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What are they teaching?

Specializes in Geriatrics. Has 25 years experience.

I have an honest question. I'm not being a old crabby nurse. Honest question here... What are nursing schools teaching? So many posts of new grads that didn't think nursing would be stressful or hard. Nursing is a very stressful job. Are these schools actually teaching our future nurses that nursing is Not a stressful job? If so, they are doing a disservice to our profession. I feel bad for these new nurses that seem to truly be shocked that it is a stressful profession.

Hoosier_RN, MSN

Specializes in dialysis. Has 27 years experience.

They are being taught that it's flexible with many different avenues to being successful. There have been many posts about the current state of new grads

egglady, LPN

Specializes in Geriatrics. Has 25 years experience.

I just find it sad. As a student I was told that it will be hard, I will be working weekends and holidays, I will not know everything fresh out of school. I think these new nurses are getting the short end of the stick. They truly believe that it's going to be easy, great, and fun. That's what they've been told. It's just sad.

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

I don’t think ANY of us could have been prepared for what nursing is really like. As one of my instructors told me 25 years ago, “there’s school, there are tests, and then there’s real life”. But even that warning wasn’t enough for me to understand how freakishly intense the work is, or how you can be driven to the edge of insanity by constantly shifting priorities, chronic short staffing, doctors and families and managers getting in your face, and having so much responsibility but very little authority. It’s a tough job even when you’re a veteran nurse, but in the beginning it’s overwhelming. And there’s no way you can tell a new grad what to expect because they think they know, but they have no idea that nursing is blood, sweat, and tears (along with other bodily fluids). It’s no wonder why so many younger/newer nurses quit within the first couple of years...they just aren’t prepared for the real deal.

macawake, MSN

Has 12 years experience.

11 hours ago, VivaLasViejas said:

I don’t think ANY of us could have been prepared for what nursing is really like. As one of my instructors told me 25 years ago, “there’s school, there are tests, and then there’s real life”. But even that warning wasn’t enough for me to understand how freakishly intense the work is, or how you can be driven to the edge of insanity by constantly shifting priorities, chronic short staffing, doctors and families and managers getting in your face, and having so much responsibility but very little authority. It’s a tough job even when you’re a veteran nurse, but in the beginning it’s overwhelming. And there’s no way you can tell a new grad what to expect because they think they know, but they have no idea that nursing is blood, sweat, and tears (along with other bodily fluids). It’s no wonder why so many younger/newer nurses quit within the first couple of years...they just aren’t prepared for the real deal.

Love your post! I’ve bolded what I believe is really the crux of the matter.

Generally speaking I don’t think there’s as much wrong with today’s graduates as with the job itself. Stress can be good, but it’s almost always negative when paired with low autonomy and ability to control and influence one’s work environment.

I think most student’s realize that their chosen future profession entails being responsible for their patients’ wellbeing. What I think might come as a rude awakening is just how little chance they have to control their workday and how there seems to be absolutely no limit on how much work their employer deems reasonable to heap upon them.

Yes, nursing is hard. But it’s being made harder than it has to be. I’m a second career nurse. I used to work in law enforcement. If you found yourself in a situation where you were outnumbered and having trouble controlling the situation, as in not being able to keep yourself, your partner and/or the general public safe, you radioed for additional resources. And help came. Within minutes. Always. You always felt that your employer had your back. And the organization made sure it had sufficient resources in order to handle unexpected events.

Early on in my new nursing career I came to the realization just how ironic it is that an organization whose very reason for existing is to help people promote or regain their health, is doing so poorly in creating a work environment that promotes sustainable employee wellbeing and health.

I hated med-surg with a vengeance. Patients today have very good reasons for being hospitalized. They’re sick. Long gone are the days when patients stayed in the hospital for a week or longer after a routine surgery to recuperate. Those who remain, require a lot of medical and nursing care. I don’t know how anyone could think that it makes sense to have one nurse care for five, six or more patients with very high needs. There is no way I would ever do that to myself in the long run.

After I specialized I started working with a 1:1 ratio and I actually love my job. Now I have a much better chance to control my day and I can give my patient all my attention. My professional input is listened to. It’s the best ”de-stresser” ever 😀

Hoosier_RN, MSN

Specializes in dialysis. Has 27 years experience.

When I interview now, many new grads, especially younger-but some older-tell me they want bankers hours/no weekend days, will/won't do this/that blah blah blah. They say that they have kids, bf/gf, a life, etc and were told nursing hours are flexible. I really wish they would lose that in our job description when discussing the role. Most of the time, the hours aren't flexible, at least until you get some solid experience behind you. Even then, still sometimes not. And each setting will have it's own set of tasks that are required-I had a 22 y/o tell me she doesn't do needles or blood, she's a BSN and shouldn't be expected to. We're a dialysis clinic, I don't what she thought she would be doing/exposed to here. Needless to say, she wasn't hired...this is starting to be the norm, from where I am.

While I agree with the comment of responsibility vs authority, especially in acute, LTACH, and LTC, many new grads don't have a realistic expectation on some levels. It's sad. If the $$$ stopped being the main driver, we could start combating some of the issues

Edited by Hoosier_RN

On 8/20/2020 at 6:01 AM, macawake said:

What I think might come as a rude awakening is just how little chance they have to control their workday and how there seems to be absolutely no limit on how much work their employer deems reasonable to heap upon them.

On 8/20/2020 at 6:01 AM, macawake said:

Stress can be good, but it’s almost always negative when paired with low autonomy and ability to control and influence one’s work environment.

On 8/20/2020 at 4:56 AM, VivaLasViejas said:

so much responsibility but very little authority

****

I believe ^ these are some of the major the fundamental reasons anyone struggles in this profession.

Our CoE makes it seem like we have a-z obligations and pretends as if there is some realistic way nurses will be able to meet these.

Our educational programs have failed to differentiate the nurse from the employer and the nursing role from the employer's policies and practices.

There's so much fundamentally wrong it's difficult to even put it into words...

RNperdiem, RN

Has 14 years experience.

Many new grads received a very theoretical education. The first job involves a lot of on the job training.

I just returned to school. So far I have learned a lot about research and correct APA format. Interesting stuff.

Hoosier_RN, MSN

Specializes in dialysis. Has 27 years experience.

7 hours ago, RNperdiem said:

Many new grads received a very theoretical education. The first job involves a lot of on the job training.

I just returned to school. So far I have learned a lot about research and correct APA format. Interesting stuff.

Yep, that'll help you with a new role for sure. Most new grads also know APA (or software), but have never inserted a foley. SMH

macawake, MSN

Has 12 years experience.

6 hours ago, Hoosier_RN said:

Yep, that'll help you with a new role for sure. Most new grads also know APA (or software), but have never inserted a foley. SMH

In your opinion, is being able to insert a foley catheter from day one more important than being research literate?

Personally I place more emphasis and value on what a new graduate has in his or her head, rather than in his or her hands. I would rather see that they have a solid physiological understanding of why a patient might need a foley and what the possible risks and complications are. If they’ve also managed to gain enough practical skills training to be fully proficient from day one, that’s great. Otherwise they’ll get there reasonably quickly with on the job exposure on a daily basis. I certainly don’t think that the primary value of a nurse is being able to perform a series of tasks.

Hoosier_RN, MSN

Specializes in dialysis. Has 27 years experience.

38 minutes ago, macawake said:

In your opinion, is being able to insert a foley catheter from day one more important than being research

APA isn't research, it's a typing format. And judging from research papers that I've graded in the past, APA formatting doesn't make the material any more valid than non APA format.

So at that, yes, having some skills are important from the get go.

A new nurse using their head is important, but APA formatting has little to do with that

llg, PhD, RN

Specializes in Nursing Professional Development. Has 43 years experience.

There are really 2 different issues here:

1. Are nursing students being given a realistic idea of what being a nurse entails? ... the types of jobs available to new grads ... the work hours ... the pay ... the duties ... etc.

2. Are new grads prepared to do the clinical/technical skills that are commonly expected in many jobs?

Those are two entirely different questions. A school can do a great job on one question and a terrible job on another.

Hoosier_RN, MSN

Specializes in dialysis. Has 27 years experience.

26 minutes ago, llg said:

A school can do a great job on one question and a terrible job on another.

Or both or neither...

macawake, MSN

Has 12 years experience.

On 8/20/2020 at 10:59 AM, Hoosier_RN said:

APA isn't research, it's a typing format. And judging from research papers that I've graded in the past, APA formatting doesn't make the material any more valid than non APA format.

So at that, yes, having some skills are important from the get go.

A new nurse using their head is important, but APA formatting has little to do with that

If I’m honest I’m disappointed by your answer. Since your post that I quoted and responded to was a direct response to RNperdiem’s post ”I just returned to school. So far I have learned a lot about research and correct APA format. Interesting stuff”, it gave the impression that it wasn’t only the focus on the technicalities of APA formatting that you were critical of. Was that incorrect?

I didn’t ask you if you think that being able to insert a foley catheter from day one is more important than being the master of all things APA. I specifically asked about being research literate due to all its implications for evidence-based practice.

Salisburysteak, ADN, RN

Specializes in Long-term Acute Care.

On 8/20/2020 at 12:06 PM, macawake said:

If I’m honest I’m disappointed by your answer. Since your post that I quoted and responded to was a direct response to RNperdiem’s post ”I just returned to school. So far I have learned a lot about research and correct APA format. Interesting stuff”, it gave the impression that it wasn’t only the focus on the technicalities of APA formatting that you were critical of. Was that incorrect?

I didn’t ask you if you think that being able to insert a foley catheter from day one is more important than being the master of all things APA. I specifically asked about being research literate due to all its implications for evidence-based practice.

I think what the other poster was stating about APA format is that it is the focus of many Nursing classes. From reading your previous posts you are not in the US and US Nursing Schools are focusing more on the theory aspect of Nursing. While that is not a bad thing; however, it takes away from the students learning hands on nursing like inserting F/C and even learning how to interact with the patients. The classes are so focused on theory that they(instructors) forget to teach how to be a nurse. I hope that makes sense.

I believe many become nurses for the higher than average income. So many who go to Nursing School really have no clue what the job/profession is all about. Many new grads do NOT want to put in the time at the bedside and become seasoned before they jump on the NP or CRNA bandwagon. They really feel bedside nursing is beneath them. That is what is so frustrating!

1 hour ago, macawake said:

If I’m honest I’m disappointed by your answer. Since your post that I quoted and responded to was a direct response to RNperdiem’s post ”I just returned to school. So far I have learned a lot about research and correct APA format. Interesting stuff”, it gave the impression that it wasn’t only the focus on the technicalities of APA formatting that you were critical of. Was that incorrect?

Hi macawake -

Not trying to speak for anyone else, but I do agree with the sentiment of the other poster. I don't think anyone means to discredit the idea of learning research principles or the importance of being able to find information.

It seems to be a common experience in our programs: An over-the-top preoccupation with APA formatting to the point that instructors will even add this requirement to assignments that are not remotely amenable to it. 🤦🏻‍♀️ Worse is when all of this is combined with instructors who don't understand that there are nuances, choices to be made, etc., about how to cite something even within APA format.

I hate to say it and might get some flack for this, but this whole topic is not unlike "nursing math" where we just have to be special...we somehow barely teach the principles and big concepts and instead get completely bogged down in making 4th grad math into this seemingly difficult thing, nursing math.

I don't know....it's disappointing. Always just a little bit off-focus, we are.

llg, PhD, RN

Specializes in Nursing Professional Development. Has 43 years experience.

Maybe if students would just focus for a little bit and learn the APA basics and how to do 4th grade math ... then teachers could move on and focus more on the other things. As it is, the number of students who don't even bother to try to format their written work correctly is appalling. As long as they refuse to even try to comply, the more I will take big deductions from their score.

However, the students who make an honest effort to learn how to write at a college level and format their papers ... when they make a few mistakes, I take very little off because I can see they tried. I am more interested in the content of what they have to say.

I don't think there are many (if any) whole courses that focus on APA. I believe that what happens is that students rebel and refuse to follow it. So the school has to keep emphasizing it in their grading to try to get students' attention -- and to separate out (via grades on papers) those students who follow directions and those who don't. If the students would simply accept that they have to learn the system (and get it over with), everyone could move on.

macawake, MSN

Has 12 years experience.

20 minutes ago, JKL33 said:

Hi macawake -

Not trying to speak for anyone else, but I do agree with the sentiment of the other poster. I don't think anyone means to discredit the idea of learning research principles or the importance of being able to find information.

It seems to be a common experience in our programs: An over-the-top preoccupation with APA formatting to the point that instructors will even add this requirement to assignments that are not remotely amenable to it. 🤦🏻‍♀️ Worse is when all of this is combined with instructors who don't understand that there are nuances, choices to be made, etc., about how to cite something even within APA format.

I hate to say it and might get some flack for this, but this whole topic is not unlike "nursing math" where we just have to be special...we somehow barely teach the principles and big concepts and instead get completely bogged down in making 4th grad math into this seemingly difficult thing, nursing math.

I don't know....it's disappointing. Always just a little bit off-focus, we are.

I understand what you’re saying, and it’s not as if I think APA is the be-all and end-all of nursing. I don’t. But my question is really simple and I’m just curious to see how some other nurses reason?

Given the choice between a new graduate who is what I call research literate but has never inserted a Foley, or perhaps has just done it once or twice, but doesn’t feel 100% confident OR one who’s mastered the art of Foley insertion but has no, or rudimentary at best, knowledge and understanding of how to find and interpret research, which one would you prefer? For me the choice is easy. It doesn’t take me long to teach them how to insert a Foley and be there as a support until they feel confident in their manual skill.

llg, PhD, RN

Specializes in Nursing Professional Development. Has 43 years experience.

I'm with macawake, MSN. It's much easier to teach a new grad a few technical skills she might have missed in school than to try to teach someone about the high level conceptual thinking, data analysis, research processes, etc. who was never exposed to that in school.

macawake, MSN

Has 12 years experience.

On 8/20/2020 at 12:49 PM, Salisburysteak said:

I think what the other poster was stating about APA format is that it is the focus of many Nursing classes. From reading your previous posts you are not in the US and US Nursing Schools are focusing more on the theory aspect of Nursing. While that is not a bad thing; however, it takes away from the students learning hands on nursing like inserting F/C and even learning how to interact with the patients. The classes are so focused on theory that they(instructors) forget to teach how to be a nurse. I hope that makes sense.

I believe many become nurses for the higher than average income. So many who go to Nursing School really have no clue what the job/profession is all about. Many new grads do NOT want to put in the time at the bedside and become seasoned before they jump on the NP or CRNA bandwagon. They really feel bedside nursing is beneath them. That is what is so frustrating!

Thanks for your response. You’re correct, I’m Scandinavian. I have some grasp of how nursing education is in the U.S., but it’s pretty basic and comes mostly from what I’ve read through the years on this forum. The one thing I’ve noticed is that it seems to be much more of a ”hot button” topic over there, compared to here.

Don’t all nursing students have to have clinicals in order to graduate? It’s such a foreign concept to me that someone can go through nursing school without figuring out what the profession ”is about”. I know that one often doesn’t get the ”full experience” regarding exactly how stressful it can be. But the basics of nursing should be hard to miss.

You’ll have to correct me if I’m wrong, but I’ve gotten the impression that students don’t always get a whole lot of hands-on training when on clinical placements? That they don’t always get to do everything? Perhaps because law suits is much more of a thing than here? Or because several students share one clinical instructor? I’m just guessing here, so any information about this is appreciated 🙂

If anyone is interested, this is an abrreviated version of my first nursing degree (It’s BSN for entry here).

This is from memory so I might be a week off +/-on some of the longer placements.

Geriatrics 4 weeks

LTC 2 weeks

Med-surg, two placements: 7 weeks and 6 weeks.

Psychiatry 4 weeks

Pediatrics 4 weeks

Mother-baby or L&D 2 weeks

Ambulance 2 weeks

Primary care facility 4 weeks

ER 2 weeks

OR 2 weeks

Anesthesia 2 weeks

(Feels like I’ve left one out but I’m drawing a blank.. 🤯)

One week = Either 4 days, 32 hours clinicals plus one eight-hour study day when you had various writing assignments (APA? You betcha) in connection with the placement OR five eight-hour days, 40 hours.

In these placements you have a nurse employed by the facility and working on the floor/unit in question as an instructor/preceptor and the school instructor showed up for weekly evaluations (verbal and written) and to observe you. (Yup, that’s the way it works here).

Then there was of course all the core subjects 📚 📚 of nursing... and..... research. And yes, APA 😂

The paper I wrote was at the end of it all was probably the most challenging I did during the entire time. It was supposed to be 10 full 40 hour weeks, but in reality I spent around 10 hours or more each day. So 50+ weeks. At the end of it all, you had to defend it. Part of the defense is open to the public so the school posted time and date everywhere 😂 It was also open to academics from other institutions/universities. I sent out copies of my paper to these schools about three weeks prior to THE DAY, and one of the persons who showed up was a bigwig from the neighboring military academy. So I wasn’t only grilled by my own instructors, but also by a colonel 😄

For those of you not bored to tears by now and who are miraculously still reading this... I inserted more than 200 intravenous catheters in my clinicals. About 50 Foley catheters. NOT a single nasogastric tube. Administered more pills, intravenous and subcutaneous meds than I can count. Never took care of a trached patient. Not one. Never did an arterial stick either.

I managed to nurse just fine even though a kind coworker had to hold my hand for the first couple of times I dropped an NG and a physician taught me to do arterial blood draws.

And I’m darn glad I went through the pain of writing that paper. It has served me well.

If you made it all the way... I’m impressed. And thank you 👋🏼

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