What are they teaching?

[egglady]

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]

8 minutes ago, macawake said:

You are of course under no obligation to answer what I’m actually asking. I’m just surprised by the reticence I’m sensing. It’s a pretty straightforward question. I guess I’ll have to live in suspense ?

what are you actually asking?You stated that you were answering someone else, although my quote appeared. I reread, not even sure where you're going. Must be cultural, as you're not US based ?‍♀️ I gave no criticism of APA, or anything technical. I just stated that there are more important things to nursing than how information is formatted

[macawake, MSN]

9 minutes ago, Hoosier_RN said:

what are you actually asking?You stated that you were answering someone else, although my quote appeared. I reread, not even sure where you're going. Must be cultural, as you're not US based ?‍♀️ I gave no criticism of APA, or anything technical. I just stated that there are more important things to nursing than how information is formatted

What I was asking of you was: In your opinion, is being able to insert a foley catheter from day one more important than being research literate?

I was trying to figure out what your shaking your head (SMH) signified, that’s all.

[JKL33]

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.

I'm all for that. Take the deductions, big ones! I have no problem with that. My work has never been significantly penalized for my small mistakes; I am a perfectionist with work I turn in. But the amount of emphasis combined with the unknowns of an individual instructor's grading add up to a lot of (seemingly) necessary preoccupation in preparing an assignment, to the point of detriment to the actual lessons at hand.

Not being able to produce a paper in APA format is almost pure laziness in 2020. Some students' laziness shouldn't overwhelm the lessons at hand for everyone else.

[JKL33]

35 minutes ago, RNperdiem said:

Going back to school for a BSN has been interesting. The APA format has been a steep learning curve for a person whose last research paper was written in MLM format and printed on a dot matrix printer.

But to survive professionally as an older nurse in a tight job market, I have to evolve with the times.

You need to get a program (on your computer) that can help you with this. There are at least a few good ones. None of this is about becoming an APA expert; even the APA experts have nuanced differences in how they do some of the specifics. Get the program so you can focus on the nursing.

[JKL33]

On 8/20/2020 at 2:09 PM, macawake said:

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.

I agree. Well, I want to, and if pressed then I guess I do. Hows that? ?

However - just to make this fun ? we should probably remind ourselves that this particular thread is in regard to whether there is something about the content of nursing students' learning (or the manner of learning?) that is leaving people woefully unprepared at the bedside.

And, it has been my consistent contention that being utterly miserable at skills, yes, all those things that apparently any monkey can do--well, if they're so easy that even a monkey can do them, then it's pretty bad if an RN can't. Those monkey skills become more than themselves at the point that someone cannot do them and finds themselves in a role where they are integral.

Nurses can hold whatever ideals we want to, and we can teach to them if we insist. But the truth (or what certainly seems like it) is that not many employers or managers really care about a bedside nurse being able to research things. They are busy trying to make it so that we don't have to figure anything out.

I want to be the kind of nurse who knows where to get solid answers on things, of course I do. But, as has been mentioned earlier in this thread, there is a big problem with the autonomy or authority that would go along with bedside nurses regularly researching things and putting their findings into use.

In addition, we (self included) have gotten a little off track and are discussing this as, "would you rather have A" or "would you rather have B" when there is so much in the middle that is also suffering due to some of our foci (in my opinion). Would I want a teacher for my child who only knows a skill, or one who only knows the theories of instruction? This may seem like an either/or question, but the answer is "no." I would want someone who can manage a classroom, interact well with children, create an inviting atmosphere, actually teach, work with other professionals in my child's best interest, help me know what I can do to help my child, etc., etc., etc. I want them to know how to get the job done. That will involve more than knowing that 2+2 = 4, and it will involve more than knowing any educational theory or how to write about an educational theory.

I do find personal and professional use in thinking more deeply about things and knowing their underpinnings. But we are still talking about bedside nursing...we have to be able to manage a patient load under the circumstances that we know are going to exist, at the end of the day.

I still maintain that in our programs we are learning a lot of things employers don't really care about and people do get the wind knocked right out of them when they get out on the floor and realize that.

[llg, PhD, RN]

1 hour ago, Hoosier_RN said:

I agree to an extent. Not all graduates get a good orientation, or have someone reasonable to teach skills. My manager friend at hospital ICU says 1 nurse she recently hired from LTC has no clue on some basic skills, never did them in 5 years. She is having her transferred to another dept to build a skill base since there isn't time to teach basics on top of the other very short orientation that this nurse needs. APA isn't going to help at this point...I don't have a good answer

I can see that. If a nurse works for an employer that doesn't provide a good orientation ... he/she won't develop some of the skills as a new grad either. Depending on their career path, that may or may not be important. If that RN in your example never switched out of LTC, she may have been a great, successful nurse.

Why would any manager think that someone who had only worked in LTC for 5 years would be able to step right into an ICU? It makes no sense to hire someone for that job with that background!

[macawake, MSN]

20 minutes ago, llg said:

Why would any manager think that someone who had only worked in LTC for 5 years would be able to step right into an ICU? It makes no sense to hire someone for that job with that background!

I agree, I think it’s pretty strange. Unless the LTC nurse also had additional experience from a higher acuity setting that we don’t know about, I would think she’d need more than a ”very short” orientation before being able to function safely as an ICU nurse.

[Hoosier_RN, MSN]

39 minutes ago, llg said:

I can see that. If a nurse works for an employer that doesn't provide a good orientation ... he/she won't develop some of the skills as a new grad either. Depending on their career path, that may or may not be important. If that RN in your example never switched out of LTC, she may have been a great, successful nurse.

Why would any manager think that someone who had only worked in LTC for 5 years would be able to step right into an ICU? It makes no sense to hire someone for that job with that background!

She was recommended by a coworker. No one realized that she had passed off skills to others since day 1 of her career due to embarrassment of not knowing how to do. She had worked a month of med surg prior and quit due to stress. Everyone assumed that she at least knew skils and could be taught everything else. The coworker who recommended her was the CNOs niece...so we see how that worked out

[Hoosier_RN, MSN]

1 hour ago, macawake said:

What I was asking of you was: In your opinion, is being able to insert a foley catheter from day one more important than being research literate?

I was trying to figure out what your shaking your head (SMH) signified, that’s all.

Research literacy is important, but at the end of the day, the SMH was for APA known, which again, no employer cares if you're an expert or not. They care that you can provide safe care

[DavidFR, BSN, MSN, RN]

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

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.

?

You have hit the nail on the head.

The days of 14 days for a cholecystectomy or a 15 day post MI régime and back to day 1 if you have any chest pain are gone. The self-caring inpatient has largeley disappeared. Anything that can now be done at home or in a day hospital is not admitted.

The result, patient dependancies have skyrocketted but staffing levels haven't. Compared to when I qualified in 1986 the patient dependency levels, not to mention the increasing technicity of our job (and the demands of patients and families who more and more know their rights and want this or that because they've read it on the internet) have altered beyond belief. Some of our patient rooms resemble mini-ICUs compared to 30 years ago. The staffing levels never increased to match that.

I think for new grads the excitement of being qualified and stepping out in your first post can sometimes mask the stress - and then reality hits. I remember our school telling us that nursing was a tiring, hard, stressful, demanding, underpaid job. Didn't stop me wantng to do it and being excited when I got my RN, and sure, 6 months later I was moaning like hell. We all need to let off steam and we all have the right to crack occasionally, so don't be too hard on new grads.

[jjsarah88]

As a nurse of nearly 4 years, I'd say being a nursing student/new grad is still fresh in my memory, but I also have a few years experience under my belt. I'd honestly say my nursing school was very honest about the profession being challenging. I even remember one seasoned professor telling us a story about a nurse who had been working for a couple years and she admitted to wanting to (legitimately) drive off the road before work every day just because she was so miserable in her career. He never shamed her, but rather stated that if we ever feel that way he need to find a new career, that no one should feel that way in their job and having a reaction like that wasn't because she was a weak person, but because nursing is a high-stress job! Thankfully, my mom was an RN too so I understood that weekends/holidays was a part of working in the hospital.

My point being, even with a parent who was an RN and a nursing school that was honest...I still had to learn it for myself. The first 6 months were BRUTAL. Feeling incompetent, dealing with coworkers for the first time, choosing a specialty (L&D) right out of school...even more uncertainty in my decisions. I nearly quit 100x, but it got better! It's different when you're in it on your own and not just being told what it's like. Nursing is sacrificial. You sacrifice your time, you sacrifice moments with your family, you sacrifice time with friends, and hobbies...the list could go on. BUT there is a way to find balance. It may mean finding a day job, a specialty, a part-time nursing job with another job on the side...thankfully there are options.

Another point to add, older nurses I know repeatedly speak of how much things have changed. Nursing used to be a trade school for many (diploma) and in a way I wish it still was. BSN's (like myself) are taught so much BOOK knowledge, but a fraction as much hands on time. You don't see the flow as much, the menial things, the hard things, and it shows sometimes. To add to that, hospitals are often run by people who have little to no medical background...how does that make sense? Patient satisfaction is great and all, but is it everything? It shouldn't be...

[Guest 1152923]

I've maintained this same sentiment for a long, long time and strongly feel that academia is completely out of step with nursing practice and set many graduates up for failure. In acute care settings (and I've worked in many), no one cares one iota-notta, none, nil, about a nurse's ability to write a NANDA approved diagnosis or cite references correctly. I have a Diploma of Professional Nursing and a BSN from a highly reputable university and found the curriculum a complete fluff that has been of zero benefit to me in my clinical practice.