Completely agree with this. In my experience as a student and a teacher, teachers who hate being corrected or shown evidence that counters their assertions are incredibly insecure in their positions. It’s as if a student correcting them is somehow a threat to them, even if it’s done politely. I’ve politely corrected my advisor, who holds two endowed professorships and has over 100 articles to his name several times on minor stuff. He’s not feeling threatened by little old me; he’s smart and he knows it. He doesn’t need me to stroke his ego.
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Gods, I hope so! I feel like I know NOTHING, but I’m sitting for the NCLEX in…7 MONTHS?! Eek! Insane. Just insane.
But I start OB Clinicals next week. I’m practicing my deep breathing and tongue biting skills, since I have a deep personal aversion to unnecessary interventions in the birth process. I know, I know, I *have *to learn how to hang a pitocin drip and strip membranes (or at least explain it to the mom) and strap on fetal monitors and the rest…I’m just going to be hating myself for every minute of it.
On the other hand, I know enough OB already that I’m scoring in the high 90s in our pretests, so the book learnin’ for the next 5 weeks won’t be so hard! 
[/personal hijack]
I suspect there are a few students out there who think to this day that I punished them because I disagreed with them/was too arrogant to admit they were right, when in reality they wrote a paper with a weak argument and received a low grade. I am happy to take the time to discuss papers with students, but over the last decade there has been a time or two when in the end I’ve had to say "I understand your objections, but in my opinion you really haven’t made a case for [hemp curing cancer/moon landings being faked/Irish saving civilization]. I really, really try not to have it come down to that, but some people just KNOW they are right and are convinced everyone else knows it too but won’t admit it. And you can’t really say “Here is Suzie’s paper–see, she had the same wacky idea but made a B because she supported it in a half-way plausible fashion.” For one thing, that’s violating Suzie’s privacy, and, in any case, they just take that as proof that you hate THEM, not just the topic.
Maybe it will make you feel better to know that a nursing license is not a license to be a nurse, but to learn to be a nurse.
No one will allow you to do anything you aren’t ready for. In fact, you’ll be reinventing the wheel for the first couple years of your career.
Yes, actually, it does. I’ve already realized that school teaches me to know where to look stuff up and only really tests me on the things I can look up when I need them, like meds and what size Foley to use. All the *real *nursing stuff I won’t learn until I’m a novice nurse, and they can’t test me on that stuff at school in any realistic way anyhow! But yes, I’m still a little terrified that my first day on the job I’m going to be set loose and in way over my head.
(I’ve also learned that CNA’s are angels, most RNs don’t really eat their young and be nice to EVERYONE from Housekeeping to the Unit Clerks 'cause they’re the ones who can save my butt when I’m in a spot!)
They’re not unrelated–they have similar causes, similar manifestations, and similar treatment, enough so that it’s convenient to lump them together.
You want unfairly lumped conditions, consider congestive heart failure. At a minimum it comprises systolic and diastolic dysfunction, which are very different situations, and each of which has its own list of distinct causes. I don’t jump on residents who just write “COPD” on a problem list without elaborating, but I’m happy to put them on the spot if I see “CHF” by itself.
We did the study you’re talking about in our Journal Club last month. It’s a good study. I’m not going to run out and make sure all my COPDers are on BBs, but it should drive a nail in the idea that they’re harmful.
“Old wives’ tale” medicine is still going strong, even in our age of evidence-based practice. For instance, I can’t convince our nurses or anyone in the ER that it’s OK to give morphine to patients with pancreatitis and it won’t cause “sphincter of Oddi spasm”.
In my experience–and meaning no disrespect to either–the two groups of people who spread these the most are nursing professors/instructors and older private-practice surgeons. Just yesterday I had it out with an orthopedic surgeon who didn’t like the evidence-based manner in which I was managing his patient’s coumadin, preferring the regimen that he pulled from the American Journal of His Ass.
I think it’s great when students and residents teach me new things. It’s one of the things I love the most about my job. But I do know a lot of instructors who care a lot more about being right that being accurate, so I probably wouldn’t generalize based on me.
True…I guess by “unrelated”, I meant by physiology - emphesyma being a loss of elasticity in the alveoli leading to stretched out alveoli and air trapping, and chronic bronchitis being an inflammatory bronchospasmy thing. “Blue Bloaters” and “Pink Puffers” just seem almost opposites somehow. But since both can have air trapping and both shouldn’t receive large doses of O2 and both are caused by smoking (another thing I’ve learned is that if a test response mentions the evils of smoking, it’s the correct choice!), and both receive similar symptomatic treatment without curative treatment, it works *functionally *to group them.
Ooh, really? Yes, they’re teaching us it’s contraindicated for that reason. But, now that I look it up in my drug book (2010 Nursing Spectrum Drug Handbook) I see that there’s no contraindication or even “use cautiously in” mentioned for pancreatitis and morphine.
How much of it do you think is because our textbooks, by the nature of print material, are at least three years out of date? I know already in OB, we’ve been told to ignore some of what the book says and that the teacher has the “correct” information. How do I know when the teacher is more current or the book is? (I know…look it up myself! And then remember two sets of information - what to answer on the test and what to do in reality.)
I was pretty floored last night looking up Fentanyl for the first time preparing my drug list for OB. Never give it to patients not already on large doses of opiods? Never give it to opiod niave patients? Never use it for post-op or acute pain? Shoot, they give that stuff out like it’s candy! So how do I, as a nurse responsible for meds administrated, know when to fight an MD who orders a med my book says is inappropriate for my patient?
I guess, for me, this question of “do I question authority’s wisdom” isn’t going to go away after school…
No, it won’t go away, and it shouldn’t go away. And the answer (in my opinion, which is not based on any experience in the medical field) is that SOMETIMES you question authority’s wisdom.
Don’t make every case, every patient a battle ground–if you pursue OB work, look for a doctor whose idea of how often–or in what situations-- intervention before and during labor match yours more often than they don’t.
But do keep reading, keep exploring, ask questions, and generally try to do your best for this patient in front of you right now.
I like to question my professors teach whenever I can. I usually present the question as a misunderstanding. “You said X in class, but I saw Y which holds a different opinion because of Z. Can you explain why Y has that opinion?” or “Which version should I use on the final exam?”
This helps you become a better student no matter what answer you get (unless the professor doesn’t explain himself). If you are wrong, then the professor will explain why and you can learn from your mistake. If you’re right, then it shows you that you’ve learned how to use the material.
I’m in my third year of law school and questioning authority is a different issue here. A lot of the law taught in law school can be disagreed upon by reasonable people. Professors care more about the way you make an argument rather than the answer you come up with. They are always more than happy to see a well argued opinion that’s different from their own.
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I was pretty floored last night looking up Fentanyl for the first time preparing my drug list for OB. Never give it to patients not already on large doses of opiods? Never give it to opiod niave patients?
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WTF? In ER and pre-hospital we love it for it’s potent, short acting, less hypotensive inducing effects on trauma pts. When I worked PICU we had lots of opiate naive babies and toddlers on Fentanyl drips. Although, I will say that lots of nursing references and school lectures will revolve around a med/surg mindset, mileage varies a lot in other parts of the hospital.