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Math requirement for RNs?

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llg llg, PhD, RN (Guide) Guide Educator Expert Nurse

Specializes in Nursing Professional Development. Has 44 years experience.

I have a question for both practicing RNs and students alike:

It's come to my attention recently that some nursing schools are on longer verifying that their students can do basic 4th grade math. By that I mean add, subtract, multiply, and divide without using a calculator. They assume that calculators will always be available and that therefore, nurses don't need to know how to do basic calculations anymore and don't have anything in their curriculum that requires students to do those things. In fact, they are aware that some of their students definitely can NOT do those basic calculations when they involve fractions and/or decimals. Also, the TEAS test now allows applicants to use calculators: so they are not testing those skills, either.

To me, that seems like a safety issue. There might come a time when a calculator is not available.

1. What do you all think?

2. Students ... are you competent adding, subtracting, multiplying, and dividing fractions and decimals?

3. Practicing nurses ... are there any times you need to use basic calculation in your work (without a calculator)? Can you give me some examples?

4. Is anybody verifying those skills in orientation anymore? (med tests without calculators, etc.)

Thanks,

llg

I'm trying to imagine a moment in time where a calculator wouldn't be available in this day and age. Beyond an EMP blast or maybe a war zone where the batteries on every cellphone of every person was dead at once.. I'm drawing a blank here.

I guess I'm old school, I never use a calculator. I'm not allowed to carry my phone and I couldn't tell you how to access the one on our computer. It's just easier to do it in my head or on paper.

A calculator should simply be an aid to check your math. If you have no understanding of the basic math process, to me a calculator means nothing.

It's extremely scary that schools are doing this. A nurse needs to be able to look at an order and figure out the dosage from the vial by just looking at it.

I will tell you nobody verified my math skills in orientation though.

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

Personally I would love to see math requirements increased.

A few yrs back I attended a meeting regarding my oldest daughter (going into 6th grade) who was aiming to take algebra. One of the benefits according to the math faculty, was that Calculus 2 is a big weed-out class for engineering and pre-med. A kid who takes Algebra 1 in 6th grade will have Calculus 2 completed while still in high school.

Doctors as far as I know, don't actually use calculus in their work, let alone Calculus 2. Nurses do use algebra for dosage calculations. So I have no trouble thinking that if one is going to be a nurse, they should demonstrate at minimum a competence in basic algebra.

To answer your question, I don't do nearly the amount of dosage calculations that peds nurses do. I have however, caught a pharmacy error in which the oral syringe contained double the ordered dose. (the affixed label was accurate.) I have also given KCentra and Mannitol, where the ordered dose was less than contained in the bag. Therefore I had to figure out how much to give.

I have never been without a calculator, but given our roles and responsibilities as nurses, there is no excuse for trouble with arithmetic. You can't do it, you should not be a nurse.

llg, PhD, RN

Specializes in Nursing Professional Development. Has 44 years experience.

To add to the coming troubles I see ...

Some school systems are no longer teaching/requiring cursive writing (hand writing, script, etc.). Students are graduating high school without being able to write in cursive and only a minimal ability to read it. Everything in their schools are printed in block letters. I've read that history professors and other social sciences are concerned because their students can't read documents that aren't in block print -- diaries, hand-written letters, etc.

The school district that my niece and nephew attend is such a school. As teenagers, we discovered they couldn't sign their names in cursive -- only in block print. We have since insisted they learn to read and write cursive on their own so that they will have the ability as adults.

brownbook

Has 36 years experience.

I agree even though I am terrible at basic math! I Googled my "problem" once to see if anybody has discovered that people have a learning disability with math, similar to dyslexia. No one has, gosh darn it!

Yet I got A's in chemistry, balanced equations like a pro! I can easily calculate doctor ordered 250 mg, it comes in 725 mg per ml, or doctor ordered 25 mcg, it comes 50 mcg per ml in a 2 ml vial.

But if you gave me a basic math test dividing and multiplying decimals and fractions......I think I'd eventually figure it out but it would be painful for me to do and I'm sure painful for you to watch.

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development. Has 10 years experience.

I graduated nursing school six years ago. Even then we were given calculators for all exams that required any kind of math.

I have never been without a calculator while practicing as a nurse. At a minimum there is one on my cell, a battery powered one in the drawer and/or the one on the desktop computer available.

Jolie, BSN

Specializes in Maternal - Child Health. Has 35 years experience.

I'm a dinosaur, not having practiced in a hospital setting for almost 20 years. But I vividly recall some train-wreck deliveries where we had to estimate weight of a critically ill newborn, calculate doses and draw up code meds based upon that estimate. In one case, the delivery took place on the way into the hospital with no scale in sight, in another case, the room was so poorly designed and set-up, the scale was there, but completely inaccessible. Mental math saved those days.

llg, PhD, RN

Specializes in Nursing Professional Development. Has 44 years experience.

I admit that there aren't many circumstances today in which a calculator is not available ... but it would bother me to have the average nurse unable to do basic, 5th grade arithmetic. Shouldn't we expect more of our profession? Shouldn't we all have basic math literacy?

Natasha, CNA, LVN

Specializes in Psych. Has 1 years experience.

I admit that there aren't many circumstances today in which a calculator is not available ... but it would bother me to have the average nurse unable to do basic, 5th grade arithmetic. Shouldn't we expect more of our profession? Shouldn't we all have basic math literacy?

I agree. I suppose time will tell. If statistics already show an increase in med errors we can only imagine what the decision makers were thinking in seeing this new method as a way of improving medication management?

My personal opinion is that very few students would get into a nursing program without having these basic math skills underneath their belts. I couldn't take my nursing prereqs without either taking a basic math course or testing out of it. I was not able to use a calculator on that test. In my nursing program, I had to take a Math for Meds class, and the the rules were similar. We could not use calculators on the first test, but could use them on the rest.

As a student, I do feel competent in my ability to perform basic math.

KelRN215, BSN, RN

Specializes in Pedi. Has 10 years experience.

I specifically remember the following example being given in my Pharmacology class in college:

Mr Jones needs to take 100 mg of X medication. Medication is available in 25 mg pills. How many pills do you administer?

Half the class immediately knew the answer was 4, the other half had no idea where we got that answer from. I couldn't believe I was in college (at a nationally ranked University, nonetheless) with people who couldn't divide 100 by 25 in their heads.

Calculators are typically readily available but I do recall a time in a code situation where I caught another nurse's error. We had a child who was seizing, the MD called for "0.1 of ativan." I was handed a syringe with 0.2 mL of ativan to push. Ativan IV is 2 mg/mL so what I was handed was 0.4 mg. That was problem #1. Problem #2 was that when the MD called out "0.1 of Ativan", he meant 0.1 mg/kg.

Julius Seizure

Specializes in Pediatric Critical Care.

To add to the coming troubles I see ...

Some school systems are no longer teaching/requiring cursive writing (hand writing, script, etc.). Students are graduating high school without being able to write in cursive and only a minimal ability to read it. Everything in their schools are printed in block letters. I've read that history professors and other social sciences are concerned because their students can't read documents that aren't in block print -- diaries, hand-written letters, etc.

The school district that my niece and nephew attend is such a school. As teenagers, we discovered they couldn't sign their names in cursive -- only in block print. We have since insisted they learn to read and write cursive on their own so that they will have the ability as adults.

Does this relate to concerns about their ability to be nurses in some way, or are you just concerned about the education system in general?

Julius Seizure

Specializes in Pediatric Critical Care.

It's extremely scary that schools are doing this. A nurse needs to be able to look at an order and figure out the dosage from the vial by just looking at it.

But why? Because that's how school and nursing has always been? Nurses used to have to count the drops in the IV chamber while looking at their watch to adjust the infusion rate. I'm glad that's changed.

If the med is something like Ativan 2mg/ml, and you are supposed to administer 4 mg....I don't mind my nurse doing that in her head. I also don't mind if she uses a calculator, as long as she gets my dose correct.

But its its something like Epi 1:10,000, administer 0.1mg/kg or Dopamine 400mcg/250ml, run infusion at 5 mcg/kg/min...

....in those cases, I hope my child's nurse IS checking her math with a calculator, honestly.

37changes, ASN, RN

Specializes in LTC. Has 2 years experience.

Thanks for this thread. This has motivated me to continue "brushing up" with the math and algebra programs I have available at home. (We homeschooled the kids for seven years.)

But to answer the one poster who cannot imagine this happening ~ I can tell you this:

I am about to be in an ADN program which does not require algebra. I am completing the one math requirement right now -- called "Quantitative Reasoning" -- and we use calculators for *everything*. I also used the calculator for the TEAS exam, and scored 100% on that section. Could I have done it without a calculator? Sure. I graduated high school 20 years ago and so, I am not a part of this new generation of schooling. But I don't believe for a second that I would have gotten 100% on it.

Julius Seizure

Specializes in Pediatric Critical Care.

Calculators are typically readily available but I do recall a time in a code situation where I caught another nurse's error. We had a child who was seizing, the MD called for "0.1 of ativan." I was handed a syringe with 0.2 mL of ativan to push. Ativan IV is 2 mg/mL so what I was handed was 0.4 mg. That was problem #1. Problem #2 was that when the MD called out "0.1 of Ativan", he meant 0.1 mg/kg.

Kel, does your place of work use code sheets? (Printed out papers with the dosage/volume of emergency drugs based on the patients weight)

When I was in nursing school, we had a med calculation test in every clinical course and had to pass with 90% and no calculator. This included old fashioned drip rate calculations. One of the instructors was pushing for the pass rate to be 100% cogently arguing that a nurse with a 10% error rate in med calculations is a ticking time bomb.

I don't think the argument should be about whether or not calculators will be avaialable in clinical settings. It's about being well-educated professionals. What's next, I don't need to know how to spell basic words because I have spell check? I don't need to know right from left because I can write it on my hand? I don't need to know how to tie my shoes if I only wear Velcro?

The math that is required for nursing practice is very basic indeed. Far below the level that should be expected of a college grad. I hope that any nurse who ever cares for me or anyone I care about (or anyone at all for that matter) can do that kind of math in his or her sleep. We are not a credible profession if we can't meet even that low of a standard.