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]

Thank you all for the refreshing discussion on nursing education and its transfer to hospital positions. It is so strongly evident that everyone believes in the importance and value of the nurse and nursing education.

I am terribly sad today that one of our local hospital systems permanently furloughed many long time RNs and CNAs (about 10% system wide). Many worked hard during times when staffing was hectic. I asked a hospital acquaintance if the hospital system had hired any new graduates. She said "that is a big secret". Is this happening throughout the country? Any ideas for nursing staff involuntary leaving the bedside in a tough job market?

[mmc51264, BSN, MSN, RN]

My first nursing degree was an ADN, less than 10 years ago, and I had over 650 hours of clinical. When I was hired, I was hired on an orthopedic unit with extended orientation (6 months!) and I felt so very prepared.

What I see now in new grads is so very scary. With the Covid issues, it is going to get worse. We are getting ready to start about 5 new nurses on our unit.

The last couple of new nurses and probably the last 2 years, are not prepared at all for what floor nursing is. They don't seem to want to learn, to work, to care. It is heartbreaking. Many are getting into NP programs with less than one year of experience. To me, that is frightening.

I used to be a school teacher. Same problem: teach to the big stakes tests. Don't care if the kids actually learn something. I got in trouble once as a teacher because I "had too high standards" I expected 5th graders to know their multiplication tables.

I have the same problem as a nurse. I am "passionate" about my job.

[Bloop41, BSN, RN]

So, I'm a current BSN student and I think the situation has only worsened with the COVID-19 pandemic. As a student nurse, I haven't touched a patient since March and that's even with a Summer term full of classes. I thankfully adapted well to online learning and have maintained good grades, but I am utterly terrified by the prospect of being a new grad with so little hands-on experience. We're supposed to get whirlwind make-up clinicals (for three separate specialties) this fall but have been told we may have to supplement with simulations if the situation gets bad again.

I have said over and over that I wish that hospitals were allowing clinicals during the pandemic: nursing students are literally free labor for them! We can do so much of the basic care: the only real difference between my Spring med-surg clinical and my CNA gig at a SNF was that I was occasionally allowed to give meds under supervision. I was still giving bed baths and oral care and cleaning up "code browns" in both settings.

I've never started an IV. I've only ever inserted a Foley into a mannequin or (I kid you not) a pizza box top with a hole bored through it. I have a solid idea of what lung crackles could mean pathophysiologically but I barely know what they sound like IRL.

Sorry, I know I'm anxiously word-vomiting here but I feel so unprepared to be a nurse by (supposedly) January.

[Hoosier_RN, MSN]

1 hour ago, Bloop41 said:

So, I'm a current BSN student and I think the situation has only worsened with the COVID-19 pandemic. As a student nurse, I haven't touched a patient since March and that's even with a Summer term full of classes. I thankfully adapted well to online learning and have maintained good grades, but I am utterly terrified by the prospect of being a new grad with so little hands-on experience. We're supposed to get whirlwind make-up clinicals (for three separate specialties) this fall but have been told we may have to supplement with simulations if the situation gets bad again.

I have said over and over that I wish that hospitals were allowing clinicals during the pandemic: nursing students are literally free labor for them! We can do so much of the basic care: the only real difference between my Spring med-surg clinical and my CNA gig at a SNF was that I was occasionally allowed to give meds under supervision. I was still giving bed baths and oral care and cleaning up "code browns" in both settings.

I've never started an IV. I've only ever inserted a Foley into a mannequin or (I kid you not) a pizza box top with a hole bored through it. I have a solid idea of what lung crackles could mean pathophysiologically but I barely know what they sound like IRL.

Sorry, I know I'm anxiously word-vomiting here but I feel so unprepared to be a nurse by (supposedly) January.

I'm so sorry. This CV-19 has made a mess of education...grrrr...We discussed this at work the other day-one of the patient's daughter is in nursing school and has yet to touch a real patient. Patient is livid because his daughter is working and has scholarships to pay for school, and they both feel like she is being ripped off. She's in a ASN program and terrified that if this goes on long, she won't have a clue when she graduates. I agree, and a SIM lab is no substitute for true hands on.

[londonflo]

2 hours ago, Bloop41 said:

We can do so much of the basic care: the only real difference between my Spring med-surg clinical and my CNA gig at a SNF was that I was occasionally allowed to give meds under supervision.

Were you able to look at the time management and organization of the RN? Did you have access to the med list and current and past lab values of your patients? These learning activities are up to you to make the best of them, whether your instructor quizzes you or not. I know everyone wants to "do, do, do" but sometimes the experiences are not there. Have you had OB yet? Most likely you will be able to cath then. ER is great for IV starts. While simulation mannequins are super great, there is is limit I know to the learning on them. Some states have specific time limits on how much the clinical can be provided in the sim lab but I believe that came about because of for-profit programs having difficulty in getting access to clinical sites. My knowledge is hearsay so please correct me if I am wrong.

1 hour ago, Hoosier_RN said:

This CV-19 has made a mess of education...grrrr...We discussed this at work the other day-one of the patient's daughter is in nursing school and has yet to touch a real patient. Patient is livid because his daughter is working and has Scholarships to pay for school, and they both feel like she is being ripped off.

Covid sure has messed things up but hospitals with limited PPE equipment had to make the decision to limit clinical student exposure. I keep reiterating that ANA and the state organizations along with the educational organizations such as NLN and CCNE sure let the student and professional nurses down by not broadcasting the limitations that the lack of PPE was for all individuals in the clinical arena. What;s done is done but let's remember 'It is what it is in November., nevermore!"

Quote

The plot of most Raven tales, tell of how Raven is able to use force or trickery to obtain or motivate someone else to relinquish an object he desires. Throughout his many stories, Raven claims daylight, water, fire, the oceans waves, the olachen, salmon, the soil, and even the weather.

[Hoosier_RN, MSN]

9 hours ago, londonflo said:

Were you able to look at the time management and organization of the RN? Did you have access to the med list and current and past lab values of your patients? These learning activities are up to you to make the best of them, whether your instructor quizzes you or not. I know everyone wants to "do, do, do" but sometimes the experiences are not there. Have you had OB yet? Most likely you will be able to cath then. ER is great for IV starts. While simulation mannequins are super great, there is is limit I know to the learning on them. Some states have specific time limits on how much the clinical can be provided in the sim lab but I believe that came about because of for-profit programs having difficulty in getting access to clinical sites. My knowledge is hearsay so please correct me if I am wrong.

Covid sure has messed things up but hospitals with limited PPE equipment had to make the decision to limit clinical student exposure. I keep reiterating that ANA and the state organizations along with the educational organizations such as NLN and CCNE sure let the student and professional nurses down by not broadcasting the limitations that the lack of PPE was for all individuals in the clinical arena. What;s done is done but let's remember 'It is what it is in November., nevermore!"

I agree, but I feel that perhaps clinicals could be postponed. There's just no amount of similation or Zoom or Teams that equals in person/hands on. It's frustrating

[JKL33]

On 8/3/2020 at 11:41 AM, Susie2310 said:

I have come to believe, based on what I have seen/experienced, that knowledgeable, ethical, competent bedside practitioners; nurses who employ critical thinking and use the Nursing Process as the backbone of the care they provide, are not generally desired as employees. What I see preferred is a much dumbed down model; practicing nursing as merely a series of tasks and obedience to employer directives with minimal critical thinking.

I agree with this 100%. Based on my observations I would clarify that this should not by any means be mistaken to mean that nurses themselves are incapable of critical thinking or lack knowledge, ethics, compassion or using the nursing process appropriately. But my experience and observation is that those who want to incorporate more than tasking and obedience to directives will have an uphill battle...they are on borrowed time before they experience "burnout" (a term used in a manner with which I disagree and think it should be called what it is: moral/ethical dilemma, moral injury, inability or refusal to reconcile employer fantasies with actual professional nursing care).

So I agree with @Susie2310: What is preferred is dumbed down nursing.

I have been in staff "education" sessions where this cat was nonchalantly let right out of the bag with no compunction whatsoever, because they see this as a good thing. "We know how busy you are and we are working very hard to lessen the critical thinking you have to do in order to take care of patients."

We are giving everything away when we leave so much of the completion of our education to hospitals. I see their objectives as being completely against this profession.

[Hoosier_RN, MSN]

44 minutes ago, JKL33 said:

I agree with this 100%. Based on my observations I would clarify that this should not by any means be mistaken to mean that nurses themselves are incapable of critical thinking or lack knowledge, ethics, compassion or using the nursing process appropriately. But my experience and observation is that those who want to incorporate more than tasking and obedience to directives will have an uphill battle...they are on borrowed time before they experience "burnout" (a term used in a manner with which I disagree and think it should be called what it is: moral/ethical dilemma, moral injury, inability or refusal to reconcile employer fantasies with actual professional nursing care).

So I agree with @Susie2310: What is preferred is dumbed down nursing.

I have been in staff "education" sessions where this cat was nonchalantly let right out of the bag with no compunction whatsoever, because they see this as a good thing. "We know how busy you are and we are working very hard to lessen the critical thinking you have to do in order to take care of patients."

We are giving everything away when we leave so much of the completion of our education to hospitals. I see their objectives as being completely against this profession.

I ❤ this 1000x. These 2 posts together is exactly what I feel, and have not adequately been able to put into words

[subee, MSN, CRNA]

We have to start limiting our numbers before we have enough power to change anything.

[WestCoastSunRN, MSN, CNS]

If the nursing schools stopped churning out students - say did not graduate current students until proper clinicals could be had - I think that would be a big eye-opener. It would empower nurses, as it would be recognized that there are, indeed, minimal standards that must be met before one is allowed to sit for the NCLEX. We would not condone a physician practicing medicine who had no hands-on patient experience, would we?

I'm so sorry for the students right now. It is no one's fault what is happening. However, those with the power to lead and respond to these challenges have a huge responsibility to do the right thing. And with our healthcare systems being squeezed by pandemic we see the true colors of priority.

[londonflo]

6 hours ago, Hoosier_RN said:

I agree, but I feel that perhaps clinicals could be postponed. There's just no amount of simulation or Zoom or Teams that equals in person/hands on. It's frustrating

I wonder what happened to the students who had no face to face clinical clinical education after Mid March. I found this is requirement for a Bachelor's program on the Florida BON site

Quote

No more than 50 percent of the program’s clinical training consists of clinical simulation.

But then I found the National Council State Board of Nursing Summary Changes per each BON: Changes in Education Requirements for Nursing Programs During COVID-19

https://www.NCSBN.org/Education-Requirement-Changes_COVID-19.pdf

Interesting reading.

[Hoosier_RN, MSN]

3 hours ago, londonflo said:

I wonder what happened to the students who had no face to face clinical clinical education after Mid March. I found this is requirement for a Bachelor's program on the Florida BON site

But then I found the National Council State Board of Nursing Summary Changes per each BON: Changes in Education Requirements for Nursing Programs During COVID-19

https://www.NCSBN.org/Education-Requirement-Changes_COVID-19.pdf

Interesting reading.

Thanks providing. That's an eye opener