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| No. 20 | 
May 09, 2004, 11:52 AM
Updated
May 09, 2004 at 12:45 PM by Susy K
Originally Posted by RNPATL It is unacceptable for a 4 year BSN to come out of school having never catheterized a patient or having never dealt with a central line dressing change. These are basic skills that need to be taught and developed through school. Sure, it is fine for BSN's to have well rounded management theory, but lets get down to the basics and make sure these people have some reasonable survival skills for clinical practice.
Ahh, and the debate begins. 
I'll probably get myself in trouble, but here goes.
I personally believe that those monkey skills (Yes. Monkey skills) are better learned on real patients in the actual setting. Cathing a manniquin only has so many benefits. And cathing of real patients depends on many, many things. You can have the best rotation in the world, but if you happen to have a patient who doesn't need to be cathed, or, cathed only ONCE, well, then you're poop outta luck.
Looking back, I would be completely disappointed if my BSN program had focused on these things which I either a) picked up and learned in 4 months on the floor - after doing it day after day after day after day after day or b) never ended up using. Example: I never placed an NG tube in school and nor have I ever placed one in my professional life.
Secondly, forget the new grads for a moment and let's think about experienced nurses. Let's say you have an L&D nurse of 15 years. She has a wealth of knowledge, no? Suppose she desires a change and decides to work in adult ICU or even a general medical floor. Would she not need to be trained again on how to do dressing changes, caths, NGs, etc even with her 15 years of professional RN experience? But what stays with her and is useful across any specialty? Her "BSN" education: the theory, the research, the management, etc classes that *typically* BSN programs "focus" on.
Many times I hear Med/Surg nurses state that Med/Surg is actually a specialty within itself. If that's the case, why do we expect nursing schools who's aim is to produce generalist nurses to produce specialists?
 | | Advertisement Sponsored Links | | | | No. 21 |
May 09, 2004, 01:12 PM
Can I get a big "Amen!" for the fact that med surg is a specialty? 
I suppose that's another thing that is changing in nursing... Hopefully we will one day recognize that med-surg is not the foundation of nursing anymore. It is one area, no more or less important than any other area. And the skills used there are no more or less important than the skills used in any other area. I've never put an NG in on an adult either, but it doesn't make me less of a nurse. I do know the theory behind putting one in and I could do it if I had to.... but sick adults are icky, so don't worry, none of you adult nurses will ever have to orient me to med-surg  | | No. 22 |
May 09, 2004, 02:05 PM
I'm not getting into the generational debate. Seems like in every generation it's "kids these days, when I was younger............" apples and oranges. There is a lot of benefit that comes with years, we had to learn our wisdom while our parents were saying "kids these days".
There is so much to learn in school nowadays, so much theory, so much pathology, a&p, etc. that I agree if one comes out not knowing how to do a skill then teach to them. We had a large clinical group and it was a struggle to find ten patients during a rotation that needed dressing changes, catheterizations, etc. I managed to get through school not having changed a central line on a live person.....horrors.
I think in the old days it nursing school might have been more clinical oriented.
I agree with Fergus that things have changed. Patients are sicker. This generation is producing awesome nurses with awesome work ethics but are being thrown into sweatshop hospitals with unsafe staffing and without proper orientation.
I remember posting a post many months ago about how our hospital takes RN graduates and uses them as secretaries and most of the replies I got were "what's the problem with that".
| | No. 23 |
May 09, 2004, 08:01 PM
 It's time for change! Originally Posted by 3rdShiftGuy This generation is producing awesome nurses with awesome work ethics but are being thrown into sweatshop hospitals with unsafe staffing and without proper orientation.
I could not have said it better myself Tweety .... however, I don't believe we can pin the entire problems of new graduates soley on the hospital. I do believe that the educational system also needs to take their share of responsibility. It is time for change within our profession. It is time that curriculum be modified and written to reflect the reality of our profession. It is also time for our professional organizations to get off their butts and start working on legislation that protects our young nurses and MANDATES safe staffing ratios as well as residency programs so new nurses can have a decent transition into practice.
There are a lot of lumps to go around, the hospitals, education and the professional associations all share equally in my opinion. As experienced nurses, I guess we share in this as well, in that we MUST stand together and demand safer conditions for our patients, new nurses and for ourselves. I hope this happens in my life time and if it does, I will be on the front line of this change!
| | No. 24 |
May 09, 2004, 08:13 PM
Originally Posted by Susy K Ahh, and the debate begins.
Looking back, I would be completely disappointed if my BSN program had focused on these things which I either a) picked up and learned in 4 months on the floor - after doing it day after day after day after day after day or b) never ended up using. Example: I never placed an NG tube in school and nor have I ever placed one in my professional life.
Many times I hear Med/Surg nurses state that Med/Surg is actually a specialty within itself. If that's the case, why do we expect nursing schools who's aim is to produce generalist nurses to produce specialists?
I think my point is more directed at that lack of clinical preparation many nurses have today. Having taught many a new nurse, I can attest to the fact that there are many things these new nurses either do not understand or have never been exposed too. This places a large burden on the hospital and on the nursing staff to have to pick up where the schools left off and train these new nurses.
I guess it takes me back to the point that we have discussed earlier, where nurses should be afforded a residency program. Perhaps this is the answer. At risk of repeating myself - please read my response to Tweety.
| | No. 25 |
May 10, 2004, 02:47 PM
Originally Posted by RNPATL I could not have said it better myself Tweety .... however, I don't believe we can pin the entire problems of new graduates soley on the hospital. I do believe that the educational system also needs to take their share of responsibility. It is time for change within our profession. It is time that curriculum be modified and written to reflect the reality of our profession. It is also time for our professional organizations to get off their butts and start working on legislation that protects our young nurses and MANDATES safe staffing ratios as well as residency programs so new nurses can have a decent transition into practice.
There are a lot of lumps to go around, the hospitals, education and the professional associations all share equally in my opinion. As experienced nurses, I guess we share in this as well, in that we MUST stand together and demand safer conditions for our patients, new nurses and for ourselves. I hope this happens in my life time and if it does, I will be on the front line of this change!
True there are a lot of lumps to do around. I think the expectation that colleges should sent out fully functioning nurses with unrealistic. Or even if we learn something in school, and do it in clinical, doesn't make us proficient when we hit the floor. I had to start dozens of IVs before I felt comfortable and confident. We should allow new nurses that and give them orientation and exposure and re-exposure to things.
But to say that this generation doesn't have the same work ethic isn't true in my experience. Sure there are plenty of lazy new grads coming from nurses school, and they make the majority of bright eyed ready to learn and work new grads look bad. But when I look around me at work, the laziest one with no work ethic is in her 50s. I'm not going to judge an entire generation based on a few of lazy baby boomers I see. Nor an entire class of new grads either. | | No. 26 |
May 11, 2004, 11:24 AM
Pt care outcomes Originally Posted by fergus51 I wonder if we can ever really compare patient outcomes relating to nursing care in different eras? I don't know if patient care from nurses resulted in better outcomes then or not.
With all the advances in meds, equipment, procedures it would be just about impossible, if at all possible to decide if pt care outcome is better now. When I got out of school, meds were in a cabinet in the medication room. We took however many we needed from a bottle of a couple hundred or so and put the rest back on the shelf. We used medication cards to pull the meds and pass them out. The advances in just this one area frees up time, reduces error and makes for less stressed nurses. Pt care outcomes would have to have improved and that wouldn't have anything to do with education.
Better nursing care always results in better pt outcomes.
| | No. 27 |
May 11, 2004, 05:00 PM
Originally Posted by 3rdShiftGuy But to say that this generation doesn't have the same work ethic isn't true in my experience. Sure there are plenty of lazy new grads coming from nurses school, and they make the majority of bright eyed ready to learn and work new grads look bad. But when I look around me at work, the laziest one with no work ethic is in her 50s. I'm not going to judge an entire generation based on a few of lazy baby boomers I see. Nor an entire class of new grads either.
I have found this generation of nursing students and new nurses to be amazing. We just finished with a class of senior nursing students on our floor and they were terrific. Yes, there were 2 that really did not seem to have a clue about what they were doing in nursing, but all of them were motivated, bright and really worked hard during this clinical rotation. Like you, I refuse to judge a whole generation of people because of a few lazy, unmotivated people.
| | No. 28 |
May 12, 2004, 01:15 PM
Updated
May 12, 2004 at 05:22 PM by mattsmom81
Originally Posted by 3rdShiftGuy
I think in the old days it nursing school might have been more clinical oriented.
I remember posting a post many months ago about how our hospital takes RN graduates and uses them as secretaries and most of the replies I got were "what's the problem with that".
Yes Tweety, 30 yrs ago I attended my diploma program and I was actually a competent new RN upon graduation. Teamleading was a rotation for me as well. Not that I knew everything upon graduation,, but I knew how to function and what my role as a nurse was...also knew about 'real world' nursing because it was actually (gasp) part of my training. I COULD and DID 'hit the ground running' at graduation.
Those who value classroom over practical see no problem with nurses graduating who never started an IV or placed a NG tube, but these tasks are part of our job and I personally think its sad some BSN proponents call these 'monkey skills' and devalue those who are competent in these areas. Some think its OK to graduate and THEN go to the job and expect the practicing staff to do what the school should have done...train and prepare them to do the real work.
I think its sad that new grads would be used as secretaries because that is all the practical use they are. Something is wrong with an educational system that graduates nurses like this, IMO. Personally I don't have time to teach and supervise new grads who have such extreme deficits. Do you??
| | No. 29 |
May 12, 2004, 06:39 PM
I posted this on another thread, but I'll post it here too:
Getting on my soapbox...
As nurses in the workplace, when you see a student or new grad who is lacking knowledge, please help them to learn AND think about writing to/speaking with the school that they attend(ed). How are nursing programs going to improve unless you let them know where their weaknesses are?
Getting off my soapbox now...
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