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

[Hoosier_RN]

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]

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]

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

[Hoosier_RN, MSN]

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]

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]

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]

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.

[londonflo]

1 hour ago, WestCoastSunRN said:

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 love this and so wish it could happen, How can we do it? When I worked with a diploma to college transition and we were designing the curriculum we asked every one to imagine the perfect nursing school. We ended up with a total course credit level of 138 credits. A bachelors level curriculum is 120 credits. ADN curriculum is 60. The more credits you add, the more it costs the student and delays their graduation. When I taught in 2 diploma programs, we never had to really look at what additional hours spent on the clinical unit since the students lived in the dorm, none were married, had children, or worked. Well...correction they worked for the hospital under the guise of "student learning".

[Hoosier_RN, MSN]

2 hours ago, londonflo said:

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

My comment stands. The schools teach to the NCLEX, and some of these graduates barely know the basics of nursing care. By reading other comments on here, I'm deducing that others agree. I don't see where I'm trying to have it both ways. Sorry...

[Hoosier_RN, MSN]

1 hour ago, londonflo said:

Well...correction they worked for the hospital under the guise of "student learning".

my mom graduated from 1 such program. They did learn, patient care, teamwork, etc. 1966 and she says it was rigorous and she and classmates hit the floor running. She retired at 48 years, MSN, a department manager for many years. She claims that the diploma program prepared her in ways that the BSN and MSN never could have

[JKL33]

22 hours ago, londonflo said:

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.

That isn't what I was referring to at all. I gave examples of the kinds of off-track lessons I was referring to.

For the purposes of this discussion I am using bedside, clinical, and direct care sort of interchangeably, sorry I should have clarified. I'm talking about the education of anyone who wants to work directly with patients providing and managing their care as an RN.

I agree that experiences outside the hospital are important. I'm not sure we shouldn't have more of them.

22 hours ago, londonflo said:

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.

Let's not be disingenuous; you know I did not claim that those things I mentioned were entire courses. Rather they are found in "role transition" courses that untold numbers of ADNs have wasted their money on, and in "Intro to Professional Nursing," ethics courses, research courses, EBP courses, leadership courses and the like in traditional and bridge programs. All of these courses could be useful if they didn't have such heavy overtones of teaching RNs how to do what hospitals want done, instead of teaching patient-focused nursing according to the ethics of this profession.

22 hours ago, londonflo said:

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.

I have truly no doubt that you are. I don't even know why you would need to state that. This conversation is not about impugning you, your character, your nursing skills, your ethics or anything about you. That's why I specifically noted that my concerns (expressed in somewhat rant format) are not directed toward you!

Many of us are just tired of hearing about (from various sources) all the non-patient care stuff a direct care nurse should know in order to be a professional. What we want is to be trained such that we can rightly be regarded as experts at direct patient care and management. On the ground we are losing any autonomy we ever had as a group and are not regarded as experts in anything.

There is a problem here--it isn't with you. But there is a problem.

[londonflo]

46 minutes ago, JKL33 said:

Let's not be disingenuous; you know I did not claim that those things I mentioned were entire courses. Rather they are found in "role transition" courses that untold numbers of ADNs have wasted their money on, and in "Intro to Professional Nursing," ethics courses, research courses, EBP courses, leadership courses and the like in traditional and bridge programs. All of these courses could be useful if they didn't have such heavy overtones of teaching RNs how to do what hospitals want done, instead of teaching patient-focused nursing according to the ethics of this profession.

I have often wondered what was taught in Leadership courses. I honestly don't know. A "Leadership" course has been present in any diploma or BSN curriculum in the schools I have taught at. I have taught minimally in "Intro to Professional Nursing Courses" and we focused on the basic care provided to patients, such as skin assessment and wound care, food and nutrition, elimination, mobility ... etc. I will say though I have always taught "nursing process" because I feel so strongly that nursing needs its professional identification, Actually nursing process does not need to be so convoluted or abstract. Anyone teaching it needs to really understand it or it becomes gibberish.

I did not have research or ethics that I remember until graduate school. Surely ethics was taught but I graduated in the late 70s.

Here I go again, writing a book. I so love teaching professional nursing I could talk about it all day. I think students were very happy to see an accurate clock in the classroom to let me know the course was over!

[londonflo]

43 minutes ago, JKL33 said:

Many of us are just tired of hearing about (from various sources) all the non-patient care stuff a direct care nurse should know in order to be a professional. What we want is to be trained such that we can rightly be regarded as experts at direct patient care and management.

I so agree with you. Although I just hate the term "trained" instead of educated but that is my problem. My son also talks about his medical "training", so it is something I need to accept!