Why is Nursing School So Flawed?

[TCASII, ADN]

We've had so much contradictory teaching so far. We've been drilled with the RACE acronym, then today we had a test where the correct answer out of the four options within RACE was to pull the alarm. What?? Last time we were tested on this the correct answer was to rescue. Why isn't there any consistency?

Then we had another question on DKA, which we've never covered by the way, on our acid-base exam. Well out of the choices given, two of them were incorrect for sure (i.e., dextrose IV), so it came down to O2 or sodium bicarb. The question focused on their breathing and what collaborative care we would provide. Well, I knew from past reading on my own that HCO3 was a last resort and deemed fairly unsafe in most cases unless the pH was less than 7.00 and special circumstances existed. Cerebral edema, over correction, cardiac issues, and so forth puts bicarb at the bottom of the list of treatment measures. Since we weren't given any ABG values in the question or anything to suggest the patient was in a poor state, I went with O2. Is O2 that helpful? I have no idea. However, the Med-Surg book puts O2 high on the list of initial interventions, then fluid replacement, insulin, and potassium. Well, the instructor wasn't swayed by our reason for picking O2 over bicarb.

This kind of thing happens all the time. Another question we had dealt with Foley placement. We were told in lab not to inflate the balloon prior to insertion, as research had shown that it can cause irritation going in the urethra. On our exam we answered the question dealing with a Foley so as not to inflate the balloon. Well we were marked wrong. Surprisingly, someone found in the book that is does say not to inflate the balloon to test it. Didn't matter, we weren't given the point.

Every week we take a test we argue with the teacher and wonder what the point of all of this is. They keep going on about "critical thinking", but it is way more a game of craps since the majority of our tests have more than one right answer and if you choose a "wrong" one but show the teacher another nursing book (NCLEX review) or the one we've been given that backs up our answer, you're shot down. They will actually say "The book is wrong". Okay, so my Saunders NCLEX review book is wrong??

I missed another one today regarding the defintion of palliative care. They had home care, hospice, and a couple choices that were more acute. I chose home care simply because palliative care is not limited to the dying patient and hospice. That is not the core definition of palliative care, which is often used in treatment of chronic conditions. Well, the teacher seems to think palliative is synonymous with hospice, and that palliative care does not pertain to the maintenance of long-term chronic disorders.

I think nursing school has so many problems in how they "teach", jumping out of sequence regarding topics (e.g., covering ethics and law after physical assessment), preventing the use of medical books to better understand diseases or write papers, giving to little time to skills lab, ect....

[laughing weasel]

Welcome to nursing. There is no single right answer to any question. Heck there are people who are allergic to water. I have had test where I would have sworn it was miskeyed or another persons paper. We had a phrase in nclex world xxx is true. It annoyed me when I was going through school also. I like hard precise answers. They are not always available.

[CuriousMe]

While it's true that there is often no single right answer to any question, I think some of your frustration is due to your specific program. If we question a test question, and show evidence why our answer was right, they will give us credit.

[semester1kid]

The deal is that you're entering a field which is not an exact science:-) The client's differ just as customers in restaurant and retail industries do. One glaring example is pain. Pain is subject and you'll be taught (if not already) that whatever the patient reports for pain, that's what it is...even if you might suspect in your own mind that they are exaggerating. And you have clients who'll try to hide the pain and you have to be able to 'read' his objective signs and others who'll scream bloody murder over the slightest thing. So it gets tricky. There are other disciplines who's responsibility it is to determine if and why they're exaggerating/lying/etc. But it's not a nurse's job...For you, me and all other nursing students, the Pt reports something, then that's what it is.

[JenniferSews]

While it's true that there is often no single right answer to any question, I think some of your frustration is due to your specific program. If we question a test question, and show evidence why our answer was right, they will give us credit.

I agree. My program was like yours. Even when they were blatantly wrong they never admitted it. On one test there was a question they had admitted was wrong in a previous class (which I found while listening to the last classes lecture on tape, where they said they would remove the question from future tests.) Not only did they NOT remove that question from future tests, they refused to give credit to those who got it wrong in my class. Sometimes they would take a question straight from our NCLEX prep book, but decide the answer Saunders had given was correct was not right and they'd choose another option. Those of us who practiced with Saunders all got it wrong because we had read the rationale from Saunders. What a train wreck that school was!

The emphasis in our school was the 100% NCLEX pass rate, not the actual material or teaching. They made up for poor teaching by flunking out those who couldn't teach themselves. To do this, they couldn't allow for ANY points given back to students, whether they were valid or not. We also were not allowed to ask for the rationales for questions we got wrong.

[mspontiac]

I'm with you. Our program has instructors who pull the same crap. Sometimes you can show them the book and if enough people missed the question, they'll credit the point back, while others straight up refuse to rectify their error by saying "the book is wrong." I once rode an instructor for weeks to give me one stinking point back...it wasn't the point, it was the principle. The "correct" answer to the question was worded with a diagnosis that didn't even exist. I showed her the nursing diagnosis book, and she said she would look at the question; the next day students in other sections told me the question had been changed.

When I asked her about it she denied it and admonished me about discussing tests with other classes. I told her I hadn't done so until all classes had taken the test. At that point she didn't know what to say and avoided the topic for weeks until she decided I wasn't going to give up, and she gave me the point back. Was it really THAT hard to admit she screwed up? I guess it was.

We've had a situation this semester where an instructor forgot to include a decimal point, so the "correct" answer was way off numerically so no one chose it. She refused to give back the point and said "you should have known what I was talking about."

I think it has something to do with the fact that many instructors are control freaks or enjoy power trips. The ones that aren't have an open mind in regards to debate from the class. It just depends on the kind of person they are.

[CaliforniaRNnow]

I COMPLETELY agree with you. It's freaking ridiculous. Nursing school is so inconsistent. One book says one thing, another says something different. One teacher says one thing, another says something different. You know what I do? I ask the teacher, "So for the TEST, what is the right answer?"

[2ndyearstudent, CNA]

I think nursing school has so many problems in how they "teach", jumping out of sequence regarding topics (e.g., covering ethics and law after physical assessment), preventing the use of medical books to better understand diseases or write papers, giving to little time to skills lab, ect....

Nursing school is flawed because it is often run and taught by people who might have been great nurses, but had very little experience teaching.

I ran into some bad test questions last year, not so much this year. A couple reasons for what you are running into:

1. Nursing instructors suck at writing good test questions. They take questions from a test bank, then change them a bit. Often when they change them, they create a question that doesn't have a good rationale for the "correct" answer. Your DKA question for example.

2. Grade deflation. They can't have too many high scores, so they purposefully create bad or even "trick" test questions where one answer really is as good as another. That way, they are assured to have no one get 100%.

The foley question appears to be an example of number two. Purposefully trying to trick you.

You are wrong about the palliative care question. Of the answers given, hospice is by far the best without question. Remember, on NCLEX questions, don't go asking "But what if...?" just answer the question. It doesn't matter that home care can include palliative care. Hospice always does.

[pedicurn, LPN, RN]

Let's also factor change into the equation as well...eg we are doing RACE now but give it five years and it will evolve into something else.

With so much evidence-based nursing and medicine information appearing at fairly rapid rate.....not everyone keeps up ( and nursing instructors may not be as current as others).

I remember a couple of lecturers I had at nursing school who would adamantly push either a nursing philosophical approach or a political viewpoint. This can also explain a strange answer.

I used to be marked wrong sometimes in sociology because I didn't portray the leftish political view that the lecturer expected ...... oh those were the days :)

[MissJulie]

It seems like we attend the same nursing school!

[TCASII, ADN]

You are wrong about the palliative care question. Of the answers given, hospice is by far the best without question. Remember, on NCLEX questions, don't go asking "But what if...?" just answer the question. It doesn't matter that home care can include palliative care. Hospice always does.

I disagree in the sense that palliative care is not limited to hospice even though too many people seem to think it is the same thing. Home care, rehab, LTC, and other treatment modalities can fall under the guise of palliative care. Just because hospice is considered a palliative form of care doesn't make it exclusive to hospice. A patient receiving continuing care is getting palliative care, whether they're paralyzed and doing fine or dying in 6 months from CA. Palliative Care vs. Hospice Care - Definition

What is palliative treatment? Find the definition for palliative treatment at WebMD

I see what you mean, but that isn't the point. They are teaching people that palliative means hospice, to be used interchangeably. One student even claimed it meant the same thing to me because she had worked in the field as an MSW for a couple years.

I'm fine with missing that question, but it sends the wrong message IMO. People don't seem to understand what palliative means. A schizophrenic on life-long antipsychotic meds is getting palliative care. They simply aren't being cured.

[TCASII, ADN]

The deal is that you're entering a field which is not an exact science:-) The client's differ just as customers in restaurant and retail industries do. One glaring example is pain. Pain is subject and you'll be taught (if not already) that whatever the patient reports for pain, that's what it is...even if you might suspect in your own mind that they are exaggerating. And you have clients who'll try to hide the pain and you have to be able to 'read' his objective signs and others who'll scream bloody murder over the slightest thing. So it gets tricky. There are other disciplines who's responsibility it is to determine if and why they're exaggerating/lying/etc. But it's not a nurse's job...For you, me and all other nursing students, the Pt reports something, then that's what it is.

All the more reason why the questions are so poor at gauging our understanding. You get a simple short MCQ with little detail and four choices that usually have 2 or 3 right answers. You ask one instructor and they say they would do X, but the correct answer according to the instructor who tested us wanted Y. As you said, it is a field full of abstract practice, however, we are asked pointed questions that don't allow any grey area, just black and white. Only technical questions should be black and white, right or wrong. If more than one answer is correct, then it's correct!

We had one question about a patient afraid of being alone and with issues of SOB. The choices were place the patient close to the nurses station in a wheelchair, encourage them to make friends with other patients, answer their call light immediately, or monitor them frequently. Anyone wanna guess what the best response is?