I have been reading with great interest the countless articles, interviews, studies and reports from a variety of sources, all speaking to the nursing shortage and it’s impact on the quality of care.
My initial nursing education was through the traditional three-year hospital school of nursing program; and I admit to a certain amount of bias toward this curriculum as it afforded me plenty of time on the unit and a high degree of comfort at the bedside when I graduated.
I agree with our wise predecessors who, in order to raise nursing to the professional realm, fashioned a curriculum that melded with the university setting. You can’t argue with the rationale of giving the student the mandatory undergraduate requirements that round out the individual. However, what was sacrificed was time in the clinical setting.
I was a Nurse Manager for seven years and hired many new graduates for my units. I noticed that the period of adjustment that we all experience in new positions was further complicated by a greater issue. Most of these graduates felt ill-equipped to perform the basic competencies such as inserting Foley catheters, starting IV’s and passing nasogastric tubes. Furthermore, their capacity for critical judgment was also very underdeveloped and the ability to "pull it all together" and take sound clinical action was, more often than not, lacking. This is not the fault of the graduate; and indeed we all acknowledge that it takes time to intuit what to do in increasingly complex clinical scenarios. The university school of nursing with which we were affiliated, our pipeline for new nurses, acknowledged these deficiencies by creating summer externships and partnering programs. Shouldn’t this need for additional programs have told them something? This need demonstrates all the more reason to graduate nurses with a high degree of confidence in their clinical skills so that they may navigate around the bedside with ease, performing the task competently and understanding the rationale for their actions. In time and with each experience, they too will put it all together in a way no classroom can.
Understanding this need behooves us to examine the present educational system. Rather than filling the gaps with special programs, I suggest we redesign nursing education against the backdrop of healthcare’s present crisis. I suggest we increase clinical time drastically. This is especially important because patients and regulatory agencies are watching us closely, assessing our competence. No new graduate has ever said, "Gee, wish I’d learned more about Nursing Process" yet nearly all of them wished they had come with more experience with a tracheostomy or a colostomy.
Therefore, let me pose 3 questions:
- Does the deficit of clinical time create a nurse who lacks the necessary proficiency in clinical skills to expertly execute basic procedures with confidence?
- Do the current curriculums (ADN and BSN) create nurses who have greater difficulty in effectively prioritizing critical issues of patient care?
- Are the above problems contributing to (not the cause of) nurses leaving the profession earlier than we have ever before experienced?
Our graduates and our patients have the right to expect from us this sincere attempt at professional evaluation and soul-searching.
Elizabeth Arsenault, RN, BSN, MHA