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.

[fergus51]

I agree nursing schools are partly to blame mattsmom, I just don't think they are that different today than 30 years ago. My aunt is proof of that. The new grads are never as good as the older grad classes :). I would argue that we are hard on the newbies and students. I think a lot of us are so stressed that it is easy for us to take out our frustration on the students, rather than dealing with what was really frustrating us (like poor staffing, increasing workloads,etc). Even now, a lot of my colleagues (and I admit, I do it too occasionally as I get as stressed and catty as the next nurse) enjoy putting down the education students receive and pointing out how much better their program prepared them and generally pointing out anything a student or new grad does wrong. Even if we all agree that nursing schools should be better preparing their grads, I don't get why we take that out on the new grad, they didn't get to choose how their program runs.

I don't think any school can truly prepare a student to go from novice to expert overnight. While in school they have the benefit of a preceptor or an instructor all the time, then they are thrown to the wolves the day they graduate. I don't think a new grad can be expected to be an expert nurse day one out of school. I don't think that's super useful to us as a profession either.

The mentorship programs I like are when experienced nurses CHOOSE to become involved and it is NOT in addition to their already hairy workload. It eases the transition for the new grad and gives the new grad a chance to benefit from and learn from an expert nurse. It made me feel more at home on my unit and decreased my stress because I knew that I had someone to talk to if things were going bad. I still keep in touch with my mentor almost five years later. She is the most amazing role model for me, and I can't tell you how much she shaped my practice as a nurse. Some hospitals here are instituting mentorship programs because it has been shown to increase retention levels by an amazing amount. Whatever we feel about nursing programs, we do need to keep new grads in the workforce.

[live4today, RN]

Whenever I worked as a preceptor of new grads, the first thing I would tell them is to stay as close to me as you did your former Nursing Instructors! Even on very busy days when the shift work was hectic, I made certain that the new grad I was precepting didn't miss a beat. If I pulled meds from the med cart, she/he had to have their eyeballs glued to what I was doing. If I did dressing and wound care, they had better be close enough to do it themselves on those busy days. When doctor's orders were written, every order transcribed from the patient's records to the MAR sheets by me was also closely witnessed by the new grads being precepted by me. When report was given, they were right there hearing every word, and did walking rounds with me and the off-going or on-coming nurse. Their little legs didn't miss a beat...no siree! We learn by listening, hearing, copying, and then applying all of the above. First we scoot, next we crawl, then comes pulling up on one's two feet, and then we walk. Once your legs are walking, they better be walking on my heels and picking up everything. Sometimes those hectic days are so hectic, the new grad wants to stop and cry. Well, so do I, but we keep on pushing on until "break time"...whatever the heck that may consist of. I would tell them to cry later when the day was done, but until that time there was no time to cry!

[NotReady4PrimeTime, RN]

I have worked in an ICU setting for almost five years. As one of the more senior staffers,I have been involved in preceptoring new staff members during their orientation period, and I also perform the charge role on a frequent basis. The BN program in our area is so deficient in basic nursing skills that one of the RN/BNs I was preceptoring, even after more than a year of employment with our facility, had NEVER d/c'd a foley. My time with this nurse came at the end of her clinical experience capping off a post-basic critical care course. A second RN/BN now working in our unit poses problems for me when I am in charge, because despite the facts that she has a degree, has been out of school for five years and is now a clinical instructor at the local university, is only capable of caring for the most stable of our patients. She has almost no time-management ability, and is often very behind on scheduled meds and treatments. Her lack of organizational ability impacts on the rest of us because she is never ready to take her breaks when she should be. As well, she isn't yet able to function independently and requires help with many routine tasks. I find it a little frightening to know that she is a clinical instructor for our next crop of grad nurses, who graduate woefully unprepared for the reality of providing bedside care.

[micro, RN]

Originally posted by fergus51

Whoa grouchy! I don't mean to sound like an elitist. I just felt that my program had enough hands on, and new grads will learn more practical skills in their first year on the job than they ever could in school anyways. School just gives a foundation. I am not trying to compare blue collar workers to monkeys. I am trying to say that the skills will come a lot easier than the thinking.

......................It's like the stories about the fish you catch, it tends to get exagerated.

I think more focus needs to be put on mentoring and precepting new grads when they do graduate so they get proficient at tasks quickly and stop worrying about them. No program will ever make new grads completely ready to practice. They need help and support in that first year.

fergus 51,

couldn't agree more........

and sorry for shortening up your quote......it all good....liked and focussed on what struck me most.........

I still remember my first nursing job, first nursing night.....when I was like a what is a shot...........what is a gauge of needle...................what am I doing here.........

there is nothing like experience and experiencing...........the reality of nursing.................

and yes, formalized(while allowing flexibility of) preceptorship and mentoring programs for new grads. is the key...........

two other points/opinions of micro here before I quit this thread response-------

1) am a bit concerned about clinical experience that does exist in some programs.........as know people going through them now.............maybe if can't do "everything" in the clinical experience, then maybe there should be more "lab time".........like a whole room with equipment, exposure to what is out there so new grad is not totally in the dark when comes out onto floor.........like this is what an iv pump looks they may not all be the same but they are on same principle........this is a PCA pump they may not all be alike, but the principle is the same.........

this is a foley catheter,etc.........micro gets thetorical so will stop for now........

2) attitudes out there..........we all got them........we all need to put them in check............like just because you have been a nurse for eons..................doesn't mean you cannot learn from someone else or that you should be selfish with your knowledge/experience..............we are all in this together..............

but to the other extreme...........I have seen some of the best, most receptive and very knowledgeable new grads out there..............and can learn from them..........but on the other hand.......

nothing ticks off an "old tired nurse" like a new grad that knows it all and not afraid to tell you........................and then wants to make sure and get those breaks and .........

now that I have ticked old and new nurses and students alike...........tehehehehehehe hope no one took it like that cause that is never my intent........

lol,

micro:kiss

[MQ Edna]

What do you all think of the concept of an internship for new grads? I"ve heard it discussed occasionally, but have never seen it tried. It seems to me that that might be useful for (especially) BSN programs that don't allow enough time for clinicals. Another thought is to require x# of hours as a cna before admission to the program--most women who've had that experience are much better at time management--and have dc'd a foley!!

[MQ Edna]

I mean "most students"--I don't mean to be sexist---

[RoaminHankRN]

When a soon to be doctor completes 4 years of med school, what do they do next??

When a soon to be nurse completes 4 years of nursing school what do they do next??

How about two years of theory and two years of residency.

??

[live4today, RN]

If theory is what is so essential for one to be a nurse, then why is it that for years on end, hospitals did fantastic with Diploma Grads as this nation's nurses? Doctors and hospitals could not survive without Diploma Nurses, and many of the docs still PREFER the Diploma RNs...

I am not a Diploma grad, but my sister-in-law is. She is in her late fifties, and she is always sharing with me how the Diploma grads were the mainstay of every health institution in this country before the baby boomers children took over the technological aspect of things...computer world, science world, etc., etc.

I can hear the Generation Xers and Yers saying now, "Yeah, what of it? Times have changed so deal with it Grandma!" :chuckle

Yes, the times most certainly have changed, so much so look at where we are today? Our healthcare system has all but collapsed for good, but remains barely hanging on by the skin of its teeth all because of HMO.

Nurses, we are not the "devil" here. HMO is the "devil", the trouble makers, the ones responsible for the downfall of nurses -- regardless of what our degree or diploma may be. Look at what HMO is doing to the patients we care for? How pitiful is that?

So, what are we to do with ourselves? Since we can't go back and change what is, we may as well move forward into the future. If the colleges and universities would stop bankrupting the majority of their student population, perhaps more students could afford a four year education, eh?

I propose that all public education be free to students in these United States of America, and make it mandatory for students to attend school from Kindergarten through their Senior year of COLLEGE...NOT HIGH SCHOOL. The only thing parents or students should be required to pay for in a public college setting are for their books, other supplies, meals from the school's cafeteria, and room and board if the students live on campus.

Somehow, the Big money makers saw that many people were pushing towards the college degree in the X and Y generation, and WAALAAH! Dollar signs started popping up everywhere as a way for college and universities to make money. Supply and demand often dictate what "rules" in this country...like it or not. That's the way it is! (As Celine Dion sings in one of her recorded songs)

If education is that essential to the point of now requiring more and more of it, then our country needs to assume a greater responsiblity for the education of its students through college level classes than it ever has before. This would eliminate the need for scholarships, grants, school loans, etc. NO MORE TUITION, PARENTS!!! WOULDN'T THAT BE A HOOT! :chuckle

As I think aloud here with you all, any feedback would be greatly appreciated to help me in my attempt to help resolve the seriousness of educational requirements in this country, much to the detriment of our nursing profession being so divided because of all the degrees, diplomas, titles, etc. Thanks for your input! :)

[Q.]

Renee,

Excellent post. A couple of things:

As far as the diploma grads; they were the mainstay of the hospitals during that era because, as a nursing student, didn't you also STAFF the floor? You were endentured, so to speak, to run the floors as part of your education, without getting paid? The bonus for you (as a student) was the experience. My alma mater used to be a diploma program and was a part of the hospital and that's how it used to be.

My contention is that as technology advances, nurses must also. Patients live longer now then they did and the acuity of most patients is higher - for a variety of reasons: aging population, low access to care, inability to pay, etc.

For you thoughts on public education: I see your rationale and I agree with it; as education becomes more apparent to succeed in our society, society should assume a greater responsibility. However I believe that that is the parent/family's responsibility - not the government's. To mandate that everyone go to school for a certain # of years may actually increase cost - as you would have alot of truancy and perhaps no available seats for students who have the drive to go. The owness of responsibility does belong with society - but society is US, not Uncle Sam.

Also, I have a fear that when the government steps in, the quality goes down simply because money does not grow on trees, unless you tax the hell out of us MORE. I agree with free public education for grade/high school, but with the option to PAY for private education if you so desire. For example, as a 29 year old now, I made the sacrifice (as did my husband) to GO to college now so that when WE have kids, we are more likely to have the money to send them to schools of our choosing - hence we deserve to have the option to send them to private schools - not what the government mandates. Or, we also have the choice to home-school if we desire.

Tuition is high, yes, but it is an investment. How can someone justify spending $20,000 on a car that depreciates immediately after purchase, and not on your own education? I just don't get it.

[fergus51]

Tuition is a whole nother topic! I have to giggle, because I was lucky enough to move back to Canada to go to school. My tuition was never more than 2000$canadian a year, so I paid about 5000$ American for my four years of school. I thought I made out pretty well, until I started working up here and found that my taxes are HUGE compared to when I was in the US. Six of one, half a dozen of the other....Eventually you pay for it, either in taxes or out of your savings...That's why I am glad I have a dog and no kids. Obedience classes are dirt cheap compared to college!!!

[live4today, RN]

Originally posted by Susy K

Renee,

Excellent post. A couple of things:

As far as the diploma grads; they were the mainstay of the hospitals during that era because, as a nursing student, didn't you also STAFF the floor? You were endentured, so to speak, to run the floors as part of your education, without getting paid? The bonus for you (as a student) was the experience. My alma mater used to be a diploma program and was a part of the hospital and that's how it used to be.

Suzy K,

I'm only pulling forward one paragraph of your very well written post (#45) to correct an assumption that you made:

Although I would not be ashamed -- but very proud -- to be a Diploma Grad RN, I am not one. In my post, I spoke of my sister-in-law as being a Diploma Grad RN and shared her feelings on how hard Diploma Grad RNs worked back in the day when they were "The Mainstay" of all the hospitals, etc., as I'm sure many of our Allnurses Diploma Grad RN members of 'yesteryear' could highly attest for. So, I'll let them respond to your above questions as to how they were treated and/or paid. Diploma Grad 'Seasoned' RNs where are you??? Would you all please answer Suzy K's questions above? Thanks!

As for including college as a part of a child's learning experience before they can be 'officially' out of school by law, the public schools that are available to our students today are also supported by the students parent's property taxes, etc..

Parents who choose to send their children to private school from K thru 12, pay for their children's education "out of their own pocket". I know because my children went to both private and public school.

Every state has a State University, and those schools should be free to every student who attends school for the majority of their school years in that state. However, the college students need to assume responsibility for the payment of their textbooks, lab fees, tests fees, room and board, and cafeteria expenses. The same fund that pays our public school teachers from grades K thru 12 should be the same fund that pays every teacher who teaches at a college level.

If the State Universities can't manage to be included in every child's educational process, then the fees need to be cut DRASTICALLY to make going to college more affordable for EVERY child, not just some. Public schools should remain free with the exception of the property taxes and other taxes that parents pay annually to support the educational system in their place of residence, but if a parent chooses Private Schooling over Public Schooling, then the government should not foot that expense.

Once you become a parent of children in the school systems, you'll be able to rationalize more clearly my thinking on this. It's a lot easier for one to say he/she will do this or that when they aren't a parent yet, but once that process opens up that parental part of you, soooooo much more will come to light in ways you haven't begun to think up yet. Trust me on this!

My daughters are 31, 28, and 25, and I've said and done things that I said I would never do or say long before I had baby one. I watched my sister's raising their children, and I use to say I'm never going to do such and such when I have a child... HA! :chuckle I've eaten a lot of words that I said prior to becoming a parent after becoming one. Now, I get to watch the process happen all over again through my own three children, and what a trying process it has been for them at times, too.

Thanks for all your comments and suggestions, Suzy K. :kiss

Sounds like you and your husband have your heads on straight, and at least have an educated plan for your future together, and are laying groundwork for the pitter patter of little feet down the way. :)

[ICUBecky]

hello everyone! this is a great post. i'd like to add my 2 cents.

i graduated almost 2 yrs ago with a BSN, and have not yet witnessed our wisest and most experienced nurses "eat their young" in my ICU. however, i have witnessed the younger, less experienced nurses be extremely rude and obnoxious to their peers, who have the same amount of experience or less. they are petty. it is a very interesting web. this is the very reason why, when i have a question i am never afraid to ask the older nurses.

my preceptor was awesome. i stood by him and learned everything i could. but, he would actually give me nightly reading assignments about disease processes, body systems, procedures etc... (these were not big assignments...like 15 minutes or less) and let me ask questions the next time i saw him. this made me learn much more than just my hands on work, which was

all that we had time for during the day. this is where i think some preceptors fall short, IMO. many of them only want to deal with the things that go on with the shift, "the hands on work", and not give their new nurse any more direction. there are a lot who think "hey...s/he just graduated from a four year program, so they should know everything" , this is not the case, they need to remember that BSNs were trained as "generic" nurses over 4 yrs, not specializing in anything, and much of the information that filled our heads in the first and second years of school, was tucked away and needed to be refreshed. i think that my preceptor realized that, because he was going back for his CRNA, and all the information that was tucked away and not used over his 10 year career, needed to be refreshed.

as far as my BSN program. i agree that there was not enough hands on clinical experience. sometimes those clinicals felt useless, because the RNs were either too busy or did not want to deal with the student nurse, and/or the clinical instructor was spread to thin, with all the other 8-12 student nurses she was responsible for. so at times, we were basically on our own. sometimes, honestly, the BSN students were more worried about their 6 page paper that was due, and the test that was going to take place, the next day. i tried to get the most out of my clinicals, but became very discouraged at times. a lot of ppl seem to blame their clinical instructors. she didn't do this, they didn't do that. but, i think a lot of the responsibility lies on the students shoulders. new grads say, well i have never started a foley, did any blood draws, started an IV, did a bed bath...blah, blah, blah. i think it is the student's responsibility to go up to the clinical instructor or RNs and say "i need to start an IV", "i need to start a foley" etc... i did this in my clinical rotations, and got results. students NEED TO BE MORE ASSERTIVE.

my mom is a clinical instructor for ADN students. she tells me that a lot of instructors, are afraid to be too tough on or fail students. b/c the students threaten to file a grievence or sue the instructor. in the last year, my mother has had 5, yes 5, grievences filed against her (she has won them all...b/c they all deserved to fail), now one of those students has threatened to sue her. she now hates a job, that she used to love, and cannot wait to retire. P.S- she was a diploma nurse, that got her BSN then MSN. she still thinks that the diploma nurse, is the best nurse out there!!

ok...sorry this is so long. i just had to give my point of view.

have a good night!

becky