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.

[LadyFree28, BSN, LPN, RN]

Well, that should be the rule not the exception.

It should not be based on a particular hospital, region, all nut one hospital etc...

That's what I'm advocating for.

My experience is nothing new in the past years of this particular hospital. The level of transitioning has had a pendulum swing between to extremes, then the expectation to "hit the ground running."

The other hospitals in the area have "transitional" programs, clinical ladder models, balanced approach to learning the system and transition exercises, such as your program that you are involved with. I just found myself in one of those hospitals struggling with it...and I found another organization who is successful with theirs, fortunately.

Looking forward, I will continue to enjoy my career and all it's journeys that I have endured. I will still reach my goals, and advocate at the bedside and do what I can; nursing is changing, and to me, for the better; now, we must make sure that the schooling and transitional period is up to par, and I don't mind doing my best to find better solutions.

[FMF Corpsman, MSN, RN]

I actually agree with FMF Corpsman about specialty nursing.

LadyFree28, You almost made that sound as if it was something hard to believe. At any rate, I applaud your efforts to achieve your own goals in your own manner and not allowing roadblocks to be put in your way. As I said in another post, those in HR and Administration who design and set up these programs really don't have a clue as to what might be best for you, in fact they aren't working to make things better for you at all, they could even be working against you. Not even Career Counselors know everything that will benefit you in the end, and unless you are paying them yourself, they don't actually work for you so their fiduciary is with someone else first. Only you know what your goals are and it is up to you to figure out how best to achieve them. It sounds to me like you have done that, so good luck and you will do well in your career.

[LadyFree28, BSN, LPN, RN]

LadyFree28, You almost made that sound as if it was something hard to believe. At any rate, I applaud your efforts to achieve your own goals in your own manner and not allowing roadblocks to be put in your way. As I said in another post, those in HR and Administration who design and set up these programs really don't have a clue as to what might be best for you, in fact they aren’t working to make things better for you at all, they could even be working against you. Not even Career Counselors know everything that will benefit you in the end, and unless you are paying them yourself, they don’t actually work for you so their fiduciary is with someone else first. Only you know what your goals are and it is up to you to figure out how best to achieve them. It sounds to me like you have done that, so good luck and you will do well in your career.

Lol. My editing apologies

Thanks for the support. I was moved by your original post because you touched on a TON of factors that do affect new and seasoned grads.

I think new grads owe it to themselves to utilize these experiences to make solutions at this point, in their future.

[decembergrad2011, BSN, RN]

I'm a year in, and I can tell you that it does get better. You do get more comfortable and learn to handle situations more calmly.

As far as ideas:

- While I was on orientation, I did not receive shift differential. It was not a huge decrease in pay, but it was a type of incentive to not linger on orientation and take it seriously that you are not a full staff member until you're flying solo. I think this is a good idea.

- I also got to go through a residency program, which had it's snore moments, but was also great support. So although I was on my own at work, I had a nursing support group and education session once a month for a year. I think this should be extended and be an offering for hospital wings/departments in nursing once a month.

- Preceptors typically must obtain a certain level on the professional development ladder (how raises are given outside of performance evals), so they are being paid for their work in precepting. The problem comes when certain preceptors always are training someone...I can see myself burning out.

I don't think you should be rushed into committees or extra commitments if you don't want to do them. Professional development is always great, but it comes in time. I'm not doing much else than what I mentioned above in addition to putting in my 36 a week!

[FMF Corpsman, MSN, RN]

Lol. My editing apologies

Thanks for the support. I was moved by your original post because you touched on a TON of factors that do affect new and seasoned grads.

I think new grads owe it to themselves to utilize these experiences to make solutions at this point, in their future.

It has been lingering in the conversation, but never really said out loud, those Nurses who try to fast track themselves and skip over as many steps as they possibly can, are doing THEMSELVES a grave disservice. They should be taking every opportunity they are offered or can find, to expound on their education and experience. Many nurses only take the CEU's that are required for re-licensure, and frequently at the last minute, while they should be finding educational offerings that are available in their particular fields of interest or practice, not because they need too, but because it makes them a better Nurse. This is a relatively inexpensive way to advance their knowledge and to network with other professionals who work in the same areas they do, but in different facilities. It is also a great idea to join professional organizations, depending on the situation; many of these things are tax deductable. This sort of goes back to the Nurse versus nurse conversation. If someone really wants to excel in their career, they need to be willing to work at it. You can only get out of it, what you are willing to invest of yourself. If you aren’t willing to put anything into it, you can’t expect to go far and trust me, if that is the case, you will live up to your expectations.

[SubSippi]

How would it even be possible for new grads to be fully competent on the floor right after graduation? More clinical hours means less time in the classroom, but since patients in the hospital now are much more sick than they have been in previous decades, I'm not sure if that's a good idea. It takes a strong base knowledge of these conditions to be able to learn how to care for these patients properly.

A friend of mine recently got a degree in nutrition, and her entire last semester was an internship, where she worked full time, and this was required for her to graduate. I don't think this would be a bad idea at all, I would have really enjoyed that.

[kbrn2002, ADN, RN]

It has been lingering in the conversation, but never really said out loud, those Nurses who try to fast track themselves and skip over as many steps as they possibly can, are doing THEMSELVES a grave disservice. They should be taking every opportunity they are offered or can find, to expound on their education and experience. Many nurses only take the CEU's that are required for re-licensure, and frequently at the last minute, while they should be finding educational offerings that are available in their particular fields of interest or practice, not because they need too, but because it makes them a better Nurse. This is a relatively inexpensive way to advance their knowledge and to network with other professionals who work in the same areas they do, but in different facilities. It is also a great idea to join professional organizations, depending on the situation; many of these things are tax deductable. This sort of goes back to the Nurse versus nurse conversation. If someone really wants to excel in their career, they need to be willing to work at it. You can only get out of it, what you are willing to invest of yourself. If you aren’t willing to put anything into it, you can’t expect to go far and trust me, if that is the case, you will live up to your expectations.

Wonderful in theory. I would love nothing more than to be able to invest time and money in furthering my education through classes and inservices. In reality, my employer has not given me a raise in 3 years, yet the cost of living has gone up considerably. My employer no longer offers training/tuition reimbursement or assistance...they did 3 years ago, that stopped when the raises stopped. My benefit costs [insurance] have increased while the actual benefits have decreased. This means I need to work more to maintain the status quo, getting ahead just isn't in the cards. Added to this tale of woe, classes are expensive as are most professional memberships. On the bright side at least I have an employer, there are many nurses that sadly do not.

[PMFB-RN, RN]

How would it even be possible for new grads to be fully competent on the floor right after graduation? More clinical hours means less time in the classroom, but since patients in the hospital now are much more sick than they have been in previous decades, I'm not sure if that's a good idea. It takes a strong base knowledge of these conditions to be able to learn how to care for these patients properly.

*** I would prefer to see a real and required nurse internship/residency required for new grads. Something like 6-12 months. of course they should be paid, but maybe at a lower rate. They should be subsidized by the government exactly like physician residencies are.

They could be competent on graduation plus 2-4 weeks of orientation. I would HAPPILY trade clinical hours for class room time. It's not as if all those classes a pharm and patho they are taking. Maybe one of each but we could cut the nurse theory down to one or two lectures and eliminate nursing diagnosis and a dozen other time wasters in nursing school. No reason at all, if we re-prioritize nursing school that each student couldn't' spend 24 hours or more a week working one on one with a trained and motivated preceptor for 6-9 months before graduation.

[LadyFree28, BSN, LPN, RN]

*** I would prefer to see a real and required nurse internship/residency required for new grads. Something like 6-12 months. of course they should be paid, but maybe at a lower rate. They should be subsidized by the government exactly like physician residencies are.

They could be competent on graduation plus 2-4 weeks of orientation. I would HAPPILY trade clinical hours for class room time. It's not as if all those classes a pharm and patho they are taking. Maybe one of each but we could cut the nurse theory down to one or two lectures and eliminate nursing diagnosis and a dozen other time wasters in nursing school. No reason at all, if we re-prioritize nursing school that each student couldn't' spend 24 hours or more a week working one on one with a trained and motivated preceptor for 6-9 months before graduation.

^

[SubSippi]

*** I would prefer to see a real and required nurse internship/residency required for new grads. Something like 6-12 months. of course they should be paid, but maybe at a lower rate. They should be subsidized by the government exactly like physician residencies are.

They could be competent on graduation plus 2-4 weeks of orientation. I would HAPPILY trade clinical hours for class room time. It's not as if all those classes a pharm and patho they are taking. Maybe one of each but we could cut the nurse theory down to one or two lectures and eliminate nursing diagnosis and a dozen other time wasters in nursing school. No reason at all, if we re-prioritize nursing school that each student couldn't' spend 24 hours or more a week working one on one with a trained and motivated preceptor for 6-9 months before graduation.

You're completely right about a mandatory internship. I think the hard part about that would be to find a spot for each nursing student.

[PMFB-RN, RN]

You're completely right about a mandatory internship. I think the hard part about that would be to find a spot for each nursing student.

*** I am convinced that there are VAST opportunities for preceptorships out there if students would be willing to go to nights, as the are likely to do when hired anyway.

Anyway limiting the number would be great. We produce too many nurse graduates anyway. Better that we should control the number of graduates like physicians do.

[FMF Corpsman, MSN, RN]

*** I am convinced that there are VAST opportunities for preceptorships out there if students would be willing to go to nights, as the are likely to do when hired anyway.

Anyway limiting the number would be great. We produce too many nurse graduates anyway. Better that we should control the number of graduates like physicians do.

The only problem with having an internship on nights is that there are far less procedures and therefore less learning opportunities in your average hospitals, then than there are on 3 to 11 and especially on 7 to 3. Or for those on 12's, 7a -7p. For those fortunate enough to be interning in Level One trauma Facilities, it might be a different story, but even then, chances of newbie's landing fresh traumas are few and far between there as well, and whoever does, isn't going to have the spare time to mentor a student or intern. However, the schedules may very just enough that they can get in more treatments and procedures on the other patients than those in lower status hospitals and LTC facilities.

Schools' cranking out far too many students has been a problem throughout the ages or at least since I was in school and graduated. My graduating class numbered 92 and we started with 130. A few years later someone started the never ending rumor that there was a nursing shortage, and it was true for a while, but it soon abated, but the schools keep turning out student nurses like a mother rabbit turns out babies, please do not take offense at that anyone, as I mean it in the best possible way. But there is now a glut of nurses and the ability for nurses to negotiate with HR or Administration effectively is non-existent, which leaves us with fewer benefits and at lower salaries in many areas of the Country. I know most of the Country is going through dire straits right now, but we started out at a lower place on the grid to begin with, so when the economy rebounds we will still be lower than most. We need to lobby Congress to initiate bills which will limit the number of students churned out each commensurate with the number of expectant retirees and nurses expected to leave the field to pursue other interests, thereby lessening the glut instead of increasing it.