Failing the next Generation of grads

[Zhakrin]

Hi there,

After 5 years as a nursing student ( I failed a clinical and had to repeat a year) I am looking back at what was and what will be for the "caring" profession. What I have witnessed leaves me very concerned.

In the past nursing education was very practical. A nursing student was taught what to do in situations and what not to do. Indepenant thinking was a liablity and not encouraged as MDs were to be our brains. Currently we have expanded our profession to the degree level and are developing critical thinkers to be nursing leaders and promoting the concept that nursing has a distinct knowledge base to draw from that is invaluable to the holistic care of clients.

So far so good I believe.

While I wholeheartedly agree with this I am still concerned about the "student nurse experience" during their educational years.

Educators with the credential required by universities are hard to come by, thus creating a system were advance degree nurses are becoming eductors without the mindset or skills to be a positive influence on our professional young. Also many professors have PhD in area unrelated to nursing (another shortage issue).

This produces a system were nursing students are taught by very therothical educators that have conceivable spent as little time as possible at the bed-side. These individual are now responsiable with developing the programs that will produce the next generation of nurses, and many seem more concerned with imposing their acedemic values on their students that preparing them for entry into practice.

This bring me to an interesting question, should the education of entry level nursing be primarily practical or theorthical in nature. I believe in trying to produce so many nursing leaders we are harming the profession because many new grad have very lacking clinical skills as a result of the overly stress theorectical curiculum.

I feel that as a student we should have a curriculum that is very well founded in material that is relevent to entry-level nurses. Very few of the hundreds that graduate have any interest in becoming research nurses, DON, PhDs etc. So i feel that filling the 4 year currictum with these types of courses should be the responsibly of a Masters program not the BSN or ASN program.

Also because of these issues there is a notiable dissatisfaction many new grads have with their education and combine this with negative experiences with nurses on units or preceptors and it is not surprising that so many new nurses already have cynical ideas about nursing.

By the end of my first year most student stop advocating for themself as this made them targets by educators. By forth year most were willing to "anything" to just get out of the program.

anyone else have something to add?

Thank you all for reading.

[live4today, RN]

Amen, Mario! Amen fergus51! Amen dstoutrn! Bravo to the eloquent and passionate nurse thoughts presented by you all here! Hope your day is as bright as your "lightbulb moments" presented here!

[nursefire]

This thread is quite interesting. I am a member of the educational arm of nursing. I teach both theory and clinicals. I'm very new to this, however, I must say that in the short time I've been teaching, I have heard the words "lawsuit" and "lawyer" more than I ever did in 26 yrs of hospital nursing. These words are from students, especially those in danger of failing. Needless to say, I will probably retire before these students graduate.

[RNKitty]

Just as a personal opinion, if I had had more clinical time to practice nursing, my stress load would have been GREATLY reduced and I could have concentrated more confidently on the theory. As it was, my BSN program only offered 14 days a semester for 4 semesters. I would have done ANYTHING for an internship, or residency, or independent study program that would have given me more opportunity to learn hands on nursing under the guidance of an instructor. Those options were unavailable at the time, and my instructors waved away concerns by stating the skills can be learned later and the theory will take you farther. That didn't do much for my anxiety or self-confidence. Not to mention that upon graduation, no hospital in the state would hire new grads since they had been in layoffs for 3 years. I enjoyed my classes, but I would have even stayed for an extra semester to get the experience if it was available. Some people just need more time to grow up I suppose!

[fergus51]

So you only had 54 days of clinical when you graduated? That is RIDICULOUS!!! MY BSN had us in clinical a lot more than that!

[grouchy]

Fergus, your program does sound alot different than mine. Ours had clinical for 2 days a week for 4 semesters. We started our many of our clinical days having a conference with the instructor and other students, presenting what we had learned from textbooks about our patient's illness. By the time we got to the floor, the nurse assigned to that pt had already gotten report, assessed the pt, and maybe done meds, and was busy with her other pts. We would end up doing the bed baths, doing a med pass with the instructor, wasting alot of time, then doing long notes which the instructor read and critiqued before we left. We usually stayed about 7 hours, including lunch. Often, the floor RN assigned to the pt was too busy to teach us how to do skills. The instructor supervised EVERY student med pass, which ate up most of her time.

[kids]

I graduated from a 2 year ADN program that was actually 4 years by the time you did the 2 years of sciences (including 1 year each of chemistry and A & P) required before admission to the program. The entire 4 years was 15-18 credit hours per quarter.

For every hour of theory you got 2-4 hours of clinical, when you walked on the floor for clinical you were expected to know the patho/phys-and NOT just the stuff on the little pre printed cards...by the final 2 quarters we did an 8 hour day of theory and 4 (8) hour days on the floor a week-all med-surg...by the last 4 weeks of the final term you had to be able to carry 4 patients, on your own, with a precept to double check your meds...the instructor came by a couple of times a shift and checked documentation.

The class I graduated with placed #1 in the state on the boards, with every grad passing and all within the top 20% in the state.

I may not have known much about the 'psychological' aspects of Nursing but I could sure guess the blood gasses on a pink puffer based on their color, VS and O2 liter flow.

[Q.]

These are all very excellent posts.

I remember my days as I new grad; I graduated from a BSN program without every having started an IV on a real person. Some of my classmates did - they got a rotation to the GI lab and spent all day starting HUNDREDS of IVs. I have to say I liked the variety of clinicals that my school offered, but you weren't always lucky to get them. Frankly, there just weren't enough nursing instructors. And, as this original post stated, Masters prepared nurses who are prepared to teach, are also in short supply. The nursing shortage effects every aspect of nursing - not just the floors.

As far as clinical skills vs theory. Fergus is right; as a student you are obsessed with the skill-learning because this is what "defines" a nurse in mostly the public eyes, as well as some nurse's eyes too. But what we forget about, I think, is that nursing has been defined as an art and a science. The science piece has taken the forefront lately because health care in general has evolved to being highly technical; as a result, nursing had to become technical as well. But where is the best place to learn this? The floors. The hospital. Isn't it part of OUR obligation as working nurses to mentor and teach the new ones? Isn't that how Medical Education works? Perhaps if there wasn't such as shortage, teaching new grads wouldn't be seen as such a burden. Nowadays we are expecting new grads to be up and running, to fill the staffing holes, not really thinking about their needs of being mentored properly. It's a darn shame, and that's where I think we are failing our next generation: not in the schools, but on the floors.

There is way too much information about nursing that has to be crammed into 4 years. Even now, in my Master's program, there is information about nursing that I was never exposed to in the BSN program, simply because there wasn't enough time. The best place to learn about Watson, et al is in the classroom. The best place to learn skills are from experienced nurses on the floor. You can't learn Watson on the floor. You can't learn research on the floor; and when it's time you APPLY research, you are lost because you never had it before. Much of nursing can be automatic, and as time goes on, it becomes more automatic and if the basis of nursing was never laid in the classroom, we are simply robots - and nursing has then lost what makes in an art.

That is my opinion.

P.S. Having graduated school never starting an IV, I learned it on the floor and now am proficient in it. I learned it from a very skilled nurse on my OB floor. She certainly didn't teach me about nursing theory and research. But I feel I need BOTH to have the potential to be an excellent nurse. :)

[fergus51]

That's crazy grouchy. Our program had us on the floor two days a week during the regular semesteer (8 hour shifts where we did primary nursing for 2-5 clients and occasional team leading), but then we had consolidated practicum where we worked full time (36-48hours a week for 4-6 weeks during the summer) and another consolidated practicum in our final semester (we only had 2 weeks of classroom time that semester and it was all about skills and assessments and pathophys).

I COMPLETELY AGREE WITH SUZY!!! It is our job to help new grads. We tend to be very hard on them because they are easy targets and that has to stop. The funny thing is I was talking to my aunt who's a nurse and she said that older nurses were talking about the poor quality of new grads when she was in school too (and that was in the sixties!).

[mattsmom81]

I personally don't see anyone being 'hard' on new grads. I do see some resentment of young nurses with huge egos and attitude...I guess the schools propogate this today but I don't know for sure.

As mentors we take on an extra assignment above and beyond our already mountainous assignment...can you get that? We wonder why this mentorship is necessary. Don't you think it is the job of the NURSING SCHOOL to train you as a competent, entry level nurse? I do! Does anyone else out there feel like me here? Why should I feel so obligated to do for you what your school has not? The needs and demands of new grads today is unlike any I've encountered, and why is this? Does anyone else think our poor nursing schools have any responsibility at all here?

What new grads see as being'eaten alive' is quite simply a reflection of multiple problems in our profession today. The fact that nursing schools are putting out poorer and poorer products through the generations is abhorant and we should be angry about this instead of blaming 'grouchy old nurses' and resorting to elitism. JMHO as usual.

Peace (and I'm pulling my 'grouchy ol' nurse ' claws back in now):)

[Q.]

Mattsmom -

I CAN get that you are taking on a new grad to mentor on top of your huge assignment. I have done it. I have also not orientated a new grad properly AT ALL because we were just do damn busy. As a unit and as a preceptor, we failed her, I think. We were concerned with getting tasks DONE, rather than actually teaching her tried and true techniques about this or not.

There is such a shortage that we are fully expecting our grads to fill the holes - and that is not fair.

Do you honestly think a new grad is going to be proficient in all aspects of technical care and skills? I am an experienced nurse and I am not. I would need orientation again to an NG tube, to a drain, to dressing changes. I have the basic knowledge, but would need guidance. I don't know these things - how can you expect a new grad to?

Physicians are taught in this manner - probably because they don't have empty staffing holes to worry about. WE DO. And that's what we view new grads as; not as young nurses who need further education on the floor, where many of your purport that "true" learning takes place, but as another member to staff so you can finally have your vacation granted. How can you argue that real learning occurs on the job, but then not offer the opportunity to your new grads, or feel resentment that you have to educate them? It sounds contradictory to me.

While you have a valid concern about staffing and you deserve your vacation to be granted, I also see it as how the nursing shortage is effecting how we teach our young nurses.

[mattsmom81]

Yes, in fact I do think a new grad should be competent in the performance of basic nursing procedures, PLUS critical thinking skills, both of which are neglected in most of today's nursing schools IME.

You have proven my point. If you would need reorientation to insert an NG or change a dressing, I do wonder at the calibre of your nursing education, dear. And I'm sorry if this sounds harsh, but YES I was a competent, basic practitioner upon graduation as were most diploma nurses of my generation. My school made SURE I was!

Your comments suggest failure of staff nurses when new grads do not do well, and again I must beg to differ.

We shall have to agree to disagree. :)

[Q.]

Mattsmom,

I see what you are saying (the skills I would need reorientation to) but I have been an obstetrical nurse for 4 years and never did a lick of Medical/Surgical after school. After time, the skills are lost. That's what I mean. I have a foundation, but not proficiency. I can't.

I feel that is comparable to a new grad perhaps having all the experience in the world at doing injections, etc, but simply didn't get to master NG tubing, etc.

You could have a valid point in the schools; they may not be able to keep up with the advancing technologies of medicine. ?? I don't know.

Perhaps schools need to be revamped, but I think part of this is the nursing shortage - hitting availability of instructors to provide quality education. But I still think as professional, experienced nurses, we have an obligation to the new grads that we are not fulfilling.