why is med/surg so difficult?

[Nolander]

I've not actually taken this class yet but I hear it is one of the hardest parts of nursing school, so why is that? Are there a lot of tests/assignments?

[ImThatGuy, BSN, RN]

So should it be assumed what you're saying is that some nursing schools have mastery in science and other do not? Because I've done organic and inorganic chemistry, biochemistry, microbiology and statistics at my school

I wouldn't say the school of nursing, NikiCharles, has a mastery of science or not. A school's curriculum is largely regional. My point initially was that nursing, as a body, is not scientific, or I don't feel it is. I don't have a problem with that either and often wonder why such claims seem to offend academically-oriented nurses or somehow feel their life's role is diminished because of them. Law and accounting aren't scientific, yet they are systematic and probably both more so than nursing. However, we don't see lawyers or accountants taking offense to their fields being called something other than scientific.

Although my friend and I have chiefly articulated how a nursing school curriculum is not typically filled with rigorous sciences I think the primary argument is whether the field of nursing is a science, and we both turned away from arguing that point. I don't think nursing is because the theories and the applications don't seem scientific in nature. Nursing uses the crutch of evidence-based practice to "feel" scientific. That is not research. Evidence-based practice is the application of research to a problem, i.e. using the conclusions of research studies to go about solving some issue with better outcomes. Research is "supposed" to be unbiased while EBP requires interpretation, or opinion, to accept or reject research findings and how to implement them if at all.

Don't think I'm trying to portray myself as a scientist, researcher, or anything similar because I'm not and have no personal desire to be. I honestly can't stand the meticulous and patient nature of research and laboratory study.

[DennRN]

Wow, this thread is starting to scare me...

Nursing IS a science, let me elaborate with just one real life example from last week.

A pt presents with an abdominal aortic aneurism, as new grad I rely on my understanding of biology, pathophysiology, chemistry, and pharmacology to know what is happening to my patient, what could happen to the patient, what lab values to watch (what they are indicative of), the medicines he needs/which ones to question, and what symptoms to watch out for (what these symptoms mean for my client), what diagnostic tests he needs (how to interpret the results and apply them to the plan of care), and prioritize his care versus my other patients.

THESE ARE ALL THINGS THAT ARE NOT ONLY WITHIN THE SCOPE OF NURSING, BUT ALSO PART OF THE RESPONSIBILITIES THAT CANNOT BE DELIGATED TO ANYONE BELOW A NURSE.

If you are not practicing the SCIENCE of nursing, you are a liability plain and simple.

Going back to the original question, med-surg is difficult if you cannot tie together the sciences of pharm, patho, physiology, chem, and various others and apply them to the multiple diagnoses your average pt gets wheeled in with.

If you don't think nursing is a science, I don't think you are nurse material, at least not the kind I want anywhere near me or mine.

If you are wondering, he was one of the most stable pts I had last week.

[nurseprnRN, BSN, RN]

thank you ^.

"nursing does have a little science, but a mastery? heck no. most nursing schools don't require anything beyond intro to chemistry..even some of the "top schools". if you go into something that requires biochem, organic chemistry, physics i and ii, real microbiology(not the "nursing intro to micro that a lot of ppl have", thennn that's a mastery."

i know i ought not to feed the trolls and i hate to encourage this one with this. here it is anyway:

however, there are impressionable people here who can't recognize this as trolling and will take it as gospel. it's not. they should read on.

the troll forgets (or dismissively ignores) the science of nursing in his rush to characterize a comprehensive nursing education as mere dabbling other scientific fields. which was my point. personally, i think that someone ought not to be in nursing if s/he can't wrap his/her head around that without being snarky that only "mastery" other sciences "counts." of course we use many sciences. a chemistry major has to take calculus 2 and 3, but that doesn't mean s/he also has to be a mathematician.

nursing science is a well-established field of study. this is recognized by the legal system as allowing nurses to testify as experts in their field (and, interestingly, to disqualify physicians from testifying on the same topic). note the description of the factors on reliability of scientific testimony:

see daubert v. merrell dow pharms., inc., 509 u.s. 579, 593-95 (1993) (finding that, in determining the reliability of scientific testimony, a number of factors bear on the inquiry including: (1) whether the theory or technique can be or has been tested, (2) whether the theory or technique has been subjected to peer review or publication, (3) the known or potential rate of error, and (4) general acceptance within the relevant scientific community). this has been applied to testifying nursing experts generally and in the many nursing subspecialties, based on recognition that the science of nursing meets those standards.

rule 702 (testimony by experts) provides:

if scientific, technical, or other specialized knowledge will assist the trier of fact to understand the evidence or to determine a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training, or education may testify thereto in the form of an opinion or otherwise.

(fwiw, i and my nursing school classmates took "a little science": three semesters of university-level chemistry (including biochem and organic) side by side with chem majors (ooooh, some were premeds-- is that better?); ditto 1 semester each real microbiology, anatomy, and physiology...as undergrads. i didn't have to take physics as an undergrad (i took honors physics in high school, though), but i know there are several programs that do require that for nursing majors, among them the university of maine. more advanced physiology and other real sciences in grad school. and, of course, nursing science.)

[MU Nursingstudent]

I wouldn't say the school of nursing, NikiCharles, has a mastery of science or not. A school's curriculum is largely regional. My point initially was that nursing, as a body, is not scientific, or I don't feel it is. I don't have a problem with that either and often wonder why such claims seem to offend academically-oriented nurses or somehow feel their life's role is diminished because of them. Law and accounting aren't scientific, yet they are systematic and probably both more so than nursing. However, we don't see lawyers or accountants taking offense to their fields being called something other than scientific.

Although my friend and I have chiefly articulated how a nursing school curriculum is not typically filled with rigorous sciences I think the primary argument is whether the field of nursing is a science, and we both turned away from arguing that point. I don't think nursing is because the theories and the applications don't seem scientific in nature. Nursing uses the crutch of evidence-based practice to "feel" scientific. That is not research. Evidence-based practice is the application of research to a problem, i.e. using the conclusions of research studies to go about solving some issue with better outcomes. Research is "supposed" to be unbiased while EBP requires interpretation, or opinion, to accept or reject research findings and how to implement them if at all.

Don't think I'm trying to portray myself as a scientist, researcher, or anything similar because I'm not and have no personal desire to be. I honestly can't stand the meticulous and patient nature of research and laboratory study.

It obviously is regional because we do take evidence-based research nursing as well the other sciences that I previously wrote about in this thread that I took. No we didn't take a "special" chemistry or microbiology. We had to take the same ones that my pre-med cousin has to take as well as bio majors. No difference they do offer those types of courses you are referring to but they are for non-science majors to take to fullfil their science/chem requirements. So maybe it depends on were you live and so forth but I do not agree what so ever with your statements but maybe you would ahve found more satisfaction in a curriculum similar to ours.

[tippytootagon]

I think this argument comes from two definitions of science.

Nurses use science to guide their practice. I don't think anyone would disagree with that statement. But do nurses have mastery of science? I think that depends on your definition of science.

If you define science as using the scientific process in your study, then no, nurses definitely do not. We don't really have the liberty of experimenting on our patients the way a chemist or a physicist would experiment in lab. Furthermore, the basis behind the scientific process is that results can be reproduced every single time. The same is not true of nursing, because each patient is an individual and needs individualized care.

So where does evidence based practice come in? I think nursing science is definitely more related to the field of statistics and biostatistics. Essentially, it boils down to, most of the time if you do it this way, you will get the best result. That said, every patient is different, and you cannot reproduce results the way a scientific experiment would reproduce results, there will always be idiosyncracies.

However, to be a nurse you do need a basic understanding of chemistry, and an understanding of anatomy & physiology. But having a basic understanding of, say, how diffusion and the kidney works is a whole other world away from knowing the exact chemical process of a sodium-potassium pump. Nurses who have retained their college a&p may understand that a sodium-potassium pump pumps sodium out of the cell and potassium into the cell, but that is hardly mastery of science, compared with the researcher who understands the exact enzymatic reaction that happens on the cell's plasma membrane so that this takes place. Furthermore, nurses don't *need* to know the exact enzyme formula and exact chemical reaction formula to practice.

So do nurses need to know some basic science? Yes. Do they have mastery of science? Absolutely not.

(And to everyone who's about to argue with me, highschool and undergraduate level science courses do not count as mastery of science. They just don't.)

[DennRN]

"I don't think nursing is because the theories and the applications don't seem scientific in nature."

Hmmmn name one field of science that hasn't had questionable theories?

When it comes to energy levels, therapeutic touch, and all those other theories, you clearly missed the explicit or implied, "feel free to disregard" clause.

But let's follow your line of reasoning with physics, something you believe is a pure science. It has a branch called quantum mechanics with non-observable theories such as string theory, membrane theory, multiple dimensions... Do these ideas make physics less scientific?

Okay, let's forget about quantum physics for a second, and consider something observable. When a leaf falls we say it is due to gravity, but where does gravity come from? Here is a wacky idea, mass creates distortions in space-time that allows radiation from an unobservable plane of existence to bleed through and exert an attractive force on objects relative to their mass. CRAZY huh??? Sounds like your definition of the "crutch of evidence based practice" in that it is using "conclusions of research studies to go about solving some issue".

Lets follow your thought process which I will call the associative-absurdist theory of negation to disprove physics as a science.

Objects fall to earth -> something is acting on these objects -> objects with greater mass exert greater gravitational force -> physics relies upon gravity in part to theorize how the universe works and was formed into its present state -> idea I can't conceptualize or choose not to agree with -> physics is not a science.

Seriously, if you have a problem with a particular theory, that's fine, but that doesn't mean a field is not based upon sound scientific research.

Nursing achieves its status as a science based upon the natural sciences, (those based upon empirical data). It draws upon the other sciences as a foundation. Observations are made and interventions (experiments) are conducted. This results in empirical data that can be analyzed, and used to create new hypotheses. This is evidence based research, also known as the scientific method.

Stop trying to rationalize, (irrationalize), why you feel the way you do about nursing, you are making generalizations that are based on illogical reasoning that goes against the very principles of science.

Phenomena are observed, a hypothesis is formed, experiments are conducted to test these hypotheses, theories are formed based upon repeated observations. these theories remain valid until disproved with empirical data.

To circumvent this process and follow your feelings that nursing is not a science because you dislike a few theories is beyond ironic. Where is your empirical data that any of these ideas are not valid?

The funny thing is if you do have any proof of your claim, you will just be adding to the body of knowledge we call the SCIENCE of nursing.

You just can't win can you?

[ImThatGuy, BSN, RN]

Why does it HAVE to be scientific? What's wrong with nursing being a field of study you go learn and then do? I'm completely comfortable with that. Sure, someone needs to exist to study the acts of the field itself and improve them, but do they have to be considered scientists? Would it make you feel more comfortable about your field or perhaps yourself if I called it a science?

Ok, fine. Nursing is a science. It is so much a science it should be added to any basic, undergraduate curriculum. Nursology should be a freshman level general education course. There!

Edit to add: I never said anything about disliking theories. You merely inferred that because I don't support them. I said they didn't seem scientific, and a lot of them don't. But yes I don't like them either to be clear.

[DennRN]

Um no, your understanding of the scientific process is flawed Tippy.

I agree with most of your post, however you forgot the part about how evidence based practice uses data to further refine hypotheses and control for variables.

In the scientific method, when an unexpected or imperfect result is observed, it warrants further study and refinement of hypotheses.

Just because an experiment does not produce a perfect or expected result does not mean that the experiment was not scientific, only that there are one or more factors unaccounted for.

[DennRN]

To Imthatguy,

Because if nursing is not a science than nurses are doing tasks without the basic principles of why these tasks need doing and what might be the right task to do for one patient, is completely wrong for another patient with the same problem but a different set of co-morbidities.

It is the science that guides our practice and why a new nurse knows that a pt with low oxygen saturation needs O2, but because of the way that the body responds to oxygen levels climbing in a COPD pt, we as nurses should not administer high flow oxygen or we risk suppressing respirations.

It is science that serves as the reason why a nurse tells a physician they cannot administer this medication to a client because they might respond in this manner, and requests further clarification of an order. Tasks alone, or relying on other sciences to make nursing decisions for us are not sound practice and would result in increase incidence of negative outcomes.

It comes down to the whole irrefutable fact that nurses make decisions. Without science to base these decisions upon there will be needless suffering and increased mortality rates for all of our pts. Do you understand that it is science that will help you understand that certain medications can be given late but later doses will have to be re-timed? How about the fact that giving certain medications to a pt can have horrible side effects such as poisoning if given under certain circumstances?

I mean come on, something as common as lithium can become toxic if the pt gets dehydrated, the cascade of clotting factors can be altered by coumadin, but vit. k is the direct antidote, but it can also be taken in through diet, and pts have to be warned about foods such as kale when receiving therapy. I could go on for days behind all of the small things I do or say to the pts I have had recently based upon my scientific understanding of what they need.

[ImThatGuy, BSN, RN]

I am not saying nursing does not draw on science or make inferences based on science. I am, however, saying that nursing, as a field, is not a science. Nursing aligns itself,as a field, with the social studies which suggests well enough that nursing, by default, is not a science. Summarily, most nurses do not have a mastery of sciences nor has the field itself mastered the sciences.

Archaeology draws on principles of geology, but that does not make archaeology, as a field, a science.

[DennRN]

Social Studies is the closest related field to nursing? You sir have officially crossed into the realm of the Grimm's fairy tales.

:igtsyt: Beware all ye who venture beyond this point.

All travelers crossing this bridge should pay the troll-toll.

[ImThatGuy, BSN, RN]

Social Studies is the closest related field to nursing? You sir have officially crossed into the realm of the Grimm's fairy tales.

:igtsyt: Beware all ye who venture beyond this point.

All travelers crossing this bridge should pay the troll-toll.

Yep, I think the Potter & Perry foundations book even mentioned that. Granted, that was a sorry excuse for a book, but do you feel nursing is more aligned with biology and chemistry (a science) or the social studies?