Last week on NPR I heard about how law firms are sick and tired of training new lawyers how to be... well, lawyers. Therefore, they're quitting. They're no longer training lawyers how to be lawyers. Now, they're refusing to hire 'new grads' because they don't know how to do their job. Hence, law schools are now restructuring their curricula to produce lawyers instead of new grads. Sound familiar?
It got me thinking. Wouldn't it be nice if we student nurses could graduate and actually preform as a nurse and not a new grad?
The economy is horrible. Virtually no one will hire a new grad RN... because they don't know how to be a nurse. Wouldn't it be nice if we were taught that in school. Employers have changed. They are saying, "We don't want 'new grads', we want nurses!".
How long will it be before nursing schools get the message? Unfortunately, I think our professional schools aren't as receptive or adaptive as law schools. It will be a long, long while before nursing schools start producing nurses and not new grads...
Unfortunately, I think our professional schools aren't as receptive or adaptive as law schools.
Ahhh yes, the beacons of change! Law schools!
You do realize that the first year classes of law schools have been the same classes for about 100 years? A little more emphasis now on writing and internships in the second and third years, but law schools aren't changing all that much.
From what I remember, I did a lot of papers in nursing school, and we had clinicals and offers of internships.
Law school is all about teaching you to think like a lawyer.
Because you can teach a chimp to write the brief or take a deposition. But it takes thinking like a lawyer to know when to write a brief and what questions to ask in a deposition.
Nursing school is all about teaching you to think like a nurse.
Because you can teach a rather stupid chimp all the skills that everyone thinks are so important to have when you graduate. That we have people bragging that diploma programs or ADN programs or LPN programs are so much better at then anyone else. Oh no! I didn't learn to insert a rectal tube! So take a tube and stick it up the patient's a$$. Didn't learn to do a foley cath? Stick a tube up the patient's urethra. Didn't learn to start an IV? Stick a tube up the patient's vein. Didn't learn to crush a med? Well, if you need to be taught that...
School is to teach you to think like a nurse.
I don't care if you can't start an IV. I want a new grad that I'm orienting to know why the patient needs one (and not just because the doctor says so) and to understand what our use of the IV, whether for fluids or antibiotics or whatever meds, is going to do to the patient.
Too many people are worried about the skills and not about the breadth of knowledge it takes to not kill someone.
You do realize that the first year classes of law schools have been the same classes for about 100 years? A little more emphasis now on writing and internships in the second and third years, but law schools aren't changing all that much.
From what I remember, I did a lot of papers in nursing school, and we had clinicals and offers of internships.
Law school is all about teaching you to think like a lawyer.
Because you can teach a chimp to write the brief or take a deposition. But it takes thinking like a lawyer to know when to write a brief and what questions to ask in a deposition.
Nursing school is all about teaching you to think like a nurse.
Because you can teach a rather stupid chimp all the skills that everyone thinks are so important to have when you graduate. That we have people bragging that diploma programs or ADN programs or LPN programs are so much better at then anyone else. Oh no! I didn't learn to insert a rectal tube! So take a tube and stick it up the patient's a$$. Didn't learn to do a foley cath? Stick a tube up the patient's urethra. Didn't learn to start an IV? Stick a tube up the patient's vein. Didn't learn to crush a med? Well, if you need to be taught that...
School is to teach you to think like a nurse.
I don't care if you can't start an IV. I want a new grad that I'm orienting to know why the patient needs one (and not just because the doctor says so) and to understand what our use of the IV, whether for fluids or antibiotics or whatever meds, is going to do to the patient.
Too many people are worried about the skills and not about the breadth of knowledge it takes to not kill someone.
Seriously. This. All over it.
Skills will come as you go along. Critical thinking is the utmost important part of our job.
I don't care if you can't start an IV. I want a new grad that I'm orienting to know why the patient needs one (and not just because the doctor says so) and to understand what our use of the IV, whether for fluids or antibiotics or whatever meds, is going to do to the patient.
Too many people are worried about the skills and not about the breadth of knowledge it takes to not kill someone.
Seriously. This. All over it.
Skills will come as you go along. Critical thinking is the utmost important part of our job.
Nursing schools have been taking this approach to educating nurses for many years now, and the result of this philosphy is the growing number of hospitals refusing to hire new grads. They are sick of having to spend a lot of time and money to teach new grads the nursing skills and abilities that the new nurses need to know to get through a shift and "not kill someone" that they (the hospitals) think (quite reasonably, IMO) people should have learned in nursing school. I doubt that this will turn around even when the economy picks up; I doubt it will turn around until there truly is a dire nursing shortage and healthcare employers have no choice but to hire new grads.
FWIW, it's not an "either/or" choice (either you teach skills or you teach critical thinking, but it's impossible to do both (as is frequently suggested on this site and by ). Good diploma schools did an excellent job of teaching both, long before the term "critical thinking" was even invented, and people used to graduate from nursing school well-prepared to function as an (entry-level) RN, and with more than enough "breadth of knowledge" to avoid killing people ... I'm not advocating for a general return to the diploma school model, but, having spent a long time in nursing and nursing education, IMO, nursing education has really "thrown the baby out with the bathwater."
Wooh, thank you for your post. As a new grad, it's nice to get some perspective of what veteran nurses may be wanting to observe from newbies. My skills may come along slowly but surely, but I really love knowing why I am doing the things for a patient to give them the best care I possibly can.
I'm a diploma graduate from about 25 years ago. Many hours of clinicals and 1 hospital taught me how to be an entry level nurse at that hospital. I think orientation would have been easier there only because of familiarity with the MDs, RNs and ancillary staff, charting, layout of the place. I would have been able to concentrate on the nursing.
I went to work at a different hospital--and had to learn all of the above, and the "how to be a nurse" part.
I believe longer clincial hours would help acquiring skills. 3-4 hrs a day 2 times a week seems to be the average of students where I work. 1 8 hr shift would give a much better idea of "flow," you'd have a better chance at seeing pts clinical condition change for the better or worse, and you'd have a chance to see how interventions turn out.
I have to say I'm a bit scared about finishing nursing school after reading this post and the responses. Can anyone give me an example of what is done on the floor as a nurse that we aren't learning in school? Maybe a few examples can help me, a nursing student, understand what is expected of me after graduation. I'm on this site almost daily reading about new grads and their struggles over finding a job. I work as a Medical Assistant now and I do have medical experience but it's NOT nursing experience. So I'm sure I will be job hunting for awhile after graduation. Thanks guys :)
Hospitals aren't hiring new grads these days because there are plenty of experienced nurses that are coming out of the woodwork or working more hours because in this economy they have to. It has nothing to do with what schools are teaching or not teaching. (Same with attorneys right now.)
The economy is to blame. Not nursing school curriculums.
Specializes in Leadership, Psych, HomeCare, Amb. Care.
I have to say I'm a bit scared about finishing nursing school after reading this post and the responses. Can anyone give me an example of what is done on the floor as a nurse that we aren't learning in school? Maybe a few examples can help me, a nursing student, understand what is expected of me after graduation.
Hands on experience is what matters. A surgical resident can read about a procedure, but until he actually does it (probably by doing little pieces of it at a time spread over multiple cases under supervision). There's no way a classroom or a video can replace that.
The more that you can do hands on, or watch others doing, the more comfortable you will become. The schools probably can't do much more unless they were able to provide additional extensive & expensive post-grad practicums.
The purpose of nursing residencies/internships/versant etc is to provide that bridge from student to practioner. keep in mind, when interns hit first hit the floors, they need a lot of coaching & hand-holding too. It takes 6-12 months before a new nurse is really hitting her stride.
I think it's just hard to find work no matter what today. I would wonder if it's not sometimes better to hire a newbie who can be molded to what the facility needs rather than someone who is set in doing what they do, how they do it, and doesn't have that 'teach me' kind of attitude.
I also have to say that I've been training some new nurses where I work and I wonder what they are thinking. As hard as it is to get a job, I would never bring a crossword book or word search book to work, I would never sit around and actually look like I'm not doing anything. Really! At least pick up a chart and pretend to read the pts hx! When I have a new LPN and I ask her to come on back and get familiar with our great paper charting and grab a pen; and her reply is "They told us in orientation that the RN's do all of the charting", I have to wonder how bad a nurse really wants to work. Do I really need to print off a copy of your job duties to show you that charting is one of them? Remember in nursing school when you were taught that the RN can delegate darn near anything except actually charting 'I assesed'? I do and I was a LPN just a few short years ago
I apologize for adding to the general rant title :)
Hi everyone. Long time since I have been here. A few thoughts. Firstly, what is happening to new grad lawyers is the same thing that is happening to all of us with one exception. The back office jobs that they are usually hired for are gone out of this country now. They are being outsourced to India and some of the higher up execs in those law firms are actually moving to India lock, stock and barrel to oversee the proceedings. See the article in the NY Times dated 1/8/11 and titled Is Law School a Losing Game? http://www.nytimes.com/2011/01/09/business/09law.html?pagewanted=all
Many of them now work for Starbucks. So, while execs whine about having to train new grad lawyers, that is just a pile of bunk. It is all about the money, not the training.
Also, like other posters have said here. Back in the days of diploma schools, when you graduated you had spent so much time in clinical situations rather than classroom situations that you were well prepared to fly on your own and did not need hand holding. Now, however, clinical placements are hard to come by for all the students who are in nursing school and instructors have to fight over spots for their students. Most of these spots only get you 4-6 hours per week of clinical time or maybe 8 if you have clinicals twice a week. The schools then place the onus of training on the hospitals in a time when budgets are really being squeezed. That may have been OK 20 years ago but it does not fly now. However, I dont know if it is a matter of the schools waking up to reality because there is really nothing they can do about the shortage of clinical time. Someone back in the late 1970's made a decision to change curriculum in nursing schools to shift more towards classroom training and away from practical training. This is similar to the decision that was made in the 1970's to stop teaching reading with phonics and to go to word recognition. This is something I know a little bit about as I trained to become a science teacher (and then could not find work and went to nursing school). The decision about the phonics came off a masters thesis that a woman wrote about using word recognition and all the school boards went for it, which is why so few people can spell nowadays. Point is: someone makes a bad curriculum decision and then no one has the guts to stand up and reverse it and it goes on and on dragging countless people down with it. To sum up, the nursing schools are going to ride this gravy train right to the bottom. Good Lord, one of my neighbor's daughters was telling me that she was going to start nursing school soon and that she knew she would make $53 an hour to start. I tried to tell her but she wouldnt listen. Oh well, just more cannon fodder.
Oh the word recognition! I had to buy Hooked on Phonics for my son 10 yrs ago and his reading level went from the bottom 1/3 to the top 1/3 in one summer. Just had to comment on sad it was to see our schools fall so far behind.
It's sad. And it used to be that when you graduate, you got a general orientation, but were expected to be one of the gang from day one. I feel bad for the folks who are thrown out there without the practical info you need. If folks are familiar with skills checklists, we had done those prior to graduation. From what I've understood on the threads here, the precepting and internships are basically an extension of school...... I'm not sure when it all changed. But I feel for you guys :heartbeat
Exactly.
Twenty years ago...
If you weren't checked off as proficient on a task (including IV starts) you didn't graduate. Last quarter nursing students were expected to carry a full patent load (with supervision).
The last 2 quarters of nursing school were spent doing 36 hours a week of clinical and 4-8 hours of theory. For two solid years nursing school was a more than full time job. And we still had all the "fluff and theory" students get today. We still wrote comprehensive care plans, research papers and case studies.
We learned how to think like nurses AND the skills...all in a community college ADN program.
Nursing schools didn't have (long) wait lists, all pre-requisites had to be completed before you could even apply (because there was no time of other classes along with nursing) and programs had a generous minimum GPA for admission.
New grads in a non-specialty could expect to get 2-3 weeks of orientation, only slightly more than an experienced nurse.
The change happened in response to the supposed nursing shortage (I've never lived in a shortage area).
A big complaint was that nursing school was too hard or time consuming, that it wasn't realistic and didn't accommodate people having jobs, families or lives.
So, one of the ways to increase the number of nurses being churned out was to make nursing school easier. Boards of Nursing reduced the number of clinical hours required for licensure and the NCLEX went from being a comprehensive assessment of a nursing practice and knowledge to being a screening tool to ensure new nurses met the minimum to be "safe".
Hospitals needed bodies and had to suck it up and provide more and more education to new grads if they wanted staff and twenty years ago the odds were pretty good that if they invested in a new grad they would get a good return on their dollar in terms of longevity. Now nursing education has been watered down to the point that it's too much of a burden both financially and on existing staff to take on more than a few new grads at a time and then only the cream of the crop.
The economy is going to turn again and there is going to be a widespread shortage of nurses again but I really think hospitals have learned their lesson and will continue to prefer to hire an experienced nurse over a new grad no matter how much training those new grads have.
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wooh, BSN, RN
1 Article; 4,383 Posts
Ahhh yes, the beacons of change! Law schools!
You do realize that the first year classes of law schools have been the same classes for about 100 years? A little more emphasis now on writing and internships in the second and third years, but law schools aren't changing all that much.
From what I remember, I did a lot of papers in nursing school, and we had clinicals and offers of internships.
Law school is all about teaching you to think like a lawyer.
Because you can teach a chimp to write the brief or take a deposition. But it takes thinking like a lawyer to know when to write a brief and what questions to ask in a deposition.
Nursing school is all about teaching you to think like a nurse.
Because you can teach a rather stupid chimp all the skills that everyone thinks are so important to have when you graduate. That we have people bragging that diploma programs or ADN programs or LPN programs are so much better at then anyone else. Oh no! I didn't learn to insert a rectal tube! So take a tube and stick it up the patient's a$$. Didn't learn to do a foley cath? Stick a tube up the patient's urethra. Didn't learn to start an IV? Stick a tube up the patient's vein. Didn't learn to crush a med? Well, if you need to be taught that...
School is to teach you to think like a nurse.
I don't care if you can't start an IV. I want a new grad that I'm orienting to know why the patient needs one (and not just because the doctor says so) and to understand what our use of the IV, whether for fluids or antibiotics or whatever meds, is going to do to the patient.
Too many people are worried about the skills and not about the breadth of knowledge it takes to not kill someone.