Why is Nursing School So Flawed?

[TCASII]

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....

[jjjoy, LPN]

a grade of

That's what it too often seemed like in my program as well. Frustrating, but interesting!

[TRR8021]

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?

I would say place the pt in a wheelchair close to the nurses station.

[TCASII, ADN]

Yes! I said place the patient close to the nurses station in a wheelchair. We were told earlier that placing a patient close to the nurses station, wheelchair or just in a room, was the best response for patients you need to monitor closely. Now, in the acute care setting, I really never see patients in the hallway unless they're ambulating. Most of them are in their room all the time. However, you could, in certain sitations place a patient who is able to be placed in a chair close to the station so they can be seen, even if it is in a room they will be right next to the station, as opposed to the end of the hall.

My thought was also in reference to a LTC setting. Those people are always put out in an area so they can be monitored and feel safe.

The correct answer? The call light!?!?!? Now, how is a call light gonna reduce anyone's fear? So now nurses are Pavlovian dogs? The nurse is going to be able to rush to the room the second that light comes on? That won't reduce their fear IMO for a good deal of time, and only if you can answer the light quickly each time. Plus they have SOB. Stupid. They are still alone and afraid! They'll be on that call light every 5 minutes.

Placing the answers in the order that made the most sense, the call light was number 3. Monitor them frequently was number 2.

[decgrad]

I finally just learned to approach the teacher in class with "So what is the answer in NCLEX world!?" It is very frustrating to deal with the inconsistencies of nursing school. In fact, my language is much more colorful than before because I needed new words to describe how I was feeling. Good luck to us all!

[Wishinonastar, BSN]

Yes! I said place the patient close to the nurses station in a wheelchair. We were told earlier that placing a patient close to the nurses station, wheelchair or just in a room, was the best response for patients you need to monitor closely. Now, in the acute care setting, I really never see patients in the hallway unless they're ambulating. Most of them are in their room all the time. However, you could, in certain sitations place a patient who is able to be placed in a chair close to the station so they can be seen, even if it is in a room they will be right next to the station, as opposed to the end of the hall.

My thought was also in reference to a LTC setting. Those people are always put out in an area so they can be monitored and feel safe.

The correct answer? The call light!?!?!? Now, how is a call light gonna reduce anyone's fear? So now nurses are Pavlovian dogs? The nurse is going to be able to rush to the room the second that light comes on? That won't reduce their fear IMO for a good deal of time, and only if you can answer the light quickly each time. Plus they have SOB. Stupid. They are still alone and afraid! They'll be on that call light every 5 minutes.

Placing the answers in the order that made the most sense, the call light was number 3. Monitor them frequently was number 2.

Sorry, I would have chosen the call light. We don't put sick people in the hall and knowing that you will answer the light promptly is very reassuring. Again you have to look at the big picture. A person who is short of breath is probably on O2 and needs to be lying down with their head elevated, not sitting in a chair where the O2 won't reach with activty all around to make them nervous. Putting patients in the hall for the nurses convenience goes back to the days of wards and no privacy. It is unacceptable today except sometimes in LTC which is their home, not a place of illness.

[jjjoy, LPN]

Again you have to look at the big picture. A person who is short of breath is probably on O2 and needs to be lying down with their head elevated, not sitting in a chair where the O2 won't reach with activty all around to make them nervous.

You have a point there. However, in "looking at the big picture" one can make similar arguments for and against of each of the options as the question doesn't give much info to base one's 'best' judgement upon. Is it an acute care environment? It doesn't say! Is the patient on O2? It doesn't say! "Pt is SOB" or "fearful" doesn't give much info either, really. Is the patient oriented enough to use the call light? If the patient passes out, a call light won't help. The more critical thinking one does on some questions, the more arguments for and against the limited options one can come up with, sometimes leading to the conclusion that not only are none of the choices the "ideal" option, but none are objectively the "best" either.

[nursel56]

Yes! I said place the patient close to the nurses station in a wheelchair. We were told earlier that placing a patient close to the nurses station, wheelchair or just in a room, was the best response for patients you need to monitor closely. Now, in the acute care setting, I really never see patients in the hallway unless they're ambulating. Most of them are in their room all the time. However, you could, in certain sitations place a patient who is able to be placed in a chair close to the station so they can be seen, even if it is in a room they will be right next to the station, as opposed to the end of the hall.

My thought was also in reference to a LTC setting. Those people are always put out in an area so they can be monitored and feel safe.

The correct answer? The call light!?!?!? Now, how is a call light gonna reduce anyone's fear? So now nurses are Pavlovian dogs? The nurse is going to be able to rush to the room the second that light comes on? That won't reduce their fear IMO for a good deal of time, and only if you can answer the light quickly each time. Plus they have SOB. Stupid. They are still alone and afraid! They'll be on that call light every 5 minutes.

Placing the answers in the order that made the most sense, the call light was number 3. Monitor them frequently was number 2.

My sympathies. Your school is a mess. :/I'm just being facetious, as you know. You're going to have to try to imagine how they are thinking if that is at all possible and regurgitate it back. After more time passes you'll probably start to see some semblance of a pattern as to how they arrive at their "right" answers.

But I came at it with a frame of reference of having been out working in the field. When information is vague and incomplete, such as "issues with SOB" our minds fill in the blanks. My experience tells me that staff being aware that a patient is afraid to be alone is more common in LTC vs the acute care setting. Including the possible choice of keeping the person next to the nurse's station reinforced that mental picture, as it is done frequently there and hardly ever in acute care. The choice of encouraging the patient to make friends further reinforces it as people in acute care haver far fewer opportunities to socialize and are sicker.

I'm not sure if the original question contained the phrase "issues with SOB" or something more specific, but I know you can't assume every patient who has "issues with SOB" is on oxygen, especially since the rest of the clues point toward a resident in an LTC. If the patient were in an acute care setting, and was on oxygen, promptly answering the call light is not the best answer because the reality is answering a call light does not bring you the nurse (usually) and certainly likely not right away. Frequent monitoring would be better than the call light option as well, because if the patient has crumped they won't be able to press the button, may become confused if their sats go way south, and often the call light looks like a TV remote and gets lost in linens or falls on the floor.

Your point about reference materials containing conflicting information may play a part in this, as well. Having the patient with issues with SOB sick enough to be in the acute care setting means that he will be likely on continuous or intermittent pulse oximetry. So all in all I would still say number 1 is the best answer. There's always the possibility that there is a Machiavellian intent to steer you away from ass-u-me ing that the patient is in an LTC. Gah. My brain hurts.

[Wishinonastar, BSN]

It was the two clues- short of breath AND anxious that point to the correct answer. The thing about these tests is that it is not like history or math where 3/4 answers are completely wrong. You have to choose the best answer. And in an ideal world the call light would bring the nurse.

[TRR8021]

Sorry, I would have chosen the call light. We don't put sick people in the hall and knowing that you will answer the light promptly is very reassuring. Again you have to look at the big picture. A person who is short of breath is probably on O2 and needs to be lying down with their head elevated, not sitting in a chair where the O2 won't reach with activty all around to make them nervous. Putting patients in the hall for the nurses convenience goes back to the days of wards and no privacy. It is unacceptable today except sometimes in LTC which is their home, not a place of illness.

I thought it said close to the nurses desk, not in the hallway. I pictured a patient in his room that's near the nurses desk in a wheelchair. I've seen that in nursing homes. I know they teach us to put patients that are fall risks or disoriented close to the nurses desk. Hmm....interesting test question..... So why would the call light help with the fear of being alone?

[jjjoy, LPN]

in an ideal world the call light would bring the nurse.

Ah "NCLEX world"?! But don't my "critical thinking skills" lead me to not assume that the call light will always work the way its supposed to and that using my own eyes and ears (eg having the patient in my sight) is really "the best" nursing care I can offer? I'm not saying that IS *the best* answer, but how is call light *the best* answer either?

[Wishinonastar, BSN]

I thought it said close to the nurses desk, not in the hallway. I pictured a patient in his room that's near the nurses desk in a wheelchair. I've seen that in nursing homes. I know they teach us to put patients that are fall risks or disoriented close to the nurses desk. Hmm....interesting test question..... So why would the call light help with the fear of being alone?

It gives the patient a sense of control. Helplessness increases anxiety which increases dyspnea. Having a way to reach you should he need a breathing treatment, suctioning, whatever he should need, gives him a sense of control. A dyspnic patient can barely speak sometimes, let alone yell for you and once you get busy, well who knows how long it will be before you pop in to check him- an hour? Two? When you need help with breathing minutes feel like hours, hours can mean death.

I had an end-stage COPD patient once in home heath care whose husband could not hear her calls at night. He was hard of hearing. She was terrified. No one could sleep. She thought she would die in the night if he couldn't help her when she needed something. He thought she would die because he was asleep. I bought them a cowbell for her to ring to wake him up when needed. She had her cowbell, they both slept. Problem solved.

[jjjoy, LPN]

cxg174 - you make a good point. I don't think the call light is a *wrong* answer but given that we don't have much of any contextual information in the question.

If the patient's SOB is too acute to handle sitting out by the nurses' station, then are they well enough to just give them a call ball and leave them alone? Do we have enough info to make that call?