What should they teach in nursing school but don't. What do they teach but shouldn't?

[Roland]

My impression of nursing school based on my very limited experience is that there are many things taught that while perhaps not a waste of time are none the less perhaps not the best possible use of that time. If you were made the supreme overlord of nursing school curricula what things would you delete? Conversely, what things would you add both in terms of content and methodology (perhaps you would teach the same stuff but would do so in a different manner). Could nursing schools today implement your ideas (if they wanted to) or would they be prevented by accredidation bodies from straying from approved curriculum?

[Altra, BSN, RN]

I trained old school, in one of the last hospital-based programs

Great post talaxandra.

I just wanted to point out that diploma schools are still going strong in some areas of the Northeast and Midwest. There are at least 7 within 50 miles of me, in addition to community college ADN programs and several BSN programs. Our grads have no problem competing for GN/new RN positions with ADN and/or BSN grads, even at the major university teaching hospitals.

Also, though we had assinged reading on various nursing theorists, we were never tested on that material. My *favorite* instructor once threatened to put any care plan submitted to her which included "Disturbed Energy Field" as a nursing dx through the paper shredder. :chuckle

[talaxandra]

MLOS, oldiebutgoodie - thank you for your kind words:) I was a little worrried I might get flamed. Well, threads not over yet...

Don't get me wrong - I had my share of ridiculous care plans too, it wasn't all wine and roses! I was tempted to put:

Potential for spontaneous human combustion

Potential for abduction by a UFO

Never thought of "disturbed energy field" though!

Hey, do you want to be a nursing instructor?

Actual that's part of my long-term goal - teach nurses about real life nursing, teach medical students about real life ethics, and work on the wards once a week to keep my hand/prevent myself from climbing in to the ivory tower. Glad you think I wouldn't suck at it :)

[rngreenhorn]

What an interesting thread.

But it does seem to me that a significant part of why so many young nurses leave is because they're woefully underequipped for the reality of nursing. Without hands on clinical practice, theory doesn't become concrete.

My nursing Dx for talaxandra: At risk for becoming an awesome nursing instructor related to well thought out commentary...

I graduated from an ADN program in May. I have yet to find the "energy field-o-meter" to test the energy balance of my patients. However, I did have a patient who had an MI while I ambulated her I will never forget the signs and symtoms of MI.

[dimpsogre]

From a 45 year old finishing my ADN. Like virtually any degree offered by almost all colleges its just a money making opportunity for the college. Let me explain:

Colleges offer classes, some required, some elective. They make a lota money on these classes. Most of it is used for administration pay and to cover their losses in the various sports programs they need (?) to support, football, basketball, lacrosse, field hockey, etc… Are these classes really necessary to perform at an entry level in the career you have chosen? Questionable. Take nursing for an example. There is an entry exam to the career of nursing that all nurses must take, (NCLEX) (The Boards). It is very conceivable that anyone with the right study materials, (Kaplan), could pass this exam with flying colors. Of course the nursing field has made it a requirement that you have a nursing degree to pass it. But, I have been having some interesting conversation with hospital hiring managers, (nurses), who tell me that they “expect me to have no nursing knowledge” on hire date, because they have preceptorships or training programs where “they will train me every thing I need to know”. Virtually every hospital nurse I have talked to have expressed there very little expectation in nurse grads, some have even expressed their down right disgust in the minimal skills and knowledge new nursing grads have.

The whole college degree program is just a big scam made to make more money for colleges and pay the salaries of nursing instructors who are burned out of doing real nursing or are incompetent of doing real nursing, remember the old saying “those who can not do – teach”.

If there is one saving grace to nursing school it would be the clinicals where at least you learn real world hands on procedures. Of course that is the way nurses used to be trained – Hospital Diplomas – Which produced a lota great nurses and with none of the college BS and I do mean B.S.

A few misconceptions here that might be worthwhile to discus. I can’t speak for 2-year programs, which I know little about. However, bear in mind a few things about most colleges and universities:

First, the majority are non-profit. So the idea that they are out to get your money is a bit misguided.

Second, the national trend is to reduce the number of credit hours required for graduation, not increase it.

Third, for many universities most of their budget comes not from tuition but from a combination of state funding, annual endowments and research funds that the faculty bring into their departments.

Fourth, the required number of courses is based on standards set by national accreditation boards. The result is, in many cases even if the U wanted to reduce the number of hours required for graduation, it may have a hard time doing so and keep its accreditation.

Fifth, and this may be surprising, the purpose of a university education is not to produce a competent worker fresh from graduation. Rather, the purpose is to provide a background of fundamental knowledge and analytical skills that would allow a graduate to solve a wide range of problems in a particular field. The ‘practical’ knowledge that many students desire are assumed to be learned on the job, as opposed to the ‘theoretical’ knowledge which cannot be learned on the job and thus learned in the classroom. To expect a freshly-graduated, college-educated person to have a large body of ‘practical’ skills is a misunderstanding of the educational mission of the university. Of course, whether one agrees with the value of that mission is another matter.

As far as ‘those who cannot do, teach’ goes, most research funds that faculty bring into universities come from a mixture of government and private industry sources. These sources often go to university faculty rather than private sector sources precisely because industry needs the expertise of university research faculty to efficiently solve complex problems.

[ldkrn]

I graduated from a BSN program in 1987, MS in 2002, and am in my second year as a clinical instructor in an ADN program. Nursing is not unlike many other educational programs where you learn the book and theory during school and your employer is expected to train you to their way of doing things after graduation. Why do you think most new grad orientations are 3-6 months long? Have you seen any new medical school graduate, beginning his or her internship in July, who is competent to take care of even a sprained ankle? No! It's completely, utterly impossible to teach students everything they need to know in two years (really 16 mos) of nursing school, and the technical procedures vary from unit to unit anyway. As an instructor, I want to know that you can safely perform an assessment before anything else, that you can prioritize actions based on that assessment, and that you are safely giving medications. Yes, we will hang IVs and give injections and all that other stuff; but that's not my biggest concern (although it may be my students). I think I inserted one foley in nursing school, but now, 17 years later, I've long ago lost track of the numbers of foleys and IVs and blah blah blah I've done over the years. Believe me, that stuff comes and comes quickly once you get employed!

[CCU NRS]

Fifth, and this may be surprising, the purpose of a university education is not to produce a competent worker fresh from graduation. Rather, the purpose is to provide a background of fundamental knowledge and analytical skills that would allow a graduate to solve a wide range of problems in a particular field. The 'practical' knowledge that many students desire are assumed to be learned on the job, as opposed to the 'theoretical' knowledge which cannot be learned on the job and thus learned in the classroom. To expect a freshly-graduated, college-educated person to have a large body of 'practical' skills is a misunderstanding of the educational mission of the university. Of course, whether one agrees with the value of that mission is another matter.

Ok I like your answer and I feel it is very well thought out and reasonable, however I feel that as I mentioned earlier LP/VN programs spend much more time on clincal experience(hands on)and while they also teach basic entry level education, they are also able to give a practical experience that builds a good solid base of experience as well. I don't see why BSN programs can't incorporate a bit mor of this, I understand that BSN programs are attempting to teach a knowledge base with deeper critical thinking and thought process implications but I also feel that most people reinforce book learning by performing skills related to material.

I understand that programs are structured for "maximum" effect but I really feel that BSN programs c/should give a more focus to skills!

[CCU NRS]

What an interesting thread.

I trained old school, in one of the last hospital-based programs; in the past, when I've raised concerns about the current process - which often seems to concentrate on abstract theory well over clinical proficiency - my concerns were ddismissed as evidence that I was intimidated by tertiary-educated nurses. :uhoh21:

We were on the ward after seven weeks (full time shifts from week nine) - three months after we started we all had a very clear idea of what a nursing career would be like. Three of my class dropped out after we passed medication administration, chosing to stay as enrolled nurses; everyone else who made it past the three month mark graduated and, fifteen years on, about a third are still working as nurses.

I'm pretty conflicted on the issue. One the one hand I firmly believe that nurses need to carve out a specific area of practice - it's encroached on all sides, and too often nurses don't see that 'giving away' our duties erodes the concept of nursing. Any (properly trained) one can do what I do, but only a nurse can do everything I do.

On the other hand it seems as though the quest for legitimacy and nursing professionalism (fought not on our terms but by the requirements defining other professions) has led to an emphasis on academic thory which is only tangentally relatable to the clinical practice the majority on nurses perform. I think it's this that is being referred to -

And:

Amen! And don't get me started on nursing ethics of care...

I'm not advocating a return to hospital-based training - patients now are too sick, for a start. But it does seem to me that a significant part of why so many young nurses leave is because they're woefully underequipped for the reality of nursing. Without hands on clinical practice, theory doesn't become concrete.

Agnus posted about nursing now being more sophisticated, and I agree that there's a lot more tech than there used to be, but basic nursing care lies at the heart of all clinical nursing practice. I disagree, however, that we:

There is more to know, but every grad I've ever asked has said they learned at least as much in their first year out as they did in three years of university. Most of that was hands on stuff that they could have got a better start on during their training...

Amen - not just for students!

Oh, and I still use a stethescope to take a blood pressure (sometimes I even palpate!) and I don't own one - the cheap disposable ward scopes suit me fine. :)

These are all pefect examples! If the current nursing education was as described above and after nine weeks BSN students learned that Pt care was required and that it is not all applying theory and using your head but your back as well I feel that many who later find nursing is not for them would learn this much earlier and this would open the way for students that were passed over for admission as well as allow the people that realize they need a different major to move to a suitable field and not waste 4 years of college on somehting they will hate doing.

[CCU NRS]

At my school, we have a simulator who is called Stan the man, he costs LOTS of money, but anyway, you can do absolutely everything to him, they can give him all sorts of different scenerios and you have to make him stable. He breaths, blinks, dies and you can revive him, you can give him all sorts of interventions and see how he reacts. Also, you can practice your skills on him such as vitals they can put him in a stressed situation and you take all his vitals then they have you critically think about why this is happening. Also, they let you tell the person that runs his CPU what meds you want to give him and then see how he reacts. He is just like a real patient, I think it was a very good idea to purchase him. They told us that they would like to purchase the ped simulator also.

This sounds liike a great tool

[Drysolong]

I am interested in what you (especially those who posted who are instructors and BSNers) really think about the ADN, BSN ,MSN education offered through schools such as University of Phoenix, Excelsior and Indiana State (online)

[talaxandra]

My nursing Dx for talaxandra: At risk for becoming an awesome nursing instructor related to well thought out commentary...

I have yet to find the "energy field-o-meter" to test the energy balance of my patients.

:chuckle :chuckle :chuckle

Nursing is not unlike many other educational programs where you learn the book and theory during school and your employer is expected to train you to their way of doing things after graduation. I want to know that you can safely perform an assessment before anything else, that you can prioritize actions based on that assessment, and that you are safely giving medications.

And that would be fine if the onsite learning was done with full supervision of qualified staff. But it isn't - graduates may have extended periods of orientation, but pretty much from day one they have a patient load for which they are responsible. However good they are, however well they learned the theory, if there wasn't a clinical connection the theory doesn't become concrete. For example:

I did have a patient who had an MI while I ambulated her I will never forget the signs and symtoms of MI.

And I'll bet that you learned them in school, but I'm guessing that the theory, divorced from clinical experience, means that they weren't real or accessable to you until this experience - please correct me if I'm wrong :)

When you're learning about the heart, or cardiovascular disease, or when you're asked about the symptoms of an MI, everything comes gushing forth. When you're walking a post-op woman with no cardiac history to the bathroom and she becomes a little short of breath, has a little chest tightness, looks a little pale, and says "I'm fine, dear" because she doesn't want to worry you, an MI is not the first thing that will come to mind.

I agree with ldkrn that medical graduates start out without the clinical skills they need, but their minute-to-minute practice is supervised by nurses, if not by senior doctors. In any case it's nurse who sees the symptoms, applies oxygen, reassures the patient, takes the obs, and calls the resident. If you have a good or experienced resident then fine; if you have a newbie it's the nurse who says "She says she's fine but I'm concerned. I've called for the ECG machine - did you want to take cardiac enzymes?"

I don't deny that theory is important - it's vital. But it's no good if students don't remember - not in class, but on the floor, where it counts. Amd nothing explains the focus on nursing theory!

[RNKPCE]

When I went to school we had nursing diagnosis( alteration in skin integrity instead of decubitus), that was worse than what we use now for care planning. Now we list problem statements. For example if a patient has Congestive Heart Failure one problem statement might be 1) Fluid overload, interventions are daily weights, monitor I/O, administer diuretics, monitor labs espec BUN, Creat, K, Na, assess lungs and o2 sat. etc. For a nursing student I think this is important. Not as important once you have the experience behind you. However if you switch to a new area of nursing I think it is important again.

The other thing I think is very important is prioritizing. I was precepting a new employee recently(a newer nurse, but not new grad) and she wanted to chart the admission note before giving the meds the patient needed.

I remembered my first days as a new nurse what I was impressed with was one nurse on days was setting up the patient for a bath, washing her back, listening to her lungs, washing her feet, checking for edema and pedal pulses. She multi-tasked. As nurses we may do an initial assessment but who said that we can't be doing other things while assessing. Assessment takes place with every interaction with a patient. That nurse was one of the strongest staff members on the floor. Another example is if the patient needs to use the bathroom since half the hard part is getting them out of bed use that time to take them for a walk in the hall. These are things that are harder to teach in nursing school.

[ReinventingMyselfAgain, MSN, RN]

that really suprises me. i am in my second semester and i had three patients yesterday. it was postpartum so they were mostly self-care, but the paperwork was a killer!

we have 1-2 pts first semester, 2-3 pts second semester, 3-4 pts third semester and 4-5 pts fourth semester. the goal is that at the end of fourth semester we are doing everything a practicing nurse does. i'm in an adn program, so maybe things are done differently with bsns.

my adn program was more like gompers' bsn program (maybe 2 pts. by the end). this thread interests me a lot, as i am in an ms-education program, and my group project is to come up with an entire curiculum. basically taking into consideration everything discussed here. after reading these posts, i'm completely overwhelmed.the bottom line is, there are not enough hours in a semester (or 4, or 8) to teach everyhing that needs to be taught. the role of the nurse is so much more complex, and academia has not caught up with it. i don't think it is possible to teach to the nclex and reality in 2 or 4 yrs. and some people are 'accelerating' to try to do it in less time?!!?!? :uhoh21: i think it is dangerous.

and i have to respond to the "those who can't do..." :angryfire :angryfire :angryfire do you really believe that this is true?!?!? do you think we're willing to take that paycut because we 'can't do it'? do you think that i would risk my career and put my self in a position where my license is on the line if i couldn't do it?!?!? don't generalize. some of us actually care about our young, and about making a difference.