Nursing School Reformation

[elijahvegas, ASN, RN, EMT-P]

One of the things that intrigued me about the nursing profession, as well a PA's and (f)NPs is how fluid the career can be. there are so many different avenues and specialties to go down that unless you really just hate the field in general, it seems almost impossible to be in a boring or unfulfilling specialty. the only problem is, how do we actually break into these specialties to see what they're really like ?

lets ignore the fact that in order to get experience, you need experience and its a vicious circle of new grads being stuck in limbo after graduation if they aren't near a newbie-friendly facility.

but it doesn't make sense to me how we get pounded and primed for med-surg, despite the fact that there are a world of possibilities out there.

Now let me preface this by saying i get it, med-surg is mostly the bread and butter, nuts and bolts, and corner stone for most nursing practices and its always good to have a nice solid foundation to build your career on.

But what doesn't make sense to me is why in a 2 or 4 year program, we spend 99% of it in med-surg, whilst only getting a glimpse into the other side of things. I don't know how the rest of your programs were structured but mine was pretty much med-surg clinicals for the entire semester, with maybe 2-4 clinical days that stretched anywhere from 8-10 hours in peds, psych, and L&D. After that it was back to med-surg for full 10-12 hour days for 14 weeks a semester.

When i graduated from paramedic school, we had mandatory check-offs, we had to successfully perform certain tasks and be signed off by a preceptor or instructor. Minimum 25 IV starts per semester for example, among other tasks. It baffled me when I read and met nurses who said they'd gone an entire 2 or 4 year program having never successfully started or even attempted an IV! But having gone through the program I see why. All of your patients usually already have lines in, so theres nowhere to actually "practice" unless you're sent down to the ED--a rotation that we never actually had.

So my proposal is to take a page out of the med school book. For a 2 year program for example, lets have the first year dedicated to med-surg, you get your nuts and bolts in, and for your 2nd year, each student has the option to explore any specialty of their choice for that semester. Kind of like a residency. If you want to stick to med-surg, by all means do so. Want to try your hand at L&D, go for it. Want psych? You've got it. Emergency meds? Off you go! Or, make nursing mandatory 4 year bachelors program, where 2 years is spent in med-surg and your last 2 years are spent exploring other specialties of your choice.

its just an idea that i used to daydream about in nursing school when i got towards the end of my program, and it may not be full-proof or completely thought out, but it still seems rather beneficial and almost exciting to me. So many of us have dreams of breaking into a specialty only to be told we dont have any exposure to it so we have to die a little bit inside every shift by going somewhere we dread, just to have a foot in the door.

Almost every specialty sounds appealing to me, I want to do a little bit of psych, i want that foundational med-surg experience, I want to deal with critical care, i love emergency medicine, and i wouldn't mind trying my hand in the OR as well. But other than reading on these forums and daydreaming a day in the life of a _______ nurse, i really have no idea what anything else entails, and i can't exactly bounce all over the place the way i'd like to, because that would set off all sorts of flags for potential employers wanting a more..permanent hire haha.

Anyway, if anyone was able to read through this entire post, what do you think of the idea? How was your program structured? Were you exposed to as many different floors as you had liked?

[AceOfHearts<3]

I always had a med surg clinical every semester, but we also had clinicals dedicated solely to peds, women's, psych, community nursing, and gero. I was fortunate that my gero clinical was spent mostly in the hospice side of a nursing facility, instead of just the nursing home. I would have loved a clinical in the ED, but overall I'm very satisfied with the variety I got, especially since I did an accelerated 2nd degree BSN program. My program offered a much larger clinical variety than most ABSN programs (and was one of the shortest), which was one of the reasons I picked it.

[llg, PhD, RN]

A lot depends on which school you go to. In some areas of the country, there are lots of nursing schools/students -- and only a few clinical settings that have the various specialties. So each school just gets a couple of days at those specialty sites. The would be happy to send their students to more specialty clinicals -- but the opportunities just aren't there. That's one reason they are called "specialties:" only a few patients need them and the services they offer are not offered many places.

[elkpark]

I attended a hospital-based diploma school. The curriculum was set up on a quarter system (year round -- four three-month blocks/year). In addition to med-surg, we did three month rotations in peds, OB, critical care, psych, OR, and the "med-surg" clinicals were 3-month rotations in specific med-surg areas -- ortho, urology, cardiac, GI, neuro, oncology, etc. The longer I'm out of school, the more amazed I am at how well-prepared we were compared to new graduates nowadays. Nursing education has really thrown the baby out with the bathwater, IMO.

[toomuchbaloney]

I went to school decades ago.

We had clinical rotations in;

med surg

psychiatry

surgery

ortho

peds

ob

ED

community health

and extended/LTC/SNF

We shadowed RT, PT, SW, and nursing management.

There are probably other things but I am old and I forget now.

It was very comprehensive and it took me 4 years to complete my degree attending classes or clinicals every month of the year. Well, maybe I took one summer off...again, it was a long time ago. But there was scant time to work outside of school.

What sort of education are nursing students actually getting today?

[RAndaRoo]

I wish we had majority clinicals and way less class. Especially for anyone who is a kinesthetic type of learner, I truly don't get half of what I'm learning until I see it or do it. My school is first semester medsurg, 2nd semester half medsurg half psych, 3rd semester half OB half peds, and 4th is half community, half internship. My internship was the only time I felt like I was getting a true nurse experience because we actually went 3 times a week for 12 hour shifts. We don't have a critical care/ED rotation and I will graduate in May without ever starting an IV, yay.

And all my friends who are already working nurses don't remember half of what we learned in school anyways if it's outside their specialty.

[KatieMI, BSN, MSN, RN]

Unfortunately, it is Board's requirement to expose nursing students to X hours of OB, Psych, community (for BSN programs) and so on. In some places, final clinicals can be arranged by students, and some schools will accomodate students who, for good reasons, cannot do certain specialty, but that's about it.

This is leaving alone the fact that you need to add a couple of years (one solely for theory and skills, and another one solely for practice) to current school time to get grads prepared to hit the floor.

[LadyFree28, BSN, LPN, RN]

During my med-surg rotations, The floors I were on were specialized-Oncology, Surgical Trauma (which was also a Telementry monitored floor) and Telemetry; they had a variety of pts and demographics, and many opportunities for learning.

I was able to observe in the OR during my Pediatrics rotation, assisted in delivering three babies, a C-Section, and spent time in the nursery and the NICU during my OB rotation; assessed and did pt care teaching at a pediatric asthma clinic during Public Health, and rotated twice in the ED and in the PACU during my Critical Care rotation; I also participated in a code team experience when I was in the ED; I also got the opportunity to shadow the charge nurse during my Critical Care rotation.

I felt that I had a well rounded clinical education despite being in an area with over two dozen schools, being a part-time accelerated program that had evening and weekend curriculum, and the ever-pesky liability concerns that most hospitals have today; it was comparable to my Practical Nursing program, which was a Hospital-based Diploma program, which was well rounded-I observed on a vent unit during one of my Med-Surg Rotations, was on a Surgical Trauma unit, and observed in the OR, IR and Pediatric Short Procedure; I also rotated to nursing homes during that education.

I think the onus is on the adult student to be pro active for teaching opportunities, as well as programs to reach out to not only hospitals, but other facilities to present a learning environment as much as possible-if they are not doing so; however, at least in my experience, my school gave us that benefit, and I seized opportunities as much as possible.

[elijahvegas, ASN, RN, EMT-P]

Boy, it sounds like old school programs really had it together. I feel like especially in my area, there is a high burnout rate in med surg so it's in constant need of staff, and that's what we end up getting geared towards.

To this day I'm still not entirely sure what goes on in a PCU floor haha