Nursing students who do not understand what nursing is about - page 3
Yesterday, in post conference a students asked me when are they going to learn "real" nursing. Each student had done med pass on one or two patients that day. When I asked the student what he meant... Read More
Apr 3, '11The only point I want to emphasize is that any leader should know how to do the tasks of those they lead. So as an RN who delegates to LPN's or CNA's, that RN must know how to do their jobs in order to be a competent leader. That's my two cents.
Apr 3, '11Quote from TheCareerStudentI agree completely and they should be WILLING to do the tasks. When I work LTC and help my aides with something I always hear about how I'm the only nurse in the facility that helps with changing, bathing, toileting, etc. Pretty sad if you ask me.The only point I want to emphasize is that any leader should know how to do the tasks of those they lead. So as an RN who delegates to LPN's or CNA's, that RN must know how to do their jobs in order to be a competent leader. That's my two cents.
Apr 3, '11the solution to many of the problems noted by the OP and others would be to require licensure of a prospective nursing student as a CNA before allowing him/her into a nursing education program.
The university that I teach at (ADN and BSN students - and yes it is a university with ADN students which is wonderful) requires a CNA license and 3 months of work experience before clinicals begin.
I also think nursing is a leadership role and from what you describe, it doesn't sound as if the student feels entitled, I think he is just misled.
Maybe you could point out that although CNA's very often do vitals and LPN's do meds, what if his place of employment championed primary care? Or even though these tasks may be delegated, he is still responsible to decipher and interpret all of results of the delegated tasks and he must be a master of the skill before he can delegate it or interpret it. He may even be a preceptor on his unit and he would be required to teach these tasks.
But at the end of the day, if he is truly not "nursing material" then talk to him about it. I had a very blunt professor tell some of my classmates "This is how nursing works, if you don't like it, let me help you be successful in some other profession." She meant it too. She failed one of them, but helped him obtain a history degree. Although some students may not be nurses in the making, as an educator, I hope to have my professor's same outlook on people.
Apr 3, '11OP you hold the power in this situation.
In my clinical groups anyone with attitude or a sense of entitlement quickly finds themselves the next day with just the right clinical assignment to turn their head around! In fact, I really admire my instructors ability to maintain their cool with the really aggravating students but still find a way to teach them what they need to know.
There have to be consequences for bad behavior - and the faculty have all the power to enforce consequences. Everyone, in every profession, is lamenting the loss of quality in human beings these days. People seem to be lost in the world, with no sense of morality, standards, tolerance, hard work etc. All I can do is be my best self, not put up with bad behavior, and look for the good in people and try to nurture it.
Apr 3, '11Quote from nep1980I believe you misunderstood the OP who was talking only about her current students. She stated that she had noticed the trend being different from the other 2nd generation BSN she has taught.(She never generalized all nursing students) This male student making that comment is not what we nurses do. We dont make decisions, the doctors do. We make contributions really which is what i would have told him.I wish you would read some of the OP's post and see what they OP really is repeatedly saying about nursing students in general its just not nice. If this was an isolated thing blame the students. However the OP states those who want to become nurses chose to do so because they are not smart enough to do anything else but be taught to a test and feel that it is the only place they can succeed......The OP needs to do some soul searching. I think the posts, not just this one but as I said I looked up all the posts by the OP seem to be a call for self help on the OP's part! Since these are NURSING BOARDS its just disrespectful to everyone on these boards!
If he wanted to make decisions, he should have forgotten about and gone directly to medical school
Apr 3, '11Quote from dns on the gomy advice to you is to be straightforward with this group. you must. they see you as their leader. you must have the confidence in yourself to tell them what is expected of them, without sugar coating it. leave the rest up to them.yesterday, in post conference a student asked me is he going to learn "real" nursing. each student had done med pass on one or two patients that day. when i asked the student what he meant he stated that nursing is not about vital signs and passing pills, hanging iv's, etc. where on earth did he get this misconception?
he wanted to learn "real" nursing.
i explained to the group that the responsibilities of the nursing include medication administration, patient assessment and documentation. he then stated that those were jobs of the aide or the lpn and that he wanted to make decisions about the patient care.
this is where i would have told him to "back the truck up bubba, cause you made a wrong turn." he is obviously seriously disillusioned regarding the fundamentals of the nursing profession. he is not getting the point that you must learn the foundation of nursing practice in order to become a well rounded and productive clinician. students with the attitude that he is displaying seem to be shocked when they do not pass exams or get low marks in clinical.
the students in the class are second degree bsn candidates. the saddest part is that when we had our introduction on the first class it was apparent that most of then were "failures to launch" i.e. they never got started in their respective first career choice and where now in nursing because they perceive it as an area with opportunity. i do not understand how or why they have the perception that nursing is a leadership or decision making profession.
well, one can interpret your last sentence a couple of ways. nursing can evolve into a leadership position, and if that were not the case, we would not have so many nurses pursuing mbas, mhas, crnas or nps. there are many leadership roles in our profession, and i am confident that you must have been alluding to something else when you wrote that sentence. you are yourself in a leadership position as an instructor. we also have a certain degree of autonomy in our profession, so that can also be classified as decision making. my guess is that you meant that this student thought that he would be given a "carte blanche" approach to pt care once he secures his license.
in previous classes, the majority of the 2nd degree bsn students had been in other fields and wanted to make a change to nursing. most entered nursing because their first career did not pan out or they did not have what it takes to succeed in their first career choice. a few wanted to really be a nurse but passed it up the first time around they went to college.
you know better than we do why these nursing students decided to make a change in their careers, because you can refer to their applications. i hesitate to comment on how negative the above paragraph sounds, because i am not sure exactly what you meant. to me, it sounds like since the second career nursing students totally bombed in their previous careers, they chose nursing as a reluctant alternative.
my concern is that these students do not understand the healthcare system or the role of the nurse in the system. the one you described clearly does not. many times i wish i had the courage to be blunt with then. ok, this is where i must be blunt with you, and please know that i am only trying to help. it is imperative that you be not only blunt with them, but also be "the heavy" with your students when necessary. they paid tuition, and they are looking to you as their instructor to lead them. part of leadership means to lower the anvil when appropriate. part of growth is pain, and sometimes we must fail in order to blossom. one's true character is revealed in the face of challenge. your students should be challenged. you must lead that challenge. i am honest with then and try to deflect them by telling them about np training but i feel that our admission department should have screened out some of these students for their own sake.
adding to the irony of the situation, a significant percentage of them have serious academic difficulties including poor writing skills (and these are all college graduates!). let this be. don't worry yourself about their baseline writing skills. you have no control over this. grade them appropriately, and if they come to your office in a mad frenzy, then point out that they should perhaps consult a tutor to improve their writing skills. although i do not hold myself to the standards of an english professor, i will admit that poor is one of my pet peeves. to read something riddled with grammatical errors by a college educated peer reduces me to distraction of the content.
any advice or ideas on how to address the students on the issue of unrealistic expectations about bedside nursing practice.
Apr 3, '11Quote from carolmaccas66b4 I comment on this, what is a 2nd degree BSN? I don't understand that part.
2nd degree BSN means that a student already holds a bachelors degree in another discipline and they are returning to school to complete a BSN.
Apr 3, '11Quote from honeykrownWhat then is nursing judgment?We dont make decisions, the doctors do. l
Apr 3, '11I both agree and disagree with aspects of your post. If I am understanding you correctly, you feel that this student is not prepared for the realities of nursing.
In education, sometimes we teach from both an idealized standard and a realistic one. For example, we may discuss how in a perfect world, the nurse is a valued part of the medical team, communicates well with all coworkers, and has time to fully care for the patient in all areas, from performing skills to documentation to meeting psych needs. I believe ideals are important for one reason: it is the healthcare system that many of us WISH existed. I think most nurses would love to leave work having contributed to a team effort that benefits the patient, to have time to fully assess, treat, and document, to comfort and to care. And on the rare day, this actually happens.
However, reality on most days is completely different, so this is the aspect that should get the majority of our attention as educators. Nurses struggle to make do with fewer resources, less support, and little understanding. In a perfect world, the nurse IS actively involved in decision-making on a large scale on a daily basis. But we all know that some days, you just try to keep your head above water. I do know that every day in the ICU I make critical decisions regarding patient care. Am I the one writing all the orders? NO. But I am the one calling to report a change in status, who gets what needs to be done accomplished. I don't believe that nursing is merely rote performance of skills, but a combination of skills and reasoning.
So, what do we teach students? Do we teach them that nursing is a perfect utopia, that we flit about spreading sunshine and light? Do we teach them that many aspects of nursing suck, that they will have immense pressure on them to excel with very limited support? I would say that the best approach is reality, tempered with a bit of the ideal. I would like my graduates to experience minimal reality shock when entering their first job. However, I would also like them to see that with activism, nurses can bring about change. Do I think they will all completely change the world of nursing for the better, bringing about that happy utopia we all wish for? Not by a long shot. But I do want them to have both high standards AND realistic expectations. This can make a difference in the daily life of their patients. The thing that I fear most about your student is that he seems to have the view that all these tasks are to be delegated, leaving only the administrative portion to the nurse. As you mention, he is not being realistic and is in for quite a shock. The first CNA that has been in practice a long time will eat him alive if he tries to "delegate" all his work, and he will not survive long.
As for second career students, I am at a loss. These are usually some of my favorite students! I love seeing all the life experience they bring to the table. The majority of them are mature, motivated, and invested in their own success. This is not to say that none of my traditional students are this way, only that on the whole, the returning students are on their own dime and their own time. They have often made great financial sacrifices to be in the program. If this is a new pattern, I would question whether admission standards have changed, or if perhaps they NEED to change.
I understand your frustration, if it is directed towards the fact that nursing reality is not congruent with nursing ideals, but I do hope that instead of becoming frustrated with the students, you could use it for discussion with them.Last edit by AOx1 on Apr 3, '11
Apr 3, '11Nursing is definately a leadership role, although it's a challenging one. You must learn to lead with little authority. You must learn to lead your cohorts to higher standards of care and give the docs you work with the correct information so they may make appropriate decisions regarding patient care, sometimes over the phone to a practioner unfamiliar with the patient.
It sounds like your students expressed multiple opportunities to learn. As a teacher your approach shouldn't be to "deal with" those students. You should be searching for lesson plans for each of those common student responses.
If someone wants to learn "real nursing" ask what is his ideal of real nursing. It's a great opportunity to role play what he'd like to do and how he could response while staying within his scope but still being an advocate for his patient. A discussion about what to do when you feel like you as a nurse know what should be done and the doc isn't listening to you would help.
There are many great learning opportunities here. But judging the students for not being a great nurse while they are still students isn't helping anyone.
Apr 3, '11i've been reading this site for some time now, but this is the first time i've felt the need to comment. i am currently a second career nursing student (bsn, may 2011) and i think that the op is correct in what she is saying. many nursing students, particularly the second bs students, are setting themselves up for failure. they have the unrealistic expectations she mentioned and will not last long. i listen to what many of them say and have started counting the days until they wash out of nursing. when i listen to their attitude concerning the less glamorous aspects of the job, i cringe. in my former career, i would have fired many of them before now. i also agree that academia should do a better job of screening people, but the sad fact is that nursing education is about money first and nursing second. don't get me wrong......i go to a great school and have many great fellow students, but when i look at some of them and especially those in clinicals from other universities, i just shake my head. i suspect that in the future there will be many people out there with unused second degrees in nursing.
i also agree that the direct-entry model for np's and the like will prove to be problematic in the future. many people seem to equate a higher degree (bsn, msn, dnp) with the ability to think and make good decisions....mistake. it is by no means automatic, and i fear the current trend will set nursing back due to the inferior product being put out by nursing schools.
as for the posters nep1980, rn2bdfw, onaclearday and others, stop being simplistic. if you think the op is just a 'bitter old instructor', you have clearly not been paying attention. pointing out the real problems that exist does not make one incompetent, but jumping to conclusions and making everything someone says personal does give the impression that you are immature in your approach.
p.s.: mix in some spell check people. some of these posts are atrocious.
Apr 3, '11Quote from DNS on the goI'd like to weigh in as a recent second-degree graduate (ADN 2008) . My first career was a "failure to launch" situation due to outsourcing, not immaturity.Yesterday, in post conference a student asked me is he going to learn "real" nursing. Each student had done med pass on one or two patients that day. When I asked the student what he meant he stated that nursing is not about vital signs and passing pills, hanging IV's, etc.
He wanted to learn "real" nursing.
I explained to the group that the responsibilities of the nursing include medication administration, patient assessment and documentation. He then stated that those were jobs of the aide or the LPN and that he wanted to make decisions about the patient care.
When I was in school, we were constantly berated for being "task-oriented", told that the real world was very different than school, and told that nursing is more than just the ability to take vital signs or do skills. We did a lot of care plans, but not much hands-on care. For me, the only real exceptions were peds (in a home for brain-injured children), and maternity. When we had to submit our care plans, my maternity instructor held one up and said "I don't care about these; I care about what you can do on the floor."
To me, your student doesn't sound entitled, they sound misled. If they've constantly been told that what they're learning in school is not "real-world" nursing, they're naturally going to be curious about what "real-world" nursing entails. Since they already have a degree (and likely a lot of debt to go with it), they don't want to waste money or time.
If anything, your student presented a teachable moment. I wish I'd had more time to practice clinical skills, instead of writing care plans and memorizing theory, nursing diagnosis, and the nursing process.