Why are Hospitals so darn mean when someone fails the NCLEX?

[Roland]

My wife works at an Indianapolis facility and one of her friends (not the same one referenced in a seperate post) just failed the NCLEX. Here's how they handled the situation:

1. She was stopped midshift and called into the office after the hospital checked the Internet state site and learned that she failed.

2. Her patients were immediately taken away. She was bumped back down to a student nurse from $20.00 to $10.00 per hour base (which actually means she will go from about $28.00 to $11.00 per hour since she works weekend/nights).

3. The worst part is that they will put her name in the hospital newsletter as failing the NCLEX. When she asked why she was told that they do it to "help" the person since people will know they failed and can thus offer emotional support!

Look, I know that passing the NCLEX is a big deal. However, couldn't they just cut the pay by say $3,00 per hour and mandate some remedial classes (they don't even offer the remedial classes until you've failed at least twice). This girl was a good student, who took the Kaplan course and is considered excellent clinically.

[LydiaNN]

When I graduated, in 1984, and in Pennsylvania, we were given 2 chances to pass before our GN status was pulled. Once the status was pulled, though, you were bumped down to CNA. I don't see any way around that one, unless there was some sort of tiered pay system that paid extra per unit of education, or something. That would be a mess, though. Advertising it in the hospital newsletter is cruel. I'd rethink working at that facility.

[caroladybelle, BSN, RN]

Why coudn't she do the same things that she did as a grad nurse? Even a student nurse can do more than a CNA especially one that has been "checked off" on various advanced skills which she has. I could even see cutting the pay to $15.00/hr.

For example I have taken and passed State Licensing examinations in Real Estate Sales, Appraisal, Fire Fighting I&II, EMT-B, CPR ect. In all of those cases I was asked things that I should definitiely know if I was awake in class and did the readings. Furthermore, the questions were very straightforward with no "word game" or multiple correct/almost correct answers. When did nurses collectively buy into the "critical thinking" psychobabble, pandered by MENSA happy, MIT psychometric fixated geeks?

She cannot be legally as responsible as a GN would be if she is working as an aide. Just because she has the knowledge to do many more things than an aide does not legally permit her to do them.

And there are a number of places in this country where $15.00 is more than a full fledged RN makes per hour.

Critical thinking is required for a nurse and useful. Nursing is rarily Black and White, and all answers are going to be dependant on all the surrounding factors. And doing the best thing counts more when someone's life is on the line. It is regretable the firefighting and EMT do not ascribe to critical thinking.

Just because you do not like the format and a friend of yours do not succeed at it, does not make it wrong or the purview of Mensa psychometric fixated geeks. It best represents real life in Nursing.

[traumaRUs, MSN, APRN]

I took the NCLEX in Indianapolis (I was already an LPN) and I couldn't be hired (at the VA) until I was officially an RN. I think this is only right. I don't agree with the public humiliation of putting your name in the newsletter though and would certainly approach management with alternatives - like an email to the management team. There is no reason the rank and file need to know this.

[Gompers, BSN, RN]

This whole post is exactly why I don't understand how hospitals can possibly get away with hiring-license pending graduate nurses. It's a liability issue, and the mere fact that they snatched her patients away from her mid-shift goes to show how serious it is to have un-licensed staff working with patients. My own hospital does it, but I don't agree with it. I know there's a nursing shortage and all, but I completely disagree with treating a graduate nurse like an RN until there it's proven by the N-CLEX. They should have to work as CNAs or patient care techs until they pass the boards.

JMHO.

[Plagueis]

I'm still a pre-nursing student, so I didn't realize that someone could work as nurse without passing the NCLEX first. Is that allowed in every state? Also, I'm stunned that they would publish the name of someone who failed the NCLEX. That is cruel and humiliating. I hope this isn't typical of hospitals.

[smk1, LPN]

i think the pullig her in mid shift to downgrade her status was a bit hokey, but it was going to have to be done at some point anyway. I personally would be mortified if everyone in the hospital knew i didn't pass NCLEX. That sounds like a humiliation tactic, to shame you into studying more or something.

[mattsmom81]

Usually a nurses board failure makes the rounds quickly via grapevine, but I am not surprised at the publishing. She's lucky she wasn't let go...some hospitals will. Its also my experience to see hospitals make a show of escorting fired nurses off the premesis; security guards and all. They are so anxious to limit their own liability they seek to make a huge show of pointing out a nurses' failure. Then they look good...they saved the public from this dangerous substandard nurse.

[Roland]

Usually a nurses board failure makes the rounds quickly via grapevine, but I am not surprised at the publishing. She's lucky she wasn't let go...some hospitals will. Its also my experience to see hospitals make a show of escorting fired nurses off the premesis; security guards and all. They are so anxious to limit their own liability they seek to make a huge show of pointing out a nurses' failure. Then they look good...they saved the public from this dangerous substandard nurse.

Here's and example of what stinks about the NCLEX. I usually score higher on the NCLEX questions (Kaplan Prestest) than does my wife. However, I just missed H/A and C/O on a test!!! She would never do that in a million years. However, I couldn't think of Headache and Complains Of. Let's make sure nurses know the basics. How to mix insulin, what the side effects of major drugs are ect. I'm not opposed to critical thinking I just don't believe that the NCLEX does a good job of measuring that attribute.

[Lawnurse]

This whole post is exactly why I don't understand how hospitals can possibly get away with hiring-license pending graduate nurses. It's a liability issue, and the mere fact that they snatched her patients away from her mid-shift goes to show how serious it is to have un-licensed staff working with patients. My own hospital does it, but I don't agree with it. I know there's a nursing shortage and all, but I completely disagree with treating a graduate nurse like an RN until there it's proven by the N-CLEX. They should have to work as CNAs or patient care techs until they pass the boards.

JMHO.

It's not a liability issue. A GN is operating under the license of the RN that is supervising him/her. GNs would be held to the same standard in a court of law because they are practicing under an RN license - that of his/her preceptor.

It's no more of a liability issue than an RN practicing nursing. The supervising RN is liable, not the GN. (The GN however, would be responsible for any mistakes he/she makes, but the law looks to liability, not responsibility.)

I am very suprised by the actions of the hospital at which Roland's friend works. When one fails the NCLEX, his/her legal status DOES NOT CHANGE. Nor should their responsibilities. She is still a graduate nurse. There is no such legal status as "GN minus 1 try at the NCLEX."

Aside from the legal status, I find it illogical. Someone is no less qualified after finding out he/she fails the NCLEX then the day before he/she takes the NCLEX. Why change his/her responsibilities?

Lastly, publishing her failure is cruel! Immidiatly HIPAA popped into my head...but that doesn't protect the healthcare employees... :angryfire And it's not libel because its true, she did fail. Its just in very, very poor taste. Do they publish it everytime someone gets dumped by their significant other? Do they publish that Nurse X is having trouble getting pregnant? These situations create a need for emotional support, but we rightly label them "gossip."

:angryfire

[Gompers, BSN, RN]

It's not a liability issue. A GN is operating under the license of the RN that is supervising him/her. GNs would be held to the same standard in a court of law because they are practicing under an RN license - that of his/her preceptor.

It's no more of a liability issue than an RN practicing nursing. The supervising RN is liable, not the GN. (The GN however, would be responsible for any mistakes he/she makes, but the law looks to liability, not responsibility.)

I am very suprised by the actions of the hospital at which Roland's friend works. When one fails the NCLEX, his/her legal status DOES NOT CHANGE. Nor should their responsibilities. She is still a graduate nurse. There is no such legal status as "GN minus 1 try at the NCLEX."

All I'm saying is that I have seen GN's working in the past that haven't been supervised, but treated as another staff RN. Not in my unit, in other places.

[meownsmile, BSN, RN]

The only reason I can think of for listing the names is that other staff can be aware of the change in status and not assign duties assuming licensure or GN status. It would take the person out of the position of having to say, "I can't do (whatever thing) that I've been doing as I failed my boards. Weak, I know, but it's the only logic I can think of.

The rest of it is just business, unfortunately. They can't have someone practicing knowing that they haven't met the requirements to do so.

I have to agree, although it isnt really right, but i agree with your possible reasoning. However, to the OP,there is no way they can keep her in the position if she has failed NCLEX. The basis of hiring is with the assumption you will pass and if you dont "officially" you dont have verification of competancy to be kept in the position.

Sorry but rules are rules for a reason.

[Gompers, BSN, RN]

Here's and example of what stinks about the NCLEX. I usually score higher on the NCLEX questions (Kaplan Prestest) than does my wife. However, I just missed H/A and C/O on a test!!! She would never do that in a million years. However, I couldn't think of Headache and Complains Of. Let's make sure nurses know the basics. How to mix insulin, what the side effects of major drugs are ect. I'm not opposed to critical thinking I just don't believe that the NCLEX does a good job of measuring that attribute.

Wow, everybody dreads the NCLEX, but you REALLY have to chill about this!!! Saying how much it sucks doesn't change the fact that you will HAVE TO TAKE IT. We all did at some point.

Yes, it's changed over the last few decades. They used to do the 2-day test with pencil and paper, that went over every single area of nursing. Maybe they should go back to that, who knows. But the NCLEX certainly does test critical thinking. There is just way too much material out there to be able to test us on every single thing - do you know how many more drugs and diagnoses there are now that didn't exist yet when they did the 2-day test? It would be a 4-day test now, at least. The "basics" like mixing insulin and knowing different drugs are taken care of in nursing school. When you get your degree, it is saying that you showed proficiency in doing "the basics" like that. The NCLEX is going to test you and see how well you can combine the knowledge learned in nursing school with the actual practice of nursing. You can know everything in the book and ace every test, yet not know how exactly to put it into practice. Critical thinking involves visualizing yourself in the situation the question presents and deciding what plan of action to take. It's probably the most important part of nursing, because anyone can memorize drug side effects and how to draw up medications. Being a good nurse is not just about knowing what to do, but HOW to go about doing it. That's why the NCLEX is so hard.

Plus, the way the test was before, you could put yourself in a mind-set (i.e. pediatrics) and reading all those questions would kind of bring things back to you, plus you could go back and change your answers if you had time. The way it is now, things just pop up out of sequence, AS THEY REALLY DO IN NURSING PRACTICE, and you can't go back later and change your answers. When you're working, you can't go back and fix a mistake you made with a patient or spend tons of time debating what to do. You have to be able to think quickly and take the best course of action.

BTW, I do think it was so cruel for the hospital to publish the fact that the woman didn't pass her boards. I've never seen such a thing!!! :angryfire