A time to reform nursing education?

[nyteshade]

After reading some very interesting posts around here lately in regards to "fluff" being taught in nursing school, I wonder if it is time to reform nursing education.

I feel we could do without the nursing diagnosis. I understand they can help a student group and rank interventions for a disease process (dare I say that?), but there are better ways to help a student understand this concept. I am not against throwing out holistic nursing practices, but we really could do without the fluff. Why is it that many new grads can't "put it together" Maybe, because fluff doesn't cross over into real-world nursing practice?

I realize that nursing schools are geared towards passing the NCLEX, and that will never change. People in the nursing adovacy groups want nursing to be a profession, no problem with that, but our hands-on skills are being "outsourced" by RTs, techs, therapists, etc. We are "losing" our skills. Nursing students are graduating and have never even put in a foley. What's happening?

I'd like to know what experienced nurses, novices, instructors and new grads feel should be included, or tossed out of the nursing curriculum. Who knows, maybe reform will come?

[nursel56]

I wish there were more opportunities for externships for students. That was BY FAR the best preparation for real-world nursing and being on my own as an RN. I was ready to go out on my own 2 months after graduation, in a specialty unit that usually requires 3-6 months of training (even for experienced nurses). I credit my year of externship as a student, as well as an exemplary preceptor.

Spending at least 1 month with a truly exemplary preceptor would be the gold standard, I think. All the nursing diagnoses and the theory classes are supposed to have as their ultimate result a nurse who integrates them into what she actually does as a working RN as well as her skill in the nuts and bolts of procedures, time management, delegating, etc.

The person who was my mentor had been in nursing for many years before Watson and NANDA and yet I can't think of a person who better displayed the concepts on the written page in real life. Seeing the potential for growth in a really good preceptor-new grad duo also highlights what a waste of time it is to have someone precepting who doesn't want to be. He or she may get the job done as a teacher of tasks but the opportunity to demonstrate in a real person the abstract concepts the student spent so many hours studying is an opportunity missed.

[evolvingrn, BSN, RN]

I think that nursing school should go to a one on one preceptor model. I didn't do traditional clinicals instead i was one on one with an Rn by the end of each of my clincals (except my first) i was expected to be taking on full pt loads with minimal support from my preceptor. I worked whatever their shifts were regardless if they were weekends, pms, nights ect....I felt very equipped to be on the floor because i was immersed into it. at our facility nursing students come for four hours, 7 hours ect... and they aren't there from start to finish and there are also so many students that they each only get one or two pts at most. No wonder its a struggle for some to make the jump. just my 2 cents

[whodatnurse]

I graduated from a highly regarded ABSN program with an extremely high NCLEX pass rate,

I did tons of papers, presentations, posters, and skits (that's right...skits.)

I am mad as hell and I am not alone.

[metal_m0nk, BSN, RN]

My ADN program started clinicals 3 weeks into the first semester - two hour blocks each week with 1:1 or 1:2 nurse, student ratio where we are expected to jump in and get our hands dirty, since we have a long list of clinical skills we must have signed off before we graduate and we only do a handful of them in the lab.

In 3 weeks, we will move on to full clinical days, twice per week, where we will be responsible (with oversight) for the care of one patient.

Next semester, when I begin mental health nursing, I will have three full clinical days each week.

They have wasted no time in getting us into a clinical setting.

[KateRN1]

When you stop thinking of nursing in terms of "what nurses do" and move into the realm of thinking of nursing in terms of "what nurses know" then you will get it.

I can teach anyone to insert an IV in less than an hour, however it takes much longer to teach the rationale for the IV, what size angiocath to use, when a central or PICC line might be a better choice than a peripheral, the choice of IV fluids, how to gauge the effectiveness of the intervention, when to discontinue the IV and/or fluids, when/how to question the physician's order, and a million other things that go through a nurse's mind with the order to intiate an IV with maintenance fluids. That is the difference between what nurses do and what nurses know.

[SnowStar4]

I graduated from a highly regarded ABSN program with an extremely high NCLEX pass rate,

I did tons of papers, presentations, posters, and skits (that's right...skits.)

I am mad as hell and I am not alone.

I thought my school was the only crazy one! I graduate in two weeks and one of my final projects includes a book report and a skit about the book. Yeah, that's going to make me a better nurse...

[JeanettePNP, MSN, RN, NP]

I'm going to get my BSN right away, but I don't see much point in my having to take statistics and other fluff classes that truly don't affect how I'm going to provide care to my patients.

Bottom line, I would support much more hands on skills in the school setting, and less fluff that ultimately doesn't matter, just costs me more money.

I do NOT consider Statistics a fluff class by any means. It is an essential foundation course if you want to be able to read and understand ANY research study, let alone participate in one yourself.

[LAM2010, BSN]

I agree that a lot of classes seem like fluff. But they're fluff in other BSN degrees, too. You do need more skills as a nurse - I think in general my fellow BSN grads didn't feel like they were prepared to go out and practice our skills, but once in a job, you get to practice them. I never put a foley in in college, but now I do it on a daily basis, almost (although all my patients are asleep when I do it [O.R.], I am still rushed by the surgeon). There was one time there was a problem with the foley, and I knew all the implications and what to check and what to watch for afterwards, etc. I put tons of IVs in in college, now I pretty much never put them in but I am always helping my CRNA assess and monitor them after insertion. I think in a few months' time, BSN nurses catch up to the skills-only trained nurses and then it's smooth sailing from there.

Anyway...my point is, what college degree doesn't include a lot of fluff?

(p.s. I got a BS degree because, along with being an RN, I wanted a 4-year degree, something I'd had as a goal since I was 18 and couldn't figure out what to do with myself. Now I'm 38 and have my BS(N)).

[singingtothewheat]

There has not been any time in my practice (many years worth) where I have ever seen nursing diagnosis used in any way, shape or form, like it was in nursing school. I never really got the point of it but we got it pounded into us and I can still do one, correctly at any point it time. Just no real reason too.

[JaneyW]

I teach nursing and I really try to use the NANDAs as a way to shape my student's thought process. It creates a plan for the patient and helps them use evidence-based interventions to help their patients. I tell them that without a plan of care, you can spend your whole nursing career passing meds and filling water pitchers and reacting to events but you will not be helping your patient get better. It is a process that gets internalized as you move through school so that when we graduate, I think we don't even realize we are still doing it.

In CA, it is part of our BRN practice codes that we use the nursing process to plan care for our patients. It is the law, plain and simple, and part of our duty as licensed nurses. Does that mean we write care plans (other than the hospital check off forms)? No, but we go through that thought process. We assess, diagnose, plan, implement, and evaluate. We critically think our way through our patient's care. Nursing school isn't the best time in the world, but I know my program prepares our students well.

[metal_m0nk, BSN, RN]

When you stop thinking of nursing in terms of "what nurses do" and move into the realm of thinking of nursing in terms of "what nurses know" then you will get it.

I can teach anyone to insert an IV in less than an hour, however it takes much longer to teach the rationale for the IV, what size angiocath to use, when a central or PICC line might be a better choice than a peripheral, the choice of IV fluids, how to gauge the effectiveness of the intervention, when to discontinue the IV and/or fluids, when/how to question the physician's order, and a million other things that go through a nurse's mind with the order to intiate an IV with maintenance fluids. That is the difference between what nurses do and what nurses know.

It is my understanding that most nursing programs (two year programs included and especially) stress rationale and critical thinking, which covers the majority of your examples. Some of it is intuition, which comes most effectively and solidly from clinical experience - not from books.

You can't get common sense out of a book.

[suanna]

AMEN!

I have said for years all the fluff with Nursing Dx. and Theory is fine as long as you are setting the priority of first and foremost providing a solid understanding of the skills and responsibilities inherent to the job of nursing. Graduating a class of "professional" nurses with a deep understanding of the relative merits of "relationship based care model" vs "evidence based practice" vs "team focused care"... is a waste of time and a disservice to the patients if thay can't provide basic bedside care in an accurate and efficient manner. I am amazed how many new grads have never attempted an I.V. start, taken off a doctors order, placed a Salem Sump, evaluated a rhythm strip but have completed the full gauntlet of what passes for nursing education today. I know new grad LPNs that can provide more complete (and safe) care with a 12mos practical skills education than many of the 5 year BSNs that are comming out of two local Colleges of Nursing. You don't have to be an "expert" care provider to be an effective RN, but I think new grads would have a much easier time finding a job if the degree they earned taught them the skills required to do the job at al least a basic level without 12mos of remedial education provided (for pay) by the hospitals that are hireing them.