Are Student Nurses Prepared for "Real Life?'

kmoonshine, RN · Jul 7, 2008

I think that nursing school poorly prepares students to enter the workforce. The problem lies with the nursing instructor shortage and lack of facilities for clinicals. To accomodate more students in nursing programs, schools have become "creative" at finding clinical sites. Whether it be at a free clinic where one IM injection would be given monthly, to the elementary schools where vision screening and health promotion is the extent of the "hands on" care; there's not alot of room to practice skills in those types of settings. Personally speaking, I had 1 of 4 semesters in the hospital setting; not realistic preparation for entering the workforce, where hospital jobs are the easiest for a new grad to get.

What's also scary is there is typically 1 clinical instructor for 8 nursing students. The clinical instructor oversees the care that these students provide but students don't get the individual attention they need. For example, lets say that the staff on a med surg unit have 1 nurse for 5 patients; a clinical instructor has 8 students, who are all providing care for 2 patients each (or 16 patients total). Thats a great amount of responsibility and not a lot of 1:1 attention can be spared. No "tips" can be given how to improve prioritizing since there is limited 1:1 interaction.

Now, schools can only do their best with what they have; but the "good" schools are pushing critical thinking. What this student should have been thinking after drawing up 5 ml of insulin was "I can't inject this volume subcutaneously...oh wait, this isn't right". Or, they should be thinking "this is a high-alert med, so I am going to have this verified by another RN". Its these "catches" that many schools are incorporating into their programs to best prepare students, since resources are scarce and clinical space is limited.

But there's nothing that says that staff nurses can't teach these students also. I personally believe that we have a professional duty to share our knowledge with each other. If you see a student, offer them some tips. Don't just correct them, but help them think a problem through so they can learn how to handle situations in the future. If I would have seen a student drawing up 5ml of insulin, I wouldn't have corrected them right away; I would have questioned the student, such as "how are we giving this", "what size needle do we need", "whats the max volume we can inject into subcutaneous tissue", and so on. It's that "a-ha" moment that I enjoy the most! I personally feel that it promotes a better learning experience. When someone immediately corrects me, I feel "stupid"; but if I have one of those "a-ha" moments, I feel like I solved a problem and that knowledge is cemented into my brain. Its much harder to learn under anxiety and embarassment (its as if those peripheral blinders come up, and all you can see is what's right in front of you and you get "tunnel vision").

premedturnednursing · Jul 7, 2008

as I like to put it....(when we graduate next summer) we'll know just enough to be dangerous....

which scares the crap outta me!

MikeyJ, RN · Jul 7, 2008

Now, schools can only do their best with what they have; but the "good" schools are pushing critical thinking. What this student should have been thinking after drawing up 5 ml of insulin was "I can't inject this volume subcutaneously...oh wait, this isn't right". Or, they should be thinking "this is a high-alert med, so I am going to have this verified by another RN". Its these "catches" that many schools are incorporating into their programs to best prepare students, since resources are scarce and clinical space is limited.

Exactly what my BSN program does -- it focuses very very heavily on critical thinking and gives us the knowledge to think our way through a situation.

There are many hospitals around the country that have done away with hiring ADN nurses for this reason (I have nothing against ADN nurses) but it is a known fact that ADN programs focus very heavily on skills and less on the theory and critical thinking.

leslie :-D · Jul 7, 2008

There are many hospitals around the country that have done away with hiring ADN nurses for this reason (I have nothing against ADN nurses) but it is a known fact that ADN programs focus very heavily on skills and less on the theory and critical thinking.

wow....

i never heard that.

since it's a 'fact', have any sources to back this up?

leslie

MikeyJ, RN · Jul 7, 2008

wow....
i never heard that.
since it's a 'fact', have any sources to back this up?
leslie

Compare an newgrad ADN with a newgrad BSN nurse -- the ADN can run circles around the BSN nurse in terms of clinical skills. There are some BSN programs that try to integrate more clinicals but I have never met a nurse that has attended one.

There are students in my BSN program who have never put in a foley, an NG, or an IV and we are scheduled to graduate in a month. Nearly every ADN nurse I have encountered has put in numerous of all the above throughout their program.

RN1982 · Jul 7, 2008

There are a lot of downfalls of some ADN programs focusing so much on clinicals and very little on the theory.

There wasn't "very little" theory involved in my program. In fact, there was quite a bit. My ADN program used Dorothea Orem's nursing theory. My care plans were six pages long. There was no skimping on theory but I valued the clinical experience the most. I'm not going to refer to Orem's theory when my patient is crashing and burning. I don't even use it. Critical thinking, learned about that in my program but as far as that is concerned you need experience to learn how to critically think. Learned about the nursing process. In the real world, you don't often using any of the theories you are taught in school. What are your sources as far as hospitals not wanting to hire ADNs because the hospitals where I live hire ADNs all the time.

MikeyJ, RN · Jul 7, 2008

There wasn't "very little" theory involved in my program. In fact, there was quite a bit. My ADN program used Dorothea Orem's nursing theory. My care plans were six pages long. There was no skimping on theory but I valued the clinical experience the most. I'm not going to refer to Orem's theory when my patient is crashing and burning. I don't even use it.

Theory is the wrong word -- I have actually not studied a single nursing theory in my entire BSN program.

And I said SOME ADN programs -- not all.

There is obviously a difference between ADN and BSN programs -- neither is better over the other but there is a difference.

leslie :-D · Jul 7, 2008

What are your sources as far as hospitals not wanting to hire ADNs because the hospitals where I live hire ADNs all the time.

i'd like to see sources for both comments.

mikey, you can't profess your assertions as fact, and not have backup.

leslie

RN1982 · Jul 7, 2008

Theory is the wrong word -- I have actually not studied a single nursing theory in my entire BSN program.
And I said SOME ADN programs -- not all.
There is obviously a difference between ADN and BSN programs -- neither is better over the other but there is a difference.

Well, I was a bit put off by your statements. When I first read them, it seems to me that you think ADNs are ill-prepared for work after graduation.

RN1982 · Jul 7, 2008

So what do ADN programs lack that BSN programs have? Explain that to me.

MikeyJ, RN · Jul 7, 2008

Well, I was a bit put off by your statements. When I first read them, it seemed to me that you think ADNs are ill-prepared for work after graduation.

Oh goodness no -- absolutely not.

I don't think either is better -- if you have passed the boards, then you are an RN in my eyes. I was just trying to make the point that there are differences between an ADN and BSN programs. One difference I can attest to -- BSN programs make their students take some ridiculous classes that are useless to their practice.

leslie :-D · Jul 7, 2008

obviously there's a difference between adn and bsn:

just by virtue of 2 add'l yrs of schooling.

leslie