Has ACLS been 'dumbed down'?

UM Review RN, ASN, RN · Dec 31, 2007

See didn't think you were to dumb..... I hear you saying you would just not prefer to paticipate. I disagree with instuctors not answering questions. I had plenty and after 2 days I went through the mega code using drug, interpretting EKG's using paddles and when I got to a point of what I'd hang next, I told the truth and said I don't know.
Congrats on your long career, but if I am your patient before you quit and I stop breathing, I'd hope you'd at least ask for help so you can pass the buck.

Frankly, I've taken ACLS and kept it current for a number of years, but have never had to give the meds, so no, I wouldn't feel too confident giving them.

I have seen the phenomenon that another poster described, in which a patient will be crashing and no one's thought to turn up the O2 or change to a mask --simple things in hindsight-- but the nurse who hasn't had ACLS hasn't heard the news that yes, it's OK to oxygenate the crashing patient, no matter whether they're a CO2 retainer or not.

Even though I don't use ACLS much, I always take away something new from the course, and I feel more confident each time I take it.

As another poster said, the study materials are better now. It's very important to study them before you get to the course. The last book I bought came with a nice test disk and test questions, and video demos. I loved it.

It did make it seem "easy" but frankly, you don't want to be a nervous wreck in a code situation because once you start to get nervous, you lose the ability to critically think. Since people do what they learn, if they learn in a fairly calm environment, they will be able to mimic this and carry it through during a code situation. Sometimes I honestly think that's the only reason that some patients survive a code. We behave as though they can, and they do.

classicdame, MSN, EdD · Dec 31, 2007

People who work in critical care areas should consider the "Experienced Provider" course, as the provider course may be redundant to them. The course is not easy if you never practice it. Also, the course was redesigned to reflect actual practice and nursing standards, not medical standards. It is a challenge to create a course that suits every type of practice, but I don't think ACLS has dumbed down. I think you have smarted up.

billythekid · Dec 31, 2007

Wow - seems like quite a wide range of experiences. I took mine a few months ago - great course. We were expected to have studied the material prior to the class. In the morning we spent about 4 hours practicing all the algorithms. In the afternoon, we were tested on a Megacode and had to pass a written test which included having to know about 20 rhythms. I don't remember the numbers, but not everybody passed - sure didn't seem too "dumbed down" to me!

This sounds like an ideal ACLS class situation... challenging enough to make you want to study on your own before going into the class so you feel confident performing in front of the instructor and/or classmates, but not so impossible that people throw their arms up in frustration.

The first ACLS class I took was right after my original paramedic program, and the testing of megacodes in the ACLS course (not speaking for every ACLS course) paled in comparison to the level paramedics were expected perform. The policy of 'group exams' some have mentioned to does nothing to further the competency of the provider (unless having a 'card' increases a person's confidence and thereby their competence), and undermines the integrity of the certification. Codes run best when every individual on the team is interchangeable and is responsible for knowing what comes next... if that means some people do not pass on their first attempt, ultimately the level of patient care is raised, and providers will take the course more seriously.

cardiacRN2006, ADN, RN · Dec 31, 2007

ACLS isn't "dumbed down". ACLS is set up where everyone will get through their weaknesses before they leave the building. Everyone I know including me have studied hard to pass the written test and we take it seriously.
Perhaps ACLS should be considered more percise rather than "dumbed down".

I took ACLS 'cold'.

I didn't have a book to study, and I had to take it in order to get off orientation as a new grad. I had little nursing experience to back me up. I think I had been a nurse for 2 months.

The class was one day, and I passed with 100% on the mini test at the end. (What was it, 20 questions?) The test took me about 7 minutes.

It was a piece of cake.

My mother is an RN with 20+ yrs. She remembers ACLS of the old. I'd have to agree that this is a far easier format.

Could you take ACLS in the past without studying? I think not.

banditrn · Dec 31, 2007

ACLS used to be an extremely rigorous course in the past. Now, more and more people are getting it and it's practically a walk in the park. I understand the reasoning of it being viewed as a learning experience, but I'm wondering if the standards have become too lax? No one fails anymore.
What do you think, should the standards be tightened up again, or is it fine the way it is?

I think it depends on the institution where you take it. When I first took it many years ago, it was complex, and you could fail. I was proud to have passed it.

As the years went by, tho, it seemed like every time that I recertified, it seemed like they were making it easier and easier. It finally got to the point where I felt that they were passing people who had no 'real' idea what it was about - just so they could brag about how many people they had that were certified.

FireStarterRN, BSN, RN · Dec 31, 2007

I took ACLS 'cold'.
I didn't have a book to study, and I had to take it in order to get off orientation as a new grad. I had little nursing experience to back me up. I think I had been a nurse for 2 months.
The class was one day, and I passed with 100% on the mini test at the end. (What was it, 20 questions?) The test took me about 7 minutes.
It was a piece of cake.
My mother is an RN with 20+ yrs. She remembers ACLS of the old. I'd have to agree that this is a far easier format.
Could you take ACLS in the past without studying? I think not.

This is what I had in mind when I posted this thread. Thanks for the example.

FireStarterRN, BSN, RN · Dec 31, 2007

I think it depends on the institution where you take it. When I first took it many years ago, it was complex, and you could fail. I was proud to have passed it.
As the years went by, tho, it seemed like every time that I recertified, it seemed like they were making it easier and easier. It finally got to the point where I felt that they were passing people who had no 'real' idea what it was about - just so they could brag about how many people they had that were certified.

My facility is pushing for everyone to be ACLS, and they started bringing their own instructor, and the re-cert course I recently took seemed like a joke. We can also re-cert online, which is even a bigger joke. I was wondering if they just want their stats up by making sure everyone can easily pass.

P_RN, ADN, RN · Dec 31, 2007

I've not taken acls, but bcls used to be an hour long. Now it's called something else and you cang et your card in like 3 minutes. The instructor said better to do something than nothing.

bthynn · Dec 31, 2007

I am a BLS and ACLS instructor and I think ACLS has gone from high stress to low stress...I think with the new changes that AHA made that ACLS does seem easier...but that is because the treatments have been clumped together making it easier to learn instead of learning a different treatment plan for every disrhythmia.

Our classes are Pass/Fail and if there is some part you are having trouble on then we will remediate and let you take it again or come back another day and do mega-code...people still get all in a wad when they come to a first time class...and you cannot learn when you are stressed...you will retain more info if you are relaxed and it is interesting.

I think every nurse should have ACLS...you never know when you might need it.

As for dental assistants and other disiplines...If you are working on an office that does sedations...you need ACLS...if you don't have it and you assist with sedations then I do not want to come there to have a procedure done.

ACLS is a team approach and no you may not remember everything thats why you have a team and should have the algorhythms on each crashcart.

tntrn, ASN, RN · Dec 31, 2007

When I took ACLS the first time 2 years ago, there were 10 OB nurses in a class of at least 80 people, all of whom were reviewing. So we were just thrown in to sink or swim, basically. Our facility bought exactly 4 books for our entire unit, so do the math there. Most of us had no access to books before class. The class was taught as if everybody was reviewing, everything was done in acronym-speak and when we would hold up our hands and say, "we don't know what that means, " we'd get "oh, you don't know what that means, EITHER?" as if we were complete morons. I venture to say we could have devise a lecture of OB-Speak that would have baffled them also. So that was the tone from the get-go.

We did have mega-code which were just us, with the instructor. I preferred that to the the group mega-code at the most recent one I took. In this scenario, everybody has to perform independently, but with everybody else looking, either sympathizing with you or thinking how pathetic you are.

Both were stressful, very stressful, and any of you who get cold sores will relate to that, I'm sure.

AS far as choosing "not to participate" as someone said, of course, we all participate. We've all had Basic CPR and ours is not available online or in 3 minutes. I feel that since there is a code team, my best contribution would be to get that oxygen going, have the patient lying flat, get the crash cart in there, begin chest compressions, and then let them come in and do what they know best: meds and all the rest of it.

Under no circumstances am I qualified to lead a code and for them to put me in that capacity is unfair to everyone concerned. And thus, I don't think the mega-code situation, either time, was of any use to me at all. I honestly remember very little of what or when or if or how much. It was justs simply too over-whelming for me.

But put me in an obstetrical emergency, and I'm there! And knowing how fast ER people hand off any female who's EVER missed a period to us, I think they understand that. And you EMT's out there, try using veins in the hand or wrist for OB patients who call you with nothing but "i'm contracting" complaints. They are horrible for patients who will need to move and hold babies. We don't even use the antecubes for our bleeders. If we can find other veins, so can you. Fastest access isn't always best.

We are all good in our own chosen areas. I respect that and also respect that those not used to OB situations are uncomfortable. Please give that respect back to those of us who are not used to the other. We are willing to help as best we can, but expecting us to have expertise equivalent to what those of you who do this every day, is unfair.

mianders, RN · Dec 31, 2007

I took ACLS in November and everything was done in real time. You had to do 100 compressions/min and they used the maniquins that showed whether your compressions were effective. The first day we did compressions all day. It was like an 8 hour code. My arms hurt so bad. We were told that this would be way ACLS was done from now on. The algorythms they used were not dummied down either, and they expected you to know them. I have taken ACLS 6 times and this was the hardest and most physical one I have ever done.

Dorito, ASN, RN · Dec 31, 2007

I am scheduled to take the one-day ACLS recert class in a couple of weeks but wonder if I should retake the entire 2-day course. Don't use the material in my job, but I do understand it. In your opinion, does the one day recert class pare down the info too much to successfully complete the course? Thanks...

I coordinate the ACLS and PALS courses at our facility. Many staff take the 2 day course even though they are current. They get the extra time to practice and use skills that they often don't get a chance to. Most of the staff in the renewal courses are pretty experienced and work in codes all the time. If your facility allows you to take the 2 day course it may be to your benefit but it's whatever you are comfortable with. I agree that the courses aren't nearly as rigid as they used to be but we still have students come through that are scared to death. We have an ACLS prep class that has been helpful in reducing their stress.