New grads being rushed into "nursing maturity"

[PA_RN87]

Based on several threads that I've read on here, and on my own personal experiences as a new nurse beginning my 4th month of experience, I'm seeing a general trend towards rushing new nurses into experiences, roles or responsibilities that traditionally are more "appropriate" for nurses with a little more experience. This coincides with hearing several stories by new nurses who were pushed off of orientation early, given a shortened or unstructured orientation, or no orientation whatsoever.

I would ask why the big rush to have new nurses function on the same level as nurses with years of experience, but I already know the answer - finances. They're paying you to work as a functional team member, and expect you to preform according to your payscale. Fine - I get that - but at what point do we cross the line where the costs outweigh the "cost benefits?" Pushing new nurses too quickly leads to problems on the patient side, and on the nurse side. Patient safety is put on the line by overtaxing a new nurse with extra patients, longer hours, or more responsibilities. Nurses are "burning out" quicker or quitting before they hit the 6 month mark.

None of these things are healthy even with experienced nurses, so I don't mean any disrespect for those experienced nurses who struggle with the same situations. However, new nurses aren't as "seasoned" and are more likely to make a mistake or burn out quicker.

Personally, I'm barely into my 4th month (including orientation), and I've been given more than the "maximum" patient load, expected to join committees, floated to 4 different units (despite being told new nurses aren't floated until after 6 months), and taken advantage of with scheduling.

Just opening this up for a general discussion. I'm interested in everyone's personal stories relating to the topic, as well as your views and opinions.

[HouTx, BSN, MSN, EdD]

LOL - "rushing maturity" made me giggle a bit. Just like those orders for a "STAT culture" - not gonna happen. You can't speed up a process with that much underlying complexity. We educators have a corollary... no matter how much you teach in a given amount of time, your results are limited by the ability of your learners to absorb and process the information.

he he he - accelerated maturity - sounds like a sci fi concept.

[PeacockMaiden]

I totally agree that the lack of quality in nursing education is largely to blame. My program was an entry level masters, and the quality of my clinical experiences weren't good at all. As mentioned, there where a lot of restrictions on what students could do. Our nursing instructor had up to 12 students at a site. On top of that, the nursing instructors that I got were not nice people, and seemed to really want to humiliate their students.

With the exception of a few good floor nurses that I got to work with, most floor nurses didn't have the time or desire to teach students. Many were downright rude to me.

My final senior preceptorship was terrible too, because the nurse who was my preceptor for 200 hours didn't want to teach a student, so she pretty much used me as a nurses aid. She even told me her nurse manager said that if she took a student then she'd get a raise, and that was the only reason she did it. It was a very uncomfortable situation. The other nurses on that unit were not any more welcoming either.

Since that time, I have been a RN now for one year, and can't find a hospital job in California. I have been working at a SNF facility. I am learning more there than I did during any one of my clinicals. But none the less, many of the LVNs at that facility are very nasty and not willing to help new nurses. They ridicule the newbies. It's a hostile work situation.

I am beginning to think that nurses are the nastiest people on Earth! Not all nurses of course. Why is this?

[CrunchRN, ADN, RN]

Tell it like it is PMFB!!!!!!!

[Amistad, RN]

Just want to chime in with my nursing school (BSN) clinical experience... I graduated this May and I have to say that the restrictions placed on nursing students at our clinical sites was very frustrating. Many of my friends never had the opportunity to practice basic skills such as putting in an IV or catheter. I was fortunate enough to find nurses on each unit who were like mentors to me and had an EXCELLENT preceptor for my senior synthesis in the PACU. I am forever grateful to her.

Quite honestly, one of the best clinical experiences I had was during a semester abroad in South America... They let us do everything and I felt like a fully functioning member of the nursing staff by the time I left. If I had not had that experience, I would not be entering the workforce with confidence in myself. It's kind of sad that I had to go to another continent to learn a lot of my nursing skills.

I agree that nursing schools do not adequately prepare new grads to be RNs, and I partially blame the clinical sites for putting such harsh restrictions on students. I don't really have any solutions, but I believe this is a problem.

[scott5698]

Man, this hits it on the head! Poor clinical sites with absent teachers, teaching that amounts to "read the book, you're in nursing school", and real restrictions on what we can actually perform at clinicals. I am one of those second career individuals and I find the attitude of some of my younger classmates appalling, yet I know experience will usually teach them just how awful their attitude was. I'm tired of hearing how my previous 25 years of experience and degree don't matter. I WANT to do the best job possible, realize that I'm limited by my experiences and loyal to those who teach/train/prepare me for the real world. If only we could get the corporations to realize it.

[rlaguswjd980]

I completely agree with you about the limitations. Many hospitals have limitations which affects students' learning as well as allowing them to build their clinical skills and critical thinking. It also depends on your professor/clinical instructor's relationship with the hospital. I notice that if professor knows the hospital or had worked there, nurses were willing to help students more if they didnt know the clinical instructor. I had a clinical rotation in one of the hospitals and it was very frustrating because students were spending hours of looking at the chart or asking nursing assistant if we can help them like taking vitals, or doing ADLS. Additionally, new grad orientation or residency is shorter than it used to be. Most of the preceptors do not get paid to train new nurses, so sometimes it is frustrating for them to help because they have their own patients simultaneously.

[learner1108]

I so agree with Not A Hat Person. In my senior clinical, I had a wonderful RN, but I did not get to plan for a patient one whole shift. I could have practiced on how I would care for a patient, and he could have checked everything I had written down and discussed it, but he had patients. I don't think he had time. He had three patients, only one less than his fellow nurses.

Not letting a student nurse plan and talk about how he/she would care for a patient, much less get to actually do something besides bed baths, means the first job she gets and her first patients after she passes NCLEX is when she learns.

The education of nurses must include more clinical time and opportunities. If not, I like the idea of a reduced pay scale for new nurses while they get maturity in experience.

[pumpkinspice555]

I agree with Not a Hat. I am a new grad myself, and starting a new job. I feel unprepared and I don't feel like my school has prepared me at all for the real world of nursing. It's incredibly tough when experienced nurses expect us to know what they know, i'm not saying all are like this. But there is quite a bunch, at least in my hospital. For the most part, I had 8 hours of clinical (one day) a week and was mostly assigned to 1 patient. I worked with various nurses: some nurses brushed me off and didn't want to take the time to teach me the skills and some were excellent teachers. Now, I understand that the day shift nurses are incredibly busy, but I felt I wasn't practicing skills for a whole day. During clinical, I mostly did bed baths, bed sheet changes, etc. In one clinical, the nurses used us students to purely do vitals, change bed sheets, and empty urinals (that's it).

I had practicum in OB and now I have a job in medsurg. I feel inadequate, but I have heard that the nurses on my unit are mostly patient and non-judgmental toward new-grads. So i'm very happy about that.

I think the education is different between the more experienced and the newbies.

To the experienced nurses: We new grads respectfully request that you be patient with us and try to remember what it was like being new grads with minimul experiences. Some of us haven't done some of these "Simple skills."

New Grads: Keep your head up high. We will get through this confusing and tough time of getting oriented on our units. (:

8-12 hours one day a week and caring for only ONE patient, just isn't enough time to truly practice all the skills we "should know" and adapt to the nursing world. In my years of nursing school, I can say i've done only 2 successful IV's, 1 intermittent catheter insertion, 1 foley catheter insertion, and no NG tube insertion (an opportunity for me just never came up during my 8-12 hour 1 day a week shift....). But I guess as a new grad, all I can do is keep my head up high and take it one day at a time.

[PMFB-RN, RN]

I totally agree that the lack of quality in nursing education is largely to blame. My program was an entry level masters, and the quality of my clinical experiences weren't good at all. As mentioned, there where a lot of restrictions on what students could do. Our nursing instructor had up to 12 students at a site. On top of that, the nursing instructors that I got were not nice people, and seemed to really want to humiliate their students.

With the exception of a few good floor nurses that I got to work with, most floor nurses didn't have the time or desire to teach students. Many were downright rude to me.

*** I am sorry that was your experience. There isn't any excuse for nurses to treat students that way. However you may have been a victim of the wide spread bias against the program you chose.

I have often heard discussions among nurse preceptors about the superior attitude and lack of interest in learning basic nursing skills among DE MSN students. I have experienced this myself. However each student should be taken as an individual and not judges by the attitudes and actions of their fellow DE MSN students.

My final senior preceptorship was terrible too, because the nurse who was my preceptor for 200 hours didn't want to teach a student, so she pretty much used me as a nurses aid. She even told me her nurse manager said that if she took a student then she'd get a raise, and that was the only reason she did it. It was a very uncomfortable situation. The other nurses on that unit were not any more welcoming either.

*** I precept nursing students nearly every shift. I get students from all kind of programs, including DE MSN. My students are either placed with me as part of a critical care class in the case of DE MSN and certain BSN students, or doing their senior preceptorship in the case of ADN and certain BSN students and spend 6-10, 12 hours shifts with me on the rapid response team. I have to admit that the DE MSN students are often different and I sort of dread taking them. However I try to judge each student as an individual.

Since that time, I have been a RN now for one year, and can't find a hospital job in California. I have been working at a SNF facility. I am learning more there than I did during any one of my clinicals. But none the less, many of the LVNs at that facility are very nasty and not willing to help new nurses.

*** Do the other new grads from ADN and BSN programs face the same treatment?

[FMF Corpsman, MSN, RN]

Adding to what the previous posters have said (great posts, BTW) ...

I believe another thing that should happen is that we need to change the pay scales so that new grads make less money while they are on orientation and not "pulling their weight" on the team. That's part of the problem. Employers aren't willing/able to pay for the expensive on-the-job training required by new grads while paying them as if they were functioning at a full professional level. But so far, that idea has not been culturally acceptable within nursing.

I know that idea is controversial, but nurses can't have it both ways. If people want to be paid salaries close to what nurses with 2 or 3 years of experience make, they need to function at that level and "be worth it" to the employer. If they need 6 months to a year of special training, reduced responsibilities, etc., they have to expect to be paid less. Medical residents and fellows make considerably less than attending physicians, law firm associates make a lot less than partners, etc. New school teachers are on the same pay scale as experienced ones, but they are assigned their own classrooms on Day #1 with NO preceptorship time. Nursing needs to decide which model they want to use -- the one in which new grads are ready-to-go on day #1 and deserve a full professional salary ... or the one in which the new grads needs additional training and transition time and does not deserve a full professional salary. We can't have it both ways.

This idea is particularly pertinent because of the high number of new grads who plan to work in the first job for only a year or two before moving on to something else. Why should an employer provide a full professional salary + a lot of expensive education to someone not functioning at a full professional level who does not plan to stay in that job long enough for it to be a worthwhile investment to an employer?

We need to look at a new model ... with different pay expectations to match the level of responsibility new grads are prepared to take ... the type of training they need ... and the likelihood of their staying in their first job for a substantial period of time.

I agree completely. What baffles me is while all of this is going on; some of those same nurses are trying to be assigned to the specialty units. If they aren't yet fully qualified to work on Med-Surg or Step-Down units, what on earth makes them believe they are even remotely qualified to work in a unit that requires specialized training in addition to a few years of experience? Can a fresh grad go into an ICU and successfully do open heart massage if it is asked of them without passing out at the bedside? I rather doubt it. That doesn't happen everyday, but it does happen.

[FMF Corpsman, MSN, RN]

The staffing model just wants bodies to get the work done. A nurse is a nurse is a nurse.

I couldn't disagree with you more. Perhaps that is true in some facilities, but it is the absolute worst mistake they could make. Hiring only warm bodies instead of the best candidates, they can find, sets them up for failure and only poisons the staffing pool they already have with discord and discontent. "A nurse is a nurse is nurse is a nurse," is pure BS. Are you a Nurse or a teacher? Those without a calling to be a nurse don't stay in the field very long, and you can usually tell pretty soon, who they are, it isn't difficult. They turn their nose up at certain task, or make themselves scarce when it comes time to do certain things that are beneath them, they are the last to answer a call light, and they think that is always the LPN or aides job, even when they are standing right next to the room. They are quick to say, "Not my Patient," but get highly indignant if someone else, who is juggling 3-4 different things at the time, says the same thing about one of his or her patients. NO, you're wrong, a Nurse is definitely not nurse is a nurse. There is a whole world of difference.

[FMF Corpsman, MSN, RN]

Man, this hits it on the head! Poor clinical sites with absent teachers, teaching that amounts to "read the book, you're in nursing school", and real restrictions on what we can actually perform at clinicals. I am one of those second career individuals and I find the attitude of some of my younger classmates appalling, yet I know experience will usually teach them just how awful their attitude was. I'm tired of hearing how my previous 25 years of experience and degree don't matter. I WANT to do the best job possible, realize that I'm limited by my experiences and loyal to those who teach/train/prepare me for the real world. If only we could get the corporations to realize it.

Scott I don't know how old you are, but there used to be a saying,"You get out of it, exactly what you put into it." or a similar concept,"You reap what you sow." If you wind up practicing in the same area where you went to school, you will likely find that those same lousy students will be lousy nurses, after they fail their boards a few times and eventually pass or either give up and go to work for Hooters or some other equally fine dining establishment. Keep striving to do the best job possible and your results will be there own reward, and you will have a great career. "When you have a job you love, you never have to work a day in your life."