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.

[JKL33]

1 hour ago, llg said:

2. That in spite of #1 above, we should all accept the fact that we won't be equally interested in every element of an educational program -- but that we should accept its inclusion in the curriculum any. We may find it unexpectedly useful at some point -- and its function in the curriculum may be to teach us mental habits and ways of thinking that will be of value even if the actual facts discussed in class don't exactly match our career dreams. Adult med/surg content is used to teach basic concepts and ways of thinking that can be applied to NICU even if the physiology and pharmacology are different.

I agree with the basis here. Frankly, yes, I have found value in some of the not-directly-necessary-for-bedside concepts I have learned and been encouraged to think about...but maybe not in the way intended. What I have learned has only made the divide more obvious and more problematic. My desires for undergraduate nursing education don't have to do with career dreams, per se, other than a dream that we would be well-prepared to free ourselves from the control and exploitation that is like a free giveaway on a silver platter when we show up under-prepared for the role at hand.

[JKL33]

47 minutes ago, macawake said:

Just a side note, I don’t understand the fixation some appear to have with APA. Darn, that’s just a minor detail in a much more useful bigger picture.

We don't either, LOL. ?

If it were presented that way no one would be talking about it. This is not an isolated experience or people just being grouchy about being made to toe a certain line. Or whining about being "forced" to learn how to write in an appropriate manner. It isn't that. I can't speak for what instructors may be thinking, but it appears as if they seem to think that APA format itself is a singular bedrock nursing principle that should be enumerated in our Code of Ethics and is always best applied to everything.

You will prepare an SBAR. In APA format.

Go here and create this blog and prepare a blog post addressing [x]. In APA format.

Create a graphic showing how you would handle the unit's budget incorporating [so-and-so's] leadership theory. In APA format.

Create process improvement plan. In APA format.

- Then there is the piling of rules (seemingly for the sole purpose of creating complexity although I'm sure that is not reality...or at least not the whole of it anyway). Must be original sources + all must be nursing research articles published in the last 5 years is a fun combo when you are assigned to discuss a topic that has a trajectory and a history (as most do). For example.

- And, if one of the sources can't be cited in one of the two most common formats (book or journal), good luck with not getting inappropriately marked down for your appropriate handling of the source.

What happens is that with the piling and combining of requirements for the assignments, concerns and anxieties about doing well and not making costly mistakes on an assignment, etc., it overshadows the assignment itself. And you absolutely can get your "A" by regurgitating junk. "In APA format."

[londonflo]

6 minutes ago, JKL33 said:

Must be original sources + all must be nursing research articles published in the last 5 years is a fun combo when you are assigned to discuss a topic that has a trajectory and a history (as most do). For example.

Original sources are "Primary sources". It is what the author said...not someone else's interpretation of what the author meant. Otherwise, it becomes like a game of "telephone" where the original facts get misquoted and misquoted again.

8 minutes ago, JKL33 said:

Must be original sources + all must be nursing research articles published in the last 5 years is a fun combo when you are assigned to discuss a topic that has a trajectory and a history (as most do).

Historical articles are great to incorporate -- you just note that.

12 minutes ago, JKL33 said:

- And, if one of the sources can't be cited in one of the two most common formats (book or journal), good luck with not getting inappropriately marked down for your appropriate handling of the source.

This site is the best reference I have found besides the published guide:

https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/reference_list_author_authors.html

13 minutes ago, JKL33 said:

What happens is that with the piling and combining of requirements for the assignments, concerns and anxieties about doing well and not making costly mistakes on an assignment, etc., it overshadows the assignment itself.

This is college work. And the is why they call it "WORK".

14 minutes ago, JKL33 said:

You will prepare an SBAR. In APA format.

Now this is plain silly. I just cannot understand the nonsensical complaining that is here and on many campuses with nursing programs.

A professional cites where they get their information. I was a preceptor for a Master's student from one of the big online programs. What a disaster. After her, the nursing program does not preceptor that university's students. For starters, she had to be at clinical one day a week for 15 weeks. She was on time ONE day. Otherwise she would stroll in 2-3 hours late. I called the faculty contact, and she told me the student is working, has children and going to this university "full time." I told her every one of MY students in the clinical group could use the same excuse. The faculty said "that's why I got out of teaching BSN students. There is always drama!"

Anyhow this graduate student had a 4 page paper for the semester course. I read it and she mentioned an author's opinion on some clinical matter. I was interested to read more about the author's work. There was nothing on the bibliography noted for that source. She graduated at the end of that semester.

[JKL33]

1 hour ago, londonflo said:

Original sources are "Primary sources". It is what the author said...not someone else's interpretation of what the author meant. Otherwise, it becomes like a game of "telephone" where the original facts get misquoted and misquoted again.

As I said, it becomes an interesting direction when combined with another direction that says all sources have to be from the last 5 years.

1 hour ago, londonflo said:

Historical articles are great to incorporate -- you just note that.

I agree they are great and I think many assignments are made more complete by their inclusion. But then there's no need to exclude those sources via the requirements of the assignment.

1 hour ago, londonflo said:

This site is the best reference I have found besides the published guide:

Yes. Have used that and have the latest edition of the manual right on my desk. But I'm not the one grading. I feel like you didn't read what I wrote.

1 hour ago, londonflo said:

Now this is plain silly. I just cannot understand the nonsensical complaining that is here and on many campuses with nursing programs.

Please explain what is silly and nonsensical about believing this to be ridiculous. The assignments I listed are very close representations of real assignments on which I have personally spent many hours.

1 hour ago, londonflo said:

This is college work. And the is why they call it "WORK".

Disagree wholeheartedly. I've done work in my life; this particular overemphasized tidbit we are discussing is foolishness, not because of what it is in and of itself, but because of external factors such as this need to make something bigger and badder than what it is.

Maybe you are unaware just how insulting it is to be disingenuous about something like this. If you actually really do think my complaint is about "work" (or having to be a professional or anything else insulting like that) you are grossly mistaken.

You yourself gave me an answer right here that simply advised just ignoring the assignment directions (which are often written in all caps, italics, bolding or with multiple asterisks). I can't take the chance of doing that, so we're back to why the assignment had to be taken to the extent of foolishness in the first place. Which is what the complaint is about.

1 hour ago, londonflo said:

A professional cites where they get their information.

Totally agree. So, if citing one's sources according to the convention utilized in this profession is all that is meant by "APA format" then a great instruction for an assignment might be "Please cite all sources using APA format," not "**ALL WORK MUST BE IN APA FORMAT OR NO CREDIT WILL BE RECEIVED**" or "Assignments not submitted in APA format will not be graded and will receive a 0," and then proceed to assign something like a blog post.

>>>Can you not understand that (at least to a student) citing sources in APA format and completing an entire assignment "in APA format" would appear to be two different things, one of them completely more all-encompassing than the other? APA includes formatting convention and other particulars, not just "citing sources."

If you think I am being petty here, then understand that what you are upset about is a student who who can very well read words and written instructions and who wants to *do* what is being asked, and who wants to do it well. I will not allow you to mis-characterize my "complaining."

I am using great restraint when I say that there is no way you would have heard about APA complaints if the complaints were of the nature you are trying to insinuate.

1 hour ago, londonflo said:

I was a preceptor for a Master's student from one of the big online programs. What a disaster. After her, the nursing program does not preceptor that university's students. For starters, she had to be at clinical one day a week for 15 weeks. She was on time ONE day. Otherwise she would stroll in 2-3 hours late. I called the faculty contact, and she told me the student is working, has children and going to this university "full time." I told her every one of MY students in the clinical group could use the same excuse. The faculty said "that's why I got out of teaching BSN students. There is always drama!"

Sounds frustrating. It has nothing to do with me as I don't agree with our low bar for program entry or unreasonable leeway being given because people demand to have things that usually take work, without doing the work--but that's a discussion for another day and it's also a very difficult one because at the same time I also believe that it's certainly moral and good when people are given reasonable opportunities that take barriers into consideration so that they can better themselves.

As for me, my program allowed two absences and you were out. If a student showed up late for clinical they were sent to the library and it was counted as an absence. I had no problem with that.

[CKPM2RN, ASN, EMT-P]

On 8/23/2020 at 4:48 AM, londonflo said:

I bet a look at your state's nurse practice act will mention the nurse uses the nursing process to plan, implement and evaluate nursing care. Identification and follow up of nursing problems is our job among a lot of other things. Every other profession documents a patient's journey toward meeting the identified problems -- PT, Social Work, Nutrition, Speech Therapy, etc.That is how they charge for their services. I know I may be in the minority here but I think identifying what nursing really does might get us out of the "room and board rate" and into being valued by administration.

I don't disagree with the need for such documentation at all, I expect it as a part of my responsibility. But the drop downs are SO BAD! And such a time waster. It would be so much better to type up a brief but clear note on what actually happened rather than choose from a list of options and pick the one that best fits the situation. Sometimes none really fit, but I choose one and make a note. I would have rather just made the note. I know that the hospital pulls data and free typing doesn't fit into the data cruncher.

[Susie2310]

22 hours ago, londonflo said:

I missed your last sentence the first time I read your post. APA is not communicating in the third person. It is acknowledging your work is building off the research and thoughts of others. It is giving credit to the original source while adding your own ideas. Using others' work or ideas and claiming it as your own shows a lack of integrity. Also citing references allows the reader to find the primary source and develop their own impressions of the writer's thoughts.

May be you could give me an example of how APA is communicating in the third person?

Students have taken college English classes in nursing school prerequisite classes, that at least, when I was a student, required one to write at least one research paper. I well remember using MLA formatting.

[Susie2310]

13 hours ago, llg said:

... and adult med/surg, adult physiology and physiology, etc. is not very helpful to people who are going to spend their careers in the NICU. But the NICU folks endure it and learn what they can from those adult-focused courses. As londonflo wrote in an earlier post, not everything in a curriculum is going to be used by every student.

The school's job in the United States is to teach the basics of ALL aspects of nursing, giving the graduates the options of entering every specialty and going down every career path. We all make our choices and expand on the knowledge we need for our careers and let go of some of the things we learned that we have chosen not to use. That's OK. It doesn't mean we should not have learned them as part of our basic introductory education.

My experience is that the community college ADN program prepares nursing students to provide bedside nursing care through a variety of clinical placements, all of which provide hands on experience in direct patient care in areas such as med-surg, psych, rehab, ICU step down, geriatrics, L&D, etc. Students had plenty of exposure to the variety of areas nurses can work in at the bedside. Many of the instructors also held jobs in acute care settings as bedside nurses, or had extensive work histories as bedside nurses.

When I was a student we provided hands on care to hospitalized patients from the second week of classes, under our clinical instructor's supervision. Students weren't required to write research papers using APA as I believe it was considered they had met the research paper requirement through their college English classes, where, at least when I was a student, a research paper using MLA formatting was required. The nursing education time was used to train nursing students to provide bedside nursing care, not to prepare them for nurse practitioner school or to give them a taste of other possible nursing career options, so that when they graduated they had received a solid foundation in how to provide safe, competent, acute and non-acute bedside nursing care that they could build on once they started their first nursing job.

I don't see the fragmentation of nursing training as a good thing during one's initial student training. It was fine to be exposed to other nursing career options/aspects of nursing in my BSN bridge program after I had already received this solid foundation, but in my view/experience these other options/aspects were a supplement and shouldn't supplant the basic foundation of bedside nursing education/training, or we have students graduating saying, as we hear here frequently, that they don't know how to provide basic nursing care but they know how to write APA papers and analyze a research paper. Ultimately it is patients who suffer.

Another thought is that public monies often go towards funding nursing schools in the form of bonds, and towards funding nursing students in the form of tuition allowances, etc. I know that as a member of the public I would like my money to go towards training/educating nursing students to provide hands-on direct patient care at the bedside as their initial training; I.e. providing students with as solid a basic foundation in nursing as I received, so that students are prepared to enter the work place as a nurse providing bedside nursing care (the majority of nurses work in hospitals, and the majority of nurses provide bedside nursing care).

[Kooky Korky, BSN, RN]

On 8/20/2020 at 3:56 AM, 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.

When I was in school more than 4 decades ago, there wasn't short staffing, if I am remembering right. You had no more than 5 patients on Med Surg on Days, maybe 7 on 3-11, a few more on graves.

You had aides, some of whom were b's, most of whom were pretty easy to work with. You had a ward secretary to answer phones, take off orders, and notifiy you of new orders.

Families and patients and managers didn't jump on us. It was only doctors you had to watch out for. And I think I had it somewhat easier in that regard than my female colleagues. Again, if I remember correctly.

It's all a lot worse today. The workload, the pace. Society as a whole is much more outspoken.

I like that a lot of doctors are now employees. They get to experience a little of what other, lesser mortals have to put up with.

[Kooky Korky, BSN, RN]

4 minutes ago, Susie2310 said:

My experience is that the community college ADN program prepares nursing students to provide bedside nursing care through a variety of clinical placements, all of which provide hands on experience in direct patient care in areas such as med-surg, psych, rehab, ICU step down, geriatrics, L&D, etc. Students had plenty of exposure to the variety of areas nurses can work in at the bedside. Many of the instructors also held jobs in acute care settings as bedside nurses, or had extensive work histories as bedside nurses.

When I was a student we provided hands on care to hospitalized patients from the second week of classes, under our clinical instructor's supervision. Students weren't required to write research papers using APA as I believe it was considered they had met the research paper requirement through their college English classes, where, at least when I was a student, a research paper using MLA formatting was required. The nursing education time was used to train nursing students to provide bedside nursing care, not to prepare them for nurse practitioner school or to give them a taste of other possible nursing career options, so that when they graduated they had received a solid foundation in how to provide safe, competent, acute and non-acute bedside nursing care that they could build on once they started their first nursing job.

I don't see the fragmentation of nursing training as a good thing during one's initial student training. It was fine to be exposed to other nursing career options/aspects of nursing in my BSN bridge program after I had already received this solid foundation, but in my view/experience these other options/aspects were a supplement and shouldn't supplant the basic foundation of bedside nursing education/training, or we have students graduating saying, as we hear here frequently, that they don't know how to provide basic nursing care but they know how to write APA papers and analyze a research paper.

That's because we are now a profession. Yes, I believe we are. But we have spent so long trying to convince others and ourselves that now, it seems, we are top heavy on the papers and short on the bedside skill acquisition.

Ever wonder how come ads for nursing school always show people with stethoscopes or suturing? Not a bedpan or stinky Code Brown or nasty gunky trach or icky wound in sight.

[nursel56]

On 8/20/2020 at 3:02 AM, Hoosier_RN said:

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.

This attitude certainly is more common nowadays. I don't understand how it's possible this expectation is so prevalent.

Maybe I was lucky in that my instructors (from decades ago) tended to be crusty, no-nonsense types who peppered their lectures with "lore", usually gleaned from their experience, about what life is actually like as a staff nurse.

[Jory, MSN, APRN, CNM]

On 8/23/2020 at 7:21 AM, londonflo said:

Would nurses hesitate to document these things as they would be liable if CPS wasn't notified? I honestly don't know how these situations would be handled as a mandated report. When does behavior cross the line and become criminal and need to be reported to the authorities?

You don't get that choice as a nurse and the law doesn't require you to act as a police investigator.  The only requirement for mandated reporting is "reasonable suspicion". 

The last time this happened there was the group at the nurse's station when I was yet again...told a long, drawn out, dramatic story that was never documented.   I told the nurse, "I am disappointed that you didn't chart this when it happened, now I'm going to have to chart this incident for you and make a note that you failed to chart the incident when it happened, I am going to chart that I wasn't notified until today, and I'm also reporting it to your manager.  So I highly suggest you go back and do a late entry."  

We don't report criminal activity to the authorities unless we have direct evidence that it is happening..that is the job of social services to get them involved.   

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

[londonflo]

2 hours ago, Jory said:

The last time this happened there was the group at the nurse's station when I was yet again...told a long, drawn out, dramatic story that was never documented.   I told the nurse, "I am disappointed that you didn't chart this when it happened, now I'm going to have to chart this incident for you and make a note that you failed to chart the incident when it happened, I am going to chart that I wasn't notified until today, and I'm also reporting it to your manager.  So I highly suggest you go back and do a late entry." 

So, bottom line..you would document what you "were told" as having happened? Would this have any weight if the family denied it? I agree, that having the "witness"  document would be much preferable and actionable. Wouldn't this have been a teachable moment as you saw a need for more education? Yes, this is not thoroughly covered, in my experience, in basic nursing education. As it is there is very limited time spent in pediatrics or any maternal-child setting as so few graduates are employed in these settings, unless there is a dedicated children's hospital nearby.

 

2 hours ago, Jory said:

We don't report criminal activity to the authorities unless we have direct evidence that it is happening..that is the job of social services to get them involved. 

So, for my own clarification, you would report this to social service and your responsibility would be done?