A student just 2 weeks from graduation once asked me, “Where is the gallbladder?” With candid unconcern, the student admitted that she had never read a nursing textbook or a journal article throughout her studies. I couldn’t decide if this interaction made me more surprised or worried. For some time now, educators and social scientists have been lamenting the decline of reading—for school and for fun, across all levels. Faculty in particular bemoan that not only do most students avoid reading altogether, but those who do engage with texts frequently lack the stamina to get through even relatively short passages. Worse still, some question whether reading is even necessary. In short, why read if one can pass nursing school without it?
This trend poses significant challenges for nursing education, where deep engagement with texts is crucial to developing clinical competence and clinical reasoning. And this ties to student disengagement, too. A student explained, “Why should I bother going to class if the faculty is just going to read off the slides?”
Why are we reading less?
Certainly there’s no short supply of bibliophiles in the world. Although the overall number of people reading for pleasure is declining, book clubs are on the rise, particularly among Millennials and Gen Zs. However, reading for fun, for example a book that one intentionally selected, is not the same as being told to read a chapter from a textbook. Disinterest in reading for school is likely an extension of overall student disengagement and academic malaise—a trend already well established before COVID.
Some students may view schools not as places to learn and extend knowledge (by deep reading), but merely as places to obtain credentials that will get them a high-paying job. Reading in academia has become transactional. Students will read a book chapter or an article if they’re told that the material will be on the test. The joy of reading has been sacrificed over the ephemeral flush of receiving an easy “A” on an exam with little or no reading. As a result, the false sense that nursing school is easy gets passed along.
Students’ and administrators’ demand for homework leniency make faculty assign less reading, even for fields of study that require critical reading for success, such as history, literature, medicine, and of course, nursing. A scoping review found that reading assessments are reliable indicators of a student’s potential for academic success in nursing programs. In the “Rogerian” master’s in nursing education program I graduated from in 1996, a course on philosophical physics was required. For this one course, we had to read three books in full: The Dancing Wu Li Master, From Copernicus to Einstein, and Flatlands. Can you imagine that happening now?
Grade inflation, the twin of homework leniency, is a disincentive to deep reading. A grade of “A” has become more common, whereas it used to represent only exceptional work. Faculty may face pressure, either overtly or subtly, to award higher grades with lower rigor and reading requirements in order to avoid negative student evaluations, maintain course enrollment, or meet institutional performance benchmarks.
Why read?
A few years ago, while proctoring an exam, three students called me over with confused looks, pointing to the phrase “next of kin” in one of the question stems. To my surprise, they had no idea what it meant, even though, to my knowledge, they were native English speakers. With suspended disbelief, I politely explained that I’m not permitted to answer questions about the test during the exam. Inwardly, I thought the phrase “next of kin” was a fairly common expression, not exactly sesquipedalian. I realized this notion is “relative” (pun intended).
Since English isn’t my first language, I had learned early on that reading would be key to building my vocabulary. For instance, in the book Titan: The Life of John D. Rockefeller Sr. by Ron Chernow, I had to look up at least 87 unfamiliar words, which I scribbled on the flyleaf. Medicalese or hospital-speak is a language all its own, and as such, nursing students face the dual challenge of learning both communication fluency and clinical knowledge—whether that’s figuring out where the gallbladder is or distinguishing between crackles and rhonchi.
In a world of truncated learning, selective and episodic reading has become commonplace. One of the most frequent questions I get from students is, “Do I really need to read the assigned chapters?” I typically respond with encouragement, suggesting they do their best with the readings and reassuring them that the material will be useful. But in my head, I compare this to the alphabet: You can’t decide to skip learning certain letters, like Q or X, just because you won’t use them often. Learning, like reading, is cumulative. Every piece of knowledge, no matter how seemingly mundane, contributes to a bigger picture.
Teaching how to read
I’m not sure if good teaching alone is enough, but I do know there’s a lack of quality reading. These days faculty have to teach both nursing and masterful reading of nursing texts. I do my best to encourage regular reading habits among students. Offering shorter, more engaging readings as well as a mix of multimedia and texts with immediate real-world applications seems to resonate more with today’s learners. Occasionally, I’ll have the class participate in collective sprint readings, where they quickly look up medical terms or solve a clinical puzzle, then explain what they’ve learned to the person next to them. This approach also helps students to sound out unfamiliar words and engage with the material.
The pronouncement that reading is at the end-of-life is grossly exaggerated. In fact, I’m continually inspired by students who read for pleasure. As Francis Bacon, the 17th-century English philosopher, advised: “Read not to contradict and confute; nor to believe and take for granted; nor to find talk and discourse; but to weigh and consider.” That, I believe, is excellent advice—not just for cultivating cognitive and emotional intelligence, but for good citizenship as well.
Fidelindo Lim, DNP, CCRN, FAAN is a Clinical Associate Professor at New York University Meyers College of Nursing
