Why the high drop out rate of nursing students?

jjjoy, LPN · Jun 9, 2008

I can appreciate that schools want to prepare their students to pass the NCLEX. However, I don't think NCLEX style questions in general, and instructor-written-not-as-rigorously-reviewed-as-actual-NCLEX-questions, are a good reflection of critical thinking, of a student/graduate's comprehension and retention of nursing school content, nor of a graduate's minimal competency as a professional nurse.

I can appreciate that the BON doesn't just want graduates who can simply recognize facts well enough to score well on a multiple choice test. They want to test a graduate's ability to assess a situation and determine what action to take. That's great. However, since nursing schools use NCLEX style testing almost exclusively, when IS comprehension of content directly tested?

I'm a good test taker and once I figured out the testing style, I realized that I could pass the the tests without studying much of the content in depth. Does that mean that that content isn't important? I hope not! But something's not right when the test questions (NCLEX style) do not reflect the textbooks being studied, the lectures being given (usually based on the text) and the care plans/case studies being written. If I were an instructor I'd be just as frustrated as the students! I'd want to either craft a course that reflected NCLEX style scenarios and situation analysis OR if required to cover specific textbook content, I'd want the opportunity to test their comprehension and retention of that content, not skip directly to NCLEX style testing which only indirectly tests those things since we can't be sure if the rationale the student used to reach the right answer was in fact correct.

SarasotaRN2b · Jun 9, 2008

I am quite mystified by nursing students that work full time, have many family obligations and expect to make great grades! Med students and Law students check out of society while they are in school, why don't nursing students? We have critical information to learn! We stay with the patients and must be able to assess quickly at times.
!

Well, I agree with your post to a point. But the truth is that as a nursing student, we don't get the financial aid that many medical and law school students receive. Since they are in graduate school they receive higher loan packages which usually include enough to not work. The majority of nurses graduating are from community college ADN programs which have a financial budget that is the same now matter what your major. Guaranteed student loan limits are less than $8000 per year...how do you pay for school, books and living expenses while you attend? Community colleges don't have dorms, so you are living in the real world with rents in some areas that can be very high. Also, when medical students finish school, they are pretty much guaranteed a job via residency and when they go into practice. By the time they finish, they already know where they are going next...nursing students may not be able to secure a position until they pass their boards. One way that nursing students can have a better opportunity for a position before graduation is if they are working at a hospital already...but that means they have to work.

Okay, off my soap box!

Kris

ceecel.dee, MSN, RN · Jun 10, 2008

Does that mean that that content isn't important? I hope not! But something's not right when the test questions (NCLEX style) do not reflect the textbooks being studied, the lectures being given (usually based on the text) and the care plans/case studies being written. If I were an instructor I'd be just as frustrated as the students!

Well, there are usually more ways than just formal testing to assess a student. If we didn't "teach" students how to test "NCLEX style", there'd be he** to pay, so we do try to incorporate it, as is only fair.:redpinkhe

meme2 · Jun 12, 2008

This is unfortunate. What you describe I believe is an anomaly. The program I teach at is about partnering with the student and doing everything to prepare them for the real world. The instructors are with the student start to finish in cinical, and their opinions, challenges, and evaluations are taken seriously as a means to improve the program.

I wish you luck! You have the heart and the interest so I believe you will perservere.

loricatus · Jun 12, 2008

Well said. I agree with you 100%. Sounds like you are going to the same school i went to :scrying: Hang in there and continue junping through the hoops until you graduate. Once out, you start learning nursing.

BTW, why don't you post the question of common drugs used?

For instance: CHF (pulmonary edema) = Lasix (affects K+ level, lowers BP-hold if low K+ or low BP)

I can't speak for every school...but at my school, it's a wonder they don't have more students dropping out. My school program has been nothing short of a disappointment.
The faculty are not teaching us nursing. They lecture, but questions are treated as a "nuisence" and an "interruption". We have two days of lecture and an exam. Exams are not covered in class so all of us can benefit from each other's mistakes.
Pharmacology is a self-taught course...so personally, other than the book, I don't think that we should have to pay for it. I didn't sign up for a distance-learning nursing program, I signed up for a CAMPUS based nursing program.
Complaints? Like talking to a brick wall. It doesn't matter if you have the signature of every single nursing student protesting something...it falls on deaf ears.
We had a question on one exam where 100% of the students missed it. Every one.. Do you think that question got thrown out? Nope...b/c the professor insisted that she went over the subject matter in class...but my recording of the lecture states otherwise...but if you tell her she's wrong...she'll just ban recordings. Not the first time it happened either.
Think one question doesn't make any difference? It does....ONE question caused me to get a B instead of an A this semester...you think I can argue that? Nope.
This is what I call the "God complex"...and it has no place in education. There is a distinct difference between people being in charge vs thinking they are incapable of making a mistake.
I can't even tell you what drugs are common in a hospital because no one has ever told us. I can tell you the adverse affects of probalby over 100 drugs by now, but probably can't tell you what any of them are SUPPOSED to be prescribed for...b/c they don't teach us that....so how am I supposed to double-check behind a doctor to protect myself legally?
Clinicals, are a joke.
We go into the facility, we are assigned to an LPN (in a RN program), and our instructor disappears for the rest of the shift. No one watches anything I am doing. I was sent in to do a head to toe post partum assessment on a patient with a c-section...(24 hours post-op).
They sent me in KNOWING I had never done one before nor had we covered this in class at all. I never saw anyone go in and check behind me. This woman could have easily had something seriously wrong with her and I wouldn't have known the difference.
The staff at the hospitals that we are paired with never seem to know anything about what we can and cannot do as nursing students. Some of them don't even want to be paired with a student that day--and you quickly figure that out after you get snapped at a few times.
If you go to the instructors with an issue, I get, "You'll be fine" or "You worry too much". They don't seem to care that I CARE about my progress.
I can't speak for all schools...just mine. If I could finish my coursework at another school I would by now.
I am doing an externship this summer because I feel I'll be in trouble post-graduate if I don't.

jjjoy, LPN · Jun 12, 2008

My program, at a reputable university, had many of the characteristics hopeful2009 lists. Our clinical instructors were available on the floor but they were usually busy making their way through passing meds with each student. I had two non-faculty CIs who the best CIs. One of them had us round on each other's patient's - a great way to get exposure to more patients and conditions! The other allowed us to practice IV cannulation on each other a couple of times - which technically wasn't allowed but she thought it ridiculous if we were to graduate without ever having tried it. She knew that staff nurses likely wouldn't agree with the school's official line that no one would think less of us as new grads for not having that skill down, much less never having ever tried it (along with all the other skills we only had the briefest of exposures to that we'd have 'no problem learning on the job' - along with learning to juggle more than two patients, hospital policies, MD interaction, etc - to take full responsibility after 8-12 weeks).

Our program had a low drop out rate (appx 10% in two years) but it was frustrating to discover that unlike I'd expected, nursing school DIDN'T give up much opportunity to become competent, if just on a basic level, practitioners. It simply gave us an introduction to several different areas of nursing, the most basic of skills (we were introduced to A LOT of skills, but graduated competent in only the most basic - like oral med administration, and basic assessment - which given two years of coursework felt a bit lacking) and a license to start learning clinical nursing as a new grad.

Plagueis · Jun 12, 2008

I am quite mystified by nursing students that work full time, have many family obligations and expect to make great grades! Med students and Law students check out of society while they are in school, why don't nursing students? We have critical information to learn! We stay with the patients and must be able to assess quickly at times.

SarasotaRN2B made great points in her post about why it's not always possible for nursing students to just stop working for the duration of their nursing program. :) As someone who is about to start LPN school next month, I realize that I would love to not work and devote myself entirely to studying. However, I am nearly 40, and I don't have any parents/grandparents or other family members around who I can move in with, rent free. I also don't have a husband or significant other to help pay the bills during school. Plus, I have a daughter to support.

Therefore, not working is not an option. Rent and utilities still have to be paid, nursing school or not. My situation is very common among second-career and other students who are not recent high school graduates. Also, I know plenty of nurses who worked, and worked full-time, during their nursing studies, and still managed to get great grades, and do a great job as a nurse. While not working during school is a nice ideal, it is not impossible for someone to work and do well in nursing school at the same time.

MikeTexas82 · Jun 12, 2008

I have completed one year in the ADN program. I am one of 13/60 students still treking along. It is a much tougher program than I expected. We were told that only the top 5% of applicants were accepted into the program. These are students with GPA's of 3.5 and higher with most prereqs for typical BSN programs completed also. I quit working and took out a loan so I could give all of my time to the nursing program... at 26 and living independently, this was tough to do. It has been well worth the sacrifice thus far.

I believe there to be several reasons for such a high attrition rate: 1. Its challenging physically and mentally, as it should be, and some people are not cut out for nursing; 2. Nursing programs appear to be more concerned with their own appearance... They want only the top students and usually the top students pass NCLEX which makes the SON look great; 3. Nursing programs need to be more supportive of their students, we have all worked hard to get in, and the work only gets harder... so let's be more supportive of eachother and help pump out nurses to ease the shortage!

Nursing is a great professional career. When I tell people about nursing, I don't lie and only tell them its great. I tell them its hard work getting into a nursing program and even harder making it through the program. I firmly believe that when nursing programs incorporate more support of their students and worry less of their appearance, some miraculous changes may occur.

jjjoy, LPN · Jun 12, 2008

Only 13 out of 60 remaining? Yikes! Do you truly believe that those who are gone couldn't succeed as nurses? Were you suprised by those who didn't make it? Or was it pretty clear that the incoming class wasn't prepared enought? Do you think that the reasons students dropped or were failed were valid? Do you think more would've done better if applicants had been screened better or if entry requirements were changed? Do you think more would've done better if the school had been more supportive of the students who were struggling or if the program were structured differently? Do you feel that what you've have tested through on so far reflects the students' abilities and comprehension of the training/coursework to date? Just curious!!

MikeTexas82 · Jun 12, 2008

do you truly believe that those who are gone couldn't succeed as nurses? many of the students that did not make it through a block have reapplied. i believe that most who are going through and have reapplied will be successful as nurses. were you suprised by those who didn't make it? i was surprised at some who didn't make it because i had seen them studying and had gone through clinicals with them. many, not all, knew the material very well. or was it pretty clear that the incoming class wasn't prepared enought? i believe so, though i don't fully understand what you mean by "prepared enough." do you think that the reasons students dropped or were failed were valid? a 75 is passing, and those who didn't make a 75 were dropped out, so it was valid by the rules of the program. do you think more would've done better if applicants had been screened better or if entry requirements were changed? i don't like to answer with a question, but what do you mean by screening better? the requirements are fair and standard to the nursing schools in the houston area. do you think more would've done better if the school had been more supportive of the students who were struggling or if the program were structured differently? absolutely! when i feel support from the educators around me, i want to do better and strive to do better. its very comforting psychologically to know that the nursing school professors have your back and are not trying to fail you out. do you feel that what you've have tested through on so far reflects the students' abilities and comprehension of the training/coursework to date? for the most part, yes. the tests are of the educators discretion. the nclex is cut and dry.

please let me know your thoughts on this also.

venturan · Jun 12, 2008

I agree with what Hopefull2009 has posted. I found that many of my teachers (a state university program) were not that adept at teaching and their class consisted of repeating what their powerpoint slides said. I have received as answers to questions that I asked, "Because I said so." Not exactly a good response to expand my knowledge.

In many cases there is an emphasis on having practicing RN's, with at least a masters, teach lecture classes. I would prefer a educator to teach the classes, you know, the kind that knows how to teach.

I also know of several instructors at community colleges that brag about how many students they have failed!

Vikingkitten · Jun 18, 2008

:twocents:OK, Nursing educators, here's my story in nursing school and why some students drop out of nursing school.

I was able to attend a hard-to-get-into Nursing school in the middle of the country; 300+ applicants for 44 slots. There were, 4 men, 3 "minorities", the rest "real nursing students" (not my quote). During the first week of classes, several of the "instructors" informed us "7" (see above), that there was no place for us in Nursing, especially us men. Also, "we" weren't going to graduate from "their" program!

My backround: I was an Army trained nurse, getting my degree so as to advance my career/ go to graduate school /etc. I had, by this time in my life, been in combat and real world medical service all over the world. I was a youngish, but Senior Army Medical NCO, teaching Combat Medics and Paramedics for the Army. Not exactly a neophyte, was I?

I won't bore you with all the gory details (it would take a book) but what followed was probably the most miserable time in my life. I do, however, love a chalenge, and NO ONE was going to run me out of school! I did end up on Prozac for a short time the summer before the final semester.

If it hadn't been for the exams, I'm not too sure I would have graduated, as every subjective practical/ project/ assignment was graded far lower than my "real" classmates. Example: Psych project. To present our pt's S&S, Prognosis, Meds, Treatments etc. in a 5 min. presentation, with a short 5 min. Q&A from the other 3 students on the rotation. Well, my presentation was done without looking at my material (my clssmates, not being used to teaching, were reading from their notes the whole time), the instructor was asking questions that had nothing to do with my patient's condition,( and my classmates were giving some wrong answers ), and it went well over 20 min. anyway. At the end of the day, my scores were the lowest in our group. This from the instructor that spent a whole 5 min. with me and my partner during the semester, and 4 of them were with her.

Shall I go on? The State Nursing Assoc. had an annual meeting we were supposed to attend. As it was in the next city over from me, I was able to spend lots of time there, yet two of the "instructors" I met there and had conversations with tried to have me counted down because "they didn't see me there".No, really don't feel like going on any more. The entire time I was there went just like that.Just so you know, I did graduate in the top 1/3 of the class, and passed the NCLEX first time without much trouble. I was the only one of the "7" that did graduate from that program. There was another program in town, and everyone that left the program I was in graduated from that other one! HMMMMMM.... Needless to say, I've never donated even one dime to that school, nor will I ever. Did I mention, one of my nemesis is now the Dean?

A few years after graduation, after coming home from the Gulf War, I happened to meet the former Dean, and told her the whole story. Well, she did ask me about it. She was very surprised ! Thought I (we 7) should have told her about it back then. Really? Let's think about it for a minute. She would have gone to the "instructors" involved, and of course, they would have confessed all, Right? Then, they would have mended their ways and ammended my scores from all those years back, Right? Sure! It would have gotten much worse after that, and I told the former Dean so, and she knew it!

So, Nurse Educators, that's my story. Thanks for listening.

"and now, for something completely different"