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| |  Why such a gap between theory & practice?
Hello,
I hesitate to write here, because every time I voice my true feelings, someone tells me I am negative. I don't mean to be so. I just want to improve our practice, and sometimes it hurts me.
Does anyone know who is actually writing the standardized tests for our entry level nurses to gain entry into this profession? Not to be critical or harsh, but I took the HESI for the specialty I am teaching. I need to add that I have practiced in that specialty for 21 plus years. While some of the questions were appropriate, many focused on arbitrary issues that nurses may never run across, but neglected to focus on the most common complications of various disorders/treatments that they should definitely know to be competent in that field. In fact some of the questions took the focus off what should be the priority and onto non-priority issues. Also, while i understand these standardized test need to focus on the nursing process, sometimes the actual approprriate or needed information gets forgotten in the "process".
I find myself struggling to teach what they need to know for good practice, and what they need to know to pass a standardized test.
Why aren't practicing nurses writing these entry level tests? There are plenty of us with the required education that still practice....
Does it requie a doctorate to write the tests? If so, that is wrong, because, while I know lots of Master's prepared nurses who still work the bedside, I honestly do not know of any doctorate nurses working and practicing at the bedside....
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| | Advertisement Sponsored Links | | | | No. 1 | 
Oct 08, 2009, 11:24 AM
Re: Why such a gap between theory & practice?
I have PhD in nursing, and I practice in a Trauma ICU. I agree fully that standardized tests, esp. NCLEX, focus on minutiae, not the important issues in nursing. I have heard that NCLEX item writers are primarily MS-prepared educators from community colleges. So please do not blame us PhD-prepared faculty for the poor quality of the items. I guess the solution is for those of us who are dissatisfied with the items to get ourselves on the item writing committees to improve the quality of the exams from within.
| | No. 2 |
Oct 08, 2009, 11:59 AM
Re: Why such a gap between theory & practice?
Tereasq,
My apologies for implying it was the fault of doctorate prepared nurses. I guess I am just wondering if it is practicing nurses that write these tests. Actually, perhaps it isn't even so much just the tests, but the fact that standardized testing is the way we assess competence... I don't think it is a very good measure of competence. I wish there was a better way. I recently worked with a nurse who went to nursing school in Australia, and she said that the nursing board actually came to the clinical settings regularly and assessed practice and knowledge of the students in the clinical setting. Students were required to answer questions about the care of their patients, as well as be observed giving the care. What a phenomenal idea!
| | No. 3 |
Oct 08, 2009, 12:58 PM
Re: Why such a gap between theory & practice? Originally Posted by dorimar  Tereasq,
Students were required to answer questions about the care of their patients, as well as be observed giving the care. What a phenomenal idea!
Don't the faculty members in your school do that before they graduate students and certify them eligible to take the NCLEX? The US system is based on the assumption (which is not always upheld) that the individual school faculty assess teh students' ability to practice safely at the bedside -- by supervising their student clinical experiences, asking questions, requiring that the students meet clinical practice standards before they pass the course. If students don't meet those standards, they the instructor is supposed to FAIL them. Does your school not do that? If that's the case, then you are teaching for a school that is not doing it's job. The NCLEX is designed to measure other things -- while the school faculty are supposed to be assessing bedside abilities.
Some states are increasing their required clinical hours for RN graduates before giving licenses -- because more and more schools are failing to uphold their end of the evaluation process. As schools scrimp on clinicals and provide more "observational" or "simulation" than "direct hands-on care" time, people are growing concerned about the lack of the type of evaluation you speak of. A student cannot be adequately assessed with written assignments and simulations alone. It's the job of the school (and faculty) to do the bedside teaching and the bedside evaluation. Too many schools are straying from that -- and that is dangerous for our profession and dangerous for our society.
The NCLEX is properly seen as only 1 piece of an evaluation process. It should not be seen as standing alone in the evalutaion of the student's readiness for professional practice.
Just my $.02
| | No. 5 |
Oct 08, 2009, 03:18 PM
Re: Why such a gap between theory & practice?
I believe that this disparity between actual practice and nursing theory is pervasive not only in exams, but in the nursing profession as a whole. I agree with the poster that stated that the PhD nurses who drive the theory and make the guidelines for the profession are very, very far removed from the realities of bedside care within a medical setting. These "leaders" and policy-makers are oblivious to the "what is" of the profession, and concern themselves only with the "what could be in a perfect world."
Nurses at the bedside should step up and try to overthrow these ivory tower scholars, but unfortunately, most of us are exhausted, disenfranchised, cynical and overworked, and therefore unwilling to put forth more effort without guaranteed results. I guess it's a viscious circle and I don't know the solution.
JMHO,
Jami
| | No. 6 |
Oct 08, 2009, 03:42 PM
Re: Why such a gap between theory & practice? Originally Posted by Jami RN I believe that this disparity between actual practice and nursing theory is pervasive not only in exams, but in the nursing profession as a whole. I agree with the poster that stated that the PhD nurses who drive the theory and make the guidelines for the profession are very, very far removed from the realities of bedside care within a medical setting. These "leaders" and policy-makers are oblivious to the "what is" of the profession, and concern themselves only with the "what could be in a perfect world."
Nurses at the bedside should step up and try to overthrow these ivory tower scholars, but unfortunately, most of us are exhausted, disenfranchised, cynical and overworked, and therefore unwilling to put forth more effort without guaranteed results. I guess it's a viscious circle and I don't know the solution.
JMHO,
Jami
I disagree. It's not a case of "good guys vs bad guys" etc. It's wrong to think that one side of the theory/practice split is 100% wrong and the other is 100% right. That kind of thinking is part of the problem and not part of the solution.
Just as those in "ivy-covered halls" need to come out and look around once in a while ... those at the point of patient care need to acknowledge the need for the further development of the scholarly, academic side of our profession. Both types of knowledge are needed to maximize nursing's potential. We need scholarly activities to provide the research/knowledge to provide good care -- and that type of knowledge development requires scholarly theories that might not be directly relevant to the bedside care-giver. Bedside care-givers need to realize that they are only one part of the profession -- and that the other segments of the professional ALSO contribute things of value.
To need to work together and recognize the value of all segments of the profession in order to bridge the theory-practice gap. We can all learn from each other. Throwing stones at each other is not the answer.
| | No. 9 |
Oct 08, 2009, 05:20 PM
Re: Why such a gap between theory & practice?
My school does assess practice in clinical, as does every nursing school in my region. However many of the new nurses I have worked with over the past several years seem to be lacking in critical thinking, practical knowledge, and skill. This is why I chose to go into education. I thought I could really help. However, the clinical time is very limited. I do take advantage of my didactic time in trying to bring the theory home to the students with real applicable examples. But again, I was hit in the face with this standardized testing, that I feel often does not test some of the most important things. I found myself having to spend most of my time preparing students for these standardized tests and not reality.... I know I am not explaining myself well.
None of the didactic instructors where I teach currently practice at the bedside, and some have not for many years. I think it is important to maintain clinical knowledge and skill when teaching. However, it is near impossible with the hours expected for nursing instructors. It is unfortunate. My friend who is a phenomenal critical care nurse, recently started doing clinicals. She told me that some students were discussing something for a test, and she told them they did not need to know that. I teach critical care, and I told her that yes they do need to know it. She was shocked. She stated that she would like to spend more time in the didactic realm just to know what the students are required to know for these standardized tests. Really it would be nice if the clinical instructors could have more experience with theory instruction, and the didactic teachers could have more clinical experience...
I realize this is not really possible. I have never put in so many hours as I have in teaching. I had no opportunity to work the bedside at all (except for clinicals, and it is not the same). I killed myself trying to make sure I taught what was needed for a standardized test, but also what was needed for good practice. I do feel I made a difference, but it wasn't worth what it did to me or my family.
So, I don't know what the answer is. I just think we are way off the mark.
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