A Call To Reform Nursing Education

VickyRN, MSN, DNP, RN · Feb 4, 2004

Thanks for the link and article! :)

hbscott · Feb 4, 2004

Originally posted by NRSKarenRN
For too long nurse educators and nursing service personnel, although cordial and respectful of each other, have not been fully engaged in collaborating to prepare a workforce that can practice effectively in new healthcare environments.

"Cordial and Respectful" of each other? Now that is putting it nicely.....

-HBS

NurseHardee · Feb 6, 2004

The road to Hell is often paved with "reforms".

Nurse Hardee

oldiebutgoodie, RN · Feb 7, 2004

Verrrrry interesting. It does seem that nursing schools are clinging to certain traditions which may or may not actually provide an education. In my program, we fill out mounds of paperwork before and after our clinical days, and yet actual learning experiences (real procedures on real people, for example) are few and far between.

I excel at putting Powerpoint handouts into binders, but in 7 months I have only done:

1 SQ injection

Removed 1 Foley (have never put one in)

Administered 3 tablets

Drained Foley bags and JP drains

Did one wet to dry dressing change.

Hopefully the pace will pick up. Yet, we spend hours analyzing the verbal and nonverbal interactions between nurse and patient, as well as creating care plans that I have yet to see the value of.

So, maybe I just have the wintertime blues. Anybody care to comment?

Gldngrl · Feb 7, 2004

oldiebutgoodie-I talk to new nurses I currently work with and I'm amazed that no matter what program they go through, they are coming out without giving injections, inserting foleys, performing dressing changes, etc. They're shocked when I tell them that when I was in school (1990), I had to administer 3 IMs and SC injections, insert two foleys (male and female), perform dressing changes, etc. and if our patients didn't need these tasks done, my instructor would go to other floors and ask the nurses if they had any pts that needed these tasks performed. I'm also surprised to see students in my hospital arrive on the floors for clinical without a nursing instructor on sight and the staff nurse is essentially a preceptor. Again, in my day, there was a group of us and our instructor and we did NOTHING without her knowledge or direct supervision and the staff nurse was there to report and discuss things with only.

bellehill, RN · Feb 7, 2004

Gldngrl-my instructor would search for things for us to do, just like you and this was only a couple years ago. I had a nursing student with me just the other night (she had one of my patients), well I had to remove a foley, place a condom cath and apply restraints...couldn't find her anywhere. Finally found here hanging out with the tech. I would have loved to have gotten her involved with these patients and let her experience something new.

fab4fan · Feb 7, 2004

Sigh...it never ends.

ER2Ed · Feb 7, 2004

I graduate in December 04 (hopefully)- I say hopefully because I have had a few run-ins with my most recent clinical instructor - one of which was a the tubing from the feeder going into the peg tube hit the floor during medications. I find that what we learn in class and what happens on the floor isn't the same. I understand this is reality, but why not teach reality? When this event occured, I informed my clinical instructor and said we needed to change it - she said, "No you don't this is not a sterile technique situation - do you know why it's not sterile?" I informed her that I understood about sterile, but this had to do with the tube hitting the floor of a hospital room and then going into the stomach of an already compromised patient and I would not simply "clean it off with an alcohol pad" (as she wanted me to do) anything that dropped on the floor in here and put it in my mouth - so I won't subject my patient to that. She eventually gave in and got the "Nurse" and the nurse came and showed use how to change the tubing, but the nurse said it would have been fine to just wash it off and re-insert. AM I JUST ANAL or is this really ok?

gwenith, BSN, RN · Feb 7, 2004

Sorry welcome to the difference between "ideal" and real. Ideally nothing that hits the floor should ever go near a patient again and I actually worked in a unit like that where if the pillow hit the floor they would change the case before putting even on the bottom of the bed!!! Was it a good unit??? In some ways but in others they were so busy with trivia like this that the BIG stuff was missed i.e. a patient did not have thier hair washed for 3 weeks and the hair was covered in blood!!!!

Now to the thread - just from reading the board - which I admit is probably biasing me I would say that there is reform needed. I wonder if you would do better to change to a "competency based" curriculum such as is common here??

oldiebutgoodie, RN · Feb 7, 2004

Well, I can see that programs are concerned about the critical thinking aspects. But are the skills being shortchanged? There needs to be at least a 70-30 (or 50-50!) proportion of critical thinking to skills, and I don't think that care plans necessarily address the critical thinking part. However, I would be happy to eat my hat if research showed that care plans do improve the critical thinking arena.

MBA schools do case studies. Perhaps the care plan should be replaced by case studies. I dunno. Just thinking out loud.

But wow, we really need to do more than practice once on a dummy and hope to God that we encounter a patient that we can do procedures on. It places a lot of strain on preceptors when we graduate and start working. Our instructors are doing the best they can, but with a 6 to one ratio on the instructors, they are busy enough making sure we don't kill somebody, much less scout around for procedures to do.

Gldngrl · Feb 8, 2004

Originally posted by fab4fan
Sigh...it never ends.

I'm unclear...what never ends?