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.

[rdhdnrs]

We have hired several new grads lately on our L&D unit. On the one hand, I love that they are so eager and willing to learn, for the most part. However, we've noticed a distinct lack of the ability to think critically and to prioritize. These are skills which are very hard to teach, I know, but I am astounded that some of these people were able to pass their clinicals. I don't know the answer.

[fergus51]

I am definitely with you on a lot of that grouchy! I was the same way in school (despite the fact that my BSN had a year more clinical time than the diploma), and I also went with a group of students to voice these concerns to instructors and was blown off!!! I was FURIOUS at the time! LOL! It wasn't until after I worked a few years that I saw the value in my leadership, research and community development courses. I was fortunate to have felt competent enough at my skills when I graduated. It was the other things that terrified me (like deciding what to do independant of an instructor! GASP!). I think having a mentor is what helped me make the transition, and I think new grads should search out such programs. I don't know about Toronto where Zhakrin is, but there are hospitals in BC (Lion's Gate Hospital) and Alberta (in the Capital Health Region) who offer year long orientation/mentorship programs for new grads. I would recomend them to any new student, especially with those who are still stressed about the hands on skills.

I agree, a lot of the push to gain BSN as the minimum for practice comes out of our desire to be distinguished from the blue collar jobs like steel workers or garbage men or mill workers. On the one hand, I agree this is elitist. On the other, I think that's real life. During our contract negotiations a big point was made of the fact that nurses aren't even required to have a college degree, so why should they get so much money or any respect? Level of education does have a lot to do with those things whether that's fair or not.

[live4today, RN]

The only RNs without a degree - per se - are Diploma Grads, the ones who for years and years sustained nursing, did everything under the sun for doctors, worked their butts off for the sick and dying, manned the entire patient units with mega patients to care for with only one or two of them on duty at a time, and yet - today - they are being "pushed aside" in lieu of "changing times" while the ANA continues to fight to make the Bachelor Degree level the entry level into nursing. If any nurse deserves to be "grandfathered" in, it is the Diploma Nursing Grads!

When I graduated in March 1987 with my AAS Degree in Nursing, and took my first job, it was a Diploma grad who precepted me on dayshift for six weeks. Out of the handful of nurses who precepted me over the course of my nursing career, she was one of the best without a doubt! :)

Nurses - on any level - are far from being "BLUE COLLAR WORKERS" - IMHO! Nurses with an Associate Degree in Applied Science were awarded a "Degree", not a "certificate" or a "diploma". There is NOTHING "technical" about the Associates program that I went through in the early eighties. There was nothing "simple" or easy about that particular program.

The only nurses who were able to CLEP clinicals were LPNs who had to first prove they were competent enough to begin with the clinical rotation of Maternal/Child, then Mental Health, then Advance Med/Surg (the final three clinical rotations in the AAS nursing program-- the only three clinicals that could NOT be bypassed regardless of one's experience level or degree).

If BSN is going to be made the entry level, then the BSN program coordinators are going to have to beef up the BSN course to include much more hands on in the clinical area of the hospital, not just in outside clinical situations; and they will need to address the rationale behind having nurses take courses that play "no part" in the actual realm of nursing.

Like any college or university, the schools have students take "nonsense" classes in every career field just to make money for the college, not because the student will need those particular courses after graduation. We all know this, but when pinpointing the exact courses necessary to become a professional nurse, the courses required should be closely scrutinized to assure their value as a whole in one's ability to be a Professional at what they do.

The first two years of the BSN program are mostly "college required non nursing studies" and some pre-nursing course studies. The final two years are nursing courses that pertain to nursing, just like the two years in the Associates Program are geared completely around nursing. The nonnursing and prenursing courses take a good year full time to complete, and the nursing courses themselves take a good two years to complete, which is why the Associates program takes anywhere from 2 1/2 to 3 years to complete. They both pretty much balance each other out when the "non essential courses" are removed from the curriculum.

It will sure be nice when this entire mess is ironed out, so students contemplating becoming nurses won't have to start out with the confusion of whether or not they are taking the right program to become a professional nurse. :) A good balance of both theory and clinical is needed, but more of clinical so the student learns "application" of what they learn is just as essential as testing and passing each course's academic structure. :)

[dstout-rn]

You all make great points. I have my BSN and MANY of my fellow students were led to believe by our nursing instructors that if we had a BSN we would be "in charge and work day shift fresh out of school", and many of the students who had only set foot in the hospital for clinicals believed it!!!!!!!!!!!! I think there should be more clinical time for one reason and one reason only.... the time students are in clinical are more controlled situations. The nursing instructor is there to help(sometimes), you have a nurse preceptor who can help ask questions and since you are in the role of student it is expected, the assignment to the student is generally not a "full load". Whereas when you have graduated and passed boards the game changes and even though you are still learning I don't think the feeling of being overwhelmed may come so hard. During school clinicals are for learning organization, time management and skills at least that is what I gathered since if there was foley to be done "where's the students would echo from everywhere" LOL. More time should be dedicated there so when nurses hit the floor as new grads they are ready to walk (not crawl anymore), and as time progresses they are ready to RUN their butts off.

In reference to nonsense classes I totally agree but "it makes you a more rounded student".

I am working on my MSN now and I am doing it online, if I ever have to see a nursing instructor face to face it will be tooo soon. And no I don't want to be manager, I am getting out of the hospitals ASAP!!

[fergus51]

Renee, I don't know where these ideas come from! Our diploma and BSN programs were EXACTLY the same until the third year when diploma grads left and BSN grads stayed for another year, so the BSNs had MORE clinical time, not less. And over those four years we took 3 non-nursing courses (not including english which is required of all grads of the university). Everytime people talk abot BSN programs here it sounds like your (American)programsl spend 80% of the time taking basketweaving 101 and 20% taking nursing. I can assure you I would never be in favor of something like that and I doubt that's the case anyways. And sorry about the degree part, I should have said Bachelors. Like I said before, the BSN is now the minimum here, but Diploma nurses are grandfathered in. I don't think anyone wants to lose good nurses, which most are regardless of whether they have a diploma or a bachelors.

[live4today, RN]

Dstoutrn: Amen on all your comments in your above post! :)

fergus51: I believe schools in Canada are somewhat different than the ones here, so I don't think it would be fair of either one of us to compare what the Canadian nurse course and degrees are like with those here in the United States. I can only speak from the United States point of view since the only thing I know about foreign nurse programs is what gets posted on this BB. Feel free to school us on the variables between the two in Canada, and maybe a Diploma Grad here will tell you if the same applies to them here. I don't know since I attended an Associate Degree program years ago. :)

I do know that when my sister-in-law went through the Diploma Degree program many moons ago in Cincinnati, Ohio, she had to go to college for 5 whole years before she graduated, and that was full time. That's why I say Diploma Grads deserve to be "grandfathered in" because they had so much hands on clinical and theory that they should automatically be granted recognition beyond their course of study in comparison to the BSN and the AAS nurses. Now, I don't know everything, so please please please keep in mind that I am only speaking from what nursing exposure I have come across or been through myself. What I share is in no way "gospel" to be applied to all nurses everywhere. Thanks for understanding!

[zumalong]

I agree that the loss of the diploma schools for nursing was not beneficial for nursing. I come from a slightly different aspect as I am an instructor. I see too many new grads (esp. straight from BSN programs) that can't do simple nursing skills. I believe that critical thinking skills are important, but you need to have the hands on in order to develop effective thinking.

I learned so much more when I graduated from school and went to work on an acute care surgical floor. I also have worked with other educators that don't have the hands on, or have been away from the bedside so long that they are out of touch with the times.

I just finished my bachelors and am very glad that I went the route of LPN to ADN to BSN. I don't think I would be the same nurse if I had received my BSN first. I also do not believe in letting graduate nurses go on to teach until they have had some clinical experience. I know that this is a fantasy--but I enjoy teaching, therefore I am going to continue to encourage hands on with critical thinking and try to stay up to date on what really happens in the "real world".

[live4today, RN]

Good for you zumalong! You are exactly the type of instructor that I would have loved to have spent time with! Never let go of that tenacity and passion to teach those who stand to gain from your vast wealth of nursing experience -- both theoretically and clinically speaking.

[mario_ragucci]

I see nursing students who are afraid of people. They are in it for the money, and thats about where it ends. Perhaps we need to focus on who we are as people, before we can attempt to assist others who are in need.

The best teachers and nurses (on the whole) I have seen in my life have been old-fashioned religious (orders), because they are totally commited and driven, and money doesn't enter into their motivation. They do doing it because they really want to.

Over the next several years, many nurses will be "manufactured." I see it all ready, where my classmates don't think very much. When asked a question, they cite what the book says, and thats where it ends.

I feel some people are "cut out" to be nurses, or teachers, and others are just attracted by money. You can't "purchase" care; Care is given. Right? Of course, you can hire someone to care for you, but it's not the same as someone who cares for you because they really care.

During our "career research presentations" many of my fellow students had to read off of cards when it came to presenting what the nurse in a particular field actually did, but I noticed they knew exactly what the pay was, and their enthusiasm was apparent when they talked about the money.

I will do what ever it takes to get my RN and pass the NCLEX when my time comes in 2004. I know there are hoops I'll be jumping through, but my mind will be open wide, and I will influence a positive change to all this. It starts with me. And you, because I get my motivation from you. We are together in this. And it will get better! Promise (wink) :-)

[fergus51]

Thanks for the reply Renee. It is obvious that your American programs differ from Canadian ones and even from state to state. I read an article today written by a nurse who explains the role of theory and the role of hands on practice very well. She said theory is to practice as clothing is to bodies. We need clothing to have a rich civilised culture, but wouldn't be well off without bodies AND we need bodies, but they are lacking without clothing. The same is true for theory and practice. One should enrich the other. I like that view a lot.

May be a little off topic Mario, but I don't think there is anything wrong with going into nursing to make a good living. No one ever doubts a doctors ability to care when he demands to get paid...:)

[mario_ragucci]

no, there is not. Of course not. But money should not be the only motivating factor. And don't get me started on doctors because I don't know enough yet. Maybe I was a little hard on people for wanting to go into nursing for the money only. Please, no offense. I want to get paid too :-) But I want to feel good about what I do, and the people who I work with, and I will :-)

[dstout-rn]

Thanks Nurse Williams for the complement. During my BSN program we had only two instructors who actually were still at the bedside and they were awesome instructors. Their answers to questions were not word for word from the book, usually they were cases they had seen at the bedside.

Yes some of the young student nurses go into nursing for the money and yes $18-19 per hour sounds great when you are working as an NA for $8-9 per hour but the reality of the work comes quick and soon its not nearly enough for the hard a$$ work we do 24/7!!!!!

I can read all day what a murmur sounds like, but until I put a stethascope to a chest and hear it , then it is just knowledge but not a skill of a nurse to detect it. Skills are not necessarily IV's and foleys, but also the all important assessment and the more assessing you do before you walk into the real world the better off you will be.