A co worker of mine recently got a specialty certification. It really doesn’t matter which one. Prior to taking the certification exam, she paid good money to take a review course, and had planned her testing for the day after she took the class.
They class she took is a nationally recognized course, presented by a well known nurse, who is very knowledgable. She learned a LOT of really neat stuff, and a few things I didn’t know about.
Let me tell you a little about this nurse. She’s 24 and graduated from nursing school a little over a year ago. She started on the floor and per her words “Hated It” She’s been working in the ED here for about 7 months. We’re a 4 bed ED that see’s on an average of 18 pt’s a day. (A far cry from the 122K in my last ED) We see a STEMI about once every 3-4 months, almost no trauma. Over the past 7 months as far as I can tell, she’s never opened a book. I loaned her a couple of books, but they stayed in the department and I eventually took them back so they wouldn’t disappear. She took the course, and now has her specialty certification. I don’t begrudge her the certification, I question how she got there, and how the system is failing.
She has the knowledge of the important stuff. But here is a list of things she didn’t know. On the DKA patient, she didn’t know to prime the insulin line before starting the insulin drip, She didn’t have a grasp that once the patients rate (A-Fib with RVR) was controlled the BP was going to go up, so not to worry so much about the fact that the med MIGHT lower the already lower BP, A new midlevel ordered VitK in a patient with a St Jude heart valve for an INR of 10.9 without active bleeding any were. She gave it without questioning. Now don’t get me wrong, she is a good nurse, just inexperienced.
Where is the fail? I’m thinking it’s in the system. The system that chooses what is important for testing in certification exams, The system that seems to encourage CRAMMING for an exam. Maybe even the whole concept of specialty certification!
I don’t have any answers but I think there needs to be some discussion on the subject. Anyone have anything to add?