Nursing Education

nursemike, ASN, RN · Jan 4, 2005

One of my instructors had a little spiel about, "We aren't teaching you to be CNA's or LPN's. You are learning to be professionals, and you have to learn the theory, not just pushing pills..."

Now, I don't disagree with her a bit, and as it happens, the theory is one of the "easy" parts for me, but her words seemed a bit ironic in clinicals when I passed meds for the first time. Told the pt what I was giving, what it was for, how it worked, and could have even explained what adverse effects we were watching for, but then I couldn't get the !^*&* wrapper open! Nobody had told me not to trim my nails to the quick. (At least I wasn't spreading Pseudomonas!)

If I had the resources and knew starting out what I know now, my path to nursing would have been Diploma nurse-to-BSN. Or if I were younger, CNA-LPN-RN-BSN. I know I'll learn a lot OJT--part of what attracts me to nursing is a lifetime of learning--but I truly believe we don't get nearly enough clinical instruction. 2-3 hours twice a week, then hours and hours of writing about it. In the real world it probably has to be this way, but I would drop sociology and "Race, Class, and Gender" in a heartbeat to learn more about nursing.

At my school, the nursing program is one of the star attractions. Classes like A&P, Microbiology, and Diet Therapy recognized that we weren't going to be biologists or dieticians and took special pains to relate the subject matter to nursing (nearly all students in these sections were nursing students, with a few paramedics for variety.)

That hasn't been as true in Psych or Soc or American Gov't, so it's probably understandable if people are wondering, "Why do I need this crap?"

The program I am in is locally recognized as a very good one, but a large part of the emphasis is on passing NCLEX.

Well, that's probably inevitable with a two-year program. Time is limited, and without passing NCLEX, it would be largely wasted. Still, I'm pretty confident that I will pass, but I'm under no illusion that I'll hit the floor as a competent nurse. My preceptors are going to have their work cut out for them. What's even more discouraging, though, is knowing that I wouldn't be better prepared if I had gone to a four-year program. I've talked to a number of grads of 4-yr courses and ADN-BSN programs, and they all say the BSN was a waste of time. I'll probably do it, anyway, but I do think I'm going to work at least a year, first--partly to pay some bills, but a lot so I'll at least know what I'm looking for before I get there.

Meanwhile, I still think the biggest thing I've learned in nursing school is how much I don't know. That's actually a big lesson in any walk of life, but I can't really blame myself--or anyone in my position--for wishing for more.

On the other hand, as much as the system needs improvement, I'm pretty darned grateful for the opportunity it has given me.

llg, PhD, RN · Jan 4, 2005

One of the major questions in philosophy deals with the whole "theory-practice split." What you are saying is one side of a philosophical discussion that has gone on for centuries. Most experts believe that both theoretical knowledge and practical knowledge are important. To have either one without the other is problematic.

As with many philosophical issues, the extremist view (in either direction) is weak. The "real meat" lies in the middle ground, in which the polar opposites are combined. It's what philosophers refer to as a "dialectic." Take one idea and it's opposite, combine them and develop something new -- keeping the best of both extremes, eliminating the worst, and resulting in a strong hybrid approach.

llg

imenid37 · Jan 4, 2005

I don't think you can supervise or delegate things which you yourself can not do. (Unless of course you're the VP of Nursing who tries to tell someone on med-surg they can care for 10 pt's safely). I seriously think students need good solid clinical skills, esp. assessment. This is what they will use as they begin clinical practice as a novice professional.They will use these skills, not a bunch of theory about systems, self-care models, and worst of all care planning. Some REAL world HANDS ON experience will serve new nurses well rather than meaningless bookwork. You can do a lot of assessing during a bath or while setting the pt. up to eat. How's their colour? Ae they breathing easily? Are they verbalizing problems re. social/pschological concerns to you as you do teaching or bathing or taking VS? We are not educating practice ready nurses or giving them a realistic picture of REAL World nursing by keeping them in the classroom. Agree with you Zenman! I would like to see clinical nursing experience elevated to what it's worth and give students some decent college credits toward their bedside experience. A program with solid basic social and natural sciences should be a bacculaureate program, not a diploma or ASN. Clinical experience is very valuable and should be rated as such!

MultipurposeRN · Jan 4, 2005

but I truly believe we don't get nearly enough clinical instruction. 2-3 hours twice a week, then hours and hours of writing about it. In the real world it probably has to be this way, but I would drop sociology and "Race, Class, and Gender" in a heartbeat to learn more about nursing.

Good grief! You only get a few hours of clinical time each week? That's not nearly enough, as you know. When I was teaching clinicals, we had a 12 hour clinical every week, and we put in a long hard day on the medical floor. generally in a few weeks my 2nd year students were taking 6 patients a piece and doing their own meds too. When they graduated, it wasn't nearly the shock to them when they started working. I firmly believe in more clinical time, less 'crap' classes. Maybe take a year of the classes that relate to it, such as the sciences and the theory stuff, a few hours of basic hands on a week. Then, have clinicals 24 hrs a week the last year and a class day for board review. I think our new nurses would come out more confident and more able to withstand those who eat their young.

nursemike, ASN, RN · Jan 4, 2005

Well, maybe it's more like 3-4, depending on how long pre- and post-conferences run, but it seems like so little. Plus, it often feels more like a test to demonstrate your skills than an opportunity to learn them (which might be more my problem than the system's). And I have to say, I'm not really sure how to go about making it better, with all the stuff that's required for a program to be accredited. On the face of it, it seems like 4 years would be better than 2, but apparently most 4 year programs get about the same clinical time we do.

More anatomy, more physiology, more chemistry--but two years after graduation, we'll already remember about the same amount, which is the part we actually use. Statistics, which is going to come in real handy at the bedside. I do see potential value in things like community nursing and leadership, and even the basics of computer use, but I don't anticipate ever needing to write a program or even partition a hard drive.

I have to say, my instructors do a good job of working with the time and opportunities we have, and adapting to what we need. And I can really only guess how prepared I'll be. It often seems like I don't know anything, but then a moment will arise when I have to think on my feet and stuff comes popping out of my brain that I never knew was in there. It's kinda freaky!

Still, I do think that in a perfect world, we would all start out as diploma nurses, then add the academic stuff later. Which seems like about what Randy is saying. Wow.

Tweety, BSN, RN · Jan 4, 2005

Kind of sounds like my program. We learned to be CNA's first. But along with that we were taking A&P, English and Sociology. Sounds like what your are proposing would be a little more time consuming.

There's a lot to be said for on the job training. There's only so much one can do in nursing school. We all vent how time consuming it is, how much work, etc. I don't see adding more clinical hours on top of it helping. Do business majors come out learning how to run a corporation? Maybe the medical model is a good one, where their education continues after they get their MDs and do internships/residencies, etc.

As for people complaining about "useless" courses. I do complain myself from time to time. But scholars in nearly every program agree, two years of liberal arts education along with the major courses makes for a better person and society. Best leave it alone. Or go back to the original intent of the ADN, to graduate technical nurses. Let the BSN's get the theory.

imenid37 · Jan 5, 2005

I'd like to see a year of science, psych, English, etc. followed by mostly clinical studies for 3 years and have the students end up w/ a BSN. Even though the BSN is a "higher" degree than the ADN or diploma, the clinical experience is "usually" (I said usually, so don't crucify me) less than the ADN and almost certainly less than the diploma (yes we still have a few in the state of PA). It is rough out there today, esp. in med-surg. These folks need all the clinical they can get. My own daughter wants to be a nurse and I am encouraging her to go for the diploma. I feel she'll be more likely to succeed in the real world and less likely to be frustrated as a new grad. I didn't get enough in my ADN program almost 18 years ago and I think pt. care is more difficult today and clinical time even more brief.

llg, PhD, RN · Jan 5, 2005

I'dMy own daughter wants to be a nurse and I am encouraging her to go for the diploma. I feel she'll be more likely to succeed in the real world and less likely to be frustrated as a new grad. I didn't get enough in my ADN program almost 18 years ago and I think pt. care is more difficult today and clinical time even more brief.

Why not encourage her to get a BSN and use the summer in-between her junior and senior year to do a full time extern program? That seems to offer the best of both worlds.

Students who go that route get the benefits of the general college eduction plus the long-term career advancements of the BSN education plus the "extra" supervised clinical learning provided by the extern program.

My hospital sees the highest rate of success for new grads who have a BSN plus externship background than with any single educational program alone.

llg

nursemike, ASN, RN · Jan 5, 2005

I'd like to see a year of science, psych, English, etc. followed by mostly clinical studies for 3 years and have the students end up w/ a BSN. Even though the BSN is a "higher" degree than the ADN or diploma, the clinical experience is "usually" (I said usually, so don't crucify me) less than the ADN and almost certainly less than the diploma (yes we still have a few in the state of PA). It is rough out there today, esp. in med-surg. These folks need all the clinical they can get. My own daughter wants to be a nurse and I am encouraging her to go for the diploma. I feel she'll be more likely to succeed in the real world and less likely to be frustrated as a new grad. I didn't get enough in my ADN program almost 18 years ago and I think pt. care is more difficult today and clinical time even more brief.

Around here, the ASN and BSN programs have about the same hours of clinicals. The BSN's do have a few off-shift clinicals, which we don't--or haven't, yet, anyway.

I get to see a lot of the BSN students, since their clinicals are in the hospital where I work. Like my classmates, they mostly seem pretty sharp--neither program is easy to get into. But, like my classmates, they're going to have a lot to learn when they get out.

My program is effectively almost a 3-yr ASN. It's so competitive that you just about have to take a year of classes to qualify for admission. Which is kind of a blessing, since I can't imagine carrying 15-16 hour loads. 12 or 13 is fairly brutal.

I guess it's a tradeoff. If the entry level was a BSN, and the BSN was really clinically focused, you'd have a lot better new nurses--but you wouldn't have nearly as many.

Realisticly, I could have done a 4-yr program, but it would have been tough, and some very good students in my class probably couldn't have done it at all.

P.S. The nurses I work with are all very good and come from every possible background. Even the brand new ones seem very capable, so I'm hoping that means I'll be okay, too. Maybe this whole argument is academic (pardon the pun).

actioncat · Jan 8, 2005

Is there anyone who actually believes clinicals truly prepare you for nursing?

yes, we had an extra year of clinicals (one quarter psych/community two quarters med/surg or critical care) than the ADN program in our community but geesh, I would hardly say that made us so much more prepared. The real preparation came once I started my job. I would think the extra clinical might make a little difference at first, but that difference would certainly fade over time.

Nursing programs all have to cover the same stuff. Some have the luxury of covering a little more stuff. In the end, we all take the same test and it all allows us to be entry level nurses! I just never think about my coworkers schooling.

nursemike, ASN, RN · Jan 8, 2005

Is there anyone who actually believes clinicals truly prepare you for nursing?
yes, we had an extra year of clinicals (one quarter psych/community two quarters med/surg or critical care) than the ADN program in our community but geesh, I would hardly say that made us so much more prepared. The real preparation came once I started my job. I would think the extra clinical might make a little difference at first, but that difference would certainly fade over time.
Nursing programs all have to cover the same stuff. Some have the luxury of covering a little more stuff. In the end, we all take the same test and it all allows us to be entry level nurses! I just never think about my coworkers schooling.

Are you suggesting I won't have an hour per patient to do a bath and assessment, then pass all my 0900 meds by 1130? Egad!

Is it too late to learn to drive big rigs?