Critique of Nursing School

[NormaSaline]

Having seen so many pitiable messages thrown up on this board from desperate students barely surviving nursing school, I wanted to give my two cents worth from a less immediate and frazzled perspective. Let me say that I understand that I'm generalizing. I don't believe for one second that all nursing schools are like mine was, but it seems like many are. And that is something to be concerned about.

For those who are serious about learning and who want to become nurses to apply that learning, nursing school is, by the looks, sounds, and experience of things, maybe not the best place to be at right now. Unfortunately, it is the only game in town nowadays and that's because it's all about the road to NCLEX.

Concepts are poorly explained or else, as I have experienced and seen discussed countless times on allnurses.com, incorrectly explained, or not explained at all. Conceptual understanding is the axis on which much acquired learning swings. Without identifying key concepts, teaching, and learning key concepts, knowledge is hanging by an insecure thread. And it is exactly here - teaching unifying concepts - that nursing schools gracelessly bow out of the game.

The majority of teachers now in nursing schools are not good. Is this why there is a nursing shortage?

The personal stories of weekend activity, the bragging, the pointless anecdotes and meaningless aphorisms - all students who are subject to these monotones are to be pitied for their wasted time and the fatigue of enduring them. Instead of the weekend stories, instead of the dull lazily-delivered aphorisms, why don't they teach? That is exactly the question. Is it ignorance or laziness? (Or, is the problem more structural in nature? More on that later.) More within the realm of realistic possibilities for the student, though, is the question, why don't they - the students - protest? The answer is complicated - one, it's generally a two-year program we're talking about, with a pace that is not to be believed, which leaves students with hardly any time to warm dinner, much less launch and sustain a protest. Often a faint, last hope, the evaluation system at these schools is often broken. In addition, there is the reality that often the professors are good buddies with the nursing school directors (at least the ones who want to make sure they keep their jobs are), so there's no barking up that tree. As with so much, it all comes down to leadership, and there just isn't any. The 'dons' appear to be fairly well cut off from reality.

The teachers as far as I can tell have graduated from the do as I say not as I do university, the same one that imparts a teaching style of - guess what I'm thinking right now ? For example they may throw out a question about heart failure, but inevitably it comes off as sounding like, "what am I thinking right this second is the key thing you should know about heart failure, and if you don't guess what is in my mind, I will say something to strongly imply that you all are not trying or don't know jack?" And then, that's it. There's no further discussion about why that thing the professor had in his/her mind was so important. There's no building on knowledge.

From what I can tell, there is scant teaching anywhere these days, and the cottage industry of nursing "strategy" packages is a booming one indeed, complete with the hard sell and slick language of snake oil salesmen. The fact of their existence absolves nursing schools of not teaching key concepts. Yes, nowadays, you cannot be so naive as to think you can simply enroll in a pricey nursing school, can you? No, you must also be taught separately by Hurst, or Kaplan, Simple Nursing or HESI. Our nursing schools are following and cribbing from them. What does this say about our nursing schools? Not much.

There used to be good nursing schools, ones with great reputations. But I must have missed the news: at what point did these schools decentralize and hand their knowledge, power, and organization over to Kaplan, HESI, and the others? Why in the world did anyone allow this to happen? The problem with weak nursing schools, among so many, is the application. There is very little applied learning in weak nursing schools (clinical rotations), which just makes the learning that much weaker as well. And it skimps on training.

Did my school do a good job preparing students? No. They were disorganized, detached, demoralized and chaotic. But, the staff and professors could also be sociable, personable, and nice in the very fleeting attention given to individual students. But only a tiny number of them (1 or 2) truly went out of their way to make sure they covered the material as well as they could. The others were either not up to the task but tried in their own way, or else they did have the intellectual skills but for one reason or another decided to fall back and not put in the effort. With some of the others, you could tell that they didn't know the material well enough to answer questions. In fact, asking questions was frowned on. The prevailing attitude among the staff was that it was no better than when they went to nursing school. In other words, they were fine perpetuating a mediocre system of learning. Our nursing schools have become nothing more than places where you can study on your own in order to take the NCLEX. Teachers are not needed; only monitors are needed because that's all they do anyway. You will be teaching yourself all the way through.

In addition to mediocre teachers, students must also contend with materials that are internally inconsistent and workbooks with incorrect answers, the final cruelty to the struggling student.

Now, just to show that I am not a total jerk, I will ask the question: or, is the problem structural in nature? When you consider the ratio of volume of material covered to class time, it does make you pause and wonder. What happened? Was it always like this? In whose mind is two and a half classroom hours per week covering 300 pages sufficient? What exactly is the point of those hours? Maybe at some school it was worth it, because key concepts were explained and expanded upon, but not at my school. There was also the issue of students who did not put in the time to learn the material. Obviously you cannot put that over on bad professors. But bad professors nevertheless exist. To what extent one enables another is an open question - but one for another time.

What to do now?

To the majority of nursing students outside the age range of 18-20, honestly I don't know what to say. So I'll address the moms and dads out there because it's the young students that I feel have the best chance and the most hope of getting the most from nursing education. If you happen to be a mom of a teen who really wants to be a nurse, I recommend scouting out the best BSN (not RN) programs in the country and start preparing her or him now. Find good nursing schools, more than one, more than four, and start planning. Now. Unfortunately many well-known and good schools of nursing have shut down. Inadvisably. Maybe the administrations at their universities wanted to play up the 'sexier' programs, and failed to realize the power of a good solid nursing program, much to the chagrin of the longtime nurses and doctors who taught there, no doubt.

But getting back...How can I nutshell this at its most fundamental? (This goes for young learners and adult learners alike.): Find the programs with the best teachers. If you find good teachers, and you are willing to work very hard, you are all but there.

[grandmabutterfly]

I think APA format is for those instructors wishing to publish letting the student perform the research. Then, if they like your work, they use your source instead of performing their own research. I have more humility that I don't need to see my name in "print" for posterity while letting the plebes do the work.

[random_nurse12]

As an instructor I want to comment on a few things.

-finding experienced nurses with Master's (now doctorates) who are not only knowledgeable, but also good teachers, is extremely difficult. This is not an excuse. To me this is where the real shortage will reveal itself. I took a 20K pay cut for this job. In my experience, there are faculty the colleges want to terminate, but they have no one to replace them.

-the admission process in nursing school sets students up for failure (in some cases). Relying on numbers (GPA, entrance exam scores) does not reflect a student's potential for success in nursing. We take students who have done well in black-and-white science classes and expect them to do well in the gray-area which encompasses nursing school tests.

-the schools are expected to maintain a certain percentage of NCLEX passing, to the point where their jobs, their program, their reputation relies on it. Kaplan and the like have exploited that.

-I have a lot of clinical experience and I am a very good clinical instructor. The classroom is an entirely different beast. Although I have excellent reviews from students, I constantly worry if I do enough. As an instructor, you have to be willing to learn what you don't know (because you will be expected to teach it). You have to be willing to say "I don't know, but I will find out." I can't know everything. It is impossible. But for some students, the second I admit I don't know something, I have lost all credibility with them (back to that black and white thinking). Others will respect it.

-unrealistic expectations. I do want to comment on this. The x number of clinical hours a student has in school is not sufficient. The diploma programs had a much better set up. Students will do better if they work as techs or student nurses. There is so much more to be learned those first two years after graduation. There is a limit to what I can do clinically with 8-10 students in a day. I do my absolute best, but it will never be enough.

It is not a perfect system. We are seeing a new generation of faculty now as many retirements are taking place. I believe this is where we can see real change. I believe the majority of instructors I know are committed to doing their best and we kill ourselves striving for perfection. It sometimes feels hopeless because there is very little appreciation for this work. Sound familiar?

[Jl8708]

Have schools ever thought that it's not the student that's the problem with NCLEX pass rates and that it's the schools fault for not teaching the material in a way that caters to all students??? That's where the real problem is! Any student can learn nursing if the material is presented to where they can understand it... Teachers need to be more patient with students and admit when they don't know something and try to explain what they know. If they don't want to be teachers cuz they take such a big pay cut then do something else cuz if u don't like the job you are a bad teacher... Just a thought

[NormaSaline]

Wow - I just want to take a moment to thank everyone who wrote in in response to my little essay. So much food for thought. I also wanted to acknowledge the responses of those who are instructors like random_nurse 12. Thank you very much. I had actually heard the challenge of finding competent instructors, and I completely agree and sympathize. This is a huge problem. Someone has recently written a book about certain countries that have gone out of their way to compensate teachers very well, to the point that teaching is now very competitive in those countries. Not surprisingly, as a result, the education level of students has soared. It's very elemental, but I suppose it's a lot more fun to moan on and on about teachers. At any rate, thank you for the honesty and for the advice in your post which I am trying to read between the lines of. The "I constantly worry if I do enough" is pretty much your student seal of approval, at least those of us who do not see in black and white.

Here are some further comments.

Please note that I did not complain about not passing nursing school or the NCLEX. I was basically a good student, who studied a ton, took clinicals more than seriously, went above and beyond to expand my learning in any way I could, loved assignments (yes, loved them), passed the HESI first try, passed the NCLEX first try, blah blah blah - so my point was that it could be done so much better, in such a way that even the best students feel prepared. If I told you the stories of my time at my school, you would not hesitate to agree it's the teachers, but in doing so I would give away my identity or at least narrow it down, and that I am not ready to do.

Someone asked who is going to come on here and post positive comments? Well, I thought it was in my original thread that I read just such a comment, which was an excellent example of the polar opposite of my experience, and I'm trying like crazy to locate it and link to it, because when I think of what a nursing school should be, I think of that poster's nursing school. It was dynamic, even risk-taking, and empowering. Most important, the clinicals were where things really kicked in for the students. At my school, on the other hand, getting dismissed early, way early, from clinicals was only the beginning.

For the kidneys, I had a teacher who had watched a Linares video, came in to class, compared dialysis to a washing machine, started to run out of energy, stared off into space, and then went, 'ok, you can go.'

And so it went….

Happy Fourth of July!

NS

[johsonmichelle]

My school has both a good and bad reputation. I personally feel like I have been treated fairly by my school and their expectations are not unrealistic. Most of the bad reputation comes from students who did make it through the program, my program is known to be very very tough but I will say that graduates from our school are well prepared. I would advise pre nursing student to really research the schools and gather both subjective and objective data. Check their accreditation and pass rates. Also check their n clex pass rates but look at the number of people who passed the exam on the first try. That is very important, a school may have 100 percent pass rate but only had 10 individuals take the exam.