triage style testing for lpn students

[barbara168]

I just completed my first term of a nine-month lpn program. I had practiced for the skills final and I thought it was going to be pretty straightforward like "perform catheter care on the mannequin" when instead the instructors decided to have us perform the skills in a triage setting. The entire class of 15 failed the skills final, and the instructors are laying the blame on the students alone ("you didn't practice enough" etc). I tried to reason with them that we need to practice in a triage setting first and that it is not fair to test us in an environment that we have not been exposed to.

Any of you nurse educators care to comment?

[Esme12, ASN, BSN, RN]

what do you mean a triage setting?

[barbara168]

thanks for replying. By triage I mean that when we stepped into the classroom we were read scenarios of three live patients you were assigned to, just like a hospital ward setting. One scenario was a patient needing a catheter before he was to be picked up for surgery in 20 min. He also had a blown out ostomy bag with crap all over the bed, and he was surly. (don't know whether the instructors asked to act that way.) Another refused meds and had to be checked back; the third was a wound care patient. And while you were calculating meds the ostomy guy yelled out about his smelly urinal. Thinking back, it wasn't entirely realistic because they were all in one ward with six beds. Don't patients typically ring for help??

The point is this: Is it fair to test students under a triage setting when they never practiced taking care of multiple patients within certain timeframes? We learnt and practiced our skills one at a time and expected to be tested that way. Both the lab and lecture instructors refused accountability of the poor performance. They said we were supposed to know how to perform our skills under any circumstances. We were all given incompletes for lab and thoroughly chewed out. We are going to be given one more chance and even if we pass, we will not get any grade higher than a "C".

Seven out of the fifteen of us are going to meet with admin to voice our concerns about the test and other problems we have had with the lab instructor. I am trying to find out from other nurse educators about whether the test was fair. Thanks for reading my diatribe...

[nurse2033, MSN, RN]

If the entire cadre failed then that falls on the instructor. Either the test was too hard, or the students were poorly prepared. Either way it doesn't seem like a fair evaluation.

[barbara168]

thank you for your input!!

[Esme12, ASN, BSN, RN]

thanks for replying. By triage I mean that when we stepped into the classroom we were read scenarios of three live patients you were assigned to, just like a hospital ward setting. One scenario was a patient needing a catheter before he was to be picked up for surgery in 20 min. He also had a blown out ostomy bag with crap all over the bed, and he was surly. (don't know whether the instructors asked to act that way.) Another refused meds and had to be checked back; the third was a wound care patient. And while you were calculating meds the ostomy guy yelled out about his smelly urinal. Thinking back, it wasn't entirely realistic because they were all in one ward with six beds. Don't patients typically ring for help??

The point is this: Is it fair to test students under a triage setting when they never practiced taking care of multiple patients within certain timeframes? We learnt and practiced our skills one at a time and expected to be tested that way. Both the lab and lecture instructors refused accountability of the poor performance. They said we were supposed to know how to perform our skills under any circumstances. We were all given incompletes for lab and thoroughly chewed out. We are going to be given one more chance and even if we pass, we will not get any grade higher than a "C".

Seven out of the fifteen of us are going to meet with admin to voice our concerns about the test and other problems we have had with the lab instructor. I am trying to find out from other nurse educators about whether the test was fair. Thanks for reading my diatribe...

Do you have access to assistive personnel like an aid or is it a group effort only using your group?

Think about what you need......the Patient that needs the foley is going to surgery in 20 min......but now is covered in feces. You go in with the aide to replace the patients bag so the aide can clean the patient up while you go to calculate the meds. You return to the aid before removing/administering the meds to insert then foley and this patient is now prepped for surgery.......you now double check the meds.....retrieve them from the med cart (or whatever med dispensing device) and administer the meds. You now go and see the wound patient.....check the wound and check on what you need for supplies....retrieve what you need and now complete wound care for this can take a long time.

I think having "fake patients" in this type of setting calling out to you was unfair, on your first exposure..... especially when there has not been any expectation for this in your classroom/clinical setting. It seems to me that they set everyone for failure. There are still facilities that have multiple rooms but that is becoming a rarity. Not all patients are alert enough to use the call bell, or they have lost the call bell on the floor, and will call out.

Sitting back and allowing students to fail with no attempt to assist them to success to me...is a poor instructor.

((HUGS))

[barbara168]

Great to hear from you again. No, it wasn't a group effort and we had no aids. Our class/lab room was the setting. Each of us walked in and was presented with five scenarios to be completed within 60 min. One might think it is not an unreasonable time frame, but none of us was even close to completing our tasks in an hour. I felt unorganized and distracted, especially the ostomy "patient" who thought he was doing me a favor by acting difficult. Add a full onset of nerves and I was done for.

Thanks for the apt quotes and hugs!

[lepew]

It sounds very unfair to me. I have been teaching for 8 years and would not put a student in that no win scenario

[barbara168]

Thanks much. I have emailed all the dept heads of the PN programs in my state for their input, as well as all the instructors of an RN program in town. If they think it's unfair too, I will bring my findings to the college VP. Again, thanks for taking the time to write.

[green34]

I think a better description would be prioritizing with mulitple patient simulation. When you say triage, I think of either field triaging where you give a bunch of people tags or ER triage where you have a bunch of people to triage and assign some sort of scale to and either send to a room or send back to the waiting room. It's a good scenario, but I don't necessarily agree with it being done the first time alone or done the first time for a test.