A time to reform nursing education? - page 9

by nyteshade 10,966 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 whodatnurse
    I felt (as did more than a few of my clinical instructors) that the educational assignments required by the faculty from our school that comprised the bulk of our clinical grades actually DETRACTED from the learning experiences we were supposed to be having during our limited clinical time.

    For example, take the almighty concept crap...er...map. That...to ME...is an exercise in how to condense a large quantity of information into a pictorial representation that fits on a poster. I shudder to think how many times people had to stay up the ENTIRE night to get those things done when they should have instead been getting a good night's sleep so they could focus on actually learning something USEFUL while at their clinical that day.
    Absolutely! Not to mention other little goodies like the "I'm OK, you're OK, I feel your pain can we talk?" courses. Therapeutic communication is necessary but by the 3rd course of it, it has lost some of its...whatever it had in the first place (which wasn't much) If your patient is going out the door feet first, all of that is moot. The "fluff" courses are, to a degree, very necessary. They round out your education and do make you more cosmopolitan. But given the that acuity on the wards is increasing exponentially (only the very sick are found in ICU anymore) and that the number of these patients any one nurse has is increasing, you have little time for urbanity. If you don't have your clinical honed and know it cold (and you never do know it all) you and your patients are likely to be in for a rough ride. ta
    Fiona59 and netglow like this.
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    I also shudder to think of how many people were warehoused in long term facilities before we got creative enough to reach patients through alternative communication even if it meant drawing a picture or giving a picture board to a ventilator, trach or laryngectomy patient. But, who cares about that as long as we get the tasks done and the box checked? Thank goodness for the SLPs, OTs and PTs who got an education in "fluff" and communication so some of these patients can have a better quality of life. As far as condensing a lot of information onto one poster, I bet everyone of you has referenced a poster board someone has designed to explain a chest tube, EVD, PICC line or some new device on your floor. Finding tools to teach others quickly and effectively is an art.

    After reading some of the posts here it is easy to see why nursing is being referred to as a trade and not a profession. Right now the entry level RN is near the bottom of the list for the least educated of the health care professions. I would say it is barely surviving in the category "profession" and will soon be back as officially a "trade" listing.

    Yet, some want to bash the educators who are attempting to make a difference. Having a Ph.D. is not a crime but a necessity to exist in a position where policies are made. Any one of you could also be educators and policy maker by achieving higher education and obtain a position on any of the boards to make a difference. Even without the degree you could make a difference by taking your concerns to state and national levels. Keep it clean and don't use personal attacks on those with higher education and your point might be heard more than typing on an anonymous forum. Some love to complain about everything and anyone but probably don't have the courage to do what others have done. Those who have gotten higher education and who have taken positions as educators, managers or administrators know it sets them up as easy marks for those in the background to take pot-shots at. Unfortunately, those in these positions sometimes fail to make a difference is because the masses fear change.

    The entry level ADN is just too short to provide what is needed for nurses to remain with the status of being a profession. Times have changed along with medicine. Unfortunately, educators are trying to cram in education as well as the skills but it is just not working. It seems the majority here would like nursing to be just a task oriented profession. We've all seen those that just check the boxes for task done and forget some of the little things that make the job about humans. Or those that flip flop a patient without explanation or jam a foley into someone's unsuspecting penis? Don't we all know nurses like that who are just focused on getting tasks done and not the patient? I bet many of you have ran interference with the patient who is complaining their nurse blindsided them or doesn't seem to listen to their needs. Yeah, communication is useless when you've got all those tasks to do. How about those who are great at all the skills but can't put a sentence together on paper? What about those who can not add 1+1 without a calculator and definitely can't do a med equation because they were taught shortcuts when their program had next to nothing for a math perquisite. How many med errors are from mistakes in basic math? What about those who don't care about Evidence Based Medicine or Nursing Practice and would rather not change because they have always done things one way? And, reading a boring nursing journal with all that science, stats and technical stuff is just for Ph.D. types.

    Skills are important but without an education for a solid foundation in communication and the sciences, they just become tasks and check boxes being counted down until time to clock out.

    Here are some links to other professions who answered the call to increase value and add worth as well as benefiting their patients.

    U of FL SLP
    http://slhs.phhp.ufl.edu/academics/undergraduate/

    Loma Linda SLP (BTW, a Bachelor Degree holder is called an "Assistant")
    http://www.llu.edu/allied-health/sah...h/welcome.page?

    OT
    U of FL
    http://ot.phhp.ufl.edu/programs/mot.htm

    Loma Linda OT
    http://ot.phhp.ufl.edu/

    PT
    http://pt.phhp.ufl.edu/dpt.html

    Here's a listing of the pre-professional requirements;
    http://www.registrar.ufl.edu/catalog...science.html#4

    After going through the list you can see why some many have settled for a two year degree like nursing without a lot of perquisites or hard math and science classes.

    Some might wonder why I keep bringing up these professions on a nursing forum but I have watched all the allied health professions grow and gain respect. I also see what a difference education AND skills can make in patient care. I also see this in the BSNs and MSNs when they are given a chance to learn the skills. What a great combination to have well educated communicators who tend to be more flexible when it comes to change and introducing new patient care techniques, protocols, technology and policies! All of the RNs in most of our ICUs have at least a BSN and they work at the bedside. They are also great mentors for the newly educated RNs to perfect their skills from. Having a college degree does not make one stupid and it is a shame there is not more time. Don't throw out "fluff" just because YOU don't see a need for it. Obviously there are some here who have seen the benefits of their educational foundation and can apply it. Others may have had mentors who believe in one way and only one way of doing things which then stifled any opportunity for advancement or seeing how utilizing education can make a difference.

    Yes, nursing education needs a reform but that includes the education part as well as the skills. If you want to disregard the education part, nursing will get further behind in practice and respect.
    flyingchange, JaneyW, AOx1, and 2 others like this.
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    Well put, GreyGull.
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    Greygull - I'm with you on the importance of advanced studies and that not all theory and communication is 'fluff'. We do need to take care not to 'toss the baby out with the bathwater' concerning our views on nursing education.

    However, I don't know about where you went to school, but things like communication as it was taught at my school seemed like it covered on a very basic level ad nauseum at the expense of covering other important skills. It just needn't, and shouldn't, take that long for students to be taught and to understand things such as providing a means of communication for someone who can't talk.

    Anyway, I'm curious what your take on a some previous comments of mine.

    Quote from jjjoy
    Maybe it just doesn't make sense to have one standard RN license. Is it realistic to have one standard teaching license for all manner of teachers?College physics instructors, master piano coaches, pre-school teachers and suburban ballet instructors?

    Some kinds of nursing only require a fairly minimal science/medical foundation. Other kinds require a very strong science/medical foundation. Some kinds of nursing can be entered into with fairly quick training. Other kinds demand years of training and experience.

    In order to continue building on the "professionalization" of nursing, perhaps nurses would need to loose some their flexibility. If it's not the case that "a nurse is a nurse is a nurse" then we may need to accept some increased obstacles for nurses in switching between specialties.
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    The big issue is knowing how to assess for a communication deficit and create a plan of action. Sometimes patient who is aphasic or even locked in gets placed in a noncommunicative category and forgotten. This becomes obvious in how the patient is cared for and any attempts at even offering communication alternatives are neglected. That is were the lack of education about the communication process as well as disease/injury are evident.

    Sidenote: Have you read the book or seen the movie, "The Diving Bell and the Butterfly"? It gives a good insight as how some take communication for granted and what the patient who can not communicate is thinking.

    Right now the current ADN + a few more "fluff" or science classes should be the very lowest amount of education for the RN. Anything less than that and an LPN/LVN should be considered. The minimal sciences and math are barely adequate. Actually, in some programs, they are not adequate for even the most minimal entry level positions.

    The Therapist programs I posted earlier have the same minimal standards regardless of what they do which is why I posted programs on different coasts. Some might argue that a Masters for OT is overkill but few would now give up their education and create a lesser level professional except for the "assistant". They like their status with CMS and have gained respect from the physicians and other educated professionals from other disciplines. Even the Respiratory Therapists have moved on and up in the past few years but that may not be enough in their profession which is also reimbursement dependent. To appeal to CMS they petitioned with a Bill for professional recognition with a Bachelors degree. By the time their Associates degree became the minimum, they were already pushing for the RT employees to get their Bachelors. They know RTs are lagging behind the other allied health professions.

    Medicine has arrived at a point where just the bare minimum is no longer good enough.
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    Quote from SnowStar4
    I thought my school was the only crazy one! I graduate in two weeks and one of my final projects includes a book report and a skit about the book. Yeah, that's going to make me a better nurse...
    *** That's why we need more men in nursing. More men = less skits.
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    Quote from PMFB-RN
    *** That's why we need more men in nursing. More men = less skits.
    Not at my school....in the past three years we've only had one opportunity to do a skit (we could do a PowerPoint, Skit, etc)

    The only group that chose a skit, was all male.
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    Quote from GreyGull
    After reading some of the posts here it is easy to see why nursing is being referred to as a trade and not a profession. Right now the entry level RN is near the bottom of the list for the least educated of the health care professions. I would say it is barely surviving in the category "profession" and will soon be back as officially a "trade" listing.
    *** How many of those other health care profession must punch a time clock like most RNs and factory workers are required to do? Given the extremely high level of supervision RNs must work under compared to other health professions who seem to mostly work with very low levels of supervision. In my hospital each unit has a charge nurse, and assistant nurse manager, a nurse manager, and of course there is the house supervisor. Compare this to, say OTs who are usually the only OT in the house and expected to work unsupervised.
    I would say we are very definitely in the "skilled trade" category, just lower paid than other skilled trades like plumbers.
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    Quote from CuriousMe
    Not at my school....in the past three years we've only had one opportunity to do a skit (we could do a PowerPoint, Skit, etc)

    The only group that chose a skit, was all male.
    *** Ya but those guys wheren't nurses, they where college students. When half or more of the nursing instructors, managers etc are males skits will go away.
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    Quote from PMFB-RN
    *** Ya but those guys wheren't nurses, they where college students. When half or more of the nursing instructors, managers etc are males skits will go away.
    They were male nursing students who when given the choice, chose to do a skit to present information (and were the only ones in the class who do choose a skit).

    I get that if there were more of you around, there would be no skits. I disagree that your entire gender necessarily agrees with you.


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