To me, nursing school often felt like a series of crash courses, one in each specialty area. Dozens of disease processes and conditions were covered each lecture, with no time for questions, discussion or digestion.
I can understand the motivation to try to cover so much. RNs currently are hired for nursing jobs as varied as those in NICU, CCU, L&D, invasive procedures, OR, LTC, and more in addition to the stereotypical bedside med/surg nursing position. But is it possible that there's just currently too much material to cover to be adequately prepared for all the potential roles an RN may be asked to fill?
Why have every nursing student cover 1000 pages of L&D nursing (or ICU nursing, pediatric nursing, etc) when most of them will never work L&D (or fill-in-the-blank)? It's great to introduce the students to the broad spectrum of nursing possibilities in case they want to pursue them, but reviewing a 1000-page book of it is a bit of overkill for an "introduction."
And why not focus on symptom assessment and management as opposed structuring nursing texts around 1000 different diseases and conditions? Why have every nursing student study retinal detachment, cervical traction, laryngeal cancer, hydronephrosis....? Cover the biggies such as diabetes, CHF, stroke, etc... and leave the rest for specialty training that's perhaps post-registration. So after one gets their RN, they can take specialty coursework, such as orthopedics, neuro, oncology etc. And it wouldn't take longer because RN training would be much shorter if all students didn't have to cover all specialties as extensively as they do now. And if a nurse wanted to switch specialties, they could take a cram course in just that one area, which would be useful for both the nurse and the employer.
I understand that both nurses and hospitals have benefitted from nursese being able to float between units, but the reality is that after years working in one area, most will forget what they learned about those other areas anyway. As it is, there aren't too many formal ways for a nurse to bone up on their skills and knowledge when changing to a different area. Yes, self-study is important! But for safety reasons, is it really enough to only count on a nurse's training from years prior and their own self assessment of their preparedness to start into a new area?
It seems as if the schools (and BON that set minimum requirements) want nurses to be able to say to just about anything they come across "I studied that in school!" That's a great ideal, but to me, reading 1-2 pages out of thousands of pages of reading doesn't count for much. Having the name of this or that disease sound familiar and having some idea of what body system it affects doesn't really help me take care of a patient. I'll still have to go and look up the condition because I won't remember the details. Meanwhile, because we had to cover so much material in class, we didn't have time to ask questions or discuss things in lecture. We didn't address real world nursing situations - like how we might deal with 6 or more acute care patients or how we might deal with 20+ LTC patients.
Just thoughts! I'm sure there are those who see things differently and have had different experiences. I'm curious to hear any responses!
Specializes in Community Health, Med-Surg, Home Health.
Well that's scary to hear that some clinicals were cancelled. What did they have a dentist appt or something? Our program has clinicals QWEEKEND BETWEEN 3 SITES,then also 2 days during the week closer at the end of the program.
Does the NCLEX focus more on theory then or do they have random equal amounts of questions on clinical application? Just curious.
Thanks.
I find it hard to say what NCLEX is for people since each exam is individualized. I did not have any skill oriented questions on my exam, thank goodness, but, I did have CD ROMS to watch and remembered the labs just in case. Didn't matter for me anyway, because most of my NCLEX questions focused on neuro and digestive disorders as well as infection control and co-horting. I leaned on theory and good guessing for those.
Specializes in Spinal Cord injuries, Emergency+EMS.
the problem is, your license is generic. You are able to practice any field of nursing. That is good in that you may change directions of your career without having to return to school, as they do in some countries. But the drawback is there is SO MUCH to learn. That is why I personally advocate BSN as entry level to RN. No flames please. It is my opinion, not a demand.
this is one of the reasons why the EU and some parts of Aus have different registrations for different branches
in the Uk we have 4 nursing Branches pre-reg (adult, child, mental health, learning disabilities) specialist community and public health nurses as post basic registration (generally adult nurses by first registration ) and midwifery as a seperate profession by regulated by the same regulator
the dutch and some ofthe scandinavian countres have sort of nurse anaesthetists and Nurse advanced practitioner Ambulance providers as post basic registrations
the EU requires 2300 hours of practical placement experience for first registration
in our third (final year) we were expected to be able to manage a decent patient load with minimal support ( often we were placed on 28- 30 bed units which were genrally staffed with 3 RNs on days and 2 at night ( plus 2or 3 HCA on days and 1 at night ) and would generally take responsbility for 6 or 7 patients OR ended up looking after the level1 critical care patient(s) (level 1 = needs more nursing input for not sick enough for High dependency - 2 = single system organ support, NIV, or really really high levels of nursing input, 3 = intensive care invasive vent and/or multi system organ support)
I agree there is a great deal of information poured into the nursing student and very few opportunity for return demonstration in the clinical site, however, the information is given the way it is so that the practitioner is prepared to begin developing critical thinking skills. No you may not care for patients with each of the conditions you covered in class but you have a starting point for narrowing the signs and symptoms to get to a clearer differential dx. For those just starting out, you will always need to refer back to the "manual" patients are different and present with the same diseases with different presentations. Our education (initial) is just to prepare us to begin our practice, to certify, after NCLEX that we are competent to recognize general patient presentations related to groups of conditions.
It is true, the more you think you know, the more you realize how little you really know.
I am a new grad and I feel like more time should be spent on patho-physiology, anatomy, and pharmacology. My program focused too much on things like "caring", "leadership", "reflection" - not enough practical stuff
I am close to surgery resident and whenever I discuss things with him, he always looks at me like I have two heads and came from a different planet.
I also thought that I walked away with too little skills and too much information. I didn't have much clinical time in school, maybe one or two days a week, and most of the time, it was not for the entire shift. I was very nervous to work in med-surg because of that.
But can't that be said about physicians, we well? I don't know too many physicians who are able to do brain surgery the day after they walk out of medical school. The same can be said for PTs, OTs, pharmacists, who all go to school alot longer than nursess, and who all have to do an internship, and in some cases, a residency.
They all make more money than nurses, and have alot more respect and prestige in the community. And they accomplish this with out being able to "hit the ground running", the day after graduation. Maybe the ability to "hit the ground running", is not as important as nurses make it out to be, and is more a defense mechanism to make up for our educational shortcomings. Is anyone connecting the dots?
I am of the opinion that the trend toward extended orientations/preceptorships/nurse residencies/whatever label you wish to use should absolutely continue. Instead of focusing on how much can be crammed into basic nursing education and whether or not it's "enough", why not recognize the reality that clinical practice is developed over time? No one would dream of turning an intern who passed the medical licensing exam 6 weeks ago loose on 6 or more patients without supervision -- why is it exactly that this is expected of new nurses?
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I absolutely agree that a longer preceptorship and longer orientations can only help a new grad to be able to apply the knowledge s/he learned in school to specific patients.
Notice also that we don't allow interns to practice on any patient w/o sufficient education, much of which was not in his/her choosen speciality.
I agree there is a great deal of information poured into the nursing student and very few opportunity for return demonstration in the clinical site, however, the information is given the way it is so that the practitioner is prepared to begin developing critical thinking skills. No you may not care for patients with each of the conditions you covered in class but you have a starting point for narrowing the signs and symptoms to get to a clearer differential dx. For those just starting out, you will always need to refer back to the "manual" patients are different and present with the same diseases with different presentations. Our education (initial) is just to prepare us to begin our practice, to certify, after NCLEX that we are competent to recognize general patient presentations related to groups of conditions.
It is true, the more you think you know, the more you realize how little you really know.
Skills are just physical movements learned after much practice. I can teach my 10 y/o to start and IV or change a dressing, and she already demonstrates time management skills when she decides to work a few lessons ahead in homeschool so she can have a day off. You are absolutely right when you say that the knowledge we gain in nsg school is to give us a starting point to decide what we need to do about very subtle changes in our pts. In other words, knowledge is the path to critical thinking.
I am a new grad and I feel like more time should be spent on patho-physiology, anatomy, and pharmacology. My program focused too much on things like "caring", "leadership", "reflection" - not enough practical stuff
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Unfortunately, all education has become much to "touchy/feely". Someone, somewhere decided that if you just make people feel good about themselves and what they do thay can do anything. I hate to break it to them but it really isn't so. I am a really confident (bordering on arrogant) woman but I am no ballarina and I am no public school teacher because I am no good at these jobs. To quote on old commercial " If all it took were caring, anyone could be a nurse". It is not for everyone so teach people what it is. A science based, health care profession where you will have to think critically in order to ensure the continued health and recovery of your patients.
No you may not care for patients with each of the conditions you covered in class but you have a starting point for narrowing the signs and symptoms to get to a clearer differential dx....Our education (initial) is just to prepare us to begin our practice, to certify, after NCLEX that we are competent to recognize general patient presentations related to groups of conditions.
As nurses, we don't diagnose. Outside of the ED or patients who are in specifically because their condition needs special diagnostic procedures, most nurses' patients will already have diagnoses assigned by the MD. There are also certain common conditions that nurses should well-trained in such as COPD, diabetes, acute coronary syndrome, since so many patients will have these as comorbidities as well as primary conditions. I can see giving nursing students exposure to all of the wide assortment of conditions they may come across,... but I don't see that those would need to part of the core content to be mastered.
To be minimially functional, the nurses needs to recognize when something is wrong, what the nurse can do independently to address the situation and when they need to bring other health personnel to help with the situation. After time, nurses WILL be able to second-guess the MD if something new comes up, but fresh out of school, new nurses shouldn't be expected to have that ability, should they?
Also, there are certain telltale symptoms that nurses should be aware of such as that of appendicitis, MI, etc. But to minimally functional, it would seem that what's most important is that the nurse recognize when a patient is deterioriating (shortness of breath, cyanosis, decreased LOC, diaphoresis, etc) and to take appropriate measures (administer oxygen, pain medicine, encourage fluids, etc) and to contact other health personnel when necessary (the MD, RT, etc). There is also all of the ongoing nursing care that helps prevent complications and promotes patient comfort and well-being.
If the nurse has a good, basic understanding of physio, pathophys, pharmacology, etc, then all they need to do is look up the diagnosed condition and put the pieces together in terms of presenting symptoms, treatments being ordered, potential problems, etc. The *nursing* care for shortness of breath, postoperative pain, etc is the same no matter the etiology, though, of course, the medical treatment (eg administered meds) might be different. The nurse will assess, determine what nursing needs the patient has, plan and give that care and evaluate (ADPIE). The new nurse will need to frequently access reference materials and colleagues' feedback in this process until their experience is such that they can quickly and automatically run through that process, mentally checking that the prescribed meds are appropriate, which complications are most likely, etc.
Yes, the nurse should understand the difference of the underlying conditions, and the nurse will - even without specific training in that condition in nursing school, because he/she will have a good grasp of pathophys and will use their training from nursing school to find out what they need to know to give good care for that condition.
I have watched over the years as nursing school has cut down on the actual education given to the students. Clinicals are a joke and even the readings and assignments are no where near what they used to be. It kills me that students today pick their own patients. And I have yet to see these students pick the patient that is high acuity or difficult to deal with. And then the students don't even want to bathe patients, change linens, etc. because they don't feel that this is a part of nursing. It really screws up the new grads when they find out that they have to do all the ADLS and the nursing work when there aren't any CNAs because the students didn't learn how to do it all when in school. Most of the students I work with only have 3-4 patients at the end of their last semester. How unrealistic is this? When I went to school, we ran the floor. The nurses sat at the station to oversee things and we called when we needed their help. But by the end of school, we were the nurses and we did it all.
In our litigious society, the faculty are afraid to allow students to due anything - since they are practicing under their license. I have had students freak because I told the instructor that I was going to take full responsibility for a student, documented this in the chart, and then took off with a student to allow them to do something other than empty a bedpan. It used to be that students were coming out of school unable to perform treatments because they didn't have enough clinical time or didn't have enough instructors. Now it is related to the instructors/schools being unwilling to allow the students to perform treatments for fear of lawsuit. Yet the nursing schools are unable to afford a well equipped nursing lab with lifelike "Annies" or volunteer humans for the students to practice on. When I went through school we had to practice on a dummy or each other before we were allowed to do it to a patient. I acutally put an NGT in myelf because there was no way I was going to let a student stick one up my nose. Talk about gross - gave me a way different perspective!
I also see a trend in students. More and more nursing students are coming to nursing because they need money. They think that because nursing pays women better than most other jobs (even though pay for what we do is crummy) they can go to school for a couple of years and make good money. They don't truly understand that nursing is REALLY hard work. It is not glamorous. It is almost completely thankless. So these people become lackadaisical and apathetic and perpetuate the many problems in nursing. These are the people who are unwilling to learn anything beyond nursing school unless they are forced to by the BON or their employer. They do not believe that they should have to spend their off time or their money to take a course to improve their knowledge base and skills. After all, they are unlikely to get a pay increase for it. And so the cycle continues.
I am also horrified at the NCLEX. I do not believe that having a few questions can truly assess a nurse's base of knowledge. I've spoken with new grads who told me that all their questions were management related. Another poster on here stated that their questions did not ask about procedure skills. This may be the easy and cheap way to have a test but it does not ensure that everyone starts with the knowledge necessary to perform basic nursing care. I know that having the 2 day, all day testing sucked and cost a lot of money compared to the computer NCLEX. But it also ensured that EVERYONE was asked questions about all areas. Thus helping to keep the patients safe.
I don't think changing schools to be "specialty" oriented is appropriate. In a course of a career, you will use a little bit of every specialty, even if it is not the main specialty you are working in. And Med-Surg is a specialty unto itself. Med-Surg also makes up the majority of care needed by patients and employs the majority of nurses in this country. If students merely studied a specialty, what's to say that they would actually work in that specialty? And if they changed specialties? How would there be any way to guarantee a basic level of knowledge to be able to practice. You can take and pass a home-study CE and never truly learn or remember what was in the course. And a hospital that is desperate for nurses will not necessarily insist that a nurse get the needed info. After all, hospitals have nurses working with little to no education simply because it is too expensive to give them the education/orientation that they need.
I don't think anyone truly feels like they learned anything in nursing school when they first got out. You are so overwhelmed by everything being new. But after a while, things start clicking and you figure out that you DO remember that weird disease and what med treats it and are glad that you missed partying with your friends so that you could read your weighty tomes.
Iwas one of those 2day all day testers and I agree it covered everything. This was for my LPN. It concerns me to read the posts and the nurses wanted more experience but could not get it.
I can't believe you put in an NG tube.......but then again I injected myself with collagen(after my certification) to get the practice.
No insult intended to diploma nurses. What I meant was they were designed to train you to be a bedside nurse and, while you may hve received great management, research, case management skills, etc. from your program that is not generally true. In addition, I think any nurse that works at the bedside long enough will pick up a lot of knowledge. There are great backyard mechanics who have been taught to work on cars by other backyard mechanics who can keep a car running that no-one thought had a prayer of cranking. Then there are mechanics who have received hours of special training and instruction on how to work on various engine parts and have been certified as experts. They both know how to work on a car but I know which one I want working on my porshe (If I had a Porshe that is).
That sounds stuck up and I don't mean it to, but I really do think that the more education a nurse has the better nurse s/he will be in the long run, even if they are a little clumsy w/ proceedures for a little while.
Your analogy doesn't really work here. So do you think diploma nurses are the "backyard mechanics"? Or the bsn nurses? The BSN students have the theory but not as much clinical are you saying that they will be the nurses are more likely to learn while just hanging around at the bedside like the backyard mechanics?
Here's a question- with your imaginary porshe- who do you want taking it apart? a person who has read about it in a book- but hasn't actually worked on a car ?
My education was 20 months long- with BOTH lots of clinical and theory , compared to a bsn of 24 months, with much much less clinical. I didn't just hang out at the beside and learn from other backyard mechanic nurses. I am not sure you understand what most ADN, or diploma programs are about. You do realize we actually go to school and it isn't just on the job training.
Shellsincanada - I appreciate your wanting to address the issue of BSN and ADN/diploma training. There are many other threads dedicated specifically to that issue, so I hope we can keep this thread on RN education in general.
I have watched over the years as nursing school has cut down on the actual education given to the students. Clinicals are a joke and even the readings and assignments are no where near what they used to be. It kills me that students today pick their own patients. And I have yet to see these students pick the patient that is high acuity or difficult to deal with. And then the students don't even want to bathe patients, change linens, etc. because they don't feel that this is a part of nursing. It really screws up the new grads when they find out that they have to do all the ADLS and the nursing work when there aren't any CNAs because the students didn't learn how to do it all when in school. Most of the students I work with only have 3-4 patients at the end of their last semester. How unrealistic is this? When I went to school, we ran the floor. The nurses sat at the station to oversee things and we called when we needed their help. But by the end of school, we were the nurses and we did it all.
In our litigious society, the faculty are afraid to allow students to due anything - since they are practicing under their license ...
... I don't think anyone truly feels like they learned anything in nursing school when they first got out. You are so overwhelmed by everything being new. But after a while, things start clicking and you figure out that you DO remember that weird disease and what med treats it and are glad that you missed partying with your friends so that you could read your weighty tomes.
Great post -- However, I can tell you, as a nurse educator, that it is the hospitals serving as clinical sites that refuse to allow students to do invasive procedures because of liability concerns, not the schools and clinical instructors. Faculty in the programs in which I've taught have been extremely frustrated by how little the hospitals would allow our students to do, and it's v. challenging to find ways to make up for the lack of "real" clinical experience. They're doing amazing things with latex these days :), but we all know that practicing skills on the lab simulators will never replace real life experience on live human beings. My area is psych, and the (several) psych units I've been on as clinical instructor won't even allow students to give meds. Too risky for the hospital ...
pagandeva2000, LPN
7,984 Posts
I find it hard to say what NCLEX is for people since each exam is individualized. I did not have any skill oriented questions on my exam, thank goodness, but, I did have CD ROMS to watch and remembered the labs just in case. Didn't matter for me anyway, because most of my NCLEX questions focused on neuro and digestive disorders as well as infection control and co-horting. I leaned on theory and good guessing for those.