If you spend any time on AN, you'll see a common theme of dismay regarding nursing education -- especially, but not limited to, graduate nursing programs. Let's pool our ideas here about how to improve the whole system -- as if someone tasked you to come up with improvements that would actually be employed within nursing academia. We can list improvements for all levels of education. I'm sure we won't all agree on the ideas, but it might be interesting to see the variety. I'll go first.
UNDERGRADUATE:
- all ADN programs should be linked to a BSN bridge program
- chemistry and biochem should be added to prereqs (some schools do require), as well as a full year of statistics (as opposed to one semester)
- Nursing Theory should be covered (and sprinkled lightly) within the context of other classes in order to show application, as opposed to a separate course.
- Written work should be heavily focused on case studies and literature review pertaining to expected or actual clinical experiences.
- Clinical hours should provide plenty of hands-on experience for students to do bedside procedures and manage patient load.
- Clinical hours should be closely supervised, and taught, by clinical instructors (not a drop off the baby nurse and run scenario and hope you got a good nurse to teach 'em)
GRADUATE
- Tightened accreditation standards for ALL schools offering MSN or DNP programs -- regardless of APRN or not, resulting in reduced admissions and closed schools.
- Incentives for schools offering Education tracks and for students pursuing this to help meet the shortage of nursing faculty.
- Direct Entry APRN programs requiring 2,000 hours of nursing practice prior to a minimum of 1,000 hours of APRN practicum in specialty.
- ALL APRN programs requiring 1,000 hours minimum of practicum in specialty.
- DNP programs either research or clinically focused -- adding 500 clinical hours and result in adding a specialty or narrowing focus on one (cardiac, critical care, heme onc, etc).
- ALL APRN programs have a business course included.
- Paid preceptors -- preceptors are considered faculty and contracted
- Hybrid learning (online and in class) with state schools incentivized to offer programs.
I'm all for promoting intellectualism in nursing but I'm also for promoting clinical competence. Liberal arts education has been sewn into nursing education which is fine however now it takes 6 months to 1 year for a new grad nurse to become competent in their position assuming they last that long. That is the problem with the current model, you can hate on "task oriented nursing" as much as you want but the truth is that the current model does not promote clinical ability which is the core of what bedside nursing is all about.
What's more is that many new grads are coming to the work force with not only a lack of clinical ability but a lack of resilience needed to build clinical ability. Within a month their ready to abandon ship or go back to grad school to get the hell away from bedside nursing.
I am not hating on nursing tasks. I simply believe that nursing is about more than that, and in fact it's about more than bedside nursing in acute care hospitals. As insurance reimbursements drop, healthcare moves further from long inpatient stays and pushes more services into outpatient settings and nurses need to be able to fill roles in all types of diverse settings. That requires knowledge about more than starting IVs and Foleys---even though those are important skills for nurses to have, no question.
I agree with the fact that there is a "lack of resilience" among many younger grads. Heck, I'm technically a millennial and I've worked with folks just 2-3 years younger than me who made me want to shake my broomstick at them from my front porch ? Don't know what the answer is there.
I guess I just don't think that it has to be either/or---making nursing programs focus solely on clinical skills/tasks vs. completely disregarding them and filling up the programs with "fluff." I don't think that promoting a BSN as entry to practice, for example, means that nurses are inevitably going to lose their place at the bedside and their mastery of patient care skills,
I don't think anybody is saying anything that opposes this but the truth is we have swung over to the "academics are more important" side with emphasis on the non-clinical side of nursing. It's very evident in the postings from students describing their clinical experiences (disappearing/disinterested instructors, limited hands on, more time in sim-labs than with real humans, fewer clinical hours). There have even been statements here along the line that nurses who want to stay at the bedside are somehow anti-education and lesser than those who continue on to terminal degrees which is utter crap. People seem to not want to face the facts that nursing, at it's core, is a task-oriented, sometimes dirty, labor-intensive, technical, service-oriented and not too far removed from a blue collar job. This does not in any way mean to say that it does not require a high level of intelligence and critical thinking skills. I have been at this gig for a long time and for my entire tenure I've watched as we have struggled to prove that we are a profession not a trade. The truth is we are an amalgam of both and neither side is less important than the other.
I for one think a BSN as entry for practice is a fine idea but we need to make it affordable and flexible to allow people from all walks of life the chance to achieve it.
I don't think anybody is saying anything that opposes this but the truth is we have swung over to the "academics are more important" side with emphasis on the non-clinical side of nursing. It's very evident in the postings from students describing their clinical experiences (disappearing/disinterested instructors, limited hands on, more time in sim-labs than with real humans, fewer clinical hours). There have even been statements here along the line that nurses who want to stay at the bedside are somehow anti-education and lesser than those who continue on to terminal degrees which is utter crap. People seem to not want to face the facts that nursing, at it's core, is a task-oriented, sometimes dirty, labor-intensive, technical, service-oriented and not too far removed from a blue collar job. This does not in any way mean to say that it does not require a high level of intelligence and critical thinking skills. I have been at this gig for a long time and for my entire tenure I've watched as we have struggled to prove that we are a profession not a trade. The truth is we are an amalgam of both and neither side is less important than the other.
I for one think a BSN as entry for practice is a fine idea but we need to make it affordable and flexible to allow people from all walks of life the chance to achieve it.
Your points are well-taken and I agree with them. I can't say I've ever witnessed anti-bedside sentiment and/or implying those who stay at the bedside are anti-education, on this site or IRL, but I agree that's utter crap.
I am not hating on nursing tasks. I simply believe that nursing is about more than that, and in fact it's about more than bedside nursing in acute care hospitals. As insurance reimbursements drop, healthcare moves further from long inpatient stays and pushes more services into outpatient settings and nurses need to be able to fill roles in all types of diverse settings. That requires knowledge about more than starting IVs and Foleys---even though those are important skills for nurses to have, no question.
I agree with the fact that there is a "lack of resilience" among many younger grads. Heck, I'm technically a millennial and I've worked with folks just 2-3 years younger than me who made me want to shake my broomstick at them from my front porch ? Don't know what the answer is there.
I totally agree with you, there is a lot more to nursing than what takes place in acute care. To clarify, when I'm talking about clinical competence I'm talking about much more than technical nursing skills, I'm also talking about the ability to truly apply the nursing process to determine the course of action for a patient. To be able to assess what is happening, determine what could be going on, knowing what to do to treat what's happening, what complications could occur and steps to prevent them from happening, orders to anticipate from the provider, etc. To me these are the skills that are most important and while certainly experience helps to build intuition related to these skills it's still pivotal for new nurses to be able to put the pieces together and too frequently they're not able to.
I get frustrated because in my specialty I get nurses all the time that have a knowledge gap in common psychopathology, psychopharmacology, psychiatric terminology, and even basic therapeutic communication tools and while I love teaching I shouldn't have to teach the most basic of concepts to someone who has completed their formal education. What I hear all the time is "they never taught us that in school." there in lies the problem, employers shouldn't have to teach nurses how to be nurses when students are spending thousands of dollars on formal education.
Specializes in OR, Nursing Professional Development.
1 hour ago, TheMoonisMyLantern said:
What I hear all the time is "they never taught us that in school." there in lies the problem, employers shouldn't have to teach nurses how to be nurses when students are spending thousands of dollars on formal education.
And yet, nursing has become so specialized. It is simply impossible to teach the skills that one would need upon graduation for all of those specialties. It would be darn near impossible to give even a fleeting exposure to each specialty, let alone have students performing independently. Does that mean we should investigate requiring all new nurses to work on med/surg? Well, even on med/surg you've got specialty units- orthopedic, urology, neuro, etc. Do we look at a system like the UK where students are not taught general nursing but rather a track within nursing? Then what happens if a student learns the realities of that track and wants to change? It's not a simple solution of less academic or more clinical or all should be a BSN. It truly would take a full overhaul.
And yet, nursing has become so specialized. It is simply impossible to teach the skills that one would need upon graduation for all of those specialties. It would be darn near impossible to give even a fleeting exposure to each specialty, let alone have students performing independently. Does that mean we should investigate requiring all new nurses to work on med/surg? Well, even on med/surg you've got specialty units- orthopedic, urology, neuro, etc. Do we look at a system like the UK where students are not taught general nursing but rather a track within nursing? Then what happens if a student learns the realities of that track and wants to change? It's not a simple solution of less academic or more clinical or all should be a BSN. It truly would take a full overhaul.
I hear what you're saying and agree to an extent. But psychiatric nursing has a designated class that students take so the basics have no reason for not being covered.
So many great thoughts here! I think we all recognize nursing education should nurture solid clinical competency while also focusing on applicable academics. I don't see why a better BSN can't be developed. Why not?
Who are the best nurses you know? They are those with consistent and broad clinical and assessment skills who have a deeper-than-most understanding of pathophysiology, critical thinking that goes beyond the moment, and an ability to interact therapeutically with patients and collegially with the rest of the care team.
So how do we teach that -- is there a way to produce graduate nurses who are more ready be those nurses? I think that is what the future of nursing education should look like.
A few ideas. Eliminate any type of nursing theory course at any level. Au revoir, bon voyage, and nobody will miss you. You are a great drain on the profession, and you should die a natural death.
Get rid of nutrition class. Too easy. Nurses don't handle this aspect.
At the MSN level, for 1000 dollars, I took a class about behavioral health change. Basically wow hard it is to quit smoking, start exercising etc.
It was a crock of feces, people. A major crock.
Please stop this silly class, we need real science.
Sohow do we teach that -- is there a way to produce graduate nurses who are more ready be thosenurses? I think that is what the future of nursing education should look like.
Look at the Diploma model. In my program all of the science/sociology courses were taught at the local university as part of the first year curriculum as well as Nursing 101. Next two years were didactic and clinicals and also included research, community health, nursing leadership and pharmacy. Our program was 3 1/2 years with no summer break. For a BSN revamp factor in another 6 months for related courses to “round out” the education or expand on previous courses. I have to tell you our program was brutal. We failed at a C. We started with nearly 200 students and graduated with only 27 but we were well educated both academically and clinically.
A few ideas. Eliminate any type of nursing theory course at any level. Au revoir, bon voyage, and nobody will miss you. You are a great drain on the profession, and you should die a natural death.
Get rid of nutrition class. Too easy. Nurses don't handle this aspect.
Yeah, any class you sit in and in your mind say “well duh!” needs to go.
Noooooo. More clinicals with smaller clinical groups and instructors who are truly invested in their students. Reviewing charts is not a clinical activity. Nursing students need way more hands on with actual real humans.
My clinical instructors were amazing and my groups were only 8 students. We weren't allowed to do much in clinical and weren't granted access to the EMR either so we were between a rock and a hard place. Reviewing charts isn't clinical activity, but that's what we spent a solid chunk of time in clinical doing in my last year of nursing school because of the limitations put on what nursing students can and can't do in a clinical setting. While it is important to get hands on experience with real patients, simulation experiences can be a safe environment to get a realistic feel for how things actually are- especially with advances in technology such as high fidelity sim mannequins. Have you used them? They sweat, cry, give real-time CPR feedback, you can hook them up to monitors and see rhythms, they have lung, heart, and bowel sounds and all of them can be made normal or abnormal and can be a tremendous learning tool for first year students to familiarize themselves with clinical concepts and assessments before ever laying their hands on a patient. Quality simulation experiences can help students apply nursing knowledge, develop nursing judgment, and can teach them how to begin to think like nurses- what priority assessments should be done when walking into a patient's room, how to talk to a difficult patient, how to calm a nervous family member in a code, when to call for RRT, the possibilities are endless and I feel like so many people dismiss it because it's not with real patients. Real patients oftentimes don't want a nursing student in the room. Nursing students simply do not understand why nurses are frustrated and can only see the tip of the iceberg of what they are doing because they simply do not yet have the knowledge. Simulation is safe and offers an opportunity to debrief and I think that it is an invaluable tool to help nursing students apply what they're learning so that when they DO go to clinical with real patients they have some knowledge and some understanding of what nursing care is.
Moreover, BSN as entry to practice is fine; but as a nurse who first graduated with an ADN I feel like I learned absolutely nothing in my BSN program. ADN programs are being pressured to prep students for their BSN and are filling their curriculum with the same coursework but in less time. My program emphasized research and APA, we took nutrition (though it seems pretty unnecessary now), chemistry, statistics, and it actually took 3 years full time anyway. The BSN just repeated what I already learned in my ADN program with a little more emphasis on what I feel roughly translates as managerial and administrative development. And nursing theory/history. Make BSN programs accessible and flexible, or allow community colleges to grant ADN to BSN degrees by adding a 4th year of courses to "round off" the ADN education. Emphasize nursing practice and eliminate nursing theory. More sim experience and do sim early- before nursing students go to clinical. Let them get their feet wet in a safe environment so they can apply what they learned in sim at the bedside. Debrief. Interactive lecturing instead of just reading slides. Engage students, have them speak up, have a conversation and compel students to develop clinical knowledge. The suggestions could go on and on, we all have ideas on what we could have learned in school.
Edit: ALSO: Teach students the realities of nursing. Violence in healthcare is a real issue and it needs to be discussed. Do not allow them to be blindsided on the floor. Do not emphasize de-escalation, we cannot continue to teach nurses to accept violence as "part of the job". Teach the next generation of nurses to make violence in healthcare unacceptable, and that admin pushing it under the rug is not acceptable. Teach them to be #silentnomore. Teach them that there is more than bedside nursing. Teach them to get involved in policymaking and politics and that nurses have a powerful voice that needs to be heard. Emphasize our responsibility as advocates not only for our patients directly, but for our communities. Teach them self-care.
I like all the ideas mentioned. I agree with having clinical instructors actually teach clinicals! I would increase the number of hours for entry into an APRN/NP school. It disturbs me that a brand new nurse can be in advanced practice and have no real bedside experience.
My bridge program’s sciences were biology based. I am not sure how adding chemistry will help. I did take chemistry for a different program and I struggled more in understanding A&P. The biology based program made A&P easier to understand.
I believe for-profit programs need to be discontinued. I don’t understood paying 30k plus for an ADN degree when a person can go to a community college for about 10k for the whole program.
In my ADN program, the clinical instructor had a group of 5 to 8 students that they supervised on the same unit every day. We were expected to pass (and discuss) meds with them, demonstrate/discuss assessments, give them report/updates, report any unusual findings, etc...
I was amazed when I realized that some school just have each student go to a unit ALONE to be with a staff nurse. How can these schools know what the students are learning (or need to learn)?! How can they adequately evaluate their clinical skills?!
LibraSunCNM, BSN, MSN, CNM
1,656 Posts
I am not hating on nursing tasks. I simply believe that nursing is about more than that, and in fact it's about more than bedside nursing in acute care hospitals. As insurance reimbursements drop, healthcare moves further from long inpatient stays and pushes more services into outpatient settings and nurses need to be able to fill roles in all types of diverse settings. That requires knowledge about more than starting IVs and Foleys---even though those are important skills for nurses to have, no question.
I agree with the fact that there is a "lack of resilience" among many younger grads. Heck, I'm technically a millennial and I've worked with folks just 2-3 years younger than me who made me want to shake my broomstick at them from my front porch ? Don't know what the answer is there.