"What Did They Teach You in Nursing School Anyway?"

[jjjoy, LPN]

My nursing program was very nursing care oriented (vs disease managment) and it felt like that put us at a disadvantage as new grads. Colleagues expected nursing school grads to know how to manage the different disease processes. Sure, I could look up what I didn't know and ask colleagues for their help, but in doing so, I sure heard a lot of "what did they teach you in school anyway?"

And I don't care if it's lecture or facilitated learning or group projects or whatever, the most important part of a curriculum is the content. And, to me, nursing school seems to try to cover way too much content (all that disease process and management) while at the same time de-emphasizing that very same content by making almost all testing look like NCLEX questions - many of which can be figured out without a thorough comprehension of disease management - and is by no means comprehensive if you only have 60 questions for 400 pages of content. The nursing care plans we had to write were 80% psychosocial, coping, comfort, ADLs and the like, with 20% or less being about disease management.

My school certainly did emphasize autonomous nursing practice... lots of focus on therapeutic communication, skin breakdown prevention, avoiding constipation, patient eduation and the like. But that wasn't very appreciated by nursing colleagues who expected a nursing school grad to know how to prioritize the nursing care for several acutely ill patients, the highest priority after basic ABCs being disease management.

Any thoughts on the curriculum by educators?

For context, I initially wrote this in response to this posting about a seminar on rebuilding nursing education; a moderator created a new thread for it. https://allnurses.com/nursing-faculty-nursing/may-1-2009-a-382687.html

[AOx1]

I certainly can't comment on your particular school's curriculum, having no familiarity with it, but I can confidently state that the NCLEX surveys new graduate practice to determine what types of things and activities occur for a newly licensed nurse. I ensure that my content for all areas is reflective of the NCLEX blueprint. I focus primarily on safety. After all, what good is a sweet and compassionate nurse who doesn't know when to call a code, or perform basic skills such as CPR?

From my personal perspective, nursing works as part of a team, and in order to do so most efficiently, we need both parts of the equation, the knowledge and the caring. One is not more or less important than the other. The issue is that both are developed to full potential over time. A new grad is learning at such a fast rate, but needs time to acclimate to a new unit, especially a specialty unit, as nursing programs train you to be a generalist.

I teach the students in my courses the key content they need in order to be safe practitioners. The conundrum in nursing education is no different than that in nursing in general- new things are constantly being added to the "key" knowledge with hardly anything being removed. For example, new paperwork forms, new equipment, etc. My thoughts are clear on this issue- with all my years of experience, if I can't prioritize the key information, how can I expect a "green" student to do so? I start at the beginning showing students how to recognize key safety issues and critical assessments, and as time goes on, they are expected to prioritize appropriately.

There is no possible way to "know it all," and the comments about "what did they teach you, anyway?" smack of horizontal violence. We should ALL be looking up information to further our learning, instead of behaving in a nasty manner towards someone who doesn't know what we know. Part of the issue stems from the fact that many facilities view nurses as expendable and replaceable, burning them out rapidly by overloading new graduates and shortening orientation programs. There is little thought given to training nurses further and mentoring them. Certainly a new grad should be able to use the ABCs to prioritize care, but time management develops over time.

Good reading that is somewhat related:

Nursing Against the Odds

Benner's Novice to Expert

[HouTx, BSN, MSN, EdD]

I am involved with the onboarding of new nurses in my organization. We find that new grads certainly have requisite knowledge but just are unable to apply it. They are unable to prioritize - so cannot manage their time & will not be able to do so without experience. However, today's econmic reality does not permit us the luxury of long, extended orientations. Our new grads must achieve minimal competency within 12 weeks in general units.

Our solution has been to implement a much more focused process with very specific outcome expectations. We utilize clinical 'coaches' who have been trained in methods needed to faclitate rapid skills development. We do very little "show and tell"; it's hands on from day one. Working alongside their coach, the new grad applies disease process knowledge to manage patient problems, implement nursing and medical protocols, and maintain communication with other team members & physicians. Coaches serve as catalysts - to prompt the reflection and self-evaluation needed to bolster confidence & validate performance. We have a very high success rate.

[AOx1]

I can see why your mentoring is successful. So many programs promise a good orientation, then 4 weeks later, the new grad is shoved out with a full load of patients, or better yet, asked to be charge nurse after a few months of experience. There is a local facility that is known for this. I try to steer our new grads away from accepting such a situation.