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Nursing Curriculum: Why do some of us still teach drip rates? (thoughts on tradition versus EBP)

March 24, 2010

Todays thoughts are prompted by excellent questions from my friend and nursing faculty Paul Pope. He really got me to thinking…. (dangerous I know).

Nursing students and faculty alike, I am curious about a few things that I hope you can comment on, helping to shed light on current trends in nursing education. Granted, we do not have to embrace or teach every new trend that comes along, but EBP is strong and needs consideration in curriculum. So, I am wondering how many of you still teach or learn certain things. Here are just a few of my questions/thoughts:

Do we still teach/learn drip rates based on medical tubing size? (how many of you out there seriously hang fluids to gravity on a regular basis… I mean there is so little time to teach them other important things…)

How many of you had an honest to goodness nursing informatics class in your curriculum in the last few years?

How many of you have switched/updated text books, but are still using the same powerpoints for lecture that you developed over 5 years ago?

How many of you still teach/learn: dorsal gluteal IM injections, aspiration with insulin injections, blood glucose checks at 5am are still good for dosing insulin prior to the breakfast tray at 7am, etc… or instead have you added new focus to preventative care, educating nurses on patient education and prevention on topics like weight loss, mammograms (if they even need one), vaccinations, etc.

How many med-surg courses still cover open prostatectomies or open GB removal and not care for the laparoscopic gastric banding patient, etc…?

How many of  you learned/taught anything but acute care nursing (meaning nothing outside of the hospital) in your basic RN programs? (Seriously, does the majority of health care not happen outside of the hospital?)

Does your nursing school offer their courses in odd blocks like 2 hours credit, so that transfer of those hours out becomes difficult for students or so you can cram more into the curriculum and still have ‘less hours’ for your degree?

Is nursing education still fragmented, teacher centered, centrally controlled, pre-digested material as Warick put it way back in 1971 (Allen and Jolley, 1987)? Why do we still remain so fragmented, from state to state, school to school, nurse to nurse, in what we agree to be foundational nursing knowledge.

These are just questions I have. Maybe this is not happening and we are all good and do not need to change anything. If so, wonderful. I am not an expert at all on the subject and am on a fact-finding an anecdotal evidence mission. I look forward to feedback on this topic.

There are some interesting discussions going on out there on this topic and some organizations are getting together to unify and change nursing education to meet new patient demands, encourage community and preventative health education, and teach congruent curriculum. Further, we are nursing! Adaptable, flexible, and the executors of great health care. Ideas and discussion can bring us to consensus to provide the most excellent nursing education.

For example, check out what the Oregon Consortium for Nursing Education is doing – (thanks @maryannagordon from twitter land). Open discussions on nursing education have also occurred at the RWJF through the future of nursing project. Standards for curriculum, like the AACN’s Educational Standards, are an excellent place to start but widely open to interpretation.

The ultimate goal is providing the most appropriate preparatory education for nurses that covers a good foundation of nursing to spark critical thinking and cover major areas of health care for our patients. Not everything can be covered, but also, what do we need to let go of?

13 Comments leave one →
  1. Melissa permalink
    March 27, 2010 1:07 am

    Terri – Interesting commentary on nursing education presented in a basic ASN program. We are all lifelong learners and as priorities in health care change, so must the material presented. It makes sense that we all must adapt and evolve as technology affects pt care. The discussion regarding cramming so much into a basic degree just gives one more ammunition to push for a BSN program for a well rounded education. One would then have the opportunity to learn the basics of where nursing begins as well as where we are headed (EBP and preventative care initiatives).

    • March 27, 2010 2:38 pm

      Actually I was speaking about any nursing education at it’s basic level, whether it be ASN, Diploma, or BSN. I agree that as health care evolves we must let go of ‘tradition’ and educate a good foundation from which to build. I honestly just wanted some feedback on what others were teaching and where that was going. I guess we will see if I get any. Thanks for reading and for the comment!!!!

  2. April 26, 2010 9:07 pm

    A couple of comments from a front-line nurse.

    1. Drip rates: yes, we still use them in the emerg — we don’t always have pumps available. Though the common joke is that there are really only three speeds: stopped, medium and bolus.

    2. “How many of you learned/taught anything but acute care nursing (meaning nothing outside of the hospital) in your basic RN programs? (Seriously, does the majority of health care not happen outside of the hospital?)”

    I think the unspoken premise behind this is troubling, that the place of a baccalaureate nurse is somewhere out in the community, the “community” being somewhat amorphously defined. While it’s probably true that most health care happens outside of the acute care setting, the vast majority of care that RNs provide is in hospitals — something like 86 or 87% of RNs work in acute care settings.

    I’ve acted as preceptor and clinical instructor a number of times. I am becoming increasingly concerned that we’re failing nursing students. We’re not giving them the education and skills necessary to provide safe, competent and ethical care in acute care settings — and I’m afraid we sometimes set them up for failure. To put it another way, I think it would be relatively easy for a well-educated nurse working in, say, a med-surg floor to pass into a community sector job. Would it be equally true the other way around?

    • April 26, 2010 10:42 pm

      Thanks for reading and replying. I am a fan of your blog and was hoping to ask you if I can post it in my blog roll :).
      I love open dialogs like this and often have these thoughts off the top of my head and then open my mouth and get myself into trouble, which I am a great deal :). Anyway, it has been my observation that the nurses I encounter have very little population or preventative health knowledge, even to educate their patients as they are discharged or enter the health system.
      Unfortunately there is so little time in nursing school and I too have concerns, mostly because I work on the preventative end of health care and see very little knowledge in vaccine preventable disease, asthma education, obesity management, diabetes management, etc… in students. I actually have nurses tell me they are not going to vaccinate their children because of the risk of autism… I think, really, they haven’t covered that in class? Or they have no idea how often a Type 1 diabetic should be monitoring blood glucose at home or that they should have an illness plan (when we get them in DKA we need this information and we need to reeducate them before they go home).
      Board exams, which it seems everyone just wants to pass, are geared for acute care and that is the majority of education the graduates I encounter get. Do they need acute care? Absolutely, and lots of it (maybe it is that we have lost our rigor in how we educate them?). However, with a backwards model of health care (acute care reaction instead of prevention) how will we ever shift health care to a preventative pro-active model without the nurses leading it, and that means the young ones.
      For example, the great post you have on DNR’s. I can’t help but think that if that patient had a home care nurse, a proactive nurse to educate them on DNR’s, and comfortable death, that she would have been at home and not in the emergency room. Or, the middle aged adult male who is over weight, with HTN, and diabetes. It is not if, but when he will have an MI. Still the system only will cover him for open heart surgery and medications, not time with the dietitian, weight management by an RN, and even an exercise program with a personal trainer. Backwards system and it all starts with education.
      Also, I laughed out loud at your drip rate analysis… in pediatrics we do not do ACLS as most pediatric patients code for respiratory or fluid volume reasons. We know heart rate only as too fast, too slow, non-existent :). Thanks for the response, the reading and the open dialog. Thanks mostly for your work as a nurse. GO NURSING!

      • April 27, 2010 12:56 am

        Link love for sure… adding you to mine as I write. It’s a billion-foot beast,this thing we call nursing, isn’t it? Your point about home care nurses is hugely well-taken — if you read back in my old posts you’ll find numerous examples of my own frustrations dealing with those patients in particular, who yes, could die more comfortably at home.

        I laughed about the autism/vaccination canard (which, incidentally has been thoroughly disproved) — the numbers of nurses refusing the H1N1 shot for their children was stupid: the ought to know better!

        I would be glad to guest blog/cross post — wanna reciprocate?

      • April 27, 2010 1:56 am

        Oooohhhh yes I would be thrilled to swap, but my blog posts are mostly useless rambles about thoughts or research… not very interesting.
        I really need a good blog post from a veteran nurse to new nurses or new grads… something like… the top 10 things you should know about your new career as a nurse but your nursing instructors won’t/don’t tell you? (or something like that) What do you think?

  3. May 3, 2010 1:41 am

    Happy to oblige… give me a little time…. wish I had the resources to write full time! About yourself, let me think and read you a bit more: I’m sure we couldfind a mutually interesting topic.

  4. Maria permalink
    May 11, 2010 12:14 am

    Yes, we still teach in the old gravy drip rate. Why? I don’t know why?!!

    I teach at a BSN school of nursing in Texas and do you know how hard it is to NOT teach these things? Whenever you suggest something different you are bucking the system! You are not a good nurse! What kind of teacher are you!?!

    Usually, I am outnumbered.


    • May 11, 2010 12:40 pm

      Oh Maria you made me laugh, because I can relate. I am just wondering if it is more important for them to know other things. Like my friend from tornotoemergency said below…. they know 3 rates in the ER… fast, slow, stop…. makes sense to me :). So little time, so many more important things to teach. Tradition be gone 🙂

  5. Maria permalink
    May 15, 2010 1:10 am

    Terri and all:

    Trying to “improve” nursing school curriculum is like pulling teeth from a chicken. I think I makes academia look petty in the eyes of the hard working RN’s on the floor (where we used to work).

    Only with an environment characterized by the sharing of information, the devleopment of common goals, collaboration in planning and implementating new curriculum will it ever change.

    I wonder, also, with only the hiring of younger faculty can it change.
    I sound terrible and work with wonderful colleagues, but some older faculty just refuse to change – even if what they are teaching isn’t relevant.


    • May 22, 2010 2:54 pm

      I understand your analogy of chicken teeth :). We as educators can begin to change this. Perhaps technology and social media can help us.

      • Maria permalink
        May 25, 2010 12:15 am

        Curriculum needs to change – or something! The students are not ready to take boards – we are missing something.

        Technology – yes – and simulation is the next big thing (actually simulation is already here). Not everyone can do simulation (actually some instructors never learned powerpoint), but I am thinking a nursing school may not survive without simulation. Clinical sights are getting more difficult to find.


  6. Dana permalink
    May 18, 2010 8:39 pm

    Heh, we still teach drip rate and I ALWAYS say that I have never used it as the way of giving medication and say if they end up in the facility where they do not have a dial flow or a pump to do two things: either write to their manager and demand right supply or run for their life ( to save their RN behind their name) . Dorsal Gluteal – Yes , we do . Again, just to say that this is not the place to “place” a needle ask a lot of guts from me because of all of those “we CAN use it”, and talking about Z track as the most preferred method hahah not possible!!! You forgot about clamping of the catheter after insertions- still teaching of clamping it after some number of ml of urine out – no EBP about it anywhere and I could not still win and get it out of tests….How about cleaning inner cannula from trach? That’s good one that we teach.. Except I have never seen it done in the hospital.. but as you say maybe one day some of them will work in the community setting and they will do it on old fashion way so ALL students need to learn and spend their time in memorizing it…Want more? :)))) I have many in my sleeve… Do not make me start ..

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