How can nursing education be improved?

JaneyW · Nov 19, 2005

This was not my experience at school at all. I attended an ADN program (have a BA in another subject). We applied our knowledge right away and the teachers were mainly concerned with our performance and knowledge of real-world things. If I remember the NCLEX correctly (three years ago), I would have to say that it reflected real-world situations and not textbook knowledge so much. Although that textbook knowledge was important to know how to answer!

My instructors also wrote their own test questions which was good and bad. I am from a psych background and had a hard time with poorly written tests. We would challenge questions that were bad ones and they would get thrown out if we made a good argument. I think this is the norm in most fields of study. That might be something to raise with the college administration once you are safely out of there with your degree.

Good luck and look for a new grad position at a hospital that will spend a lot of time with you working on those clinical things you don't have confidence with yet. There are good programs out there. You may need a longer orientation time if you aren't feeling competent on the floor. You will be able to find a program.

gauge14iv, MSN, APRN, NP · Nov 19, 2005

Take the focus off of theory - you don't hear docs talking about "medical theory", or architects talking about "architectural theory" or respiratory therapists talking about "RT theory"

A lot of time and energy is spent on things that should be background - not foreground!

More in depth teaching in patho and pharm as it applies to nursing - rather than "quick and dirty" as it were...Why do we do what we do based on the evidence as opposed to here's what to do and how to do it.

veggiegarden · Nov 21, 2005

More hands on clinical experience, for sure. And if not with a real patient, which *is* best no doubt, at least in lab. These "1-day-lab-classes-then throw 'em out on the floor" expereinces suck. Oh, and the ability to actually perfrom skills in clinical. Many in my program work in fear for doing something inappropriate (maybe performing a minor skill under the guidance of the preceptor) lest they be told to go home. With some instructors, we must always page them so that we may perform a skill, but by the time they answer or come, it's too late--the staff nurse wants/needs to get it done already. It really isn't a good system.

Less, or make that no, projects--reading for tests and researching/writing the mountains of paperwork for pre-clinicals take *plenty* of time.

KatieBell · Nov 21, 2005

I had a great experience in my BSN program. We are known in our state though for producing "clinical nurses" rather than research ones.

It helped that before I graduated I was experienced in taking more than one patient-we had to successfully complete doing 4 at a time, blessings to that clinical instructor who had 6 of us in clinical. And I spent 3 months working 36 hrs a week one on one with a preceptor in a SICU. Most programs are mvoing towards this, but others are still in the one patient per student mentality.

One comment though.

I'm not for students missing class. It is not appropriate, and was not allowed in my program. (If you had a physician note, for you or your child, it was ok, otherwise people did get kicked out for blowing class off.)

vamedic4, EMT-P · Nov 21, 2005

As a nursing student in my next to last semester in school, I feel ill prepared for the career that lies ahead of me. It seems to me that my school cares much more about keeping a high NCLEX pass rate than it does in producing capable and caring nurses. I went into the program excited and ready to soak up as much information as possible. I have kept a high GPA and do not complain about the amount of work I have to do at all. It is more the fact that in our BSN program, we spend so little time in clinicals that I feel I cannot apply what I do learn.
I also feel this "us against them" mentality coming from most of our professors. For example, many people missed a lecture a few weeks ago. I rarely miss class. However, these 2 weeks were horrendous with papers and tests coming out of the wazoo. I was hovering on a C in my psych class so I stayed home that morning to study so I could be fresh for the 1:00pm test. I take full responsibility for making this decision. What our lectures usually consist of is having a powerpoint presentation read verbatim to us anyway. Well, the instrutors who lectured took the lack of attendence personally and refused to give notes, made up out there questions for the test which have nothing to do with nursing (for example, what country is instructor x's son adopted from). I just feel, instead of trying to punish, could they try to understand maybe that the day before we had a 50 page paper due in another class and later that day we had a major test? Could they perhaps make their classes worth coming to? Honestly, I do not need notes read to me. I can do that on my on time. I need to be taught something.
On top of this being the hardest semester of them all, we have a clinical instructor who has a years long history of being incompetant, racist, and abusive. Yet, all the school does is move her from one course to another instead of doing something to improve the situation. I know there is an instructor shortage, but come on, students need more than just a warm body to guide them on this journey.
The instructors write their own test questions. Now some are very good at this. Others write incoherent misspelled questions in which one has to use the eeny-meeney-miney-moe answering method. I answer hundreds of NCLEX questions and get most right, I did extremely well on my practice HESI exam. On their tests, I will answer something I learned from the textbook or by answering an NCLEX question and these people will say, "well if you see conflicting info in what is in the text and what we say, go with us" (even if it is blatantly wrong). It is frustrating. I don't take tests anymore thinking, what is the best thing I would do for my patient based on evidenced based practice, but what would instructor X want? And of course, this is something different than what instructor y would want.
I remember my first week in the program and going to my assessment skills lab. We were told the following "I don't want to be here, I hate teaching this lab. If you have a question, look at the book or ask someone who knows." Wow, I did not know the impact of that statement at the time. But, I know it now. Assessment is THE BASIS of the nursing process and the most important set of skills a nurse can pocess. I feel cheated of a good education at this point.
Is this just my school, or is this a nationwide problem? If so, what can be done to improve this? What can we do to make nurses fell at least somewhat prepared and competant upon graduation?

:angryfire First off, let me assure you that you are not alone. Years ago (1988) when I was fresh out of high school and a new nursing student, I came across the same problem. Being a young male in nursing school was very difficult for me- I didn't so much mind the work, but when you're constantly singled out for everything INCORRECT that you do and nothing you do right...it can damage the psyche a little. I was a student in a 3 year diploma program and it didn't take long for me to get fed up and leave.

Now it's 17years later, I'm an experienced paramedic, and I have had my share of bad instruction like you mentioned above.

Many of the nurses I work with who came from 4 year programs share your feelings - telling me that it's much more "theory" than "practice". And as for instructors...let's say this: Your instructor can do the things you mention above AT LIBERTY. It's almost a joke. As with any college professor, they can condense an entire semesters learning to 5 pages in one book. They take all the info from, say, Kozier pages 303-309. And there are instructors who do just that. Obviously reliability and validity in examination means little to those instructors!

Clinicals are handled the same way, with some of the absolute worst nurses ever to grace the profession working as your instructors on the floor. Now they are few and far between, but they're out there.

Keep telling yourself "I'm gonna make it through this"....and stick to your guns. If an instructor tells you you're wrong..ask why. If you're not satisfied with the answer go over and above her head. You bang on enough doors you will get results.

Oh, and make sure to let the school know EXACTLY what you think of your instructors at the faculty evaluations at the end of the semester.

Best of luck.

vamedic4

Paramedic / Nursing student:chuckle

oreo75 · Nov 23, 2005

This is a UK perpective on the question, (everyone else might think they haven't got things to bad) where to start.....

university

We get taught for 6 hours a day 2 days a week for 6 weeks a semister, & for most of that time it is spent repeating previous lectures, we spend very little time in the skills lab (practice ward). I read about what you learn about & the things you get to practice & I'm so jealous.

We have had 2 terms when we have learnt about illness & how to care for that illness the rest has been about politics & researching nursing articles.

It takes the university I attend 2 months to send out the results of assignments & 3 for resubmissions

Placement (clinicals)

We are told about a week before where we are going on clinicals, or sometimes we have to arrange things for ourselves as they haven't got round to it

They have so many students on each placement area that it is difficult to learn some days there is 6+ students!

They arrange placements for a week or even a day, which means you find it hard to get practice outcomes signed off.

Even though you are not meant to be counted in the ward staffing numbers you still do & get used as health care assistant (I think they are nurses aid in the USA) which isn't helpful to learning how to be a RN

I think that's all I can think of for now

oreo75 · Nov 23, 2005

I forgot to write how nurse education can be improved, this again is from a UK view point.

Smaller cohorts, would help the drop out rate, as there would be few students on placement but if there was fewer students it would be they could improve the bursary or maybe even give us a wage which is the main reason for the high drop out rate.

Mentors prepared to fail students on placement (clinicals) there are too many people prepared to sign off paperwork as it's easier than failing a student, so you get students that are not competent to practice. There is one who graduated 2 months ago & is still not able to practice without supervision.

A more varied assessment process, I have had 2 presenations, 2 exams & about 14 essays & I'm so much better in an exam.

A longer time in placement, a week or a day is not long enough in most placements to get an idea of what goes on, & most of the time it's just a way of spreading out the students.

Learning more about ill health & less about government policy, it's ill health I'm going to be thinking about when caring for a patient rather than the latest government policy.

I'm sure there most be more that this, but that's all i can think of for now