaced with the hard sciences. I'm not sure that the hard sciences would be any more applicable to our actual work than the "fluff", to tell you the truth. The hard sciences are certainly more difficult and would raise the bar for nursing programs across the board, but it would also probably prevent a lot of people that could be successful nurses from gaining entry to the profession. Not all of us are capable of college level organic chemistry, physics, and calculus, and I think that's ok.


    All very true you'd get no argument from me on those points. My statement, is based on several debates within other threads about raising the entry level bar for nursing to the BSN, and a common complaint among nurses about a lack of professional perception within the industry.

    It seems to me, that you could kill both birds with one stone if you did this. The entry level bar would be raised to something more significant than the current BSN curriculum, and the professional perception of Nursing would be different if everyone was an MCAT away from medical school admission. Short of this, I don't see those two issues ever going away otherwise.

    As you noted, it's way too much of a hurdle. The rank and file must be filled with able bodied and capable nurses to serve the public interest.
    CuriousMe, Jarnaes, and SummitRN like this.
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    Nursing schools should link into nursing residencies. When we have new nurses all varying durations of on the job training, this inconsistent does not produce cohesision within the profession. Some new grads have 2 weeks on the floor. Others have 6 months. others, 12 months (very reasonable, especially on acute units.) Match day for nurses?
    CuriousMe and Not_A_Hat_Person like this.
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    Quote from linguine
    Match day for nurses?
    Ha! A month ago I would not have known what this meant. I just finished reading the book "Match Day" (fascinating insight into medical school and medical internships/residency!).
    Jarnaes likes this.
  4. 0
    Quote from mnono009
    How about a new nursing school model? I'm not certain of the exact timing needed for each of the sections, but: 2 mos to CNA, 10 mos to LPN, 12 add'l mos to ADN, another 18-24 mos to BSN. At any point, the student could opt out to work at that level, or continue part or full time, or opt back in when ready. More "hand on" actual care at the beginning, more higher level skills at the RN level (you'd have more time for that, since the basic care of pts would already be well-known).
    http://www.cna-nurses.ca/CNA/documen...Snapshot_e.pdf

    Is being promoted here in Canada. The difference from your plan is our Practical Nurses require two years education and the ADN does not exist here.

    The way it's been explained is the Practical Nurse Diploma being the entry point to nursing and then stepping up the ladder to PhD in Nursing along the way.

    Working LPNs aren't holding their breath waiting for it to happen.
  5. 0
    Quote from mnono009
    How about a new nursing school model? I'm not certain of the exact timing needed for each of the sections, but: 2 mos to CNA, 10 mos to LPN, 12 add'l mos to ADN, another 18-24 mos to BSN. At any point, the student could opt out to work at that level, or continue part or full time, or opt back in when ready. More "hand on" actual care at the beginning, more higher level skills at the RN level (you'd have more time for that, since the basic care of pts would already be well-known).
    Many schools already do something like that (especially community college programs). The school from which I got my ADN had a month-long CNA class that was required before starting the nursing program (you had the option to take the state exam after the class was done - some students took it, most opted not to), then after the first year of the nursing program, you could take one additional class over the summer and be eligible to sit for the LPN boards (again, a few opted to do that, most did not), and then after the second year, you received your ADN and could sit for the NCLEX. You could then transfer to a university program that had a satellite campus at the community college to get your RN-BSN (or you could opt to do the RN-BSN program at any other university that offers that), which is another 12-24 months.
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    It's only natural that as a registered professional you try to protect your own scope of practice; clearly this also occurs within the ranks of nursing between RNs and RPNs.

    Of course the same thing occurs between MDs and RNs. For instance, in Canada (ON) there is resistance against NAnesth by the medical colleges and associations, such that even though universities have set up educational programs for NAnesth, it's not a recognized practice yet. I asked an anesthesiologist about this, and he told me that he did not believe it was a likely to happen here and (candidly) that obviously it was invading anesthesiology's scope of practice.

    To me, it seems obvious that the friction between MDs and RN concerns funding, prestige and autonomy. However, in my nursing theory classes, texts like Doane and Varcoe consistently talk about this conflict (and it's a subtext throughout most of the book) in terms of feminism v. paternalism, individualism v. collectivism, EBM v. holistic care, etc. I feel like nursing theory and those who teach it either have completely lost touch with reality, either that or they are just people who ended up in nursing, but really should have been in political sciences or the humanities.

    I feel that people like that are a detriment to the profession and when we use texts (Doane and Varcoe) that speak glowingly about things like "therapeutic touch", I can completely understand why some MDs ridicule nursing. Indeed, my fellow nursing student and I worry that this will affect the future funding, prestige and autonomy of nursing...yes, we are all very bourgeois and institutionally socialized!
    flyingchange, Fiona59, metal_m0nk, and 3 others like this.
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    Quote from lxpatterson
    It's only natural that as a registered professional you try to protect your own scope of practice; clearly this also occurs within the ranks of nursing between RNs and RPNs.

    .... However, in my nursing theory classes, texts like Doane and Varcoe consistently talk about this conflict (and it's a subtext throughout most of the book) in terms of feminism v. paternalism, individualism v. collectivism, EBM v. holistic care, etc. I feel like nursing theory and those who teach it either have completely lost touch with reality, either that or they are just people who ended up in nursing, but really should have been in political sciences or the humanities.

    I feel that people like that are a detriment to the profession and when we use texts (Doane and Varcoe) that speak glowingly about things like "therapeutic touch", I can completely understand why some MDs ridicule nursing. Indeed, my fellow nursing student and I worry that this will affect the future funding, prestige and autonomy of nursing...yes, we are all very bourgeois and institutionally socialized!
    Basically, it's a case of those who can do and those who can't teach. Nursing instructors are often so high in their ivory towers that they have NO clue of what it is like to work on the floor. Don't even start me on how little the BScN instructors know about the scope of an LPN in my province.
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    I graduated in 1987 from a three year three month program that was essentially clinical with a few weeks of theory here and there... but, I know the evidenced-based rational behind the tasks I perform everyday, including those that involve an understanding of statistics - nursing is, after all, a science based profession.
    I even know how to arrive at a nursing diagnoses, not that I have ever needed to, ever. I can write a detailed care plan, but in reality who has the time... what I do not know how to do is relate to students who are too scared to even talk to a patient, let alone touch them, help them to the bedside commode etc. or are so overwhelmed by clinicals that they cannot administer meds on time, even when they only have one patient... flame away.
    flyingchange, DogWmn, roughmatch, and 1 other like this.
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    I have been in Nursing RN/BSN for 34 + years and never used a Nursing Diagnosis. We in the real world use Medical Diagnosis across the board to plan treatment along with the MD. I hated the concept of nursing diagnosis and found it to be a waste of time.
    DogWmn, KneKno, roughmatch, and 3 others like this.
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    Quote from GreyGull


    Maybe your teachers did not explain the purpose of those activities or relate them to the patient care environment. These assignments should help with your creativity for conveying your messages to others. I do skits, presentations and posters everyday as part of my communication with patients and co-workers. I often will get people who speak different languages or who forgot their hearing aide but I still must find a way to communicate. For teaching, if you just give a few dry statements to a patient who is already overwhelmed with information, you may think you've done enough to check the education box but in realty the patient may have gotten nothing from your words. Just writing the instructions down may not be enough either. I use the dry erase board frequently to draw a picture. When doing a skit or presentation in class you should be instructed on how to read your audience to know your message is being received. This translates into the patient care environment. If you don't know your patient is not understanding, just checking off the "done task (education)" box is not good enough. One problem when some just focus on skills or tasks is that the job becomes just a bunch of checkboxes.
    Sorry, but lose the skits. It's an insult to nursing students. Teach them to start an IV, place a foley, give meds through a G-tube, and explain why you're doing it. They will learn more than through skits.

    Oldiebutgoodie
    DogWmn, frumpter, cherryames1949, and 3 others like this.


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