During my stint in nursing school (1980's) our med dose calc class was about six weeks long, show all work, use formulas provided by instructor only, and totally in our heads (or scrap paper, *LOL*), no calculators allowed. The floors/units one worked on at the time as a NA RNs young and old also did everything in their heads as well, right down to drip rates.
OTHO am hearing today many schools allow calculators and many hospitals have systems to do the "work" and of course pumps can be programmed. However have also heard that some places do not have these systems and or still require all drips to be calculated out by hand/head regardless of availability of pumps.
Am asking as one keeps hearing more and more "complaints" if that is the right word from both students in programs, and floor nurses along with those in management regarding the "poor" math skills of some new nurses. Students, especially the young people who have recently graduated from high school, where it seems calculators and or computers are so common that doing math in one's head is "old fashioned" as using DOS computers. From what one has seen helping with homework and tutoring lower grade students, long division and multiplication, along with memorising times tables seems to also have gone by the wayside. As student nurses some are under the impression knowing how to do medical dosage calculations 100% accurately by head and hand is, well silly as computers can and will do the job for them when they graduate. Many are often furious if not heartbroken when a failure of MDC causes them to be removed from the program.
The RNs one hears from complain that some new grads, young nurses don't get the fact that a small math error such as misplaced decimal when preparing meds can cause injury and or death of a patient.
Just because I come up with 100 mL as an answer doesn't mean I should go ahead and give it if I know that 10 mL makes more sense. I still have to know what's safe, the calculator is just a tool.
This is exactly what every math prof I ever knew tried to drill into students. Whether you are doing simple arithmetic or DiffyQs, figuring the load limit on a bridge or the drip rate for an IV, you have to ask yourself: Does my answer make sense?
there are a couple thoughts here. i hope i can keep them straight and make sense. my mind is going 100 miles/hr.
this is one of my pet peeves.
you know, this is actually a great thread. most recently i have seen a trend to go completely and totally to pump control only. ivac & alaris pumps actually have lockouts where you input sensitive medications into the pump and it controls your drip rate and does your calcs for you.
now, there aren't enough pumps to go around. traditionally we reserved the pumps for micro drips and medicines that require a slow infusion rate right? now the expectation is that all fluids be on a rate controlled pump... um, but there aren't enough pumps and... they aren't always calibrated correctly.
not only that but i was going over drip rates with a new grad and she didn't know that there were different drip chambers that control flow. 10gtt/ml vs. 60gtt/ml. no clue about standard sets and vented sets. she told me that they didn't even teach them about drip rates. she couldn't do it. really, i'm not kidding. new trend? i'm thinking wow...just wow.
next is actually doing calculations. i went through the process of orienting many new grads. the formulas they are teaching are about ratio/proportion. okay, so the math works but can you tell me what the concentration is per ml? no! sure can't. the figures come out right but to draw it up there is no understanding what they are administering.
i keep it simple and am no means trying to "sharpshoot" them while orientating. i'm evaluating their knowledge and attempting to teach them right? so much easier to know your concentration per ml. plez' to lem'me 'splain.
tylenol-
to make it easy here lets say child is 6.4 kg.
pediatric dose is 15mg/kg q4.
concentration is standard 160mg in 5ml tubs.
out comes this scratch paper, a calculator, and a mathematical equation/explanation on paper that would make albert einstein proud... all to come out with an answer of 3. an entire page of ratio & proportion. no concept that there is a specific dose there. how much medicine per ml? dunno she tells me. how much are we giving? 3. no, how many milligrams? dunno. i asked if she ever thought about it? no, i just do the formula. this happen to anyone else out there?
i asked her if she could see that 160mg:5ml was just 32mg/ml and that 6.4 kg child that you are looking at 96mg and 3 ml's? no, i can't do it that way...
soooooooo many additional medications that are easy to does if you know the answer in ml's to include gtt-rate.
no critical thinking whatsoever and absolutely no dosing anything without a calculator.
people are going to go off again about how i'm an us vs. them personality and how i just hate the next generation but this is serious and so am i. there is a knowledge deficit here and it's scary. many new grads are not functional and it's not all their fault. mandated formulas are okay for facts & figures but where is there actual thinking???
i hope some of you pause for a little bit and think about it. calculators are fine but you need to use your head!:spbox:
that's really sad that there are new grads out there like this. being a new grad myself, i can honestly say that my school did focus on drug calculations quite a bit and allowed us to learn the method that made the most sense to each individual student, so that we could actually understand what we were doing and not just plug in numbers nonsensically.
working in a cardiac unit now, the calculations that i use the calculator for most are my drips. when you are figuring out mcg/kg/min, it pays to use a calculator, it eliminates the risk of little mistakes, as long as you know how to do the equations.
Am asking as one keeps hearing more and more "complaints" if that is the right word from both students in programs, and floor nurses along with those in management regarding the "poor" math skills of some new nurses.
So, how are things done out there?
I am honestly appalled at the lack of simple math skills displayed by my younger peers in nursing school. It isn't even funny. They utterly refuse to learn to do simple math - a skill not unlike shooting free throws, it just takes a bit of practice.
They come up with horrifyingly wrong answers on dosage calc questions and don't seem to get why. Further, if they are using a formula or proportion, apparently plugging any random number into the equations is perfectly reasonable.
Or you ask them what 800/500 x 1 is and they bang their gonk (calculator) for 2 minutes (seriously, 2 minutes!) - and then get it wrong.
I think it is a matter of students insisting on being lazy and programs and instructors giving in. Getting good at problems like this is a matter of practice.
I don't care how long I've been at it, I always check my work against someone who is not me. It's the ONE time you don't where a mistake is made (and I've seen HORRIBLE mistakes with BAD outcomes). It's just not worth it.
If someone I'm precepting can't do dosage and calculations even after I've given them a book or asked them to get theirs, then the cannot remain working next to me. I don't want to see someone die because a kid didn't bother paying attention in high school. This is HIGH SCHOOL (actually grade school) math!
If they can't do it, lose em...they don't pass orientation! I'd give em some time to work on it but also tell them "I can't do that" is the same as "I can't work here".
Mistakes are made by human error. Doing calculations in one's head promotes human error. I write it down and have it checked. Read all the dosage deaths and lawsuits and license revokations; nearly all did it in their head or failed to double check (I don't trust my head but I trust algebra).
and... they aren't always calibrated correctly.
belgarion
697 Posts
Just because I come up with 100 mL as an answer doesn't mean I should go ahead and give it if I know that 10 mL makes more sense. I still have to know what's safe, the calculator is just a tool.
This is exactly what every math prof I ever knew tried to drill into students. Whether you are doing simple arithmetic or DiffyQs, figuring the load limit on a bridge or the drip rate for an IV, you have to ask yourself: Does my answer make sense?