Saving lives by the numbers: Purdue Nursing researchers study high-stakes medical math

Purdue Nursing graduate student Benji Milanowski and Ann Loomis, clinical associate professor of nursing, stand in front of a white board with math equations on it. The duo of researchers, along with Nursing department interim head Elizabeth Richards, are analyzing the fast calculation skills of sophomores in the program. The study wants to find out how the current students’ math skills measure up to past cohorts. Nurses must calculate quickly for different medication dosages and sometimes even IV drips.(Tim Brouk)

Written by: Tim Brouk, tbrouk@purdue.edu

One decimal place off can prove deadly.

This is the mathematical pressure — along with all the other job pressures — nurses must face in many critical situations. It can come in the emergency room where a patient needs an immediate dose of medicine, or it can be converting standard measurements to metric or timing an IV drip.

“You have to know it,” said Ben Milanowski, a PhD student in the Purdue University School of Nursing and registered nurse. “I do think there’s a certain component of, ‘Oh, I’m going to go become a nurse, a doctor or pharmacist because I want to help people in this way.’ They have those skills, but they don’t necessarily realize that ‘Oh no, I have to learn all this information. Anatomy and physiology. I have to still use this algebra, math.”

Math is used heavily in the nursing profession, and Milanowski along with Elizabeth Richards, professor and interim head of nursing, and Ann Loomis, clinical associate professor and assistant head of undergraduate evaluation and strategic innovations, want to make sure current Purdue nursing students are making the grade.

An ongoing internal study, “What Strategies Facilitate Learning Medication Dosage Calculation in Undergraduate Nursing Students?,” takes a deeper dive into the skill level of School of Nursing sophomores in the required NUR 21801 (Health Assessment and Essentials of Nursing Practice) course.

The team is analyzing test scores of the current class — 175 students — but also running students through 10- to 15-minute medical dose simulations. Calculations are meant to be made on the fly in real time during an emergency event, including skills taught before the digital age.

“You’re not always going to have that IV pump, and you still have to understand how to program (the drip rates) on your own. And we talk about manual drip rates like the old days,” said Loomis regarding drip rates, which are calculated by dividing the total volume by the infusion time and multiplying by the tubing’s drop factor to determine drops per minute. “This is what we try to stress to the sophomores. You cannot always depend on technology. There’s going to be times you’re going to have to manually do things. And that’s down to calculating a dose.”

Data drawn from the simulations will be compared with test scores from three previous cohorts of second-year nursing students. The focus is on how Purdue nursing students are progressing — or regressing — in their calculation skills.

‘Add It Up’

Loomis and Milanowski noted some student nurses struggle with dose calculations and some do not. Some have taken required and rigorous mathematics classes their first year while others put them off for later. Regardless, many mathematical concepts carry over to nursing, especially dimensional analysis.

“Dimensional analysis would technically be algebra,” Milanowski explained. “They’re going to be solving for X, but what they’re solving for here is how much of this dose do they need to give? How many milligrams per kilogram per day?

“We need to isolate X. We need to get everything else on the other side of the equation. That’s what your algebra teacher would have told you.”

But whether they have a knack for numbers or not, every nurse must be adept at calculating quickly because math problems come at them from everywhere. For example, an insulin syringe has different measurements than a traditional syringe. A miscalculation there could prove fatal. But established nurses know context. Milanowski and Loomis mentioned most nurses in the field can recognize quickly if a calculation is off. Even if they don’t know the exact dosage calculation, they know not to administer the medicine before they are sure it’s the correct measurement.

“It’s been drilled repeatedly, so it’s just a reflex,” Milanowski said. “We’re not looking for them to multiply large sums in their head. We’re not trying to make them into savants as much as it’s you just know the numbers.”

Mathematical emergencies

Milanowski cited multiple situations during his pre-Purdue nursing career where his fast math skills helped save lives — working on the Navajo Native American reservation that ran out of IV pumps required him to make life-saving calculations for manual IV drips. Math skills were key in setting up a pediatric intensive care unit while on a medical relief trip to Ethiopia. Then there can be power outages or technological failures when a nurse must crunch numbers quickly.

While the Health Assessment and Essentials of Nursing Practice course can be rigorous — three of the same mistakes and you’re out — Milanowski’s simulation isn’t meant to put more pressure on the students. They must remember they are working with manikins, not real patients. Mistakes can happen in the Purdue Nursing Center for Education and Simulation but not in the hospital.

“We can kill the robot (manikin) as many times as you’d like. And we’ll learn. We’ll discuss it. We’ll learn from it and move on from it. And we’re going to do that again. And we’re going to do it until you can’t get it wrong,” Milanowski said.