What are they teaching?

Hoosier_RN, MSN · Aug 29, 2020

3 hours ago, Jory said:

There needs to be some serious training in nursing schools on what constitutes mandated reporting and they are obviously not teaching it.

I agree with a general commom sense overview, but also realize that what needs to be reported varies from state to state, facility to facility (per policy), and specialty setting (adult vs child vs infant). Employers definitely need to emphasize this. When I worked LTC, we had semi annual classes on what was reportable at every facility at, regardless of state. In other settings, not so much

londonflo · Aug 29, 2020

On 8/23/2020 at 1:17 AM, Jory said:

My major beef right now with new graduates is this "trend" not to chart anything. They will say, "Oh, we are supposed to 'chart by exception' " but if you ASK them EXACTLY what that means? You get the deer in the headlines look. They have no idea

Wouldn't the facilities guidelines for a method of charting (such as "charting by exception") be unique enough to cover in an orientation? When a hospital uses charting by exception, there should be very explicit protocols and definitions regarding a baseline finding when assessing a patient and the need for follow up charting.

We cover the types and legal aspects of charting but since none of our clinical sites use that method , students would not have any practical experience. For myself, I would need some explanations and examples to get up to speed with it, despite 40+ years in nursing.

We can add it to the ever growing list of suggestions of topics that "nursing schools need to teach". We do not teach to all hospitals unique elements. As it is we have to get students up to speed on both Meditech and Epic for their medical/surgical experience as well as home health charting and other specialty foci.

JKL33 · Aug 29, 2020

3 hours ago, Jory said:

There needs to be some serious training in nursing schools on what constitutes mandated reporting and they are obviously not teaching it.

And when they get out on the floors there is little guidance as well.

It doesn't help that assessing a social situation is thought of as "judging" and very little guidance is given in how to neutrally assess a situation.

And, with regard to the documentation itself, it really doesn't help that narrative documentation has been so maligned. It wouldn't surprise me to hear that there are people out there not documenting things solely because they can't figure out how to (can't find the box to click) and figure that since there's no box they don't need to document it.

It's imperative for nurses to have a thought process that can function simultaneously but separately from the employer's policies, mandates and word-of-mouth directives.

Editing to say: Narrative documentation is maligned mostly by employers, not so much schools of nursing.

debirn918 · Sep 3, 2020

I want to save this thread as a topic for discussion in my nursing program and need to figure how to do that. Hopefully by commenting here, I will be able to come back to this.

NurseBlaq · Sep 3, 2020

On 8/20/2020 at 5:02 AM, Hoosier_RN said:

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,

So what did she learn during the renal lesson in school? I think I'm more amazed that she's at a dialysis clinic thinking needles and blood won't be involved.

Hoosier_RN, MSN · Sep 3, 2020

7 hours ago, NurseBlaq said:

So what did she learn during the renal lesson in school? I think I'm more amazed that she's at a dialysis clinic thinking needles and blood won't be involved.

That was my take as well. But you'd be amazed at some, regardless of education level, that will learn and master every aspect vs those that turn their nose up and think they're walking in to a desk job with no responsibilities

JKL33 · Sep 3, 2020

But she's a BSN professional.

It properly brings us to what we're discussing here! She knows about PICOTs and process improvements and...uh...stuff. Her education prepared her for "something else." She's beyond the blood and the needles. She probably bought it so thoroughly that she actually thinks places need a bunch of BSN who don't do patient care.

Psychnursehopeful, ASN, RN · Sep 3, 2020

On 8/23/2020 at 7:20 AM, Newishnurse1995 said:

My clinical experience did not prepare me in the slightest. We only had 6 hour clinical days and we were just paired with a nurse. We couldn’t do any procedures or give out meds without our professor. There were about 10 people in our clinical group and only one professor. Obviously can’t be in 10 places at once. I wish we had the opportunity to actually stay for an entire shift and have more independence. I could have learned a lot more and gained more insight.

You're describing my program's day cohort. Two 6 hour shifts with a lunch break. They would schedule them m-f. Day group has had people walk off clinicals and even sued when they fail! During our mixed orientation all the day group kept talking about was travel nursing and becoming an NP.

My evening cohort does 12 hour clinicals on Saturday plus a grueling post conference. Lunch break may be 30 minutes to a hour or depending on the needs of the unit. The evening group has LVNs, EMTs and tough but fair instructors who took very little crap. After watching us perform a skill we were paired with a nurse for the shift, took report on all of their patients and went to WORK! IVs, po med pass, bathing, potty, positioning and of course students were code brown/ stool sample / suppository helpers for our busy nurses.

Tenebrae, BSN, RN · Sep 5, 2020

On 8/25/2020 at 9:09 AM, Nurse with the Purse said:

...

I often wondered.."Where do they work?". I'm not an overachiever, but I go beyond my duties and leave my shift tired, sweaty and hair definitely not looking like it did when I walked in! Certainly not the glam looks I see posted by these young/newer nurses after a long shift.

? I spent my whole last shift in PPE and walked out feeling sweaty disgusting and gross.l

rntracy1, BSN, RN · Sep 8, 2020

On 8/20/2020 at 1:59 PM, llg said:

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.

I have to say, I agree with you and macawake MSN. I got frustrated at times with APA formatting and citing my references, but I found my instructors really didn't deduct if my margins were slightly off or my reference indentations weren't perfect. Like you say, they wanted us to try. As long as I was putting forth a solid effort, there weren't any problems. The thing I don't think most RNs understand is, it's the critical thinking, theory, college level writing and formatting, grammar and math skills, etc that separate us from LPNs. Nothing against LPNs at all, but if you are solely focused on hands on skills, LPNs and CNAs can perform most those skills. As professional nurses, we need to focus more on the reasons why we are performing those skills, the patient's response to the intervention and patient outcomes. That's my opinion on the subject for what it's worth. You can learn how to insert a Foley in 30 minutes. Everyone's reason for needing one, their response to it, and their outcome is going to be different.

Susie2310 · Sep 8, 2020

On 9/8/2020 at 2:17 PM, rntracy1 said:

The thing I don't think most RNs understand is, it's the critical thinking, theory, college level writing and formatting, grammar and math skills, etc that separate us from LPNs. Nothing against LPNs at all, but if you are solely focused on hands on skills, LPNs and CNAs can perform most those skills. As professional nurses, we need to focus more on the reasons why we are performing those skills, the patient's response to the intervention and patient outcomes. That's my opinion on the subject for what it's worth. You can learn how to insert a Foley in 30 minutes. Everyone's reason for needing one, their response to it, and their outcome is going to be different.

This is a rather misinformed comment: "The thing I think most RN's don't understand is, it's the critical thinking, theory, college level writing, and formatting, grammar and math skills, etc that separate us from LPNs'?"

No-one has said that RNs' are solely focused on hands on skills, or that they should be. Of course they aren't/shouldn't be. But they need to be able to perform them when needed in the course of providing patient care, and being trained to do so in the course of their NURSING education is the backbone of the discussion on this thread.

The nursing scope of practice is greater for an RN (thus requiring more education/training than an LPN), and the level of responsibility for an RN is greater. RNs' have more nursing education/training than LPN's. This is the most important difference between RNs' and LPNs'; not that RNs' may have a greater ability/proficiency at English/math than LPNs'. RNs' have often taken more college English and math classes than LPNs'; the pre-requisites for ADN programs when I was a student required college English and elementary algebra (of course, some students have already completed courses at higher levels than are required by the programs). Nursing math uses arithmetic and elementary algebra in dosage calculations, so there is no need for higher level math at the bedside (where the majority of nurses are employed). It doesn't make nurses more professional to require them to complete college courses they don't need.

In the ADN program I attended, the ability to write and comprehend at the level of College English papers and to do basic math at the level of arithmetic/elementary algebra was presumed as students had completed these prerequisite courses. If students couldn't perform at this level and were unable to complete their nursing coursework to the required standards of the program, or perform adequately in clinicals', they would not have been allowed to continue in the program; there wouldn't have been any remedial English or math classes that took time away from the subject the entire class were there to learn, namely, how to practice as a nurse.

Of course critical thinking is important (have you noticed people refer to the importance of using the Nursing Process?). Of course nurses need to know why they are performing clinical skills and to be able to evaluate the patient's response to the nursing interventions, and be able determine patient outcomes (all learned in my community college ADN program) - why would this be otherwise? In addition, many clinical "skills" also require clinical knowledge (learned in my ADN program) and knowledge of anatomy/physiology, etc. (covered in pre-requisite classes for my ADN program) to perform safely.

JKL33 · Sep 8, 2020

5 hours ago, rntracy1 said:

The thing I don't think most RNs understand is, it's the critical thinking, theory, college level writing and formatting, grammar and math skills, etc that separate us from LPNs.

I don't even know what this means, LOL. I don't routinely sit and ponder how my education differs from that of an LPN, true. That has nothing to do with whether the things you've mentioned are recognized as generally being important. Although...college level formatting?? I guess I do disagree that is an important part of nursing education specifically. How about we only admit people who can figure out how to utilize extremely simple APA software and call it a day.

I feel so unheard. ??