Crash Course?! Thoughts on RN education

Nurses General Nursing

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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!

i was alwasy told it is so we "know where to go to look things up IF we should ever need it - makes sense to me - what doesnt make sense to me is back then we had GOOD orientations - months of being followed as an intern and months more followed as a grad nurse- nowadays these nurses get thier license in a few days and they get a day or 2 ( if that in a nursing home often it isnt even that) of orientation and are expected to perform and those of us who would love to mentor them are so overloaded it is almaost impossible. just my opinion.

Certainly, it's good to know where to look things up when needed. But one needn't "read" the bulk of a 1000-page pediatric critical care nursing book or orthopedic nursing text to know that they are good references if you end up working with that type of patient. And that one book will only be a good reference for a year or so and then you've got to find an updated reference anyway. So you need to know where to find the info if you DON'T have a whole slew of recently purchased nursing text books.

It's really quite a conundrum. As nursing education offers less on-the-job-type experience, new grad nurses are needed & expected to start "pulling their own weight" within just a few weeks. Eight to twelve weeks is the average in hospitals, though more and more places are offering extended training periods because there is such a gap between school and practice. As noted, LTC facilities often only offer a few days of orientation to new grads.

The thing is that it isn't at all clear what a new grad should graduate being able to do & know. Should they be able to start IVs? My school didn't teach it. Should they be able to recognize the normal dosages of certain meds? If so, which meds exactly? The rest, they will have to look up to check on... and new employers and colleages should expect that and that it will take more time to pass meds (and that it takes more than one or two days to be able to quickly recognize what's a right or wrong dosage). The list goes on and on of what a new nurse might or might not be expected to know or be able to do in an efficient, timely manner right out of school. And it seems that many don't agree on it, given what a hard time many experienced nurses give to new grads about what they should already know or be able to do and given the short amount of time employers expect new grads to be able to be scheduled as just another "FTE" on that shift.

Certainly, it's good to know where to look things up when needed. But one needn't "read" the bulk of a 1000-page pediatric critical care nursing book or orthopedic nursing text to know that they are good references if you end up working with that type of patient. And that one book will only be a good reference for a year or so and then you've got to find an updated reference anyway. So you need to know where to find the info if you DON'T have a whole slew of recently purchased nursing text books.

It's really quite a conundrum. As nursing education offers less on-the-job-type experience, new grad nurses are needed & expected to start "pulling their own weight" within just a few weeks. Eight to twelve weeks is the average in hospitals, though more and more places are offering extended training periods because there is such a gap between school and practice. As noted, LTC facilities often only offer a few days of orientation to new grads.

The thing is that it isn't at all clear what a new grad should graduate being able to do & know. Should they be able to start IVs? My school didn't teach it. Should they be able to recognize the normal dosages of certain meds? If so, which meds exactly? The rest, they will have to look up to check on... and new employers and colleages should expect that and that it will take more time to pass meds (and that it takes more than one or two days to be able to quickly recognize what's a right or wrong dosage). The list goes on and on of what a new nurse might or might not be expected to know or be able to do in an efficient, timely manner right out of school. And it seems that many don't agree on it, given what a hard time many experienced nurses give to new grads about what they should already know or be able to do and given the short amount of time employers expect new grads to be able to be scheduled as just another "FTE" on that shift.

i agree its not clear what is expected though i think to much is expected of a new grad - at least in LTC - i have seen many a good compassionate insecure new grad just quit due to the lack of training they are given and its sad. heck- i have had trouble getting ivs in since i have had to start them again - i didnt need to for a long time - i need practice- it will come back - but like you pinted out they get the gist of it sorta in school and thats it - then they get yelled at by many cause they arent able to do it??? i have had my share of "talks" with older experienced horrible nurses who treat these new grads like crap. its just sad to me for them.

Specializes in Cardiac Care, ICU.

Sometimes it is not just a matter of knowing where to look something up or even what to look up, sometimes its a matter of knowing that you need to look something up! I agree that our nursing programs need to give students more bedside experience but there is no way you can experience everything before you graduate. I can read about a dozen or more pts in a shifts time but I can only take care of 2-3 in ICU. Granted, I don't remember everything I read, but I don't remember every pt. I've had either. Over the course of my life I've had thousands of meals but I only remember a handful of the very good or the very bad ones. In spite of that they provided me with the nutrition I needed. Similarly, I don't remember all the info I've been exposed to over the years but it has all nourished my mind and , I believe, made me a better nurse.

Specializes in oncology, surgical stepdown, ACLS & OCN.
Certainly, it's good to know where to look things up when needed. But one needn't "read" the bulk of a 1000-page pediatric critical care nursing book or orthopedic nursing text to know that they are good references if you end up working with that type of patient. And that one book will only be a good reference for a year or so and then you've got to find an updated reference anyway. So you need to know where to find the info if you DON'T have a whole slew of recently purchased nursing text books.

It's really quite a conundrum. As nursing education offers less on-the-job-type experience, new grad nurses are needed & expected to start "pulling their own weight" within just a few weeks. Eight to twelve weeks is the average in hospitals, though more and more places are offering extended training periods because there is such a gap between school and practice. As noted, LTC facilities often only offer a few days of orientation to new grads.

The thing is that it isn't at all clear what a new grad should graduate being able to do & know. Should they be able to start IVs? My school didn't teach it. Should they be able to recognize the normal dosages of certain meds? If so, which meds exactly? The rest, they will have to look up to check on... and new employers and colleages should expect that and that it will take more time to pass meds (and that it takes more than one or two days to be able to quickly recognize what's a right or wrong dosage). The list goes on and on of what a new nurse might or might not be expected to know or be able to do in an efficient, timely manner right out of school. And it seems that many don't agree on it, given what a hard time many experienced nurses give to new grads about what they should already know or be able to do and given the short amount of time employers expect new grads to be able to be scheduled as just another "FTE" on that shift.

17 years ago as a new grad I only had 6 weeks orientation and then I was on my own,Today our new grads get 6 months orientation before they are on their own.

I think new grads are pampered more today than years ago.

scooterRN52

Specializes in oncology, surgical stepdown, ACLS & OCN.

I also was not taught how to start IV's I learneds that on the floor as I was putting my organizaational

skills together. You had to be good or else your career ended. Today it is fake it until you make it!

That is quite scary!!!!!

scooterRN52

Specializes in Cardiac Care, ICU.
I also was not taught how to start IV's I learneds that on the floor as I was putting my organizaational

skills together. You had to be good or else your career ended. Today it is fake it until you make it!

That is quite scary!!!!!

scooterRN52

I'm not sure where you work but they need to upgrade their philosophy on orientation. New employees to our ICU have a structured orientation program and they don't move to the next stage until they and their preceptor are comfortable with their abilities in the current stage. It can range from about 6 weeks for an experienced employee to a few months for a new grad or a new to critical care employee. It is a new program and not all the kinks are worked out yet but it gives employees a chance to get comfortable w/ their job before being all on their own.

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