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.

[llg, PhD, RN]

About simulation as a teaching method. I see its value and it has it's place -- but too much of it is not a good thing.

It's value is that it can force the student to integrate facts in a changing situation help diagnose and teach critical thinking skills and deficits. As the student is doing the simulation, more facts emerge and you (and the student) can see if they can integrate that new information and respond appropriately. Used appropriately, that can be a valuable teaching tool.

However, like any teaching tool, it is just a tool. Over-reliance on it isn't good and it is not always worth the time and money if the users aren't good at using it.

[londonflo]

Quote

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.

I missed this kernel of kindness when I jumped on the LTC to ICU to my regret. I am glad to read that this manager sees a way to keep the employee and address her learning needs.

[JKL33]

I more than take exception to the way this is being presented. From the link above (emphasis added):

Quote

Decreases opportunities for clinical placements, combined with increased patient safety issues and ethical concerns, has also led to a drop in the number of opportunities available to nursing students for direct experience with patient care.

[vSim]

Simulation provides a way to make up for this - it provides nursing students with opportunities to practice their clinical and decision-making skills through various real-life situational experiences. What's more, this increased use of simulation and nursing simulation scenarios, specifically, is also being driven by trends like a shortage of nurse educators and patient confidentiality concerns at hospital-based clinical training sites.

This is wrong. IMO presentations of this nature expose enemies of nursing and they should be called out as such and/or shunned.

Safety issues? Ethical and confidentiality concerns?? That is pure nonsense! Yes, those are concerns but they can be mitigated and they should be, just as they obviously are somehow dealt with in order to facilitate medical students' education.

Nursing just seems like this tumbleweed blowing this way and that, wherever the wind may blow. We are not critical enough of the ideas we consider, readily accepting and embracing plenty of things that just take us farther away from our own tenets and philosophies.

If clinical sites are so hard to find (especially in acute care), then maybe it's time to make acute care one or two rotations instead of all but one or two. We need to stand up, here. Send students to other settings. Acute care has spoken, they want widgets. We can either keep pumping out widgets ripe for abuse, or we can take back control of the situation.

[londonflo]

35 minutes ago, JKL33 said:

Safety issues? Ethical and confidentiality concerns?? That is pure nonsense! Yes, those are concerns but they can be mitigated and they should be, just as they obviously are somehow dealt with in order to facilitate medical students' education.

WoltersKluwer is a publishing company. Laerdal sells simulation equipment (they were the first to market simulators in the 2000s.) This is an ad for their product and is using rhetoric to persuade you your school absolutely needs this. Advertising for college software and other products uses the same gimmicks that regular advertising does. I clicked on the link and I couldn't even get the price. It probably involves high level discussions while they figure out how much $$$ your college has or how much your philanthropist/donor wants to give.

(all the ones our college had were donated from grateful patients or families through funds they earmarked for simulation).

I have never heard a clinical affiliate state we could not have a rotation because of safety or ethical/legal concerns. (BTW I though you posted this link)

Both hospitals in our city have simulators that are used for staff education and medical student education. However, you can be sure that they will never become the major learning activity for medical students. 1) Hospitals receive funding for have medical students present (medicare pass-through funds)

2) a medical student takes precedence to be present for any procedure or patient care situation taking place: notable surgeries, childbirth. I have had nursing students asked to leave the room because a medical student needs/wants their spot.

[londonflo]

5 hours ago, direw0lf said:

This is what I was told as to why nursing education is like that. It’s because of salary. So diploma nurses could only make so much. To get higher salary they needed ADN and BSN

During WW2, nursing educators studied how to get nurses educated faster for the war effort. Mildred Montag developed a type of 2 year program to cut one year off the diploma program. Of course, anything cheaper, faster is bound to be utilized and so, nursing moved into the community college system which was also springing up then. Students received college credit for their schooling and the beginnings in articulation in nursing degree programs began. I lived through the 1960s and remember the push for all high school graduates to continue onto college. I was the youngest nursing student in my family. 4 cousins and my oldest sister attended diploma programs. My second sister went to college for a non health care degree and I was steered also to a 4 year degree.

It was not until the 1990s that it was made much easier for the ADN and diploma graduate to move smoothly into BSN education.

Was the money the reason nursing education transisted to ADN and BSN? I graduated in the late 1970s from a BSN program. My initial hourly rate as a new RN was $5.98. I received 10 cents more than my diploma and ADN co-workers.

---

Regarding nursing graduates unaware of the stress of the job, this has been my experience:

I taught at a midwestern college and the average age of an incoming nursing students was their 30s. We did collect information on their backgrounds and the majority were working as EMTs, CNAs,or Surgical Tech. Believe me, they knew how stressful any job in healthcare could be but they may not have realized the weight of being the head of the health care team in the hospital.

[CommunityRNBSN, BSN, RN]

Okay on the Sim thing:

Too much of it is a waste of time. Obviously it is no replacement for patient care and it’s dumb when nursing schools make you do a ton of it and call it a clinical experience.

BUT. In my class (2018) I remember four of us going in there for a surprise “code” scenario with the Sim. We had to actually figure out in real time what we needed to do. Now, that poor mannequin did not get the best care. But it was the only code I was involved in (thank goodness). You can’t have nursing students trying to figure out how to do compressions and how much oxygen to give, when an actual patient is coding! So for me, the Sim was valuable. I also work in an FQHC, which means that I haven’t been involved in a code SINCE graduation either. If somebody goes down at my work, I pity them, but I’m still better prepared than I would be if I didn’t do the Sim. The BLS certification etc are good but not the same as the simulations.

[Hoosier_RN, MSN]

6 hours ago, londonflo said:

I missed this kernel of kindness when I jumped on the LTC to ICU to my regret. I am glad to read that this manager sees a way to keep the employee and address her learning needs.

No worries, because I was asking the same questions

[londonflo]

7 hours ago, JKL33 said:

If clinical sites are so hard to find (especially in acute care), then maybe it's time to make acute care one or two rotations instead of all but one or two. We need to stand up, here. Send students to other settings.

Slowly but surely we have been adding alternative clinical rotations when we can't get a satisfactory clinical assignment in the hospital. We have added pre-anesthesia, pacu, ER, day hospital (outpatient IV medication/blood administration mostly) pediatric clinic visits, these kind of things. However we cannot guarantee a student to get hands on experience as no school is going to pay an instructor to work with 1 or 2 students and that is really all that these sites can absorb. We do tell the unit nursing staff and students that students will need to be observed or precepted when doing higher level skills (central line dressing changes, IV starts, IV medications and fluids (including priming tubing and setting up the pump) and more. The experience for the student, well .... it varies.

Our hardest experience in one of the two hospitals we have is OR observation. Their rule is a student can only observe one surgery during their entire educational experience. They claim they have too many requests for students to be incorporated into the OR suites. I miss the observational viewing room we had when I was a student -- we could watch from above! It is very disheartening when a student subsequently has to miss a surgery that their then-assigned patient is having. I could not risk us losing the whole experience by disregarding the OR rule. This implementation of this rule was by OR administration. The OR nurses would offer to have the student come again, especially if the student indicated this was a future choice of work. This OR rarely hired new graduates. I worked with one student who wanted OR from her first day of school. I reviewed her resume and told her to read Atul Gwande's work on the surgical checklist and mention it in the interview. She and I were very pleased she broke through their resistance on hiring new grads!

I guess I was surprised JKL33 you suggested sites other than acute care. This thread and other threads on AN regarding the state of nursing education today always cite the lack of skills students graduate with.

[JKL33]

13 minutes ago, londonflo said:

I guess I was surprised JKL33 you suggested sites other than acute care. This thread and other threads on AN regarding the state of nursing education today always cite the lack of skills students graduate with.

Sometimes just thinking out loud...and not necessarily in a linear fashion. ?

I probably can't convey what I'm thinking but I'll try.

- We seem too shackled to acute care...

- ...but we insist on teaching students many things that acute care employers don't hold in high regard. Or any regard.

- We know students need at least some skills, but since clinical experiences are very difficult to provide we're looking for ways to not need as much of the on-site clinical training that will produce empowered bedside nurses

- But acute care wants students to have clinical training and if they have to provide it they will either do a very poor job or hold this against the grad in various ways (contracts, for example)

I do think students need to learn skills (and not just singular skills like inserting a foley catheter, but all-encompassing skills like how to manage a patient load and how to operate safely under the stressful conditions of having more than one or two med-surg patients). I've already plainly stated more than once here that I do not agree that any monkey can perform nursing skills (and definitely not well) and I think that is a dangerous and very short-sighted attitude for our entire profession. I especially think we need to learn the skills found in acute care if schools are going to keep pumping out grads to meed the needs of acute care corporations. What we are doing now is some half-way thing of making the RN bodies available but few are mostly ready to do the job.

So, if we're not going to have people well-prepared and empowered to become direct providers of acute patient care, then maybe we need to consider whether we should be so focused on acute care at all. Maybe it should be one stop in an education that includes acute care, LTC, hospice organizations, home care, primary care, community health, etc., etc. Some of this we do already, but nothing else is emphasized the way acute care nursing is.

I don't have the answers, but it seems like something's gotta give...we're all over the place and no where at the same time.

[VRS82, BSN]

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

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 ?

Can I ask what you specialized in?

[2BS Nurse, BSN]

They're teaching EPIC!! How to write lengthy progress notes that no doctor will ever take time to read!

[Hoosier_RN, MSN]

1 hour ago, 2BS Nurse said:

They're teaching EPIC!! How to write lengthy progress notes that no doctor will ever take time to read!

Those notes are not necessarily meant for the Dr to read. They are to convey to any reader (insurance, surveyor, or lawyer, etc)