Nursing school claims to not be able to teach prioritization.

[humanoidRN]

Hello AllNurses, I am creating this thread to ask for some opinions. First lets get some background information. I am a 20 year old from an anonymous city, state. I graduated high school in May 2011, I graduated #3/168 students with a 3.986 average my ACT score was a 26. I graduated with honors, multiple scholarship offers, and 9 college hours. I have always wanted to be a nurse and am adamant about becoming an RN. I chose my current nursing school over 5 other colleges that offered me scholarships, this school did not offer a scholarship because it is a 2 year college and I made the decision to go based on past students of various programs and DONs of 3 hospitals saying that this school was the best RN program because they are small, professional, and very rigorous. So I skipped my freshman year because of dual enrollment classes and my high ACT score. I challenged 2 other prerequisites and received credit, then did all other prerequisites in two semesters. I applied to the program, reviewed a 77 on my TEAS exam, and got in.

Here's the thing, upon getting in I got an inside scoop of everything. Of course everything was disorganized, the instructors posted things online what not. Lecture came around and I realized that none of these people had a drive to teach. Questions would be asked and teachers would be speechless and couldn't answer them. Teachers come in late for lecture, then struggle to read off the monitors, not knowing how to pronounce words. For testing questions would directly go against what the book states, instructors would write questions based on their personal experience and not what is supposed to be done. Also there was an instance where the instructor told us in lecture not to worry about information and that she would not ask questions from it. Well surely it was on the test, we even had proof of what she said recorded. For drug calculations an instructor tried her best to teach us how to calculate dosages, however it was using what i call "witchcraft" and not real math. then for instruction on the nursing process and nursing dx and care planning we received a 30 minute demonstration and that was all. So that was last semester.

This semester, we were told by our coordinator that there were no changes in policy and everything was the same. However they dramatically changed quite a few policies. For lecture the teachers seemed to present minimal information for a vast amount of information, I'm sure y'all allllll know those med surg tests with 18 chapters lol, the problem is that none of these instructors know the information to the extent that they want us to know it. We have one instructor that tells us what to concentrate on for the test so that we have a general idea what to study, however she makes it clear that all material is fair game, so we read everything but concentrate our focus on what she said. When we ask critical thought questions that arise from the book or lecture, we get the same blank, generic answer. Needless to say, by test 3 of 6, 80% of the class is failing. Tests have a focus on prioritization this semester (being nclex is heavy with prioritization this makes sense) however we have never been taught prioritization nor given examples of prioritization. Our book lists possible interventions, like for a client desaturating, raise the HOB, put o2, call HCP, chart all interventions, however it never tells us do we raise HOB or put O2 first (in the real world these are done almost simultaneously however we need one answer) therefore we need that instruction in class. When we asked to be taught this, our reply from the instructors was that they cannot teach us prioritization...however I've seen posts on here, spoken with other students from other programs, and spoken with other program directors who say they teach prioritization because it is a vital part of nclex and of being an RN. Also for testing we have the same problem of one Instructor wants us to forget personal experience for the test and go by the book, the next instructor wants us to go by her experience, the next one wants you to forget all NCLEX formats and test taking strategies because she totally goes against all of them.

Personally I feel let down by this program, I have had to teach myself in clinicals because instructors just can't teach us. My instructor last semester told students "if you have a problem, go find (my name)" and this semester my instructor would let us harm the patient with a mistake, then softly tell us what we did wrong after the fact. My patients all love me and tell me and my instructor how great of a nurse I am. I also make it a point to help take care of as many patients as possible (my assignment or not) because I want to be that person that makes a difference with their care.

I am currently the class SNA president and my opinions reflect those if majority of the class. I am also currently failing and most likely will fail.

What I am asking from you is to give your opinion. Am I wrong for feeling let down? Is there really something going on here? Can instructors really not teach prioritization?

Any opinion is good, just please don't insult me.

[RLtinker, LPN]

Yes they can to a point. What it really boils down to is knowledge and critical thinking. It really is hard to explain, but it depends largely on the question. It is late where I am so I will have to answer this in more detail later.

[WannaBNursey, ADN, ASN, RN]

Actually, they can teach you that you would raise the HOB and then put in O2. I don't understand why they claim they can't do this! Are there rationales at the end of your tests? That's ridiculous. Try not to fail and attempt to transfer. Sounds like this school is a huge let down. I'm sorry.

[stefanyjoy]

I think when your instructors say, "We cannot teach prioritization", they are more referring to the fact that they cannot teach critical thinking. They teach you your ABC's, Maslow, etc. and all the tools you need to prioritize, but they can't sit there and tell you every single little thing such as raising the HOB vs. giving O2 first.

As far as instructors being inconsistent, teaching a vast amount of information in one lecture, etc. these are all common complaints in nursing school. My classmates and myself all whine and groan about the same exact stuff. I'm not saying that you should just accept it as-is, but either you deal with it or you don't. I have one more year of this god foresaken program and I'm praying my nursing preceptorship will help fill in the gaps.

[Blessed_RN2011]

Figure out with teacher wants you to jump through what hoop, and jump. It's not ideal, but unfortunately it is nursing school. I agree, they can give you tools and a knowledge base to be able to critically think for yourself. To use your example about the SOB - would u raise the HOB or administer oxygen first? You would raise the HOB first because that is something you can do without a physician order. You need an order for oxygen. Now I realize in an acute care setting you are going to do those things simultaneously, but for test purposes elevate HOB is a nursing intervention- oxygen is a medical intervention. See the difference? Good luck in getting through nursing- it's not easy but we all have been there!!

[humanoidRN]

Thanks for the replies!

The problem though is that a few of us taught ourselves Maslow, ABCs, and how to answer NCLEX style questions from well established names in nclex prep (Saunders lippincott Kaplan) we only heard of maslows hierarchy in passing on one slide. No talk of ABCs or how to prioritize. I understand that they can't possibly go through every scenario for these questions that would take a lifetime. I feel that if I had instruction on how to prioritize from the beginning with info like Maslow, ABCs, and nursing process, then I'd be in a much better place. Also it wasn't until halfway through this semester (our second semester) that we were told we need to: assume there's an order for everything(even though we were told first semester not to assume anything), we were told about ABCs after our third test, also we were informed that we should review nclex questions from other authors. I do approximately 800 nclex questions from various books, keeping in mind that our school book sometimes teaches aspects differently (I always go with our book info) and I can get majority right. Multiple times we have found evidence to support our answers in the book, however we are still wrong.

Our tests do have rationales, however none of these have book page references, and majority of the time it lacks in differentiating between the two "right answers" in the rationale, or the rationale is actually worded in a way that supports our answer.

[BeenThereDoneThat74, MSN, RN]

As a professor (and a former nursing student, albeit many years ago), I will echo some of the responses here, about how much of what you are going through is very typical. I challenge you to find one nurse who loved their program 100%, especially while in the midst of the journey.

The fact that you are in the second semester is significant, to me at least. I teach that level, and it is the toughest one for our students. There is a huge adjustment between first and second semester. We have most of our failures in this semester. While you may feel you have learned a lot in 101, it never seems to be enough. And sometimes the second semester faculty forgets that. You're not learning how to think in 101, you're learning how to survive lecture, lab and clinical, how to stalk to a patient, bathe a patient and assess vital signs. What is an IV, a drip rate, a gauge, a nasal cannula and a how to check placement for an NG tube, mrsa, standard precautions, cliff, and all NANDA. for the most part, you're learning the rules, not when to apply them and in what order. As others mentioned, it is hard to give students the rules on this, because the rules change depending on the situation. We all know airway is the priority, but what do you do when airway is not a choice, or if it is made perfectly clear that there is no issue with the airway? Sometimes your professors may sound like politicians, dodging the answer. I learned early on (just like I've learned to never promise my child ANYTHING), that you have to be very careful what you say, because students will interpret it in a way that is incorrect, or that the rule applies to all situations.

You mentioned that this school is highly regarded in your area. How much research did you do beforehand into the school? Did you look at online discussions here, or on the 'dreadful' Rate my Professor? If this school is better than the ones you turned down, imagine what is going on in the other schools? Again, much of what you speak about is very common, and has been for a long time. I'm not saying its right, but this is an incredibly difficult and stressful career you're entering. And sometimes, you will,l not get all the answers you need. I know there are nurses who should not be teaching; I have worked with some of them. Believe me when I tell you, there is a shortage of QUALIFIED faculty.

[kaydensmom01]

I'm sorry but I also think that what you are complaining about it common. The instructor does not have time to go through everything, it is up to us to teach ourselves unless you want 40 hrs of lecture a week. It is common to have to read and everything be fair game, everything is important in most cases. Sometimes professors cant answer questions, you are the one that needs to look them up.

In clinical the instructor can't be everywhere. Most of my clinicals were spent alone assessing, bathing, etc with the pt and at post conference the instructor would ask us what we did and that is when we would find out if we needed to do more, etc. That is just how it is when the instructor is passing meds, or other procedures with other pts.

I also agree that your instructors are meaning that they can't teach critical thinking. You will read all about prioritizing pt's, but with experience you will gain critical experience.

I really felt everything coming together in my preceptorship, which is the way I think it should be. Before your preceptorship you are learning about all of the different pieces in the puzzles, and in the preceptorship you are able to put them together. We also lost most of our class in the 2nd semester.

[lillymom]

I agree with the other posts. I am just now finishing up my program and the first year I didn't understand much and I couldn't figure out how to prioritize care. They didn't really discuss Maslow's, Bloom's Taxonomy, in-depth assessments, or ABC's. They were focused on building the base and the above concepts are a little more advanced. Now when I started my second year this stuff started getting hammered into us. When we asked them about not teaching this stuff earlier they said that we simply did not have the fundamental knowledge to apply the concepts correctly so to teach this before then could be a detriment to the learning process.

So for the HOB vs O2 the answer is always HOB. Why? Not only because you need an Rx (most policies will have a standing order for this anyway so that answer is moot) but because you need to sit them up and to help relieve any pressure they have on their airway and straighten their posture to get the maximum benefit of the O2. In other words if you kink the airway tubes O2 won't make a hill of beans difference because it isn't getting to the lungs.

I will also say that they teach these things separately and randomly but by the last semester you should be able to independently make connections to the body systems and concepts. For instance when I take a test now I have to look for the topic of the question but sometimes it's not what you think it is. The question may say that they have a certain disease process such as Lupus (autoimmune) and ask you what to be concerned about (A) They will give you a normal or close to normal lab value but one that you want to monitor for lupus WBC 11,000, (B & C) they will say a typically important answer like circulation or oxygenation but this isn't really something that affects lupus pts, (D) then they will say BP 90/60 and high fever. Well I know some who would count this out because fever is expected with lupus but not high fever and technically the BP is still in range but combined with the fever this is looking like septic shock may be on the horizon and because they are more than likely immunosuppressed this would be the answer. I like A but with no other S/S it is not too worrisome because inflammation can increase WBC counts. So to answer this question you would first have to know the disease process and its treatments but also the s/s of septic shock and how the inflammatory process works. The topic wasn't really about lupus it was about septic shock and if you can independently recognize the signs in a patient whose diagnosis may mask the symptoms. Not the best example but I tried.

One more last thought, answer as many questions from multiple sources and read the rationale not just for the right one but for the wrong ones too and this will help you make the connections as well. Practice makes perfect and I typically do very well on tests because I have learned on my own to connect the pieces and see the whole picture by answering multiple questions and reviewing the answers. Good luck!