Crash Course?! Thoughts on RN education

[jjjoy]

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!

[nanacarol]

References are always our ally. No matter what level we are on the reference drawer is to be accessed. nanacarol

[nanacarol]

The lack in the education of nursing is a result of the nursing education system. A system where many of the instructors are novices themselves and have a mandate to move students as quickly as possible through the system so the professional impartation is missing. Nursing administrators are correct, we graduate nursing student who simply demonstrated the can pass the NCLEX. These are not real nurses they are task performers. They are not professionals they are license holders. I don't wish to offend anyone, but the truth is the truth. nanacarol

[kellyskitties]

OK, first I got to get this off my chest. Most of the fields of nursing you listed are bedside nurses. Unless you are in community health, home health, legal nurse consultant, doctor's office etc you ARE a bedside nurse. I believe in med surg and I don't think we are "stereotypical."

Now, that being said, on my med surg floor when things are bad nurses float. We get psych nurses, OB nurses, ICU nurses etc. They come to us to help out and we go to their departments to help them out. We usually baby them when they come our way so they will want to come back. But they need a little knowledge about the other floors even if it's just to recognize what's going on around them so they can be more helpful.

Second, on med-surg I have had overflow from every other floor. I have taken care of a miscarrying OB patient that was passing a fetal demise. I have had psych patients on suicide watch that are waiting on a bed in psych. I have had a patient waiting to transfer to ICU who we started ICU meds on to save their life even though they were not in ICU. Diabetics may also be pregnant or schizophrenic. Pregnant women may have gall bladder disease or could fracture their leg. No floor is exclusive. We see it all everywhere eventually.

Thirdly, I have come to believe the broad spectrum of education given to nursing students gets them into uncomfortable zones and makes them reason. Even if you never again have to locate a fundus (and I can say I have had to since we have had a fetal demise patient a few times to care for) you had to learn the process. Get out of your comfort zone.

Stick to it. It's worth it. In the end you'll see you needed more knowledge. Unless you manage to land a private duty job with a kid with one oddly uncomplicated disease and that job holds you until retirement - the broader spectrum will serve you best.

[jjjoy, LPN]

You make a good point about nursing school forcing students to work in areas that they wouldn't choose to since they might end up with patients (either through floating or overflow from another unit) that they don't usually care for on their unit.

My issue is that with only 2 years to cover all nursing content (one year for accelerated programs!) is it really possible to adequately cover all that is required?

Yes, nursing school graduates do manage somehow but so many struggle the first year out and who knows how many give up. I don't expect the transition from student to professional to be seamless or easy. I just wonder if perhaps there are other effective ways to approach to teaching nursing.

At a bare minimum, what does a new nurse need to be able to do? I would think it would be recognize symptoms of distress and emergent crises, to know when to call for help and what interventions the nurse should implement in such situations.

Outside of emergencies, nurses also need to be able to recognize and document any deviations from normal (in other words, assessment skills). They need to learn how to take care of various symptoms, whether through independent action or by doctor's order. They need to learn how to prioritize the importance and severity of different symptoms (can it wait an hour? should the doctor be contacted? etc)

Nurses administer meds, carry out invasive procedures and work with open wounds, so they need training in safe medication administration and sterile and clean technique.

Nurses are at the front-line of prevention and control of complications - so they need to know about skin breakdown, pressure sores, thromboembolism, infection, and the like. Preventive measures, early symptoms, treatments.

Since nurses are responsible for basic personal care as well they also need training in feeding, toileting, and bathing patients with functional limitations.

Finally, the nurse needs a basic foundation in human physiology, pathophysiology, pharmacology, and human development. With that, the nurse can turn to any reference (colleagues, books, P&P manuals, etc) and get the information needed to take care of just about any patient, whether or not the particular condition in question was studied in school.

[Cecileno1]

I agree with everything you've said about nursing education. I was surprised that someone other than myself found nursing education to be a crash course. I thought this was only something that happened in my country (in the Caribbean) where we do four years work in three years and at the end of each year you feel as though you do not know enough about anything you have done that year. At the end of the course you wonder if you know enough to actually manage a patient and you are almost afraid to give care. Something needs to be done to restructure these courses because like you, I see no reason to try to learn everything one time especially diseases that you may never come in contact with or are very rare.

[doe9181]

I think it would be a great idea to make it mandatory for students to particpate in an externship or internship. My school always notified us of possible opportunities that were available but not everyone wanted to do it. I never had the opportunity because I had to take a summer class to catch up on my prerequisites. I was also afraid to quit my very flexible job as a pharmacy tech. I could work as little as 4 hours in a day if I wanted. If an externship was mandatory then I would of had no choice and I would of probably benefited a bit more from that experience. I know my classmated that took advantage of the opportunity had a bit more knowledge than the rest of us and a better idea what areas they were interested in. I strongly encourage any students out there reading this to take advantage of any externship/internship programs that are offered to you. Even if you don't get paid, the knowledge and experience alone are valuable. I wish I had. I don't think my role transition class at the end was long enough to teach me half the things I needed to know. When I first strated I felt like a deer in headlights at times.:uhoh21:

[ShelNewGrad]

Hi there!

I got my BSN from a local university and feel that nursing school taught us the basics of patient/nursing care. I was told 2/3rds of what you learned is on the job and that is so true. I think that's true about most jobs.

You know there is no subsititute for experience! I would have liked to have a class in troubleshooting (for RNs) because there are so many things you encounter on the job that dont have clear-cut answers.

I hope the nursing shortage will get better though.

I appreciate all nurses; we all work so hard.

Shel (not a new grad anymore)

[fronkey bean]

Sorry I am so long in getting back to you, my email server is blocking allnurses

First you say a new nurse should be able to recognize subtle changes and then you note that it's not uncommon to find that such signs were not recognized by experienced nurses you work with.

Yes, ideally all new grads would be well-prepared... but they aren't. Just like there are practicing nurses who don't seem to make the grade. The question is whether those who show deficits have had their chance and shouldn't be nurses there or if they just need additional education and training. You probably don't treat newbies poorly, but too many experienced nurses give newbies a hard time for not being able to "hit the ground running" and to know things right off the cuff - which, given the way many programs are run these days, isn't a realistic expectation.

But is giving them less information the answer? Experienced nurses who miss obvious signs were probably poorly taught themselves and thay would appear to be less than the most helpful resources to a new nurse w/ questions. That new nurse better have as much info as possible to draw on b/c her coworkers may not always know the answer.

You make a good point about nursing school forcing students to work in areas that they wouldn't choose to since they might end up with patients (either through floating or overflow from another unit) that they don't usually care for on their unit.

My issue is that with only 2 years to cover all nursing content (one year for accelerated programs!) is it really possible to adequately cover all that is required?

I agree. I think all programs should be 4 years w/ clinicals starting from the first semester.

[Ausculapius]

The lack in the education of nursing is a result of the nursing education system. A system where many of the instructors are novices themselves and have a mandate to move students as quickly as possible through the system so the professional impartation is missing. Nursing administrators are correct, we graduate nursing student who simply demonstrated the can pass the NCLEX. These are not real nurses they are task performers. They are not professionals they are license holders. I don't wish to offend anyone, but the truth is the truth. nanacarol

As someone who will be graduating soon, I completely agree with this. I've been told by several people that "nursing school only teaches the basics" or "All you will learn is how to not kill a patient" and I've found this to be true. Yet the standards and practices from school to school vary so much that some will feel more prepared than others on graduation. This is evidenced by the daily threads on whether or not new grads should work in the ICU or ED.

Imagine graduating from graduating from law school and being told you couldn't practice civil rights law unless you practiced family law first. Preposterous right?

I understand nursing school cannot teach everything, but there needs to be not only improvement on "real" skills and clinical time, but greater uniformity among programs to ensure everyone graduates with roughly the same skill level.

[lindarn]

You always have a lot of questions about the status qo and I like that about you. I almost never agree with your conclusions, but nevertheless I really appreciate someone who looks at a situation and questions the value of a certain way of doing things and wonders if there is a better way of doing it.

Now as to this particular post, I can appreciate where you are coming from but here's the thing: I have rarely taken care of a patient who only had diabetes or only had cancer or only had a fractured femur. While you may specialize in one area, you will likely take care of people who have two or disease processes and it is important that you have had at least exposure to the concepts of other diseases.

If you really want to know in-depth about oncology, for instance then you learn the basics of nursing and then you specialize in practice. But you WILL be exposed to other disease processes, even in your specialty.

Your nursing education is meant to prepare you for the basics; entry-level. Unless we return to a situation in which nurses lived and worked in the hospital during their training, there is no remedy for your feeling a lack of preparation for the real world of nursing. It's get exposed to the basics and pick up the rest as you go. I think it's the right way to go about it.

By the way, most students feel to some extent as you do. Have you ever heard the phrase "the more you know, the more you realize what you don't know"? It's true.

This is all the more reason that nursing needs to abandon the ADN and Diploma nursing programs, and go to a BSN as entry into practice. A one year mandatory internship would follow, and thus bring us toe to toe, with other health care professionals.

There is not enough time in the two year programs, and not enough clinical time in the BSN programs, to adequately prepare student nurses to be effectiveley work in the "real" work of nursing.

Years ago, PT, OT and even MDs, abandon the need to teach everything students needed to know to be able to work effectely after school. They sacrificed technical skills for the class room and book knowledge, to present a more "professional", image, and compentant image. This has translated into higher pay, and prestige for these career fields.

We continue to propagate our blue collar, "technical image", rather than our "professional", image to the public, and our employers with our two year, "hit the ground running", education. Think outside the box, folks.

Lindarn, RN, BSN, CCRN

Spokane, Washington

[elkpark]

Imagine graduating from graduating from law school and being told you couldn't practice civil rights law unless you practiced family law first. Preposterous right?

Maybe your example is "preposterous," but I can easily imagine someone graduating from law school and being told that s/he can't try a capital murder case until s/he has gotten some basic criminal trial experience ... That might be a better analogy -- I don't see anything wrong with requiring people to gain some basic, general nursing knowledge, skills, and competence before moving into the "higher stakes" areas of nursing.

[Ausculapius]

Maybe your example is "preposterous," but I can easily imagine someone graduating from law school and being told that s/he can't try a capital murder case until s/he has gotten some basic criminal trial experience ... That might be a better analogy -- I don't see anything wrong with requiring people to gain some basic, general nursing knowledge, skills, and competence before moving into the "higher stakes" areas of nursing.

Except it's not just the "higher stakes" areas where med surg experience is needed or recommended.

Public health nurse? Nope, need med surg.

Psych? Med surg.

Uh.. Home Health? Again, med surg first.

etc. etc.

My point is, if med surg experience after graduation is recommended by so many to strengthen skills, then clearly something is a bit off with the nursing education programs in this country.