Nursing & Midwifery Maths

[PlanetmarsLondon]

I was planning to study a degree in Midwifery and I was accepted into university. I have an access diploma in Midwifery, I then passed the maths and English tests via the university’s I applied for. I have a grade C in GCSE Maths and a B in English. I sat my GCSE’s in 2011 because I was home schooled for a few years but I didn’t end up sitting any exams due to a bad family dynamic at the time.

I am in my 30’s and I am just realising how much Maths might be involved in the day to day job role. I am great at studying however I worry that I will not cope under pressure, and I worry about making a mistake. My main concerns are drug errors. I do currently work in a hospital and some midwives have told me that they nearly didn’t graduate or pass exams due to the calculations they tested them on, and that the parts involving maths were very difficult.

Can someone give some examples of what level of difficulty we would be looking at? At least then I would know if it’s too far out of my depth. I can do basic maths, most of the stuff I learned in my GCSE’s have been forgotten. I can learn it all again but I have absolutely no interest in Maths, so will probably struggle to retain the more difficult information. I love Science, so I find it easy to learn about this type of stuff.

Could anyone give a few insights into how maths comes into your day to day job? I know the pharmacy and doctors will arrange the medication however as a midwife, I would be giving it out. All in different dosages, measurements and forms such as, pills, liquids and injections. I’m perfectly capable of calculating my own medication doses however when you have 8 patients on multiple medications, I can see where I would get stressed out.

I worry having peoples lives in my hands might be too much pressure. Everyone at work says that I would make a great midwife however I think my lack of confidence and anxiety will stop me. I’m afraid to try and fail, I also don’t want to ask my colleagues for advice in case I come across as not clever enough. Thank you 🙏

[NeverEndingBoring]

I'm sorry I don't know but bumping for you 🙂I hope you feel you can do the course.

[NeverEndingBoring]

You could maybe ask for this to be moved to chat for more traffic?

[RapidlyApproachingEndOfMyTether]

www.amazon.co.uk/Calculation-Skills-Nurses-Student-Survival/dp/111980812X/ref=asc_df_111980812X/?amp%3BlinkCode=df0&amp%3Bhvadid=534959025250&amp%3Bhvnetw=g&amp%3Bhvrand=15994084248129805764&amp%3Bhvdev=m&amp%3Bhvlocphy=9045627&amp%3Bhvtargid=pla-1427736639549&amp%3Bpsc=1&amp%3Bth=1&tag=mumsnet&ascsubtag=mnforum-21

Maybe look at a book along these lines to see the sort of things you might be expected to know-how to calculate. This one was written by a practice development nurse at a local trust to me. I think the extent of drug calculations you use in clinical practice will vary a lot depending on the clinic setting, I rarely use them these days (clinical specialist nurse in the community) but did a lot more when I worked in inpatient settings. In any case you need enough to a) pass your degree and b) pass your drug calculations test as part of meds management/IV meds administration competencies when newly qualified. Good luck!

[MissyB1]

I never passed my maths at school. I got into nurse training with no maths qualifications whatsoever! However that was back in the day. I did have to do drug calculations on a day to day basis in my job, including highly potentially toxic I V drugs. Never made a mistake. They do test you on drug calculations, you will memorise the formulas, honestly if i could pass those anyone could. And I used to carry handy little cards with the formulas at work in my pockets. These days tech will give you all that and the iv machines are much cleverer anyway!
Don’t let your anxiety about maths put you off or scare you.

[RapidlyApproachingEndOfMyTether]

Some basic examples of drug calculations would be:

Dose prescribed is 40mg, tablets are 5mg, how many tablets do you give? (40÷5=8)

Drug comes in 10mg/2ml ampoules, dose is 2.5mg, what volume of the drug do you draw up (2.5/10) X 2 = 0.5ml

Woking out the volume to be delivered over time (in mls/hr) for IV drugs, based on a prescription e.g. prescription for IV fluids is 1 litre over 8hrs so how many mls/hr do you need to set the pump to (1000÷8 = 125ml/hr)

Then working out the drop rate for that IV bag,knowing how many drops per ml your IV set delivers and working out how many drops per minute you need to deliver at the right rate.

I think in paediatrics and neonates a lot of drugs are given based on body weight i.e. so many mg per kg of body weight so calculations based on that to get the right number of mg for your patient, then working out how many mls or tablets that would be.

I wouldn't let the maths put you off, lots of people I trained with struggled as it didn't come naturally to them at first but with perseverance and taking it logically step by step you will get there. It's just arithmetic really, with care to convert things to the right units along the way.
As per previous poster, you will learn the formulae and if you follow those every time, you won't go wrong.

Plus in clinical practice the complex drug calculations you will always double check with another registered nurse or midwife (except in the community where things are a bit different for e.g. home IVs or syringe drivers in palliative care, but I don't imagine you'd be doing that in community midwifery.)

[Taq]

You need to be correct with drugs but it’s basic.
The Safe Medicate exam in uni is far harder than in practice, because in practice you can use a calculator and say ‘hey Sharon, can you check this for me please?’

If you got a C then you can do it. There’s no panic or stress with drug calculations in practice because you take your time, and can always get it second checked before you give.

Its very important, but it’s nothing to stress over :)

[Lougle]

There are basic formulas that you will use regularly.

What you want ÷ what you've got x what it's in

So if you need 2mg of a drug that is in a 10mg/5ml solution:

2mg ÷10mg x 5ml = 0.2 x 5 = 1ml

The most complicated drugs in ITU are given in mcg (micrograms) per kg (kilograms) per minute, which sounds really complicated, but you just take it step by step and always double check with another HCP.

[antipodeancanary]

Friend had to leave her uni nursing degree course as she persistently failed the medical calculations module. It was really sad but she just couldn't pass and had about three attempts. She had GCSE grade c

[PlanetmarsLondon]

I just see how busy my colleagues are… and I don’t know how they do it! Being so rushed off your feet and having to make potentially life saving decisions whilst working a night shift. It frightens me that I could make a mistake. I don’t have any other interests though. I would enjoy a career caring for people, particularly women. I tried the calculations above and I couldn’t figure out how to convert from mg to ml. I suppose I’ve never needed to use this in real life, as I just google things like measurements for cooking if needed. I can figure out how many tablets to give depending on how many mg is in each tablet but converting to another type such as liquid is confusing. I don’t understand the counting of how many drips in the IV, or how to figure out how many hours. I know I could learn that quickly if it was explained to me, I guess I’m just getting anxious as I don’t like maths and have never been clever.

[PlanetmarsLondon]

@Lougle those calculations just hurt my brain. I tried to understand and I just couldn’t. Is it possible to learn all of this? Or do a lot of students already know how to do all this maths via their A levels? I’d feel pretty silly against other students, especially if I need to ask for help on the ward on placement. Maybe we will all be in the same boat and will all be worrying about the same things but I’ve been out of study for years, and even then a C in GCSE is not very helpful. Im surprised I was offered a place to be honest. After all it does seem quite complicated, all the calculations. Nothing medical is worrying me, I’m confident in that aspect as I have a genuine interest. It’s just the drug doses.

[RapidlyApproachingEndOfMyTether]

OP, really try not to worry. It is part of the role of the university to teach you these things during your training, and it all makes so much more sense when you're doing it in practice. Once you get the hang of it you'll wonder why you were worried. I wouldn't expect anyone to be able to do them immediately without being taught first so I think you're giving yourself a hard time here! These are just examples to show the kinds of things you'll be learning, not a stick to beat you with before you've started! We really need committed HCPs who are passionate about their chosen career pathway, I hope this doesn't put you off.

[Toddlerteaplease]

I got an F in GCSE maths and U the second time, round when the school forced me to do intermediate, despite failing foundation. Fortunately my uni at the time (2001) didn't require it.
You learn the calculations pretty quickly. And it's easier as you are actually applying them to something practical. One of my colleagues used to do all hers in paper. And make students do it as well. But we all use calculators anyway.

[Laughingnome1]

Honestly I promise Uni will teach you all of the things you need to know. I qualified in 1992 and had NO O'levels and had to sit the entrance exam for the school of nursing. I learned the calculations that I have needed through experience and checking with colleagues until I just did it without needing to think about it. Fast forward 30 years and I finally get to Uni to do the non medical prescriber course and had exactly to same fears as you. That everyone else would just know how to do all of the complex calculations. But turns out, almost everyone felt like they didn't know enough. Uni were amazing and went over it as much as everyone needed. There are a ton of different text books focused just on drug calculations for nurses. Please don't let this put you off.

[PlanetmarsLondon]

Thank you everyone 🌸

[Lougle]

@PlanetmarsLondon we just need to break it down.

Let's look at a liquid medicine that contains 10mg/5ml. Every 1ml of medicine contains 2mg of the drug (10÷5=2).

Your patient requires 7.5mg. We can break that down in whatever way we want:

7.5 = 5 + 2.5
5mg = 2.5ml (10mg ÷2= 5mg; so 5ml ÷ 2 = 2.5ml)
2.5mg = 1.25ml (5mg÷2=2.5mg; so 2.5ml ÷ 2= 1.25ml)
2.5ml + 1.25ml = 3.75ml.

But also, the formula I gave works like this:

Step 1: I need 7.5mg (what I want) but I have 10mg (what I've got). 7.5÷10=0.75.
Step 2: the 10mg is in 5mls of liquid (what it's in). 0.75×5=3.75ml.

If a patient needed 60mg of a drug and you only had a 40mg tablet, you can use the same formula:
60 (What I want) ÷ 40 (what I've got) x 1 (what it's in- one whole tablet) = 1½ tablets.

It's just practice. Lots of practice.

[Lougle]

You can download a workbook and answers here: london.hee.nhs.uk/medicines-management-drug-calculations

[PlanetmarsLondon]

Do you find that you sometimes forget these things or do you just remember somehow after doing it for so long? Thank you for the calculations it helps to actually see some examples written down.

[Toddlerteaplease]

I think in paediatrics and neonates a lot of drugs are given based on body weight i.e. so many mg per kg of body weight so calculations based on that to get the right number of mg for your patient, then working out how many mls or tablets that would be.

Correct, but it's really easy when you get the hang of it. There are always people to check with. And pharmacy if needed.

[Toddlerteaplease]

For example, max dose of ibuprofen is 30mg/kg/day. To work out each dose;

Fr example the child weighs 36kg.

36x 30 = 1080.
1080mg per day.
Divided by the number of doses which is 4. So each dose is 270mg.

[Lougle]

@PlanetmarsLondon

Do you find that you sometimes forget these things or do you just remember somehow after doing it for so long? Thank you for the calculations it helps to actually see some examples written down.

I returned to practice after almost 10 years in 2015. I last gave drugs in 2017. Once you know, you don't forget, you just get a bit slower if you are rusty.