New grads being rushed into "nursing maturity"

Pediatric Critical Care Columnist · Jul 19, 2013

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.

I don't think NY_teach was actually saying s/he agrees with that pronouncement. I think the comment was more to explain the HR view of things. And trust me, HR really only cares about having a name attached to a shift. Of course the notion that "a nurse is a nurse is a nurse" is false - we aren't the interchangeable widgets most lay people believe us to be. But I'm seeing the erosion of appropriate staffing picking up its pace on my unit where we're now having nurses with ZERO critical care experience being floated to our high-acuity PICU on a routine basis now. The regular staff members are too busy with the sickest and most complex patients to watch over and support the floats and it's a disaster in the making. But this is how our administration has chosen to deal with the high turnover, high sick time and short-staffing ever-present on our unit. After all, "a nurse is a nurse is a nurse", right?

Susie2310 · Jul 19, 2013

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.

I had read several posts on other threads that refer to the quality of RN clinical training having decreased, but I was still shocked to read on this thread of some people's nursing school clinical experiences. It seems appalling to me to pay tuition (often very large sums) and graduate from nursing school saying you received poor quality clinical training and that your school didn't properly train you to be a nurse. As another poster on this thread pointed out, providing extended nursing education is very expensive for employers, but the new grad is left high and dry with insufficient clinical training in nursing school. The posters on this thread who referred to the deficiencies in their clinical training are aware deficiencies exist, but, (and I am enlarging my comments now to all of the posts that I have read on these boards) often it appears some new nurses, from some of their comments that reference aspects of their nursing school clinical training or from other comments they make about nursing clinical practice, do not really understand that they have not received adequate clinical training in nursing school. To me this is very concerning. I agree in general with your observation of the incongruity of not being fully qualified to work on med-surg or step down units yet believing one is qualified to work on a specialty unit.

FMF Corpsman, MSN, RN · Jul 19, 2013

Thanks JanFRN, Nothing will get me more agitated than that phrase and before I retired, I used to go thru long dragged out fights with HR and the Nursing Supr. who were trying to staff my unit with "warm bodies" just to meet quotas. I can't count the number of evenings and nights regular staff had to pull doubles, of course then came the over time wars, just to staff the unit. I just don't believe in leaving patients with extremely high acuities with unqualified staff. There is nothing anyone can say that will justify making those decisions. HR is staffed with non-medical personnel and the House Supr's are usually not critically trained nurses, so aren't capable of making those types of decisions either. They are administrators in their current position, not nurses, which is why I resigned my position as an administrator, I didn’t like the position it put me in and I missed the patients and my Unit. NY_Teach, if I read you wrong, I'm glad, I was certainly hoping I was mistaken. Thankfully I didn't call you any of those nasty names, LOL.

Gentleman_nurse, MSN · Jul 19, 2013

Thank you janfrn for your support.

To clarify my previous post FMF Corpsman, some organizations view all licensed nurses as equal in knowledge, skill, and abilities. It's a management model to labor. It doesn't matter if we're talking about nurses, teachers, or widgets makers. The worker is considered an interchangeable part in the organizational machine. To this type of manager, providing training to someone who is already trained doesn't make sense.

I never said I agreed with it nor do I.

PMFB-RN, RN · Jul 19, 2013

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.

*** Of course new grads SHOULD be going into specialty units. Saying they should spend a few years in med-surg first is as silly as saying that a orthopedic surgeon should spend a few years doing family practice.

Of course they will require more training but experience as a med-surg nurse usually isn't valuable for ICU and other specialty units, and we (my hospital) has some data that shows it may well be harmful.

FMF Corpsman, MSN, RN · Jul 19, 2013

*** Of course new grads SHOULD be going into specialty units. Saying they should spend a few years in med-surg first is as silly as saying that a orthopedic surgeon should spend a few years doing family practice.
Of course they will require more training but experience as a med-surg nurse usually isn't valuable for ICU and other specialty units, and we (my hospital) has some data that shows it may well be harmful.

I'm afraid this is turning into a discourse where some of us will simply have to agree to disagree. I will never agree that a new grad should be allowed to cut their teeth in an intensive care unit as counted staff. If they are working under a Preceptor, okay, but not as a staff member, they simply do not have the required skills or the mental acuity needed to work in that capacity. If you think they do, then I question your judgment as well.

Do you think that Certified Orthopedic Surgeons grow on trees? Yes, there are Orthopods that function in the field, but to be Certified or even before you specialize as an Orthopedic Surgeon, you have to start out somewhere in General Medicine. You don't graduate from med school as an Orthopedic Surgeon. To be Certified as an Orthopedic Surgeon you have to take the specialty Boards as I'm sure you know.

FMF Corpsman, MSN, RN · Jul 19, 2013

As I said, I was hopeful I was mistaken as that is a very drastic mistake and one I wish Hospital HR's and even Nursing Agencies and LTC facilities, would learn not to make.

PMFB-RN, RN · Jul 20, 2013

I'm afraid this is turning into a discourse where some of us will simply have to agree to disagree. I will never agree that a new grad should be allowed to cut their teeth in an intensive care unit as counted staff.

*** There is nothing for us to disagree with in this case. Nobody said anything about turning them loose as counted staff. Currently nursing schools are turning out licensed, but completely helpless grads. I wouldn't turn them loose unsupervised to care for ANY patients.

What if instead of our nursing students spending all their time writing papers on nursing theory and useless nursing diagnosis they spent their final year of nursing school working one on one with a skilled and trained preceptor in an organized training program? Maybe THOSE grads could be turned loose in any unit with just a couple weeks of orientation.

If they are working under a Preceptor, okay, but not as a staff member, they simply do not have the required skills or the mental acuity needed to work in that capacity. If you think they do, then I question your judgment as well.

*** As I said "they will require more training".

Do you think that Certified Orthopedic Surgeons grow on trees? Yes, there are Orthopods that function in the field, but to be Certified or even before you specialize as an Orthopedic Surgeon, you have to start out somewhere in General Medicine. You don't graduate from med school as an Orthopedic Surgeon. To be Certified as an Orthopedic Surgeon you have to take the specialty Boards as I'm sure you know.

*** Yes I am well aware of that. My point being that we don't make nephrologists first learn to be orthopedic surgeons. All physicians receive the same basic education, followed by a specialized post grad training. Orthopedic surgeon do not get training in general medicine beyond med school. That is why they are so helpless when any non-ortho problem comes up in their patients.

I envision that nursing post grad training (or pregrad training depending on how it's set up) would be short enough that a nurse could change areas of nursing fairly easily, unlike physicians who require multi-years residencies.

LadyFree28, BSN, LPN, RN · Jul 20, 2013

I actually agree with FMF Corpsman about specialty nursing.

Being a critical new grad happened not to be a good fit for me...I felt as though the intangibles that I needed wasn't there for me. Now, mind you, this is NOT my first new grad rodeo...I had six months orientation as a LPN, and I started his position within 2 months passing my boards. I have precepted LPNs and RNs. I helped create protocols at my job. I know how the system works. I worked in a specialty as a new grad LPN.

This position was started one yet removed of my last clinical rotation, an I was still working at my previous job, but the move was so lateral, there really wasn't no "new grad curve." I was very vocal about it; however, when they have people lined up, you don't expect (at least I don't) expect people to invest their time in creating a successful nurse and team player, especially if they have a "system" that a organization has in place. I took the chance on a opportunity that I saw for my self five years down the road; but even based on what they said on the interview and what I saw and advocated for, for the betterment to my practice; it reached an impasse...no hard feelings, but for some new nurses, with NO true idea of our profession, it can be a bitter pill to swallow.

I believe that having an honest conversation about learning needs, extensive training for not only preceptor's, but for nurses who oversee the preceptorships should come into play based on learning needs, and Benner's model for the preceptor should be followed as much as possible ad well. Utilize the nursing process in ourselves if need be; let goals be met; goals that are not net addressed with REAL support.

I agree with a poster to have them start salary lower if needed; the investment in quality nurses is MUCH more paramount.

I have received an opportunity I wanted in skilled nursing, and have the opportunity to expand my role into leadership. I WILL get a very intense orientation, and I am ready for the challenge, the curve, at a place that will give me the transition I need. :yes:

I plan to be able to be involved in staff education, and nursing education. I do plan to become a trauma nurse, a critical care nurse, and it will happen; I more honest in getting that base and filling in those gaps of transition at I need to be a better nurse; I owe that to myself, and ESPECIALLY the patients and my healthcare team. :yes:

I'm not detracting from my clinical expertise or rotations, or even my residency either; if anything, the delay of getting a job did more to me than schooling ever did; no self studying could replace the learning needs (I'm a hands on kinesthetic learner) that I needed; I felt (and still feel and plan to) I needed a Nurse Refresher Course.

The new grad must advocate to do what they can; as well as the preceptor needs to as well; I would think the nursing staff wants a team member and new grad to excel...I know I want them to, and of course, the new grad. :yes:

PMFB-RN, RN · Jul 20, 2013

I actually agree with FMF Corpsman about specialty nursing.

*** So you also believe that new grads should spend a few years in one specialty (med-surg) before moving into a different one?

Being a critical new grad happened not to be a good fit for me...I felt as though the intangibles that I needed wasn't there for me. Now, mind you, this is NOT my first new grad rodeo...I had six months orientation as a LPN, and I started his position within 2 months passing my boards. I have precepted LPNs and RNs. I helped create protocols at my job. I know how the system works. I worked in a specialty as a new grad LPN.
This position was started one yet removed of my last clinical rotation, an I was still working at my previous job, but the move was so lateral, there really wasn't no "new grad curve." I was very vocal about it; however, when they have people lined up, you don't expect (at least I don't) expect people to invest their time in creating a successful nurse and team player,

*** Nobody is talking about doing that. What happened to you is what's known as being "thrown to the wolves".

My hospital has a decade of experience turning new grads into competent SICU, L&D, NICU, ER, MICU and PICU nurses with our 9 month nurse residency program followed by a year assigned to a unit mentor. Many of the more forward thinking hospitals also have this experience.

LadyFree28, BSN, LPN, RN · Jul 20, 2013

PMFB-RN, I rather have residencies that have the option to have M/S, Stepdown/Immediate care to a critical care setting, to give a new grad a feel of the fundamentals, feel of the nursing process in action, and give the new grad that transition. If it takes one year to 18 months to get comfortable. It would have classroom time, seminar and lab, where the expectations of the roles are defined. It gives and option to whether a new nurse will feel comfortable to be in Critical Care. Their nursing "career ladder" can be tailored for the future, even if it means floating and covering the unit, if they option to desire to enter in critical care in the future, if they needier ground work.

I was at a "forward thing hospital" who, for the past few years have been candid in having "issues" with helping new grads transition...it's been happening for a couple of years. That was the LAST hospital I wanted to work for as a new grad. It was pretty sad that my educational department orientation coordinator is very apologetic and trying to be PC about the dysfunction. And they are still tweaking it. There are other hospitals in the area that have programs that you speak of...and they have a better comprehensive programs for nurses at ALL levels. I will get my opportunity in the future absolutely...until then, I will build a better, competent nursing career :yes: I am responsible in doing that.

PMFB-RN, RN · Jul 20, 2013

PMFB-RN, I rather have residencies that have the option to have M/S, Stepdown/Immediate care to a critical care setting, to give a new grad a feel of the fundamentals, feel of the nursing process in action, and give the new grad that transition.

*** Of course. Months 2, 3 and 4 are spent working two 12 hours shifts a week on a med-surg floor with a trained (and rewarded) preceptor and two 8 hours shifts in the class room. It is a RESIDENCY program so that would be expected.

If it takes one year to 18 months to get comfortable. It would have classroom time, seminar and lab, where the expectations of the roles are defined.

I

*** Ya, it's a residency so all of that would be expected to be part of it.