Nursing Education Must Change

  1. An opinion piece written by June M. Harrington (retired nurse), and appears in the Providence Journal.


    http://www.projo.com/opinion/contrib...2.2762efb.html
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  3. by   SharonH, RN
    From the article:

    A year at a two-year college followed by a 12-18-month hospital-apprenticeship program could be the framework for the 21st Century episodic career pathway described in “An Abstract for Action.”

    So basically, Ms. Harrington is advocating less education for nurses? A year of book learning followed by a year of an apprenticeship is less training that the old diploma nurse programs! She's talking about slightly more training and education than an LPN program. Thanks but no thanks!
  4. by   himilayaneyes
    I'm definitely for nursing students getting more actual clinical experience. However, I'm totally against getting rid of the academic part. A nurse has to be able to critically think. I realize that critical thinking develops as you work. However, the things you learn in the classroom give you the foundation for critical thinking. In my opinion, the academics should remain and more clinical hours added...perhaps nursing programs should be longer i.e., 5 yrs instead of 4. But if we do that..I hope they give these new grads jobs...don't make it harder for students only to leave them out in the cold when they graduate.
  5. by   TakeOne
    Quote from DoGoodThenGo
    An opinion piece written by June M. Harrington (retired nurse), and appears in the Providence Journal.


    http://www.projo.com/opinion/contrib...2.2762efb.html

    Let me guess what kind of nursing program Ms. Harrington attended.

    She is right when she says that nursing students need more active clinical exposure, but she is dead wrong when she discounts the need for broader education. If nursing is ever going to be the profession it yearns to be, its practitioners must have the same advantages and exposures the other professions have. The defining aspect of "profession" is that of autonomous decision maker, and part of creating autonomous decision makers is providing them with access to experiences which open the mind and widen perspective. A year of Nursing 101 followed by a couple of years serving as student pack mules will not provide that enlightenment. Nursing will always be a trade subservient to non-nursing entities unless we can strip the virtue-scripted notion of obedient service and sacrifice out of nursing training. We also need to kill the common concept that anyone can be a nurse. Clearly not everyone has the patience, the wits, the stamina, the personality or the aptitude. Just as aspirants to other professions must meet the standards and rigors of their training without favors, shortcuts and work-arounds, those who aspire to enter nursing should have to be able to meet professional standards from the beginning or be denied admission or licensure. Yes, students need more clinical, but that's not all they need.
    Last edit by TakeOne on Oct 9, '10
  6. by   Lillian2515
    There is no question that students need more clinical time....but they also need experienced nurses that will mentor them. There is still a problem with students coming on a unit, even in their senior year of a BSN program, and still being given tech tasks. How many times does a nursing student have to give a bed bath? There are also the very experienced nurses that have no patience for teaching....or want to teach "their" way....and dismissing protocol (like how to insert a Foley in skills lab as opposed to the "real world.)

    Most students want more clinical time. Most students do not feel prepared to coordinate patient care when they graduate unless they've been lucky enough to have a tech job that they can fit in between classes. Most mentors set their students up for failure or simply give unconstructive criticism. Most mentors do not understand that criticism is not a form of teaching. Most nursing students are focused on memorizing information to pass a test and pass their boards, not patient care. Too many clinical instructors are interested in paperwork....writing care plans...research papers. I understand that communication is important, but those tasks can be accomplished in a basic writing class before clinical instruction begins. Once you write one paper, you've proven you can write so move on to sayyyyyyy......IM injections?......or a NURSING skill........

    Nurses are being replaced by medical assistants, LPNs, LVNs, and techs. While critical thinking is being practiced, most of the time it's not really necessary. Nursing, realistically, is still task oriented and charting. The nurses that I've had the priviledge to shadow are not using critical thinking. What is critical thinking anyhow? The ability to know that when you're patient has a SaO2 of 50% is in trouble? That's not critical thinking in my book.

    Without more clinical time the nursing "programs" are wasting time, energy and money.
  7. by   DoGoodThenGo
    Whilst patting themselves on the back for mostly removing the education of nurses into colleges, everyone seems to forget the otherside of the coin. Previously hospitals had a vested interest in "training" nurses in their programs because many would end up employed by said facility. In a round about way this decreased costs associated with hiring and orientation of graduate and newly licensed RNs.

    However now that link is broken, no one is really examining the true cost of educating nurses, and why should it fall mainly to a hospital.

    Providing clinical sites is one thing, long as the program provides instructors the costs associated aren't that great I think. However once you start going down the road of asking staff nurses to function as educators (however reluctantly) and so forth, that is a different kettle of fish. I mean is it fair to ask a nurse who already probably has enough on her daily plate as it tis to add yet one more responsibility?

    As pointed out upthread, yes, there is a good number of nurses who will take on the task if only out of altruistic reasons, but there aren't enough. Even if there were, it still does not address the matter of why a hospital should contribute to "training" student nurses it may have no intention of hiring.

    In terms of overhauling of nursing education in general, methinks many of the BSN programs that start students in their sophmore year is a good start. In such programs nursing students are admitted from their freshmen year or even apply to the nursing program at the same time as the college. Once admitted to both they start right away (maybe even in their first year), with basic nursing and core classes, then begin clinicals the next year. Basically you almost have a hospital type program dropped into a four year university.
  8. by   dollparts13
    Wow, this is unsettling almost.
    I am currently in my third semester of a two year ADN program.
    Every semester we have had clinical once a week, along with the strenuous class work, reading, and tests of nursing classes. I believe we get enough clinical time. It is scary to think some people would rather a person get trained to do a job, and they might not fully understand it, or have the intellectual background needed to critically think in nursing.
  9. by   elkpark
    I've been saying for decades now that I believe the best model of nursing education would be to make it a five year degree, like architecture (also a practice discipline) and some teaching degrees, and make it two years of general college plus a 3-year diploma program. I always bristle at the current, popular notion that diploma education consisted of learning only rote tasks. I graduated from an excellent hospital-based diploma program in the early '80s, and got a much better nursing education (including professionalism, "critical thinking" (despite the term not having been invented yet ), legal/ethical issues in nursing, leadership, and a stronger science background) than that offered by any of the ADN or BSN programs I've taught in or had contact with since then. I (and my fellow graduates) also came out of school prepared to function (at an entry level) from day one in any typical clinical setting, without extensive orientation, "new grad programs," "externships," etc.

    I certainly have no problem with the idea of college education for nurses (I came to my diploma program with two years of a classic liberal arts college education), but I agree that nursing has "thrown the baby out with the bathwater" in significant ways when it comes to nursing education.
  10. by   DoGoodThenGo
    Quote from dollparts13
    Wow, this is unsettling almost.
    I am currently in my third semester of a two year ADN program.
    Every semester we have had clinical once a week, along with the strenuous class work, reading, and tests of nursing classes. I believe we get enough clinical time. It is scary to think some people would rather a person get trained to do a job, and they might not fully understand it, or have the intellectual background needed to critically think in nursing.
    Don't think that is what the OP is advocating, but rather diving into the stormy waters of if nursing is still a "practical" profession, requiring a return to the apprenticeship method of education.

    Many diploma and ADN programs of old had two or more days of clinical time, and were talking full shift days of 8 or 12 hours of duty. In such programs one not only rotated through the entire nursing service of a hospital, but you did "everything". From L&D to scrubbing in OR, to bed making, and so forth one spent quite allot of time on the floors observing, learning, and practicing over and over again nursing tasks. By the time one graduated (assuming you did ), one had not only the academics to pass the boards, but the skills to step right onto the floors taking a full load of patients, or close to it.

    As the classroom part of college education for nurses bit into clinical time, hospitals upped the orientation time of gradaute nurses (yes, at one time most hospitals would hire you right out of school, even before one took the boards), to get them up to speed.

    What seems to be happening is a perfect storm if you will of expectations from nursing education. Hospitals no longer wish to spend sums on "training" new nurses, up to and including covering material they feel should have been covered in school. In short they want a fully competent nurse right out of the box, one that requires just a bit of seasoning. This explains why new grads are having such hard time finding employment in many areas, especially those with a surplus of experienced RNs.

    Nursing programs for their part are have several masters to serve. On one hand they must educate nurses that are safe to let loose on the world. But they also have to prepare nurses that can pass the NCLEX and so forth. There being only a finite amount of days in a school year, something has to give.
  11. by   DoGoodThenGo
    Quote from elkpark
    I've been saying for decades now that I believe the best model of nursing education would be to make it a five year degree, like architecture (also a practice discipline) and some teaching degrees, and make it two years of general college plus a 3-year diploma program. I always bristle at the current, popular notion that diploma education consisted of learning only rote tasks. I graduated from an excellent hospital-based diploma program in the early '80s, and got a much better nursing education (including professionalism, "critical thinking" (despite the term not having been invented yet ), legal/ethical issues in nursing, leadership, and a stronger science background) than that offered by any of the ADN or BSN programs I've taught in or had contact with since then. I (and my fellow graduates) also came out of school prepared to function (at an entry level) from day one in any typical clinical setting, without extensive orientation, "new grad programs," "externships," etc.

    I certainly have no problem with the idea of college education for nurses (I came to my diploma program with two years of a classic liberal arts college education), but I agree that nursing has "thrown the baby out with the bathwater" in significant ways when it comes to nursing education.
    Or, if ADN programs are to remain, simply stop the farce about obtaining a nursing degree in "two years", and go to a three year model. Most programs run that long if you include pre-nursing, and it can be managed by following the lines of diploma schools. Admit students directly into the program without a "pre-nursing sequence. Such classes can be folded into the first year of study, and there are other ways to screen applicants for entry.
  12. by   elkpark
    Quote from DoGoodThenGo
    Many diploma and ADN programs of old had two or more days of clinical time, and were talking full shift days of 8 or 12 hours of duty. In such programs one not only rotated through the entire nursing service of a hospital, but you did "everything". From L&D to scrubbing in OR, to bed making, and so forth one spent quite allot of time on the floors observing, learning, and practicing over and over again nursing tasks. By the time one graduated (assuming you did ), one had not only the academics to pass the boards, but the skills to step right onto the floors taking a full load of patients, or close to it.
    In my program, we spent two (8 hour) days a week in clinical the first year, starting within the first few weeks of starting school, three days a week our second year, and four days a week our third year. We went to school year-round, with two weeks off at Xmas and two weeks off in the summer -- a total of 33 months of full-time study. And we didn't just "practice nursing tasks" -- we were expected to be knowledgeable about the pathophysiology, medications and all aspects of nursing care of all our assigned clients (I vividly recall getting "ripped a new one" by my ICU instructor once because I couldn't explain the biochemical rationale for why one of my clients had D51/2NS running instead of some other IV fluid) -- we did in-depth care plans for all our assigned clients, wrote research paper case studies each quarter, etc. And, at my school (I realize there were good, bad, and mediocre diploma programs, just like anything else, and my school was not necessarily representative), the academic standards were at least as high as any of the ADN or BSN programs I've had contact with (and I've taught in both ADN and BSN programs over the years). The school had a boards pass rate consistently around 100% -- once every few years or so, someone would not pass boards on their first try, but that was rare (this was back when the state board exam was two full (8 hour) days of testing).
  13. by   TickyRN
    If any concrete changes are going to be made, I believe it would start with making the BSN the point of entry into the profession. Any other changes made without first standardizing entry would be redundant.
  14. by   GilaRRT
    What exactly is the problem with her model? This is almost an exact copy of a model that is currently used at a community college based paramedic programme where I am faculty. We "front load" the didactic experience over the first year, then the students spend a year doing hospital rotations and ambulance rotations while assigned to an experienced "preceptor." Then, during the last two weeks of the programme, we spend preparing the students for national registry.

    I seen nothing wrong with this as a nursing model assuming the students enter the programme with the appropriate pre-requisite classes. In this case, you are still looking at a three year course of study prior to entry into practice.

    Reading through this thread, I gather people are actually defending current models where nursing students may do a day a week and graduate with less than 700 hours of total clinical experience?

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