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.

[llg, PhD, RN]

16 hours ago, Susie2310 said:

I've bolded the part of your post I am referring to. I'm not sure why you found it necessary to use the phrase: "In most areas of the country even associate degree nurses . . ." Why not just say: "In most areas of the country, associate degree nurses . . .?" You are well educated, so you know that your choice of words conveys meaning. In this case, your words conveyed to me disdain for the abilities of Associate Degree Nurses. No doubt you will post back and say that you intended no such thing and offer a reason for your choice of words; however, this is how you are coming across to some of us.

Yes, I will respond that I meant no such insult. If you read the post I was directly responding to and consider its meaning, you'll realize that the poster was emphatically stating that nurses with Associates Degrees did not perform those kinds of functions. He was ranting that the NCLEX expected him to have knowledge of those types of activities -- and that wasn't fair because as an ASN/ADN, he would never be expected to perform those types of duties. My word choices were in response to his tone and assertions that ADN/ASN nurses were not expected to provide any type of leadership.

That context should be considered when interpreting my use of the word "even." I assumed that ADN/ASN nurses are able to understand that.

[Nurse Beth, MSN]

I've thought for a long time that we need to go to a medical model, where nurses are given progressive independence. A year of residency, with a fellowship after that for specialties.

[JKL33]

3 hours ago, RoundAbout33 said:

There is a reason why there are so many different platforms, resources, and content dedicated to helping you pass the NCLEX - there is a strategy to the test. NCLEX-world you have everything you could need and everything available right then. I had a practice question once involving a pt who had a previous resuscitation earlier in the day and was now in v-fib again. Two of the answers were start compressions and shock. I chose compressions (as what we are always taught in the real world - jump on the chest) as in the real world, we would do compressions until the AED was charged and ready; however, in NCLEX-world (perfect world), it was already charged and v-fib is a shockable rhythm.

I think your post is great, others have offered some good advice too. My comment is not about arguing with any of that.

***

I just don't see the need for a question as described above, though. This is where a preoccupation with "critical thinking" becomes wrong. If you* want to know if the test-taker understands that v-fib is a shockable rhythm there are plenty of ways to ascertain that. If you* want to know whether the test-taker can discern between right and absolutely wrong actions to take in this scenario, there are ways to ascertain that, too. In the example given, the test-taker is is given a choice between the answer that is always right and the answer that preserves the integrity of the situation including preserving the integrity of a situation where no one is standing there with a defibrillator.

The minute we start taking time coaching and discussing and wasting untold resources on helping students understand the ?? psychology (or whatever you want to call it) of answering these types of questions....that's less time for making darn sure everybody knows that v-fib is a shockable rhythm and that you always shock it as soon as humanly possible.

IMO almost all time spent on these discussions ("welllll....yes, you are right...but what is the really truly **best and most ideal** answer....") is time wasted. Students are not there to waste time on pedagogical and rather esoteric matters of someone's good idea or theory about how to teach or evaluate "critical thinking."

*you=those who construct tests, etc.

[macawake, MSN]

7 hours ago, HiddencatBSN said:

With the pass rate for first time takers high followed by low subsequent attempt rates across the board, why doesn’t that suggest to you that grads who are not initially successful have themselves not integrated the education well or have teat taking difficulties?

A lactation consult, stat!

(Sorry, I know it’s just a typo. Just thought this angry thread could use a little levity ?)

[guest1008832]

8 hours ago, HiddencatBSN said:

You didn’t read the instructions before filling out the application. That’s on you. The information is available and it’s your responsibility to make sure you understand the requirements and conditions of applying before you apply.

Dear HiddencatBSN & Nursing Professionals,

I want to thank each of you for your feedback. Some has been helpful while others simply believed I was "ranting" and "angry". Make no mistake about it, I'm depressed and disappointed. I will make this my last statement here so we can move on to other conditions.

Before I go, just a few closing statements. HiddencatBSN claimed in a response that Paralegals should be required to take the same Bar Exam as a recent law student. Unfortunately, I disagree and they are not required to. Some states don't even have formal Paralegal training but are hired by law firms and provided OJT and are simply awarded a title. I wanted to make that distinction. I made that comparison based on the on-going dialog between testing and the various levels of degrees in nursing (for those following along).

Second, I appreciate "Nurse Beth" who made the recommendation for "Progressive Independence" along with extended precepting periods of 1-yr. for new nurses. Some of the hospitals in my area have already implemented this form of training upon being hired and maybe it's the NCLEX replacement we need to consider moving into the 21st Century.

HiddencatBSN along with Londonflo made arguments to suggest it was my responsibility to know what application I was filling out, particularly for a "Nursing Permit". The PA BON has been riddled with complications and although you both provided me with information on where to find the PA Statute in the PA Bulletin, at the time I completed my application to the PA BON the "link" was broken and not available. In fact, there have been so many complaints against the PA BON here is a link to such one article out of many, including 290 Google reviews not in favor of the PA BON. https://www.inquirer.com/news/pennsylvania/spl/nurse-licensing-board-pennsylvania-delays-complaints-20190911.html I recall looking back at an email I sent to the PA BON claiming various links on their site were broken or did not even exist when it claimed, "Click on this link" and the link was nowhere to be found. I wasn't able to review the information pertaining to the revoking of a "Nursing Permit" as a GN. Hence, I pray you understand some of the frustration with this system and why I have referred to it as a unorthodox, unwarranted "Hazing".

Yesterday, I took my niece to a St. Luke's Care Now facility here in PA. She required two (2) vaccine shots for school (University of Pittsburg) but will be doing this semester via long-distance learning because the school is closed to in-person education. She required proof of a flu and meningitis booster vaccine. Initially, I left my niece go inside without me. She returned almost 8 minutes later to tell me they could not give her the shots. I asked for her to elaborate and she said, "The Nurse claims she can't give a meningitis shot" and more-so, "I can't get them both in the same day!" I was floored. In fact, I gasped. I got on of my car and said, "LET'S GO". When I approached the desk to speak with the nurse I asked for clarification why my niece could not get the shots today and she absolutely parroted the same information to me as she did to my niece. Sarcastically, I said, "You are an RN right?...and you're telling me not only can you as an 'RN' not adm. a vaccine but you're alleging she can't receive both in the same day?" I obtained her name and left SMH! We proceeded to a local CVS Pharmacy and presented the paperwork from her physician ordering the vaccines. Within 20 minutes, a Pharmacy Tech emerged and provided my niece with two(2) vaccines adm. in the B/L UE's. DONE! But according to all of you, the NCLEX exam is all about safety and making sure you can function as a RN with competency. Where is the competency in this example yesterday? The RN claimed she didn't know she could adm. a vaccine yet alone two at the same time. I've now switched from drinking to taking pills after this experience!

Lastly, another member here made the statement, "There is a strategy to the test!". What strategy? Making the best educated guess makes you a paramount RN or LVN/LPN? Testing should not be designed to "Trick" someone but to test their core fundamental knowledge of material offered in resources and then provide for remediation when they fail.

I've taken hundreds of test...all my life. Seemingly, I didn't fail out of high school. I became and "EMT" followed by "Paramedic" and some of you here didn't even know the difference between the two. I spent 23-yrs in the Army, so yah...I've been tested my entire life and I've learned from mistakes and failures. When you fail the NCLEX, you get a CPR (Candidate Performance Report) claiming your either "Above, Near or Below" the passing standard in various categories. There is NO remediation. How do I know if I got the Viagra question right and know if the client gets the medication stuck in their throat if they will get a stiff neck or not, or make a proper decision regarding Interdisciplinary Team questions, etc...

I personally don't want to sue anyone. What I want is a fair system of testing so I can continue my education and start learning all there is to know about nursing. I have a thirst for medicine but I also have a disdain for obtuse testing methodologies. When new EMT's or Paramedic's and even RN students come ride with me on the ambulance, I provide them with no tricks or deceptions. I want them to know how we do things and if things go south, how we can have an AAR (After Action Review) to improve on pt. outcomes. WE ALL LEARN by experience.

Congratulations to each and every one of you who passed the NCLEX at some point in your life. But you know how that experience changed your life for the good and maybe the bad. I know I'm not alone, I'm just being that guy who is standing on his chair at the moment potentially causing "necessary trouble" to call attention to a system I believe needs review.

I was banking on re-entering the military as an Officer because even after 23-yrs., I want to serve my Country at the age of 47 and be proud of my accomplishments. This NCLEX exam is prohibiting me from achieving all of my goals.

Thank you again for allowing me on your open forum to "vent", "rant", "shout", "throw things at home" and get it all out. I have a lot of thinking to do on what I need to do next. If you see me on CNN, Fox, NBC or some other news channel...don't judge...just send me a message that my hair wasn't looking stellar that day and we will agree to disagree.

God bless to each of you, stay safe out there and GO VOTE in Nov.

Bruse O. (No animals, children or feelings were hurt in the creation of this final message.)

[Susie2310]

4 hours ago, llg said:

Yes, I will respond that I meant no such insult. If you read the post I was directly responding to and consider its meaning, you'll realize that the poster was emphatically stating that nurses with Associates Degrees did not perform those kinds of functions. He was ranting that the NCLEX expected him to have knowledge of those types of activities -- and that wasn't fair because as an ASN/ADN, he would never be expected to perform those types of duties. My word choices were in response to his tone and assertions that ADN/ASN nurses were not expected to provide any type of leadership.

That context should be considered when interpreting my use of the word "even." I assumed that ADN/ASN nurses are able to understand that.

I've read the whole thread and I re-read emtpbruse's posts and your replies to his/her posts, and I am well aware of the context of the discussion. I still disagree that it was necessary to use the phrase "even ADN nurses" just as I think it is unnecessary to say in your last paragraph above: "I assumed that ADN/ASN nurses are able to understand that."

[RoundAbout33, BSN, RN]

4 hours ago, JKL33 said:

I think your post is great, others have offered some good advice too. My comment is not about arguing with any of that.

***

I just don't see the need for a question as described above, though. This is where a preoccupation with "critical thinking" becomes wrong. If you* want to know if the test-taker understands that v-fib is a shockable rhythm there are plenty of ways to ascertain that. If you* want to know whether the test-taker can discern between right and absolutely wrong actions to take in this scenario, there are ways to ascertain that, too. In the example given, the test-taker is is given a choice between the answer that is always right and the answer that preserves the integrity of the situation including preserving the integrity of a situation where no one is standing there with a defibrillator.

The minute we start taking time coaching and discussing and wasting untold resources on helping students understand the ?? psychology (or whatever you want to call it) of answering these types of questions....that's less time for making darn sure everybody knows that v-fib is a shockable rhythm and that you always shock it as soon as humanly possible.

IMO almost all time spent on these discussions ("welllll....yes, you are right...but what is the really truly **best and most ideal** answer....") is time wasted. Students are not there to waste time on pedagogical and rather esoteric matters of someone's good idea or theory about how to teach or evaluate "critical thinking."

*you=those who construct tests, etc.

I completely agree with you that those types of questions really aren't good assessments of critical thinking. When I initially got that question wrong, I reached out to one of the clinical instructors (it was a Kaplan question) to help me understand, and she gave me the rationale I mentioned. She also said that she too hated questions like those. In my actual NCLEX testing experience, however, those types of questions were few. It is crazy that so much comes down to passing this one exam, but for now, that's just the way it is. I appreciate your insight!

[llg, PhD, RN]

2 hours ago, Susie2310 said:

I've read the whole thread and I re-read emtpbruse's posts and your replies to his/her posts, and I am well aware of the context of the discussion. I still disagree that it was necessary to use the phrase "even ADN nurses" just as I think it is unnecessary to say in your last paragraph above: "I assumed that ADN/ASN nurses are able to understand that."

Hey ... I'm the one assuming that all RN's are able to understand what I originally wrote. I have great respect for RN's of all educational backgrounds. I have high standards for all of us. I'm not "the enemy." The fact that you got so riled up about my use of one word says more about you than it does about me.

[HiddencatBSN, BSN]

4 hours ago, emtpbruse said:

Dear HiddencatBSN & Nursing Professionals,

I want to thank each of you for your feedback. Some has been helpful while others simply believed I was "ranting" and "angry". Make no mistake about it, I'm depressed and disappointed. I will make this my last statement here so we can move on to other conditions.

Before I go, just a few closing statements. HiddencatBSN claimed in a response that Paralegals should be required to take the same Bar Exam as a recent law student. Unfortunately, I disagree and they are not required to. Some states don't even have formal Paralegal training but are hired by law firms and provided OJT and are simply awarded a title. I wanted to make that distinction. I made that comparison based on the on-going dialog between testing and the various levels of degrees in nursing (for those following along).

I misread your post and thought you were talking about lawyers and not paralegals, because your paralegal comparison doesn’t make sense since lawyers and paralegals do not practice at the same level but RNs regardless of degree are prepared to and do all practice in the same professional level. Comparing an ADN to a paralegal and a BSN to a lawyer underscores how deeply you misunderstand nursing. I guess my brain simply didn’t even consider that was the argument you were making but apparently it is.

Nursing is not paramedicine. Paramedicine has a medical model as well as having a very military-like structure to it. Your paramedical and military experience fit very nicely together and reinforce each other well. Nursing is a different model and a different field. You see it as the next level and a continuation of what you already know, and while a lot of the knowledge and skills are transferrable, it’s a different framework and focus altogether. And you can fight against that or you can focus on your areas of weakness and work on improving them before the next time you take the NCLEX.

I still can’t get over though you applying for a GN permit without understanding the terms of the application. When you encountered a broken link you just thought meh well it probably didn’t contain important information anyway I’m just gonna forge ahead here on gut instinct?

[HiddencatBSN, BSN]

3 hours ago, Susie2310 said:

I've read the whole thread and I re-read emtpbruse's posts and your replies to his/her posts, and I am well aware of the context of the discussion. I still disagree that it was necessary to use the phrase "even ADN nurses" just as I think it is unnecessary to say in your last paragraph above: "I assumed that ADN/ASN nurses are able to understand that."

Bruse is comparing ADN/BSN to paralegal/lawyer and you’re concerned that llg is arguing against that by highlighting that the ADN prepared nurses are practicing the same nursing as BSNs. That’s your prerogative of course, but llg doesn’t need your approval before deciding how to engage with someone who is actively arguing that ADN is an inferior degree. I feel this sidebar is unnecessary but it’s a forum and that’s how things go.

[Susie2310]

1 minute ago, HiddencatBSN said:

Bruse is comparing ADN/BSN to paralegal/lawyer and you’re concerned that llg is arguing against that by highlighting that the ADN prepared nurses are practicing the same nursing as BSNs. That’s your prerogative of course, but llg doesn’t need your approval before deciding how to engage with someone who is actively arguing that ADN is an inferior degree. I feel this sidebar is unnecessary but it’s a forum and that’s how things go.

No, I've already explained what my concern was in my first reply to llg if you'd care to go back and read it. I'm not concerned about what you have just written above, and this is not a point at issue for me.

[HiddencatBSN, BSN]

1 minute ago, Susie2310 said:

No, I've already explained what my concern was in my first reply to llg if you'd care to go back and read it. I'm not concerned about what you have just written above, and this is not a point at issue for me.

Oh, I’ve been following along. Your feelings are your feelings.