I hesitate to write here, because every time I voice my true feelings, someone tells me I am negative. I don't mean to be so. I just want to improve our practice, and sometimes it hurts me.
Does anyone know who is actually writing the standardized tests for our entry level nurses to gain entry into this profession? Not to be critical or harsh, but I took the HESI for the specialty I am teaching. I need to add that I have practiced in that specialty for 21 plus years. While some of the questions were appropriate, many focused on arbitrary issues that nurses may never run across, but neglected to focus on the most common complications of various disorders/treatments that they should definitely know to be competent in that field. In fact some of the questions took the focus off what should be the priority and onto non-priority issues. Also, while i understand these standardized test need to focus on the nursing process, sometimes the actual approprriate or needed information gets forgotten in the "process".
I find myself struggling to teach what they need to know for good practice, and what they need to know to pass a standardized test.
Why aren't practicing nurses writing these entry level tests? There are plenty of us with the required education that still practice....
Does it requie a doctorate to write the tests? If so, that is wrong, because, while I know lots of Master's prepared nurses who still work the bedside, I honestly do not know of any doctorate nurses working and practicing at the bedside....
I too, am disheartened by the leaders in hospitals, etc. turn away from the values of nursing and towards those of pure business. A business perspective is necessary to some extent. I realize that. But too many managers, clinical leaders, etc. just adopt the role of supporting the administrators and physicians in their work and leave nursing behind. They no longer stand up for the staff nurses and fight for those nursing values and perspectives. They act as "lackeys" for other disciplines rather than leaders of nursing.
But I think that it's hard to determine cause and effect here. When considering what I just said in relation to the theory/practice split, which is the cause and which is the effect? I think it is a little of both.
Wait a minute. I am not implying that nursing has become business, and that science and research and evidence-based practice is not an important reality or at least goal for our profession. I also use the nursing process everyday (I am soooooo happy to be back at the bedside). I think the problem is how we how we teach it, or don't teach it.... & how we test it.
I may not worry so much about wording a NANDA correctly, but I always know what my priority problems are, and plan monitoring and interventions to result in best outcomes. I am always evaluating how my patient responds, adn if they don't respond as hoped, I am always changing my plans and actions and interventions... I know my post-op patient will have potential for fluid shifts, bleeding, & pain. When my post-op patient is tachycardic, I try to figure out if this is related to any of those problems (assess & treat pain, assess urine output, bp, cvp, labs, etc. & treat accordingly). I then may have to consider other causes too (have we suddenly stopped their beta blocker). Then we revise our care based on all of these assessments. That is the nursing process & it is critically thinking. We use it everyday in reality, we just mess it up and confuse it when we try to label it with NANDA, NIC, NOC, and try to teach it without application...
I also highly value EBP. I have drastically changed my practice over the years based on research! There is a post on this very forum discussing the use of friction scrub with chlorahexidine versus concentric circles for skin antisepsis. I knew the evidence early on because school taught me the value of research, science, & EBP, and i looked for evidence to guide my practice.
Nor am I knocking nursing scholars.... Truly, I have great respect for those who are able to accomplish so much for our profession.
I just think we are not teaching the important stuff for entry level. I think we are trying, but missing, and I think part of the problem is how we are assessing learning. It is changing what we teach.
Another main issue is the current model of instruction. When I went through my master's program, the majority of the courses focused heavily on nursing theory with little emphasis placed on education theory and practice. It is difficult to be a true expert in multiple didactic content areas while maintaining clinical expertise in all these areas as well.
Especially in smaller universities, I see many of my colleagues struggle to balance full time employment, family life, and part time work at the hospital to maintain clinical experience. Many of us teach in many different courses.
In order to maintain the best standards I can for my students, my solution has been to work full time every summer and during most holidays, and two weekends per month. I also read a LOT of journals in my specialty. It is definitely not a perfect solution. It is quite tiring trying to work 70+ hours a week, spend time with my family, and pursue my doctorate all at the same time.
I would love to a partnership between clinical sites and the schools in which the hospital pays a portion of the employee's salary and benefits, and the school pays the other portion. I have heard of other schools using this model and they mention it has gone well. It sounds as if it would be an appealing option as long as communication and expectations were made clear and upheld consistently as to what the students' objectives would be.
I think the overwhelming majority of faculty members I work with strive to maintain expertise in not only clinical nursing but also as nurse educators, but unfortunately, there are a select few who have likely not laid hands on an actual patient in years.
dorimar, you should definitely look into a Sylvia Rayburn workshop. I was able to attend one early in my career. She has valuable input on content saturation. Also, last I checked Donna Ignatavicius' Boot Camp for Nurse Educators had a lot of valuable information on content saturation. I think an issue at the heart of the problem is that so many things have been added to nursing curriculum, but nothing is ever taken out. For example- nursing informatics, magnet hospitals, so much new technology- none of which was around when I was in school. We work in an ever-changing profession, and it can be difficult to "edit" down to the priorities.
I also think just the sheer understaffing that is a reality on the floors of hospitals in this day and age is partly to blame for the disparity between what we teach as an ideal and what is practiced. For example- I teach my students how to perform a competent, thorough, targeted assessment. I teach them to carefully identify each patient using 2 forms of ID and never to give a medication they are not familiar with. Yet the last time I was in the hospital watching a relative who was post-op, I never once saw the nurse perform a correct assessment. Although he was elderly and largely immobile, they did not turn him frequently (I did), did not listen to his lungs even once, and gave him "something for pain" without even checking his arm band or identifying his pain level. I witnessed this over three days, so I know the issue was widespread. Yet, I will still continue to teach my students how to thoroughly and correctly assess, despite the fact that it is not always practiced this way on the floor. It should be! I really believe almost every nurse wishes it was possible to provide the highest level of care to all patients, to really do what most of us wanted to do when we entered this profession- to help people, to care, and to save lives. I know that I wish it were possible every day I'm on the floor to have enough time for perfect assessments, comforting of the frightened, and knowing all the important facts you need to know to give perfect care. But as we all know, some days you are lucky just to keep everyone alive, reasonably content, and still have time to use the bathroom once during a twelve hour shift.
I think this disparity between what we know to be the best way to take care of someone and what our limited time and staffing allows will also account for the high attrition rate among new graduates. I remember being acutely disappointed that I could not be that "perfect" nurse when I was a new graduate, and it took years for me to be okay with doing my best every day, even if it meant I wasn't perfect.
llg, PhD, RN
13,469 Posts
I too, am disheartened by the leaders in hospitals, etc. turn away from the values of nursing and towards those of pure business. A business perspective is necessary to some extent. I realize that. But too many managers, clinical leaders, etc. just adopt the role of supporting the administrators and physicians in their work and leave nursing behind. They no longer stand up for the staff nurses and fight for those nursing values and perspectives. They act as "lackeys" for other disciplines rather than leaders of nursing.
But I think that it's hard to determine cause and effect here. When considering what I just said in relation to the theory/practice split, which is the cause and which is the effect? I think it is a little of both.