Monday, December 19, 2011

An Education (In Nursing)

I decided on nursing after I realized that my first degree would not land me a job that I’d even remotely enjoy. However, I gained invaluable research and analytical skills that have served me well, and continue to do so, in my nursing career. I enrolled in an accelerated nursing program in which I could skip some electives and concentrate on core nursing courses. I bring this up because I recently finished preceptoring a nursing student and it was nothing short of a challenge. His lack of motivation was only matched by his creative excuses to justify his tardiness and absence from shifts. However, what really struck me was his absolute lack of research and math skills. I’m not talking about designing one’s own RCT in the midst of a code or solving a limit of a function as x approaches infinity but basic stuff like being able to look up the pathophysiology of DKA or calculating infusion rates by plugging values into an equation. When I brought up these concerns with him, he said that I was judging him unfairly because I was more educated when I started nursing. I was quite offended because even though I was aware of the economic factors that led to inflation, that knowledge did not really help me in figuring out how to manage someone in septic shock.

He did, however get me thinking about nursing education in general. I have worked with many students from the school that my student was enrolled at and they all mentioned that their school concentrated far too much on nursing theory and not enough on research and data interpretation skills. Based purely on anecdotal data collected during three night shifts, nurses who had another degree in the sciences were much more comfortable with gathering and interpreting data and understanding the biochemistry behind medications and disease processes. Sometimes I think that perhaps there should be a greater barrier to entry in the profession but I realize that the nursing shortage issue would be exacerbated. So nurses discuss – do you think that new grads are adequately prepared to face the job? What do you wish was taught more in school?

41 comments:

Earl said...

Years ago, I worked with an engineer (I also am one), whose kidneys had been removed, plus he couldn't swallow. He was fed via a tube to his stomach via a hole in his abdomen for most of his waking hours. When he went for dialysis, he was usually still being fed.

He was dismayed to discover the nurses (maybe technician?) couldn't handle units conversion, as well as account for the amount of fluids being added by his food pump. After setting up and solving the proper equation, he would tell the nurse the flow rate value and time. Also, since the flow rate was measured by a floating ball in a tube with numbers, he found that some used the bottom of the ball while some used the top of the ball.

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nurse 8 said...

I'm kinda with you, Maha. I get frustrated with the nurses who have never done anything else and have no real-world perspective beyond nursing. I get even more frustrated with the nurses who have no apparent grasp of microbiology and the fact that organisms are ubiquitous and touching *anything* before you touch the patient requires Purell in between. (I work in the NICU - we are supposedly very aware of infection control, though watching some of my co-workers you would think otherwise).

Then there are those who don't really care if there's any evidence-based reason why we're performing interventions!

In my perfect world, nursing school would be like medical school, with the presumption of a 4-year degree prior to applying to nursing school. But the nursing shortage makes that impossible, I guess.

I also have a previous degree and did an accelerated nursing program, for what it's worth.

jberry said...

I'm a new grad in the OR at an academic center and I LOVE the way the staff there are able to push me to truly do research on something that I don't know. I do feel that my nursing school lacked that drive but at the same time I appreciate that I can practice safe nursing and I passed the NCLEX. I feel that there were too many of those lazy nurses in my program and that's a shame for the patients they see and for the profession.

Anonymous said...

I also have a previous degree (Bachelor of Music, with a lot of science courses), was trained as a paramedic, and did an accelerated/bridge nursing program...I have never had a hard time with math but have wondered exactly how those who do get by in the real world. It's kind of scary.

Nursing shortage? Not here. Increasing barriers to entry might help me land a job....

RehabRN said...

Maha:

Glad you're back, girl!

Yes, I agree with you, having had life experience before I became a nurse--it does make a difference.

Some of the people I work with have "drunk the Kool-Aid" of local nursing lore and cannot fathom research or using other skills to solve problems. Nursing is a job, not a vocation, nor one with a lot of skill in their opinion.

They look at me with awe, envy and contempt. I am a servant leader. I want to learn the best way to do something from whomever can teach me, but don't bulls*&t me.

If you do, I will find research (and other opinion leader staff) to back me up and you won't like me very much.

It's the least a "one year wonder" (as some of the more snide call accelerated students like me) can do.

danielle said...

I'm an "old" nurse. And I still believe that to put up with the crap in nursing you need to have a passion for it. The past several years worth of students I have dealt with have had an appalling lack of passion. And the majority of them will admit that they have chosen nursing because of the paycheck. That has backfired on them because very few have been able to find jobs once they have graduated.
Critical thinking is lacking iin nursing. But I think it is lacking in education in general. Without critical thinking you will not even know that you need to do the research, or know how to do the computations - or why. That is scary.
The majrity of nurses who are graduating make me very very very scared of ever becoming ill....

Anonymous said...

From my perspective as an MD, you are absolutely correct. I've been a doc 35 years, and the nurses graduating now are far below those of years ago in knowledge, skills, critical thinking, etc. I don't know if this is the nursing schools fault, or the students. But it is worrisome. Lots of "theory," little practical experience.

Shrtstormtrooper said...

A few points:

1. Welcome back!

2. I graduated from an accelerated BSN program, although I went straight from my first degree into nursing, with no real world stuff in between. However, my first major was physics- perhaps having gone through all that required math gives me a leg up. I can't fathom someone working in nursing who cannot even calculate simple infusion rates. Yet there are still nurses out there who skate by on shaky math, and it's terrifying to work with them sometimes.

3. I think there is a general lack of passion now from many students, and the ones who do come into nursing can't take constructive criticism. I've precepted 2 new grads, and both of them have been epic fails. One was an unmotivated, lazy, blase slacker who got the job due to her connections, and the other got so defensive with any guidance that he shut down completely and might actually kill someone with the skills he doesn't have and won't learn. Both are still working in the ER, because management doesn't have the balls to tell them they aren't progressing and should probably find a job elsewhere in the hospital.

Scrub Ninja said...

Stories like this make me feel great about my accelerated BSN program.

We had a whole course in research methods and interpretation. Our harder-science courses like pharm and pathophys treated their subjects scientifically. We had exams on med math (unit conversions, infusion rates, etc) twice per semester, on which we had to score 100% to continue in the program.

I had a prior degree in the sciences and so was familiar with most of this already, but for those students who'd never seen it before, it was taught carefully and thoroughly. Though not everybody became as comfortable with it as me, we all learned it.

Scrub Ninja said...

Oh, also, lateness or absences from clinical weren't tolerated. Missing even one clinical day, without prior permission or a really awesome and verifiable excuse, was grounds for failing the course. The SN you describe would have been tossed out on his lazy ass.

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Vivien said...

Wow, thanks "air jordan"!! What great deals!! (Please note the use of sarcasm).
I am a nursing and paramedics student and while I agree wholehearted-ly in regards to the lack of math skills and "real world experience" among some of my fellow students, I find the emphasis that my university has placed on research to be grossly disproportionate to "real world" practice.In other words, uni is saying "use research to change your nursing practice" while the Australian hospital system is saying "Practice the way we tell you or you wont have a job". I feel the science content in my degree is being squeezed out by the concept of "holistic nursing", and this, (along with other issues that Victorian nurses are facing), make me very grateful to have my paramedic degree because I sure as hell don't want to go into nursing in Oz in it's current condition. Sorry for the long post.

Jessica Ellis said...

I think what's missing from nursing school is the emphasis that school is only a BARE FOUNDATION, and that if learning isn't ongoing and purposeful (like looking up pathophys, and consulting more experienced nurses on tips and tricks), the nurse will be inadequate, unsure, and dangerous.

It's why continuing education for nurses, and the "re-learning" of what basics of general nursing we may have forgotten due to our specialties (like NICU nurses forgetting basic adult ambulation techniques) is a passion of mine and the company for which I work.

It is a sign of a passionate and diligent nurse to always have an open mind to reviewing the old, and stretching the brain with the new.

Jessica Ellis
Nursing.Coursepark.com

Allison said...

First off, I loved your posting. You are so accurate when you describe many new nurses entering the workforce. I got my BSN from Uconn in 4 years, but felt that I entered college with a passion for the career and couldn't wait to become a pediatric nurse. I entered directly into critical care and have no worked in a pediatric and cardiac ICU for almost 6 years. I have definitely encountered nurses who don't have good educational backgrounds, but I wonder if that has to do with the schools they went to, the reason they are in nursing or if they just don't know what they really want to do in life. I know that nursing has been an extremely difficult career (emotionally and physically) and there are times when I think, "If I had known how hard this would be (school and real-life work), would I have really chosen this path?" It's a question I bet a lot of nurses ask themselves (the good ones and the ones that should have chosen something else). I just hope that us good ones can make up for the ones who can't calculate a drip rate . . . which is basic middle school math to boot.

midwest woman said...

The keyword in your post was nursing theory. A feelgood new age voodoo of regurgitated pablum of the dreaded and useless careplans of yesteryear.
I googled nursing theory. No wonder no one has math or data interpretation skills. What a Deepak Chopraesque mess. No science but a lot of i words.....integrated, interpersonal, ideals, blah, blah, blah.
I once asked a fourth year BSN student about
a patient who stated no health problems with a med list as long as your arm. What medical history could she discern from the med list? Basically what's wrong with this picture???? She didn't have a clue. Hadn't crossed her mind. She did think her patient was sweet.
It seems to me that nursing is suffering from self esteem issues. It wants to be recognized as it's own scientific entity by having it's own theories, diagnosis and interventions seperate from the physicians. Hence the BS of nursing theory. Why this enhances us as nurses is beyond me.
Drip infusion rate? What's that? I'm worried my patient isn't "integrated".

Lisa said...

It would seem in a perfect world one would have some "real experience" in a hospital along with the college education. We hear of complaints that medical offices hire those with short term certificate programs working in doctors offices with no hospitsl experience.

Nurse Practitioners Save Lives said...

Theory is an absolute waste of time. There is so much more need for common sense and passion for the profession. I would not tolerate lateness or lack of interest for very long.

Laura said...

I graduated a year ago from a 2 year ADN program. I am now six months into my first job as an RN. Looking back at my nursing school experience, I believe there was far too much emphasis on teaching us to pass the NCLEX, and not enough emphasis on what we really needed: clinical skills. Yes, acquiring my RN license was obviously important, and I appreciated the help we were given to master the exam. But overall, I don't feel as though enough time was spent on the clinical floor. I'm aware that it is difficult to coordinate the clinical schedules for students with so many other schools competing for floor time at the same hospitals. But I don't feel that I was very well prepared for the clinical setting. We were taught to employ our critical thinking skills in the classroom. But those skills need to be translated into skilled patient care, care that can only be gained by clinical experience. I wonder if my school's teaching methods are a good representation of the typical nursing school in the US.

Scrubs said...

So many people are switching degrees these days, and a lot of people I know seem to be trading in suits for scrubs. I hope that you find more joy as a nurse than at your old job!

Nurse and Hospital Stories said...

"...do you think that new grads are adequately prepared to face the job?"

Oh, it all depends upon the school'd curricular (more actual lessons and balance nursing theories) as well as it also depends upon the student, if he is willing to learn more. Indeed education is somewhat different from experiencing the career itself. Yet education could be a key for a better outlook and performance in your own nursing career.

Cheers,
Peny@discount scrubs

Kris said...

What a great post!

I am currently pursuing my MSN in Nursing and this is one of my most favorite posts. I decided to go back and get my MSN because I want to eventually teach nursing. I knew I didn't want to be in hospitals on my life and that I wanted to get out and start teaching the new generation of nurses!

Jo said...

I completely agree! I am almost finished my BSN program and have almost a chemistry degree. The analytical skills I learned in my previous program proved invaluable throughout nursing school. I'm pretty sure I am the only one of my friends who can interpret an ABG. I also find that the critical thinking skills of those of us with previous education, especially in the sciences, are at a much higher level than those who started nursing right out of high school. There definitely needs to be more focus on clinical judgement and critical thinking. My program is ending and the new program that it replacing it actually has less clinical hours! I'm not sure how this benefits anybody.

GRC - Greg said...

I teach NCLEX prep, part of which involves teaching exactly what the test, and those who rely on it for licensure, expect of new grads.

New Nurses are expected to be able to think, and use their judgement, and not to take much at cafe value, to prioritize, etc. They are not expected to know much beyond basics and generalities when it comes to working in specific departments: their education is far too broad and brief to allow detailed training in all those specialties, and most such training would be wasted on them: soon forgotten for lack of use. Hospitals are expected to make up the balance, providing adequate orientation for safe functioning in the setting for which the new Nurse is hired, the same requirement they face with Nurses changing fields, or States, or merely units or facilities. When a Nurse seems inadequately oriented, the responsibility to find and address this issues lies on the institution, but as with so many issues in Nurses, we tend to blame the individual instead: unfair and counterproductive, and a sure way to increase turnover and burnout, while increasing errors and reducing quality of care.

Nurse said...

I also had a different career/different degree before going into nursing. A lot of nurses I encounter are also well-versed in an entirely different field. And there are some nurses who seem to have no skills and experience outside nursing, and few in nursing!
I view nursing as an ongoing, daily learning process. If someone cannot recognize the need to develop new skills and then actually develop the necessary skills, that is a character flaw not unique to the nursing field. Such nurses are dreadful to work with and eventually leave nursing.

Nurse Kitty said...

I'm a new grad and coming up to reaching that golden 1 year mark as an ICU nurse. And I will say that I don't feel that we are in any way prepared for the real world when we graduate. The biggest problem is the lack of independence while in school. I know there is liability as a problem but honestly if you talk to the "old school" nurses school was SO different. By your last semester you had to literally care for 4 patients all by yourself like a real nurse.

In other countries in order to graduate you must precept for nearly a month where you take on the role as a staff nurse under the supervision of a senior nurse...but you do all the work.

I think that here in the US we have been in such a hurry to get students out of school that we are relying on the hospitals to train them on how to to their job which is making it SO much harder for new grads to find work.

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Hern said...

Yes, I studied the old fat nursing theorist in my ADN, BSN and MSN program! Enough already! To this date I cant tell you how any of their theories are more applicable than my own theories I have formed based on my patients and my experience.

I learn more from the the experienced nurses on my first ICU floor than in any book of theories. Ugghh!! The only application I had for the theories was my exams and my final thesis as I had to correlate my findings with one or more of the old windbags. I can now safely forget them until I return for my PhD. Uggghhh

Anonymous said...

I enjoy nursing theories, however I believe too much emphasis is placed on them. Nurses need to be comfortable on the floor and learning from experience. They need great communication skills in order to work well with more experienced nurses and learn from them rather than getting eaten alive. Personally, I believe that nurses should start as personal support workers or practical nurses because in this way they can see if they enjoy working with people. Maths and sciences are important and theories are nice, but being able to translate knowledge into action on your feet takes time and experience with real patients in real situations in order to become competent. Nurses need to be able to attend to the patients' basic physiological needs in an effective and efficient manner. You don't need a degree to perform the essential tasks of the job, but if you cannot perform them well your patients suffer, your colleagues suffer, and your ability to apply your knowledge may be affected.

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Karina said...

I feel in no way prepared to take on the full load of a Registered Nurse. I have 6 months left of study before becoming a New Grad. I feel that universities now place way too much emphasis on the theory, and not enough on the practical. Students are crying out for more practical experience, only to be met with attitude and the inability to perform nursing duties while on clinical experiences. Experienced and senior nurses complain that we are uneducated and not experienced enough, however what they aren't realising is that most students do not have adequate opportunities to practice! I understand they feel an 'obligation' towards 'their' patients, but how else do us students learn? The thought of being thrown into the deep end in months time is absolutely petrifying. I think universities and hospitals need to understand the importance of practical work (which is what nursing is all about) and give students many more hours. In Australia the minimum required hours for registration is only 800, no where near enough in my opinion.

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Anonymous said...

Hi there,

I'm a nursing student in BC, Canada. I am very sad to hear that you've been exposed to the lazier side of nursing students. Most of us would kill for a down-to-earth perceptor like you.

I don't know how programs are being run in the US, (though I hear we're joining your NCLEX team in 2015) but us BC nursing students are busting our asses. There is a ton of emphasis on nursing theory (as there should be) but also, in my program you must achieve 75% in the anatomy, physiology and pathology classes, and minimum 80% in statistics in order to pass the course. I think it really depends on what school your students are coming from.

Do not get me wrong... students in general are idiots. Not everyone is in school to actually do the work: many just want a degree handed to them for showing up at clinical. I believe that if the process to GET into school is rough and competitive (like is sure as hell is up here) it weeds out the boys from the men, so to speak.

Where experience is concerned, our instructors are very firm with us. Our experience in nursing school is what we make of it. We HAVE to seek it out... it will not fall into our laps. It's the mindset.

Don't give up on us yet! There IS still hope.

Veronica Clark said...

Hi. I don't know if your still active or not one your blog but I have a lot of questions regarding nursing and I'm hoping that you could answer them :)

My Name is Veronica and I am a high school senior and will me graduating this spring. I've been looking into nursing for a while now and I have the feeling that this profession might be for me. I know, High school student...pfft what does she know. I am completely aware that I may change my mind along the way, I still have a lot of figuring out to do, but that's why I need your help.

I am an outgoing person, I have good people skills, I'm good under pressure,not at all squimish,I enjoy anatomy and physiology and I'm pretty good at it. (not to sound cocky). I sucked at Chem, math is kinda tough for me, and I'm still working on being patient.

Anyways, whats your opinion? Do you think I could cut it as a nurse?

I love your blog by the way.

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Anonymous said...

I guess one of the reasons I had so much difficulty getting someone to respond to my IV pump alarm during a recent week-long hospital stay for antibiotics was that the nurses were busy fulfilling themselves doing research and analysis.

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