Nursing students who do not understand what nursing is about

Specialties Educators

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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 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.

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.

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.

My concern is that these students do not understand the healthcare system or the role of the nurse in the system. Many times I wish I had the courage to be blunt with then. I am honest with then and try to deflect them by telling them about NP training but I feel that our schools 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!).

Any advice or ideas on how to address the students on the issue of unrealistic expectations about bedside nursing practice.

Specializes in Professional Development Specialist.

Nursing 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.

Specializes in ..

i'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.

Specializes in Geriatrics, Home Health.
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.

I'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.

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.

We are not all that guy! I have an AAS and a BA, both with honors. I liked my job but wanted something different. I was a CNA and HHA in my late teens. It wasnt until I was called upon by my family to help out with a family member that I remembered how much I loved the interaction. It took a year of consideration before I made the huge leap into the prereqs! I am so happy to say I got accepted to the program of my choice, I got 1 of 60 seats out of a field of 1000 applicants. I have no clouds over my eyes. I know that I will be peed on, puked on, pooped on, spat on, bled on at some point in my career. I know I will deal with rude, angry people. I also know that I will be able to ease pain, draw out a smile, and I will be thanked by someone.

My interviewer told me my essay was phenomenal and that my answers to her questions were excellent. I know that the 2 years I am in school (I am pursuing an ADN an will pursue a BSN following) will be among the most intense of my life and I cant wait!!!

Also, I think every pre nursing student should be required to read the gross and disgusting stories thread on allnurses.com I have discovered my dry heave button can be pushed by people consuming bodily substances!!!

I hope I have instructors who with be patient enough to tell me when my expectations are skewed and help me to develop realistic ones!

Specializes in MCH,NICU,NNsy,Educ,Village Nursing.

It would have been interesting to know what the student who wanted to learn about "real" nursing actually meant. Might have started a great discussion on the realities of nursing, how to be agents of change, patient advocates, etc., etc.

Specializes in family practice.
What then is nursing judgment?

Nursing judgment is part of contributing to the care; in the end we are all contributors and not the final yea or nah sayers

Specializes in ER.

I am also a second degree BSN and I have to say that I think you are way off the mark.

First of all, I left my last career just as it was becoming lucrative to me because I wanted something more fulfilling. While I have certainly felt more fulfilled in nursing, I have also questioned my own sanity in leaving a job where I had more respect and better pay to run my rear end off in the ER!

My fellow second bachelors students were also not "failure to launch" candidates but rather people who felt more focused and ready for a new role. This is not a crime!

In terms of whether or not nursing is a job where you must demonstrate leadership, I agree with the student: it is.

As an RN, I very much tire of listening to nurses who think of nursing as being task oriented. To them, its all about doing meds or starting IVs. Well, I may be just trotting out my own personal theory but I am thinking that most of the facilities are past the point where they want to pay RNs NOT to think.

I remember taking a team of patients from another RN who was simply awaiting a patient transfer to a psych facility. The patient had been holding for DAYS. I went to the charge, called our social worker and the facility the patient was supposed to go to and got the ball rolling by advocating for this patient. Most RNs are just content to let the patient await transfer while they busy themselves with the "jobs" of nursing but in the end, we are accountable for these people.

I also notice that more and more, we are accountable for procedural practice. Is everyone wearing a mask and cap? If not, why not, Ms RN? It is up to us to manage infection control during a procedure.

If I were advising the OP, I would say please go teach the people who still think that its all about doing doing doing and not about delegating, thinking and leading.

The 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. After all, it's not like "House" where doctors perform intensive bedside care, leaving RN's free to gad about in the background!

This is actually a common practice. I know of only one school in my area that doesnt require students to be a CNA before they can apply. Even the BSN program requires a cna license to meet application standards.

Specializes in Medical Surgical.

To the OP:

Judge people much? Maybe you should just quit teaching if this is how you feel about students.

I can't stand teachers who think that they know everything about every student and judge everyone based on some sort of psychic abilities they think they have of knowing everything about everyone.

Specializes in Trauma Surgery, Nursing Management.

AOx1,

I LOVED reading your post. Very well written, concise and to the point. Thank you for sharing.

Specializes in Trauma Surgery, Nursing Management.
Nursing judgment is part of contributing to the care; in the end we are all contributors and not the final yea or nah sayers

I think that nep1980 was posing this as a rhetorical question.

Specializes in Oncology; medical specialty website.
It would have been interesting to know what the student who wanted to learn about "real" nursing actually meant. Might have started a great discussion on the realities of nursing, how to be agents of change, patient advocates, etc., etc.

How can you be an "agent of change" or a "patient advocate" until you have actually done the work and know what it is that needs to be changed and for whom/what you need to advocate?

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