Math requirement for RNs?

[llg]

I have a question for both practicing RNs and students alike:

It's come to my attention recently that some nursing schools are on longer verifying that their students can do basic 4th grade math. By that I mean add, subtract, multiply, and divide without using a calculator. They assume that calculators will always be available and that therefore, nurses don't need to know how to do basic calculations anymore and don't have anything in their curriculum that requires students to do those things. In fact, they are aware that some of their students definitely can NOT do those basic calculations when they involve fractions and/or decimals. Also, the TEAS test now allows applicants to use calculators: so they are not testing those skills, either.

To me, that seems like a safety issue. There might come a time when a calculator is not available.

1. What do you all think?

2. Students ... are you competent adding, subtracting, multiplying, and dividing fractions and decimals?

3. Practicing nurses ... are there any times you need to use basic calculation in your work (without a calculator)? Can you give me some examples?

4. Is anybody verifying those skills in orientation anymore? (med tests without calculators, etc.)

Thanks,

llg

[WKShadowNP, DNP, APRN]

I'm a dimensional analysis girl! Makes so much more sense to my brain!

Me too! I like it and fractions.

When I precept new grads I make them do it on paper.

[JennyMac]

brownbook you have just described me to a T. I can always do drug calculations, they way I do it isn't pretty but I get it done in a timely manner. Basic math test? After hyperventilating I will get the equations done. My problem has always been that I figure it out "my way" and I don't follow the formula that math teachers wanted, I got the right answer but was frequently marked down for not doing it the "right" way. I say if the end result is correct, who cares.

I've always been the same. I struggled with math in elementary/high school, despite doing very well in every other subject. As I got older, I improved a lot. But I still have trouble using the formulas given to get the answer. I figure out my own way to do it, and get the right answer.

[DoGoodThenGo]

I have co-workers that cannot do basic medical math. For example there was a med, and we were supposed to give 5 mg. The pills came in 2 mg. Right on the label, it said to give 2.5 pills. This co-worker kept arguing that the label was wrong, but she did not know how many pills to give. I tried to explain how to work out the math, she did not get it. I finally broke down, and I drew dots on a piece of paper. "One dot equals one MG, so each pill is worth 2 dots. So, 2 dots from the first pill, another 2 dots for the second pill, and since we are cutting the last pill in half, you only have one dot! Now count the dots... one, two, three, four five! So, 2 and one half pills, make 5 mg" She was still confused but gave the med anyway. She also cannot figure out the volume of a medication, for example insulin. In our software (CERNER), we have to enter the units AND the volume. So... 2 units = 0.02 mL, 30 units = 0.3 mL That is WAY above her math skills. I would hope the NCLEX would weed out people like that, but it does not.

Now that is scary!

[DoGoodThenGo]

I have co-workers that cannot do basic medical math. For example there was a med, and we were supposed to give 5 mg. The pills came in 2 mg. Right on the label, it said to give 2.5 pills. This co-worker kept arguing that the label was wrong, but she did not know how many pills to give. I tried to explain how to work out the math, she did not get it. I finally broke down, and I drew dots on a piece of paper. "One dot equals one MG, so each pill is worth 2 dots. So, 2 dots from the first pill, another 2 dots for the second pill, and since we are cutting the last pill in half, you only have one dot! Now count the dots... one, two, three, four five! So, 2 and one half pills, make 5 mg" She was still confused but gave the med anyway. She also cannot figure out the volume of a medication, for example insulin. In our software (CERNER), we have to enter the units AND the volume. So... 2 units = 0.02 mL, 30 units = 0.3 mL That is WAY above her math skills. I would hope the NCLEX would weed out people like that, but it does not.

NCLEX math; anyone care to take a stab at these questions? *LOL*

Would You Pass the Mathematics Section of the NCLEX? - Nursing Link

[DoGoodThenGo]

Re drip rates - if you travel as a volunteer on a health care mission trip, which many nurses do, to Central America or rural Africa, you will find yourself counting drops.

There are still a good many in the profession that recommend professional nurses still know how to calculate drip rates manually. Reasons given range from verifying pumps are correctly programmed to unavailability.

The nurse's quick guide to I.V. drug calculations : Nursing made Incredibly Easy

[DoGoodThenGo]

Just a quick bit of research on the Internet shows the United States is far from alone when it comes to nurses and maths literacy.

A third of new nurses fail simple English and maths test - Telegraph

Relationship between High School Mathematics Grade and Number of Attempts Required to Pass the Medication Calculation Test in Nurse Education: An Explorative Study

However that being said still stand by my original statements, med dose calculations does not require any more strong maths skills than freshman level high school. Even then that is really because of word/algebra problem solving skills. If one can master those by middle school then that should be the end of things.

Anyone up for a quick pop quiz? *LOL*

The nursing calculations quiz | Scrubs - The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

[LuckyMoon]

I would normally just read and not post on a forum like this, but since you specifically asked for input from students as well as practicing nurses, I'll go ahead and share my thoughts.

I start nursing school this coming fall. I recently took the TEAS VI and didn't miss any problems on the math section. I found the on-screen calculator a little bit of a pain, and only ended up using it for a couple of problems to verify my answers. I am confident in my ability to perform chemical conversions, and dosage problems, the kinds of problems I think someone should absolutely be proficient in performing by the time they finish Intro to Chemistry (or any additional more advanced chemistry such as General or Organic), let alone Microbiology etc.

That being said I have become aware that many of my peers are unable to complete these types of problems with any kind of proficiency. And while I understand there are instances where a calculator is not always immediately available, I don't think the real issue is whether or not people can perform these problems without a calculator, but whether they can perform them at all. I have found that a lot of people, at both a university level and a JC level, who are taking nursing prerequisites, are unable to do these types of problems, even people who have completed the majority of their science prerequisites. I constantly hear people say that they are, "just not good at math", but in my opinion you don't have to be good at math to learn how to proficiently perform medical dosage calculations and other related types of math problems. Anecdotal as it may be, I have worked as a teacher, and recently as a science tutor and have taught a number of people how to do them who all claimed that they, "just weren't good at math". Generally what it takes is hard work, regular practice, and repetition. I am of the opinion that most people who put in the effort can learn to do them. I am also of the opinion that anyone who wants to be a nurse should put in that effort.

[bgxyrnf, MSN, RN]

Re drip rates - if you travel as a volunteer on a health care mission trip, which many nurses do, to Central America or rural Africa, you will find yourself counting drops.

Of course you will... but you'll still have access to a ciphering machine to determine how many drops there should be.

[bgxyrnf, MSN, RN]

Some of us believe a nurse should know how to do it -- just in case he/she needs to do it by hand in an unusual situation.

If we get to a point where there literally is no ciphering machine available, then I seriously doubt that we have the drugs available either.

[DoGoodThenGo]

Don't think anyone is arguing against nurses using technology; just that a professional nurse needs a certain foundation in maths in order to function safely.

Pumps, Pyxis dispensing and so forth are all very well and certainly have their place in healthcare; but none of it removes or replaces the "Five Rights".

There is a danger in all professions of becoming overly reliant upon technology forgetting that machines are only as good as the human who programmed or built the things.

Pumps have been known to be incorrect or not properly programmed. Latest heparin fatality speaks loudly-What have you done to stop the bleeding?

Decimal points matter: Nurse Commits Suicide After Accidentally Giving Baby Fatal Overdose – TheBlaze

Quaids recall twins' drug overdose - LA Times

Back in the day a nurse could make up a "banana bag", calculate the drip rates then whip up an indication strip (usually on masking or bandage tape), attach and *bam*. That nurse or any other could check that bag from across a bed, room or even doorway to see if things were infusing too fast or slow; or juuust right.

[djh123]

Interesting that some programs require(d) students to get 100% on dosages & calculations tests (and the subsequent ones each semester). My school only required a 92%, and at that, you had 3 tries. Amazingly, a few - very few - didn't pass at least one semester and had to repeat. I do agree that 100% is the goal.

On another subject, I don't get the anti-cursive thing. But I'm older. Although I can print faster than most people, I can write cursive even faster. What's wrong with writing notes to yourself in cursive? Actually, when I started at my LTC facility, just a few years ago, we were writing nursing notes by hand in charts, and that meant cursive for most people.

[LondonFog, BSN]

Hello. As a current ADN student, I can proudly say our campus has an absolute policy AGAINST calculators during the course of our program. This comes with the understanding that this is not how it will occur on the floors in reality. The policy seems brutal to some students, but so essential in my opinion. There are many who failed the math exam due to basic arithmetic. We do need to get 90% (10questions) on our exams and our problems range from basic dosage calculations to advanced IV, peds (weight based), etc. We get two chances to pass, otherwise we have to repeat the math class and we are withdrawn from clinical/lab. We are continuously drilled in the importance of trailing and leading zeros, and as a person who's strong point is not math, I am very thankful that this program has made me work harder at basic skills. You don't use it, you lose it, right? I'm old school, I guess and I don't really like relying on the crutch philosophy of calculators and spell check. I think it's great for larger conversions and the floor, but certainly we should all have a basic foundation. I know not being able to use a calculator has certainly strengthened my skills.