Stop the (Deskilling) Merry-Go-Round, I Want to Get OFF!

[Rose_Queen, BSN, MSN, RN]

And IMO (I probably will be flamed for this) but the NCLEX has been overly simplified over the years. I remember the 2 days from hell and hundreds of questions (400?). Now a new grad can pass at 75. If healthcare has gotten increasingly complex, how can a new grad only be tested with 75 questions?

I know..minimal entry as an RN, but still, IMO it's not enough.

I agree, I think nursing school focused more on passing the NCLEX, so schools look good.

Not flaming; I'm one of those 75 question passers and I thought it was far too simple. I'd rather see not only a test but also competencies required.

[malestunurse]

And IMO (I probably will be flamed for this) but the NCLEX has been simplified over the years. I remember the 2 days from hell and hundreds of questions (400?). Now a new grad can pass at 75. If healthcare has gotten increasingly complex, how can a new grad only be tested with 75 questions?

I know..minimal entry as an RN, but still, IMO it's not enough.

I agree, I think nursing school focused more on passing the NCLEX, so schools look good.

Because your ability to practice should not be examined for in the NCLEX that is decided by you passing your accredited program. Your ability to practice safely is what should be examined in the NCLEX.

[tokmom, BSN, RN]

Because your ability to practice should not be examined for in the NCLEX that is decided by you passing your accredited program. Your ability to practice safely is what should be examined in the NCLEX.

How can you judge the ability to practice safely with only 75 questions??

Heck, my certification test for med/surg was a 150 questions, and I had to answer every single one. No computer shut off at 75!

[Gentleman_nurse, MSN]

This student also made it clear that she had no intention of learning bedside skills. She stated she was going to go into management so she didn't need to learn how to care for a patient. Ultimately she was failed from the program 2 months from graduation. The school was very surprised to discover she couldn't perform basic skills.

Unfortunately this attitude is not uncommon.

[Gentleman_nurse, MSN]

And IMO (I probably will be flamed for this) but the NCLEX has been simplified over the years. I remember the 2 days from hell and hundreds of questions (400?). Now a new grad can pass at 75. If healthcare has gotten increasingly complex, how can a new grad only be tested with 75 questions?

I know..minimal entry as an RN, but still, IMO it's not enough.

I agree, I think nursing school focused more on passing the NCLEX, so schools look good.

It's a Computer Adaptive Test. The computer adjusts the level of difficulty of the questions to match your knowledge level. Harder questions are worth more points.

[ThePrincessBride, MSN, RN, NP]

There are any number of facilities who will do just about anything to retain a fully BSN staff.

BSN prepared nurses may have some clinical experience, but for any number of them it is a means to the end of either managment or specialties. I am not sure where the programs are that allow students in the US to actually start IV's, etc. But if they are there, it should be the go to school.

Unfortunetely, they keep ADN's, Diploma RN's and LPN's around just long enough to teach a new nurse the very basics of bedside care, then they are on their own, as then everyone else is phased out. And quite honestly, a nurse can "get around" basic care--and it happens every day--there is more than one school that has a whole class on "delegation" and well, if there's no one to delegate to--ah, well, they are going home tomorrow anyways.

Local community or state schools should not be discounted. Many have excellent programs. As noted by their long waiting lists. This adds to the elitist nature of private expensive schools. They all teach the same thing, however, the "label" makes it better? I am not so sure that is the case.

I am entering my senior year of a BSN nursing school (state university), and I have only placed in one foley and one IV (but I work as a tech and routinely do blood draws, and my old job allowed techs to foley/straight cath), but I have worked with several vented patients, have learned about tube feeds, have given numerous IM/SQ injections (including working with insulin) and IV push meds along with hanging numerous bags, setting up the IV pumps, and have performed wound care. I haven't placed in NG tubes or perform trach care, unfortunately.

Not everyone gets an opportunity to put in a foley or IV or work with a vented patient. Some hospitals severely limit what nursing students can do, no matter the degree, for liability reasons. Back in the day, nursing students could do MUCH more with patients and weren't put on a tight leash. I would love to have gotten more hands on experience, but we are limited to the amount of care we are allowed to provide.

To the OP,

You do make excellent points that I agree with. However, nursing instructors have all told me that the thing that separates the nurse from all others is her/his assessment skills. My teachers have even gone as far as to say that they could teach a monkey how these skills, but they cannot train them to think critically or assess a patient, the hallmarks of nursing. That isn't to say that the psychomotor skills aren't important because they are, however, what is the point in knowing how to perform tasks but not knowing why?

[ThePrincessBride, MSN, RN, NP]

I worked with a nurse who refers to baths and toileting as CNA work. Totally blew me away. You can find out so much about your patient if you actually touch them beyond a simple assessment of breath and bowel sounds.

I work as an aide and have heard this far too many times. There is no such thing as "CNA work" as "CNA work" is really just basic nursing care.

[tokmom, BSN, RN]

It's a Computer Adaptive Test. The computer adjusts the level of difficulty of the questions to match your knowledge level. Harder questions are worth more points.

Yeah, but why the change? We did hundreds..hundreds of questions and it was rare to have an easy question. You HAD to study to pass the old NCLEX. I still don't buy that you can assess competency in 75 questions. As I said before, even my certification was a 150 with no shut off.

IMO the newer NCLEX dumbs down nursing. Does an MD have a computer shut off at 75?

[Carrie RN]

I often wonder when new grads are stating they have few skills when leaving nursing school what kind of a rinky-dink college they went to. I understand college is different now, but nursing is actually more skilled than ever. I am leery of the computer testing. It is scary that there is only 75 questions between a ditch digger and an RN.

[NotReady4PrimeTime, RN]

You do make excellent points that I agree with. However, nursing instructors have all told me that the thing that separates the nurse from all others is her/his assessment skills. My teachers have even gone as far as to say that they could teach a monkey how these skills, but they cannot train them to think critically or assess a patient, the hallmarks of nursing. That isn't to say that the psychomotor skills aren't important because they are, however, what is the point in knowing how to perform tasks but not knowing why?

My question is: how do we assess our patients if we're not even touching them? If an aide is doing the bottom washing, tube feed hanging, med passing and ambulating am I - the RN responsible for assessing the patient - going to know that Mrs Smith in 321B is unable to turn herself at all, or that Mr Jones in 325A has new onset difficulty swallowing his meds, or that the young person with cancer in 318 has a skin tear between her buttocks? When I'm the one doing the bottom washing, I'm assessing the patient's skin integrity and motor strength, making note of quantity, colour and consistency of stool, and even assessing mental status by engaging the patient in conversation. The aide knows how to wash bottoms. Or hand over a med cup with a handful of tablets in it. Or how to set a rate on a feeding pump. Their focus is the task. For the RN or LPN, the focus is the patient; the task itself is secondary.

[loriangel14, RN]

My question is: how do we assess our patients if we're not even touching them? If an aide is doing the bottom washing, tube feed hanging, med passing and ambulating am I - the RN responsible for assessing the patient - going to know that Mrs Smith in 321B is unable to turn herself at all, or that Mr Jones in 325A has new onset difficulty swallowing his meds, or that the young person with cancer in 318 has a skin tear between her buttocks? When I'm the one doing the bottom washing, I'm assessing the patient's skin integrity and motor strength, making note of quantity, colour and consistency of stool, and even assessing mental status by engaging the patient in conversation. The aide knows how to wash bottoms. Or hand over a med cup with a handful of tablets in it. Or how to set a rate on a feeding pump. Their focus is the task. For the RN or LPN, the focus is the patient; the task itself is secondary.

Exactly. students that really don't care will use the old " a monkey could do the tasks" line. They don't get it.

[ThePrincessBride, MSN, RN, NP]

Exactly. students that really don't care will use the old " a monkey could do the tasks" line. They don't get it.

I hope you aren't implying that I don't care as I didn't personally state that; my instructors did.