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?

[metal_m0nk, BSN, RN]

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.

Meh...all you really need to know are three things:

1. What a bell curve looks like, what it means, and that it will explain the great majority of observed phenomena.

2. What "standard deviation" is.

3. That statistics are are highly malleable, able to be manipulated to support just about any set of data.

Unless you plan to be a statistician, the rest is probably fluff.

[elprup, BSN, RN]

Sorry I did not read all the posts. Being a new (now old) grad still looking for that coveted RN position I have a few things that I have noticed.

For one, having my BSN almost seems to be a disadvantage these days. When I worked for a short time in a long term care center, the new grad LVN's ran circles around me! It was soo frustrating! I had all this schooling but no real "hands on" skills like they were taught day in and day out. Sure makes me feel super dumb, even now! Everybody seems to think that since one graduates with a BSN, they should know everything about everything, which just is not so. Nursing school only pumps out generic nurses. We need the added training to learn and grow our experience.

Secondly, new grads are supposed to hit the ground running and become an experienced nurse in a matter of weeks. But that is not what evidence based practice states occurs. It takes at least 1 year for a new grad to feel comfortable at any place. So why do everybody expect us to know it all when research states it takes a year? Just does not make sense to me.

Thanks for the vent.

[JeanettePNP, MSN, RN, NP]

Meh...all you really need to know are three things:

1. What a bell curve looks like, what it means, and that it will explain the great majority of observed phenomena.

2. What "standard deviation" is.

3. That statistics are are highly malleable, able to be manipulated to support just about any set of data.

Unless you plan to be a statistician, the rest is probably fluff.

It doesn't sound like you've ever read or analyzed many research papers.

[metal_m0nk, BSN, RN]

It doesn't sound like you've ever read or analyzed many research papers.

I have. Quite a few. And written and edited a few of my own. Even edited one for Eli Lily and Company during my first undergrad experience. It's published in Neurology. I'd be happy to email you the citation.

The experience has taught me how to cut through the bull ****.

I'll let you know when I run into a bedside nurse who uses advanced statistics in nursing practice on a daily basis.

Hint: Don't hold your breath.

[nyteshade, BSN]

I don't want to be misunderstood here, I am for more hands-on care, plus the theory on how, when, and why we do interventions. I am in no way suggesting just mindless tasks.

The nursing process is a wonderful tool to get students thinking like nurses. I don't think the education would suffer without nursing dx, and many common sense theories. It is possible to assess without sticking a generic nursing dx to it.

I just don't think it fits the criteria for a unique body of knowlege (I am expecting to get flamed for this one).

I just think we are going about it all wrong. Many of the nursing theories are common sense. Some are just far out.

I don't think stats is fluff, as it is useful for those that want to do research in nursing. Can't exactly knock that.

[nyteshade, BSN]

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.

I totally agree with you! My hospital puts all new grads in a 6 week hands-on lab/critical thinking class before they get started on the floor. I couldn't help but ask why?

[KneKno]

How about a new nursing school model? I'm not certain of the exact timing needed for each of the sections, but: 2 mos to CNA, 10 mos to LPN, 12 add'l mos to ADN, another 18-24 mos to BSN. At any point, the student could opt out to work at that level, or continue part or full time, or opt back in when ready. More "hand on" actual care at the beginning, more higher level skills at the RN level (you'd have more time for that, since the basic care of pts would already be well-known).

[sistasoul]

I agree. When I graduated I had never put in a foley, ng tube and had one complicated dressing change. We had to perform inserting a foley, dry dressing and an IM injection in lab as our skills check list in lab. There was not a skills check list in actual real life clinical that had to be met. Our check list in clinical consisted of doing the 13 functional health patterns on one patient through out the semester. These had to be done in detail. My God there seemed to be a million questions in each health pattern. In fact all of our checklists in all of our clinicals consisted of care plans and all different kinds of various paperwork. I remember two of them were about quality control and risk management. All of these check lists took so long in clinical that there was never time to deal with hands on care. We were all so worried about all of these "checklists" that we would waste valuable clinical time trying to get them all done. I had to ask Rns on the unit about their quality and risk management policies. Unbelievable. I have students with me now and I have never had one ask me the types of questions I had to ask the RNs I worked with. As an ADN student who gives a flying fig about this stuff at that point in time.

I remember another checkoff was to go out into the community to promote nursing. This took numerous hours to complete. The papers, presentations and poster boards were ridiculous. All of these things were included in Nursing 1, 2, 3, and 4. It was not like any of these were things that were done in the additional classes that are needed to get an associates in Nursing. I had already done all of the other courses and only had the Nursing courses left to take.

By Gosh I could make a killer poster board when I graduated but could not hang a piggy back IV or insert a foley on a real live person. I got hired at a hospital 18 months ago and received 3 weeks of on the floor training. Needless to say I cried almost daily that first year and I am still not comfortable with some tasks and still ask a lot of questions. Having one or 2 patients in clinical is a whole lot different than having 5 patients with admits, discharges, taking off orders, dealing with families, and the various departments with in the hospital. Nursing school does not prepare you at all for this. Or at least my program didn't. I think that the 2 year schools should have an extra added semester of even 6 weeks where you can precept with a nurse 1:1.

Forgive me for the length of this post. I still get upset over this. When you are a student you don't realize you are not being trained the right way until you graduate and get out in the real world.

[MisterSimba, BSN]

I could discuss this subject for hours! I just feel like so much time in nursing school was spent on care plans, care maps, papers, group projects, and PowerPoints, as well as preparing for the NCLEX. I was so scared of taking the NCLEX, and then I finished in a little over an hour with 75 questions! Why are schools teaching to the NCLEX instead of teaching us how to be nurses?

Also, why are nursing school classes watered down so much? I feel like I sailed through classes that should have been really challenging, like Pharmacology, Pathophysiology, and Critical Care. Wait, I know why! My physiology professor expected us to eat, sleep, and breathe physiology for the entire semester...and I'm eternally grateful to her for that! Her class made all of the nursing school classes easier than any high school class I ever took. Why is that?

Like someone else said, I learned the most in clinicals, so I wish I could have had a much longer preceptorship as well as an externship in pediatrics, which is what I want to go into. Instead, all of us got stuck in med-surg for our preceptorship.

Finally, if most nursing schools don't actually prepare students to be independent, competent, and safe nurses, these programs need some drastic changes, and/or hospitals need to offer extensive new grad residencies.

As nurses, we spend 8 to 12 hours with our patients. Doctors make rounds and spend a few minutes with the patient. We're on the front lines and responsible for people's lives. New doctors that are fresh out of med school all take part in extensive residencies. Why can't we get something similar? I'm obviously not asking for four years and 80+ hours a week, but even six months to a year would be amazing...

[Flying ICU RN]

If you really want to make a difference in nursing education, turn it into a pre-med eligible curriculum to give nurses the ability to transfer the basic science prerequisites for med school later if so desired.

[Fribblet]

Part of improving education would be higher standards for entry into a program, as well as culling the weak (both professionally and intellectually.)

In addition, the licensing exam should be more difficult with a cap placed on the number of times one can attempt it before remedial course work is necessary.

[lxpatterson]

I completely agree with you, Triquee. I also did research and medical writing in my first career and as I understand all the common statistical tests use some assumption of normality -even things like linear regression which don't superficially seem so. Tests more complex than that are usually only understood by the statistician consultants and not the investigators, regardless of whether they are MD, DDS, RN or whatever.

That said, I realize that some of my classmates (a minority) have absolutely no experience with stats. And so it goes.

I am in a 2nd entry (post Baccleaurate) accelerated BSN program and I find that there are two strains of instructors with differing agendas: hands-on clinical, and ivory tower activists. While the clinical instructors are trying to instill safe, effective and ethical clinical practice through their labs and classes, the ivory tower instructors are focused on (it seems to me) "promoting the profession" by changing the direction of the profession to become more like social work or psychology rather than something so plebian as a bedside clinical worker.

I am sure you can guess which profs we students respect more.