oh so now we PAY to do residency to get a job?!?! seriously?

psychonaut · Jan 4, 2010

No, the answer is not to bring back diploma programs. I was a graduate of a diploma program from what seems like a hundred years ago. They may have turned out better nurses clinically, but they were an educational dead end. None of our credits transferred to colleges for college credit. You had to start from scratch to go back to school and further your education.

I have read similar statements in nursing education theory. Is there not a possible middle road? Meeting the academic fundamentals required by a baccalaureate education, while maintaining a focus on producing a skilled clinician?

Nursing needs to emulate what PT, OT, Pharmacy, etc have done, in terms of increasing the entry into practice, and add a 6 month to one year PAID internship. New grads should have learned basic skills in school, but should not be made to feel that they have to hit the ground running the day after graduation.

I would add PA to that list. There is an evolving system of voluntary, competitive, *paid* post-grad residencies for the PA profession. I would agree that a 6 month residency for new grad nurses could alleviate the clinical shortcomings of the modern programs. Acceptable for it to be at a lower wage (maybe 60%-80% of full pay), but including didactic components and a guided (not ad hoc) process. Perhaps with the goal of producing a nurse equivalent to one with 1-2 years experience in that department, and that nurse having the fundamentals for leadership and resource positions.

However, I do feel that the degree program itself could be redesigned to produce a new nurse that can be successful, if not on day 1, than at least with the 6-12 week new grad training common these days. I say fix the BSN first, then design the "residency" concept as a bonus for the very motivated new nurse (who, like new PAs going into residency, makes the conscious choice to accept a lower paying position in return for the added education).

I really do feel you should contact the agency who determines the school curriculum, and complain. There should be a standard curriculum with clinical and a skills checklist. That is what medical residents do. They have to accomplish a certain skill level and or procedures in each year of their residency. I remember hearing them tell the senior residents that they needed to place another Aline in ICU or central line, etc, you get the picture.

I agree. Our clinicals were too focused on spending 4 hours the night before creating a "concept map", care plan, whatever. Rather, having the clinical instructor focus on getting the students opportunities to practice skills and assessments along with the patient care, med pass, and care planning.

Demand the the schools teach what needs to be taught. Or maybe, before you start school, or when you apply, ask what skills you will be learning each semester. That of course would be for new nursing students to do.

Yep...I see this a shared responsibility of students, faculty, clinical instructors, and us nurses in the community that may precept students, as we all have a stake in the future of our profession.

Again, you might look into contacting an attorney who specializes in Education Law and talk to one of them. If you can get enoughy of you, ask about filing a class action suit against the school. If enought of you do this in different parts of the country ,the schools will have to sit up and take notice. You can call the State Bar Association, or go online to Findlaw, and check there. I feel you pain.
Lindarn, RN, BSN, CCRN
Spokane, Washington

Here, except for feeling the pain, we are in disagreement. This can be laid squarely on the shoulders of the "Ivory Tower", of nurse academics and nurse PhDs, of the accrediting agencies and licensing boards, professional organizations and even nursing unions. Our profession, at both the staff and advanced practice levels, is a fractured mess. The one thing we have right is a single, competency-based license. If that could be backed up by a single, strong set of expectations for any new RN, enforced by a single accreditation body, and overseen by a representative ANA, then the educational system could be reformed.

llg, PhD, RN · Jan 4, 2010

I have read similar statements in nursing education theory. Is there not a possible middle road? Meeting the academic fundamentals required by a baccalaureate education, while maintaining a focus on producing a skilled clinician?
.

I agree. We need to stop arguing about which is better -- clinical or theory -- and start acknowledging that BOTH are necessary. Then we can get on with the business of designing educational programs that provide adequate education in BOTH domains. I'm sorry for the inconvenience if that means that someone can't become a professional nurse in 15 months. But nursing is a highly complex and important job. If you want to an RN, you should be willing to make a significant investment in your education -- and that means spending considerable time in school mastering BOTH a set a clinical skills and a theoretical knowledge base needed for practice.

For people who can't or won't make that educational investment -- there are (and should be) alternative roles that require less education -- and have less responsibility (and pay) to go with them.

karenchad · Jan 5, 2010

Did any of you nursing students/new grads complain about this to your state nursing association or board of nursing? What did the school teach in exchange for all that tuition money they collected?

iamRN09 · Jan 5, 2010

all that being said...would an experienced nurse recommend this program for a new grad, considering the educational flaws in nursing and the current state of the economy?

karenchad · Jan 5, 2010

I'm sorry to say NO I wouldn't- I think nursing students should get the real hands on clinical experience that I and many others got 30 years ago in a diploma program. I know that not a popular conviction nowadays I just don't see how you can teach someone how to ride a bike with out a bike. All the other fluff is nice but it's meaningless with out a solid foundation- teach about foley insertion, show foley insertion, do foley insertion. There is an art to teaching. I asked a nursing instructor up on the unit I was on about 1 year ago- why there is such a shortage of nursing instructors- her answer was; because students are sueing the instructors for failing them. Since when is that allowed- if you don't know something- especially with someones's life at stake, why would you think your instructor would pass you?? If you are not going for extra help, or asking a question, are you really interested in the course material? maybe the student should aske themself- am I nursing material??( I think now a days it's phrased- a good fit to me that's a description of a bra not whether someone belongs in nursing or not)

**canoehead, BSN, RN** · Jan 6, 2010

I agree, I've seen a post where a student talked about 6 hours a week clinical...are you kidding me? In my diploma program we did 28 hours clinical plus a prep day during our clinical weeks. It seemed to me there was about a 50/50 split between clinical and nonclinical weeks, so we were VERY comfortable with basic nursing care duties. Then at the end of the program we shadowed a nurse for 12 weeks straight- and knew what to expect from our future orientation experiences. If we could make it at our own familiar hospital we'd probably do OK at our new jobs, we just had to work hard and stay with it. Right now grads come out having not done a full 12 hour shift, let alone having real RN experience. It's not right.

If I had a family member starting nursing school I would recommend they look at the time spent in clinicals at each program over NCLEX pass rates. Real life is on the floors, not in the book.

jjjoy, LPN · Jan 6, 2010

Funny how these same topics seem to come around on a regular basis, isn't it? I'll have to dig into my posting history to see when the last time I got ranting on this was.

Wow... you took the words right out of my mouth... again... as I, too, am drawn back again and again to this topic. I agree with much of what you wrote. And even if we keep rehashing the same things, I do appreciate hearing you and other posters (hi to you other regulars!) on such topics because most everyone else I interact with will fall asleep if I dare to venture into the exciting topic of nursing school curricula!

psychonaut · Jan 7, 2010

Did any of you nursing students/new grads complain about this to your state nursing association or board of nursing? What did the school teach in exchange for all that tuition money they collected?

I commented on this (lack of clinical emphasis) in the final evaluation we completed prior to graduation. Beyond that, my immediate post-graduation attention was consumed with passing NCLEX and then orienting to my new career (was hired prior to graduation).

Although my thoughts on this subject were there, I didn't really start to give this much thought until about 1 year post-graduation, at which point I was settling (somewhat) into my role as RN, as well as beginning to take MSN courses dealing with APN roles, nursing theory, etc. At that point I read what we had for those classes, then went looking for more (including reading material from an early BSN class on "Nursing as a Profession" that had new import for me as a practicing RN vs. as a 1st semester BSN student).

As for what the school taught? I don't really feel all that short changed (compared to how I feel about what I am getting in my "on-line" MSN courses, but that's another thread). While I feel that the program as a whole would have benefited from having more of a clinical emphasis, the individual classes were generally very educational and challenging. My pharm and pathophys classes were great, as was med surg. My critical care course, both lecture and clinical (with different instructors for each) was outstanding, and was truly the highlight of my BSN experience. In terms of nursing knowledge, I learned more in that class (again, both didactic and applied) than in any other class in the program. In fact, when I write about my "dream BSN program", my design is based in great part on how that single class was approached.

So, I don't feel I was ripped off by my program. I don't automatically consider courses on nursing theory, nursing as a profession, management, etc. to be "fluff"; I feel they can have value, and they consisted of only a small portion of the program as a whole (again, compared to what is being offered at the MSN level; again, whole 'nuther thread). However, I do feel that a de-emphasis of skills and procedures does a disservice to new grad RNs.

psychonaut · Jan 7, 2010

Wow... you took the words right out of my mouth... again... as I, too, am drawn back again and again to this topic. I agree with much of what you wrote. And even if we keep rehashing the same things, I do appreciate hearing you and other posters (hi to you other regulars!) on such topics because most everyone else I interact with will fall asleep if I dare to venture into the exciting topic of nursing school curricula!

Yeah, not many of my fellow employees are interested in these sort of discussions. I did manage to get some good conversations started in a couple of my MSN classes with other students. Sadly, the largely absentee professors couldn't be bothered to join in these discussions (which were definitely on-topic for the course, i.e. role questions in the "Roles of APM" class, and theory issues in the "Theory" class). When they did engage, it was never of any more substance than saying to us students, "That is a very good (question/point/concern/whatever), you should continue to research that!" Basically just positive affirmation crap with no content.

...and I keep saying that's another thread, and I keep bringing it up, sorry, just on my mind right now...