Jump to content

Prepare Nurses to Pass NCLEX, or Prepare Nurses for Real World?

Updated | Posted

Specializes in dialysis. Has 28 years experience.

On 7/28/2020 at 5:42 PM, KatieMI said:

I do not know how schools nowadays let out nurses who literally do not know ABCDs of pathology and pharma and how these nurses successfully pass NCLEX in droves and get employed without having the slightest idea of what they are playing with.

Oh, bother....

Schools teach to the NCLEX because of the all important pass rates needed to stay in business. Students don't get the same education that I got 30ish years ago, that taught me to learn in depth and develop the critical thinking skills needed to adequately care for patients once I left school and got my license. Nowadays, they depend on facilities to fill in the blanks, which is proving to be detrimental to nurses, as well as patients. Not all residencies are good, and not all new nurses get the training and support that they need. I don’t blame nursing instructors, per se, they are hired to teach a class by the model the school wishes. I blame the schools that take these students money and leave many of them grossly under prepared.

londonflo

Specializes in oncology. Has 44 years experience.

1 hour ago, Hoosier_RN said:

Schools teach to the NCLEX because of the all important pass rates needed to stay in business. Students don't get the same education that I got 30ish years ago, that taught me to learn in depth and develop the critical thinking skills needed to adequately care for patients once I left school and got my license.

The body of nursing knowledge and the complexities of care have grown exponentially in the last 30 years. One of the measures of a school's success is NCLEX scores. Our accreditation bodies do not have that as a criterion to receive continuing accreditation but the state board of nursing does (for continuing approval). Actually since I have taught for the last 40 years I can speak to the specific school dedication to "critical thinking". Richard Paul was the founder of the Foundation for Critical Thinking and we utilized his theory when transitioning from a diploma school of nursing to a BSN program in the 80's. It is inherent in nursing programs today. Perhaps that is when his content was introduced to you Hoosier_RN in your nursing program. Prior to that event, I believe nursing schools have always influenced students to use a form of critical thinking although that specific label was not used. Also in the 80s, because of the explosion of nursing knowledge; educator-scholars often talked about what should be the educational program of entry into practice. A Master's degree was most considered but society is not willing to pay or wait for such degreed entry level nurses.

Everyone who has ever gone to school believes they can provide the direction educators should take. Everyone who has ever cared for an ill family member or be a hospitalized patient also believes their insight is invaluable for members of the health care team. I ask you and others to consider that entry level education is multifaceted and is dependent on clinical facilities, state board of approval requirements, accreditation criteria, ANA standards of nursing practice, department of public health and the opinions of local employers. Before the public and practicing nurses decide to paint nursing education with a broad brush, only citing the aspects important to them, I would ask you to think of all that is expected of the new graduate - I am totally sure we NEVER please everyone!

On 8/1/2020 at 10:32 PM, londonflo said:

Before the public and practicing nurses decide to paint nursing education with a broad brush, only citing the aspects important to them, I would ask you to think of all that is expected of the new graduate - I am totally sure we NEVER please everyone!

I agree with other posters. Being dependent on nursing employers to finish so much of nurses' education is not working out well. These (employers) are a group of people who have repeatedly proven themselves to be entities that have to be forced to even begrudgingly invest anything in nurses or nursing. They will never invest in nurses for nurses' sake, it isn't in their playbook. They also are entities who, because of their staffing models, cannot provide adequate proctoring to students during clinical rotations. They disallow students from doing things, put various restrictions on them, and assign them to RNs who quite literally do not have time to instruct students any more. When did it become okay for instructors to leave this bedside proctoring to the RNs on duty?

Clinical time is an educational opportunity for which the student is paying the school.

Schools need to re-focus on the nursing process and the underlying knowledge necessary to perform it (3 Ps, etc.). Keep communication/interpersonal training and training on legal and ethical aspects. Every other trendy thing that is one of those "it's what employers want" things, needs to go. Employers can take responsibility for teaching all about their business fantasies and what they want from their employees, but nurses need to know how to be nurses and do the nursing process.

Students should come out of school in an empowered--not completely dependent--state. Graduating students in increasingly dependent states is allowing employers, business people, to take over this profession.

Hoosier_RN, MSN

Specializes in dialysis. Has 28 years experience.

10 hours ago, londonflo said:

The body of nursing knowledge and the complexities of care have grown exponentially in the last 30 years. One of the measures of a school's success is NCLEX scores. Our accreditation bodies do not have that as a criterion to receive continuing accreditation but the state board of nursing does (for continuing approval). Actually since I have taught for the last 40 years I can speak to the specific school dedication to "critical thinking". Richard Paul was the founder of the Foundation for Critical Thinking and we utilized his theory when transitioning from a diploma school of nursing to a BSN program in the 80's. It is inherent in nursing programs today. Perhaps that is when his content was introduced to you Hoosier_RN in your nursing program. Prior to that event, I believe nursing schools have always influenced students to use a form of critical thinking although that specific label was not used. Also in the 80s, because of the explosion of nursing knowledge; educator-scholars often talked about what should be the educational program of entry into practice. A Master's degree was most considered but society is not willing to pay or wait for such degreed entry level nurses.

Everyone who has ever gone to school believes they can provide the direction educators should take. Everyone who has ever cared for an ill family member or be a hospitalized patient also believes their insight is invaluable for members of the health care team. I ask you and others to consider that entry level education is multifaceted and is dependent on clinical facilities, state board of approval requirements, accreditation criteria, ANA standards of nursing practice, department of public health and the opinions of local employers. Before the public and practicing nurses decide to paint nursing education with a broad brush, only citing the aspects important to them, I would ask you to think of all that is expected of the new graduate - I am totally sure we NEVER please everyone!

I have taught as well. I stopped when I was told to pass students who were subpar, and in my-and other instructors-opinions, should not have been in the program. I was told that they would be ready to pass boards at the end of the program. This is at a respected institution in my state. I taught for 6 years, this was not just a 1 or 2 semester job, and started getting more pronounced about 3-4 years in. So believe me, I'm very aware of how teaching in the nursing program works. I'm also aware of what the school itself will do to continue getting funding

FWIW-I stopped teaching 5 years ago, so this is fairly recent. I taught didactic Med-Surg 2, and clinicals for Med-Surg 1 and 2

Edited by Hoosier_RN

Hoosier_RN, MSN

Specializes in dialysis. Has 28 years experience.

On 8/2/2020 at 8:17 AM, JKL33 said:

I agree with other posters. Being dependent on nursing employers to finish so much of nurses' education is not working out well. These (employers) are a group of people who have repeatedly proven themselves to be entities that have to be forced to even begrudgingly invest anything in nurses or nursing. They will never invest in nurses for nurses' sake, it isn't in their playbook. They also are entities who, because of their staffing models, cannot provide adequate proctoring to students during clinical rotations. They disallow students from doing things, put various restrictions on them, and assign them to RNs who quite literally do not have time to instruct students any more. When did it become okay for instructors to leave this bedside proctoring to the RNs on duty?

Clinical time is an educational opportunity for which the student is paying the school.

Schools need to re-focus on the nursing process and the underlying knowledge necessary to perform it (3 Ps, etc.). Keep communication/interpersonal training and training on legal and ethical aspects. Every other trendy thing that is one of those "it's what employers want" things, needs to go. Employers can take responsibility for teaching all about their business fantasies and what they want from their employees, but nurses need to know how to be nurses and do the nursing process.

Students should come out of school in an empowered--not completely dependent--state. Graduating students in increasingly dependent states is allowing employers, business people, to take over this profession.

100% the reason I say schools are failing students. They take the money, and students know how to pass the NCLEX. Some don't know the repercussions of lab values, but they know lab value ranges. It's disheartening, to say the least

londonflo

Specializes in oncology. Has 44 years experience.

3 hours ago, JKL33 said:

Schools need to re-focus on the nursing process and the underlying knowledge necessary to perform it (3 Ps, etc.). Keep communication/interpersonal training and training on legal and ethical aspects.

I agree with this, although I have read on the AN boards that some nurses do not believe in "nursing process". I do with all my heart.

I have much curricula experience, having been employed to develop a BSN curriculum from 2 diploma programs. In addition I have taught at an ADN school. Some things we got right, some things we got wrong. But one of the major tasks for a Bachelor's level curriculum is to develop a program of studies that is at the same level of other college majors. If you believe other wise, you are not believing that nursing is a professional major....rather a trade or technical certificate. If you review how nursing got to where it is today, you will find that many nursing educational pioneers worked hard to raise nursing to a college level.

Quote

Nursing and Nursing Education in the United States (1923), generally known as the Winslow-Goldmark report, was effective in prompting the upgrading of nursing education, particularly through the establishment of university affiliations and national accreditation procedures.

And with regards to ADN programs

Quote

Mildred Montag, PhD, developed the nursing program and was recognized for her impact on nursing education in the United States and throughout the world. Mildred Montag transformed the nursing education system. She was able to shorten the education period of nurses. The goal was to provide a workforce to assist the professional nurse who she envisioned as having a baccalaureate degree. The implications of Dr. Montag's work for our current generation of nurses still centers around the dilemma she notes in 1963. How will nurses and health care centers provide “top of license” performance, and who will provide direct care to our patients?

Even after 6 years of employment, Hoosier___I have not seen a newer faculty member have a total immersion in what is needed in a nursing curriculum other than a knee jerk reaction or a pet concept task believed that a ADN/BSN nurse cannot be without.

I am not the enemy but I am a realist. I do NOT understand why an hospital on boarding needs so much time. But I will say the programs I have a familiar knowledge base in, often involve many sessions devoted to the hospital's philosophy (I am looking at you magnet hospitals) and the latest publicity campaign.

With regard to recognizing students who cannot meet a safe level of practice I can testify that I have provided the necessary documentation for dismissal and have NEVER had a Dean refute me.

londonflo

Specializes in oncology. Has 44 years experience.

3 hours ago, JKL33 said:

They also are entities who, because of their staffing models, cannot provide adequate proctoring to students during clinical rotations. They disallow students from doing things, put various restrictions on them, and assign them to RNs who quite literally do not have time to instruct students any more. When did it become okay for instructors to leave this bedside proctoring to the RNs on duty?

I agree! The staff nurse is not responsible for teaching, explaining, assisting a nursing student to develop or practice a skill. All schools I have taught at have a high value attached to faculty keeping their skills current. I have worked PRN for many years, and it has helped with my income since education pays less than staff nursing.

I do want to add that I have assisted staff with skill acquisition, answering questions and collaborating with the night staff when I come in at 5:30 am to complete assignments. I have taught in my city for a long time and have a good reputation for helping new nurses and seasoned nurses. At least I am attributing the good reputation to anonymous evaluations where students observed my help to staff, my notes from nursing management and the RNs themselves. I have certainly been the recipient of my "can do" attitude when hospitalized. I am very lucky to have had my past students and current nurses "reciprocate the care I taught them" in the hospital and homecare.

Hoosier_RN, MSN

Specializes in dialysis. Has 28 years experience.

1 hour ago, londonflo said:

I agree with this, although I have read on the AN boards that some nurses do not believe in "nursing process". I do with all my heart.

I have much curricula experience, having been employed to develop a BSN curriculum from 2 diploma programs. In addition I have taught at an ADN school. Some things we got right, some things we got wrong. But one of the major tasks for a Bachelor's level curriculum is to develop a program of studies that is at the same level of other college majors. If you believe other wise, you are not believing that nursing is a professional major....rather a trade or technical certificate. If you review how nursing got to where it is today, you will find that many nursing educational pioneers worked hard to raise nursing to a college level.

And with regards to ADN programs

Even after 6 years of employment, Hoosier___I have not seen a newer faculty member have a total immersion in what is needed in a nursing curriculum other than a knee jerk reaction or a pet concept task believed that a ADN/BSN nurse cannot be without.

I am not the enemy but I am a realist. I do NOT understand why an hospital on boarding needs so much time. But I will say the programs I have a familiar knowledge base in, often involve many sessions devoted to the hospital's philosophy (I am looking at you magnet hospitals) and the latest publicity campaign

And I've said that I don’t blame individual instructors, but I do blame schools. We can disagree philosophically all day, but these residency programs are needed to fill the gaps that nursing schools are missing. Years ago, when we were in school, residencies weren't there. We got a few shifts to acclimate-learn facility policy/culture and location of necessities, and that was it. Now, a 6 month to 1 year residency is what many need to just begin. I'm sorry if you're taking my comment that the schools are failing their students as a personal attack, it's not meant to be. I think instructors do their best to teach. Most schools see $$$ and that's the bottom line

londonflo

Specializes in oncology. Has 44 years experience.

On 8/2/2020 at 12:44 PM, Hoosier_RN said:

Years ago, when we were in school, residencies weren't there.

Years ago (in 70s and 80s) we gave few IV meds via few lines besides a peripheral IV. Jeepers, when I started we didn't even have DNR orders.

On 8/2/2020 at 12:44 PM, Hoosier_RN said:

. Most schools see $$$ and that's the bottom line

Since the cost of having a nursing school is the most expensive undergraduate program a school can host, I have to disagree with you here. I believe for many it is a community service. Especially community colleges and state schools. If you can show me the money trail I will believe you;

Quote

100% the reason I say schools are failing students. They take the money,

I have been on the dollar side of education and I don't think you have.

NOW, if money comes from other sources, like the Medicare pass through funds that medical schools and hospitals get that offer student learning experiences, I would agree with you there. You may find that hospitals are oh-so-happy to have nursing students when there are government payments available. I believe there are also funds for on boarding new RN graduates.

On 8/2/2020 at 12:44 PM, Hoosier_RN said:

my comment that the schools are failing their students as a personal attack,

I just feel that taking a cheap shot at education and not knowing the facts is a threat to the programs and faculty that strive so hard to produce the nurses needed. I am not blaming you and am not taking it as a personal attack. I think, rather, a lack knowledge is perpetuated with posts like yours. Tell me..Why did you quite teaching? Was it for a better salary in the public sector and less grief?

2 hours ago, londonflo said:

Some things we got right, some things we got wrong. But one of the major tasks for a Bachelor's level curriculum is to develop a program of studies that is at the same level of other college majors. If you believe other wise, you are not believing that nursing is a professional major....rather a trade or technical certificate.

But why do we have to diverge from clinical/bedside nursing care in order to claim a curriculum has arrived at that of a professional level major? It seems like we (whoever the "we" nursing-powers-that-be are) somehow simultaneously decided 1) entry-level (bedside nurses) should be prepared at the bachelor's level, and 2) this professional level curriculum had to focus on a lot of things other than being an expert at direct patient care.

Are we nuts? Hospitals will gladly take your BSN-prepared nurses at the bedside because it sounds/looks good, no problem--and still treat them as expendables whether they fancy themselves professionals or not! What changed there? Nothing, because these BSN professionals were not taught to provide expert bedside nursing care to patients at a level any higher or better than those other RNs who are deemed not professionals. And because providing bedside care is not even championed by the schools themselves as the bona fide professional activity that it is. Instead of schools beefing up their bedside care curricula and turning out empowered experts in patient care, they made their students spend time messing around learning about process improvements and change management and professional ladders and a bunch of other crap that sounds good. Nursing schools have been right there with this unthinking and toxic attitude about bedside nurses by failing to raise bedside nursing itself to the level of a professionally-prepared nurse; instead their idea is that if/since you are learning all of this other "professional" malarkey in the BSN program, you will be qualified to do something else (other than provide expert bedside care)!! You know what I mean? I'm ranting a little but not at you personally.

Edited by JKL33

Hoosier_RN, MSN

Specializes in dialysis. Has 28 years experience.

23 hours ago, londonflo said:

Years ago (in 70s and 80s)

Tell me..Why did you quite teaching? Was it for a better salary in the public sector and less grief?

I graduated in the 90s, plenty of IVs and IV meds. I started many before I ended my ASN program at a state school.

And yes, I left teaching due to the pay. 80 hrs invested to be paid 400 week 5 years ago

londonflo

Specializes in oncology. Has 44 years experience.

36 minutes ago, JKL33 said:

But why do we have to diverge from clinical/bedside nursing care in order to claim a curriculum has arrived at that of a professional level major? It seems like we (whoever the "we" nursing-powers-that-be are) somehow simultaneously decided 1) entry-level (bedside nurses) should be prepared at the bachelor's level, and 2) this professional level curriculum had to focus on a lot of things other than being an expert at direct patient care.

In order to enhance a students ability to provide expert teaching, the student must have direct experiences with public health nurses, home health nursing practice, clinic and office nurses, and other positions OUTSIDE the hospital.Otherwise how can we refer patients appropriately, explain to patients what the home healthcare nurse will provide, and so they understand when to call the physician's office. While we treasure our roots and the expertise of bedside nursing, the expert skills needed in direct patient care, we cannot limit the focus of nursing to a bedside role.

In ADN programs, we incorporate bedside care but also day hospital experiences, pre anesthesia bedside care, post operative care, observational operative experiences and nursing clinics.

47 minutes ago, JKL33 said:

these BSN professionals were not taught to provide expert bedside nursing care to patients at a level any higher or better than those other RNs who are deemed not professionals. And because providing bedside care is not even championed by the schools themselves as the bona fide professional activity that it is. Instead of schools beefing up their bedside care curricula and turning out empowered experts in patient care, they made their students spend time messing around learning about process improvements and change management and professional ladders and a bunch of other crap that sounds good. Nursing schools have been right there with this unthinking

I have taught in 3 BSN programs, and direct patient care at the bedside was the majority of a students clinical hours. It is unthinkable that a student can provide care in another setting without assimilating direct patient care.

50 minutes ago, JKL33 said:

students spend time messing around learning about process improvements and change management and professional ladders and a bunch of other crap that sounds good.

Exploring the management structure is important to all nurses, LPN or RN. How can we understand how the health care dollars are used? But when you find a course about this can you let me know because I have never taken one in my BSN, MSN studies and I believe a course like that may empower me. How can we improve without measuring what we actually achieve. Professional ladders are unique to the Human Resource department to move nurses on the pay scale (I think) and well I can't explain the other crap that sounds good.

1 hour ago, JKL33 said:

And because providing bedside care is not even championed by the schools themselves as the bona fide professional activity that it is

I truly know you are not ranting at me but it is what it is.

I am a darn good bedside nurse and loved every minute/month/year of it (well I had to earn more pay during the school year and summers to exist) I have stressed this every day when working alone or with students.

londonflo

Specializes in oncology. Has 44 years experience.

19 hours ago, Hoosier_RN said:

Schools teach to the NCLEX because of the all important pass rates needed to stay in business.

This statement actually puzzles me as on AN I read so many recent graduates asking who and what program they should purchase to study for NCLEX and they often cite that weeks are going to be devoted to studying.

I do believe that students should graduate with the expected knowledge sufficient for a safe practice of nursing. After all I expect them to be safe practitioners in the hospital setting during their last weeks of school and just intercede in their decision making when necessary. A whole industry has sprung up to provide coaching and "diagnostic" testing to find weaknesses in the nursing student's knowledge base.

Why do they need these expensive test preparation packages?

Hoosier_RN, MSN

Specializes in dialysis. Has 28 years experience.

13 minutes ago, londonflo said:

This statement actually puzzles me as on AN I read so many recent graduates asking who and what program they should purchase to study for NCLEX and they often cite that weeks are going to be devoted to studying.

I do believe that students should graduate with the expected knowledge sufficient for a safe practice of nursing. After all I expect them to be safe practitioners in the hospital setting during their last weeks of school and just intercede in their decision making when necessary. A whole industry has sprung up to provide coaching and "diagnostic" testing to find weaknesses in the nursing student's knowledge base.

Why do they need these expensive test preparation packages?

because some still don't know the basics, plain and simple. Also, many graduate doubt their knowledge, and these companies play on that. I don't even know if anything existed beyond Kaplan when I graduated...with many schools having a 90 or above pass rate, someone is watching that. Students know how to answer questions, but many times have no clue as to application. How many conversations on here have we seen about that? Way too many

Edited by Hoosier_RN

Hoosier_RN, MSN

Specializes in dialysis. Has 28 years experience.

3 hours ago, londonflo said:

I have been on the dollar side of education and I don't think you have.

Why would you say that? I sat in on many department budgetary meetings as well as institute budgetary. When you see what is charged per credit hour for a nursing program (it is higher than other programs, except perhaps engineering programs), and what is paid out in salaries for instructional staff, lab charges, software, etc, and are shown how much the school is making off of the program, you realize it's not rocket science. But we are getting away from the subject of this thread.

There are reasons that graduates need the residencies that were not in place even 10 years ago. Many schools are not giving the needed skills to start out of the gate

WestCoastSunRN, MSN, CNS

Specializes in CVICU, MICU, Burn ICU. Has 25 years experience.

3 hours ago, JKL33 said:

But why do we have to diverge from clinical/bedside nursing care in order to claim a curriculum has arrived at that of a professional level major? It seems like we (whoever the "we" nursing-powers-that-be are) somehow simultaneously decided 1) entry-level (bedside nurses) should be prepared at the bachelor's level, and 2) this professional level curriculum had to focus on a lot of things other than being an expert at direct patient care.

Are we nuts? Hospitals will gladly take your BSN-prepared nurses at the bedside because it sounds/looks good, no problem--and still treat them as expendables whether they fancy themselves professionals or not! What changed there? Nothing, because these BSN professionals were not taught to provide expert bedside nursing care to patients at a level any higher or better than those other RNs who are deemed not professionals. And because providing bedside care is not even championed by the schools themselves as the bona fide professional activity that it is. Instead of schools beefing up their bedside care curricula and turning out empowered experts in patient care, they made their students spend time messing around learning about process improvements and change management and professional ladders and a bunch of other crap that sounds good. Nursing schools have been right there with this unthinking and toxic attitude about bedside nurses by failing to raise bedside nursing itself to the level of a professionally-prepared nurse; instead their idea is that if/since you are learning all of this other "professional" malarkey in the BSN program, you will be qualified to do something else (other than provide expert bedside care)!! You know what I mean? I'm ranting a little but not at you personally.

^^ This 1000%.

Nurses should be able to have patho/pharm knowledge far beyond what they do when they exit nursing school. This knowledge, paired with the ability to speak and write coherently, would certainly translate to being respected as knowledgeable healthcare professionals whose clinical thinking is essential to the entire interprofessional team. I understand nurses are educated as generalists - I am not suggesting nursing schools provide nurses with deep, disease-specific patho (THIS is something specialty residencies could provide) - a very firm, know-it-like-the-back of my hand understanding of even the basics seems to be lacking for many. And then skills .... some schools are not even teaching students how to put in an IV.

I agree nurses should understand other aspects of professionalism such as basic tenets of ethics, research, public health, and interprofessional collaboration. However, the expectation of deep-diving into any of these areas should be reserved for graduate programs.

Knowledge is power. For bedside nurses, clinical knowledge is especially powerful.

londonflo

Specializes in oncology. Has 44 years experience.

1 hour ago, Hoosier_RN said:

because some still don't know the basics, plain and simple.

But you were the one who said "Schools teach to NCLEX". You can't have it BOTH ways--

londonflo

Specializes in oncology. Has 44 years experience.

1 hour ago, Hoosier_RN said:

I sat in on many department budgetary meetings as well as institute budgetary. When you see what is charged per credit hour for a nursing program (it is higher than other programs, except perhaps engineering programs), and what is paid out in salaries for instructional staff, lab charges, software, etc, and are shown how much the school is making off of the program, you realize it's not rocket science.

I have sat in on similar meetings and been active representing nursing on many college wide committees. Tuition and fees for nursing (which I acknowledge are higher than say an English major) and salaries for instructional staff, lab charges, software, etc do not explain the whole financial picture. What did your school pay for malpractice insurance, salaries for financial aid, adminstration, foundation expenses, library services...books, journal fees (These can be astronomical), admissions, health care, subsidies for the cafeteria and bookstores, student services, transcripts and records department. ...I am sure I have forgotten many. There is also heating/cooling, janitorial maintenance, construction costs, parking lot maintenance, plumbing costs, security force etc.

If you feel that it is financially feasible to run a community college or state university on tuition alone, please, please, please open your own consulting firm!

Before I taught I really thought the tuition I paid was highway robbery. But we all don't know all the costs that "keep the lights on". Most of my teaching supplies I buy myself -- one of my faculty positions was at a school that supplied NOTHING in terms of supplies -- oh, I forgot we got used EEG paper (before HIPAA) for our writing paper and also 5 plastic transparencies (which we had to wash off in the bathroom and reuse). The Dean for that school was particularly odd - she thought if she came in under budget it would show what a great manager she was. Instead the budget was cut every year. The students had to have fundraisers to pay for the college graduation expenses. Dang!

Hoosier__ Everyone complains about expenses and the cost of tuition. I don't doubt that my last college position was saving money for the costs of constructing another new building. As all hospitals do.