Why such high new RN turnover?

Nurses New Nurse

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My understanding is that new nurses (recent graduates) are the most likely to leave the field. If true, why is this? Is it because they underestimated the job's demands?

Specializes in Assisted Living nursing, LTC/SNF nursing.
A lot of the hospitals here in Florida are getting rid of the patient care techs....so if you plan on being a nurse, you better make sure you're ok with doing a lot of what a typical CNA would do for the patients. I can understand why turn over is high for new grads....it is crazy out here. I've been a nurse for over 7 years & even I am getting fed up with the shortstaffing, poor pt to nurse ratios, the constant berating of HCAHP scores & how we (the nurses) need to do better.....even though the hospital chooses to keep us running with as few nurses as possible. Our poor new grads are started out on med/surg with 7 patients, no techs and no secretary. If I had started in an environment, I would have turned around & ran the other way.

I don't think it's so much that older nurses are eating their young......rather they are too overwhelmed themselves to help very much. I am not jaded towards nursing.....nursing is a fine career. It is when administration thinks because a nurse "can"...that they "should" do everyone's job. We put in our orders, we are doing respiratory treatments, now they are telling us to make sure we clean the rooms on a daily basis.....as well as emptying the trash & laundry. Cater to not only the patients, but their families also...because 60% of the patient satisfaction surveys are filled out by family members. Remind doctors to do this or that. Call doctors with results of tests....and in turn get yelled at by these doctors for bothering them with results.

Where is the nursing in all that? We are being turned into a jack of all trades & then blamed when something doesn't go right. Lab messes up a time or a order....well, the nurse should have caught the mistake & corrected it....or the nurse should have noticed no one from lab drew the blood at the exact time & the nurse should have made a call to remind lab to draw the blood. The doctor orders the wrong test or doesn't give a reason why a test is ordered....the nurse should figure it out or follow up with the md. MRI is ordered but the dept is taking awhile to get the patient...the nurse should call & find out why they are taking so long. Pharmacy is questioning medications, have the nurse call the MD to clarify & then call the pharmacist to follow thru on clarification. Pharmacist still doesn't agree? The nurse should keep calling until it is resolved. Why can't the doctor & pharmacist talk to one another? No one around to answer the phone, the nurse should drop everything to answer the random unit phone calls. It goes on & on & on. Put the nurse in the middle & then blame the nurse for everything that isn't perfect. That is not nursing!

OMG, I couldn't have explained it any better than this :bugeyes:

I have just completed my first 11 months as a new RN (2nd career with lot's of other work experience). The first 4 months were the worst work months of my life. I really, for the first time in my life, began to doubt whether I was up to it. I stuck with it and things got better and better. I feel much more confident now and am able to handle the job. I am always aware of how much there is to learn. I say give it 6 months at least.

Specializes in Oncology; medical specialty website.
A lot of the hospitals here in Florida are getting rid of the patient care techs....so if you plan on being a nurse, you better make sure you're ok with doing a lot of what a typical CNA would do for the patients. I can understand why turn over is high for new grads....it is crazy out here. I've been a nurse for over 7 years & even I am getting fed up with the shortstaffing, poor pt to nurse ratios, the constant berating of HCAHP scores & how we (the nurses) need to do better.....even though the hospital chooses to keep us running with as few nurses as possible. Our poor new grads are started out on med/surg with 7 patients, no techs and no secretary. If I had started in an environment, I would have turned around & ran the other way.

I don't think it's so much that older nurses are eating their young......rather they are too overwhelmed themselves to help very much. I am not jaded towards nursing.....nursing is a fine career. It is when administration thinks because a nurse "can"...that they "should" do everyone's job. We put in our orders, we are doing respiratory treatments, now they are telling us to make sure we clean the rooms on a daily basis.....as well as emptying the trash & laundry. Cater to not only the patients, but their families also...because 60% of the patient satisfaction surveys are filled out by family members. Remind doctors to do this or that. Call doctors with results of tests....and in turn get yelled at by these doctors for bothering them with results.

Where is the nursing in all that? We are being turned into a jack of all trades & then blamed when something doesn't go right. Lab messes up a time or a order....well, the nurse should have caught the mistake & corrected it....or the nurse should have noticed no one from lab drew the blood at the exact time & the nurse should have made a call to remind lab to draw the blood. The doctor orders the wrong test or doesn't give a reason why a test is ordered....the nurse should figure it out or follow up with the md. MRI is ordered but the dept is taking awhile to get the patient...the nurse should call & find out why they are taking so long. Pharmacy is questioning medications, have the nurse call the MD to clarify & then call the pharmacist to follow thru on clarification. Pharmacist still doesn't agree? The nurse should keep calling until it is resolved. Why can't the doctor & pharmacist talk to one another? No one around to answer the phone, the nurse should drop everything to answer the random unit phone calls. It goes on & on & on. Put the nurse in the middle & then blame the nurse for everything that isn't perfect. That is not nursing!

Dr. orders the "wrong" antibiotic for surgical procedure; nurse should call doc and "remind" him that per SCIP protocols, blah, blah, blah...

ok, everyone all together! ::looking for that little musical note font:: "everything old is new again!"

i wasn't real thrilled with my first job (in 19 smumblemumble), but i stuck it out, and lo, in four or five months i got into the swing of things, started knowing what was going on, got my leash loosened a little more each week, and ended up being asked to take evening relief charge and to help students with their observation days in my 17-bed pacu by the time i'd been there 7 months. then...we moved.

my next job was no picnic either, but guess what...in four or five months i figured out what was going on in the 20-bed mixed med/surg/neuro/open heart critical care unit. that year our icu inservice people oriented over 200 people for our unit. do the arithmetic-- that's a lot of turnover, although the turnover was mostly new people coming in, not liking it or washing out, plus the usual number of spouses-getting-transferred and new-babies. the staff were mostly young, most of us

so, you have to excuse me for not buying a lot of this whine and cheese. if you were to ask me why so many new grads come and go so quickly, toto, it would be because they don't expect to work hard, are terrified of new experiences, and (i get so tired of saying this) come from the everybody-gets-a-big-trophy-just-for-showing-up generation. sure, it's fine to have good self-esteem, it is. but you know what? pretty much everybody else doesn't care whether you feel good about yourself or not. they do care about whether you will be a good coworker who will pitch in, take some responsibility for self-development, and stop looking for someone else to blame your problems on and fix them for you.

off soapbox.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Ha! Esme, I knew I liked you!! You responded to my 7 paragraph tirade with a great 7 paragraph response of your own!

Yes, you did hit a nerve. I hear so many comments from nurses who ridicule and undermine other professionals I finally let loose! I've sat in meetings, classes and symposiums where I hear the same trite comments from different nurses, "We are the true patient advocates", "Nurses are the only ones who care about the patients" I sometimes wonder if these nurses even know what they're saying.... They seem to just repeat these mantras to make themselves feel good.

No, I wasn't responding to your overall comments about the burdens of nursing, the difficulties encountered by nurses and the reasons we become frustrated. The 'yelling at the lab' comment struck a chord (yes, in your case figuratively, but too many times, literally).

I knew I liked you too.....:lol2::hug:. You got the humor! That's hard online.;)

I feel as though I have a unique perspective here.

I'm a nursing student right now at the age of 30. I have a Bach. and Masters and before this, I practiced as a veterinary technician. It's the equivalent of an RN, Nurse Anesthetist, surgical tech, radiology tech, and dental hygienist, and the dreaded "lab technician". It requires licensure and has the option of a 2 or 4 yr. degree. I have to agree with Esme12 on her post. In my clinicals in nursing, I'm amazed at the behavior of some newer nurses and the "It's not my job mentality". I did it all, cardiology practice, emergency practice, general, and orthopedics in the veterinary world.

After my latest human ER experience, I just can't believe some of what I've seen. Half of me would prefer to be treated in the Animal ER, where as a tech, I would transport the patient from the room, draw the blood, urine, feces, etc. for the lab, place the IV catheter, get the fluids started, actually DO the labwork, chart the lab work, report to the vet, take the radiographs (anesthesia often required), do treatments every hour, get the patients to the potty, recover them from anesthesia, maintain anesthesia records, mandatory TPRs q4h on ALL patients, charting all of the above and observations. Administering all meds, IV, IM, SQ, PO and charting these, discharging patients, changing dressings and bedding, infection control, taking out trash, wrapping and sterilizing packs, mandatory checks, tests, and maintenance of instruments, monitors, IV pumps, anesthesia equipment and accessories, faxing records to primary vets, and for an average of 30 patients per night. Throw in a 3 hour emergency surgery (prep, induction, anesthesia admin, monitoring, warming, recovering, clean-up, clean sx suite, wrap packs, autoclave, CHART!), a barium series, and at least three toxicity cases (emesis induction, gastric lavage, activated charcoal) and you'd have my average 12 hour shift at a veterinary ER.

Sadly, these techs make half the money of RN's, get half the respect, and seem to do TWICE the work. If a tech I was supervising went in to do treatments or meds considered "licensed staff work" but neglected a wet patient sitting in their own filth, waiting for the assistant to do it, I would have fired her. Yet we see that all the time, "I'll send someone in to change you in just a minute." is something I've heard far too often in human hospitals, LTC, etc.

I may be feeling a bit jaded today as I've just come off of clinicals and I don't know the full job yet because I'm just a student BUT where does this mentality come from? I guess I just fully expect that nursing is a running, sweating, crazy job only for people who thrive in that type of environment. I'm entering nursing because I found in the veterinary world that I really like helping people, I'm good at the technical, and it seems more meaningful to me to help humans. Maybe it's the departmentalization of human health care that makes it so much more difficult. After all, when you don't do it yourself, you are forever reliant on scheduling, timing, and efficiency, let alone communication skills of the other departmental staff.

Specializes in ICU, PACU, OR.

As with any thing, generationally speaking, the nurses who have been nurses for 30 years+ understand that the workplace was much different than it is today. We paved the way for more autonomy, developed and staffed specialty units, went from glass to plastic, and paperworked and data collected ourselves into a paperwork situation. The more we try to get to the patient, the more we are told now to delegate those tasks away. It has grown and grown and grown into patient care on paper. Not saying it isn't done, but I'm just saying we are losing out on the most important part of why we became nurses. That's hands on patient care. If you find out you don't like patient interaction, there are alot more opportunities to perform as a nurse. IT, School nursing, industrial/prison nursing, military (even past the recruitment age), not to mention the higher degreed job opportunities in management and academia.

There are more and more people trying to make healthcare a business and there for a time (but I see it changing a little) the patient was considered a client. It's true to a tiny extent, but human bodies are not like a toilet that can be replaced if damaged during installation or repair. I don't know if new nurses, who are not yet experienced enough to know how to cope with that critical point. Sometimes there are no do-overs. It's very stressful when you think about the trust that patients give to the healthcare profession.

Technology has developed to the point that we can use it to think for us and sometimes DO for us. But it still requires watching and advocating for the patient when the technology doesn't work. Some new physicians don't know how to do surgery the "old fashioned" way. Ex. Open gallbladder procedures vs. laparoscopic gallbladder. Experience is the best teacher, and what I am saying is that the student nurse does not, for the most part, get a number of experiences under their belt to feel comfortable enough to handle the stress and fear of venturing out on their own. I am also afraid that we don't have enough staff to adequately do the school of nursing's job teaching real clinical situations to them on the clinical units.

Similar threads have been posted to that effect, and the same conversation has been stated over and over. The question, to me, is how do we get people in charge to listen and keep from losing beginner nurses?

Specializes in Acute Care Psych, DNP Student.
If you find out you don't like patient interaction, there are alot more opportunities to perform as a nurse. IT, School nursing, industrial/prison nursing, military (even past the recruitment age), not to mention the higher degreed job opportunities in management and academia.

As a correctional (prison) nurse I find this statement very odd. I'm sure school nurses and military nurses would as well.

Specializes in ICU, PACU, OR.

I meant to say in a traditional hospital setting. Sorry for the oddness-just trying to give the options out there.

Specializes in Med Surg - Renal.
Yes.

And if I see one more "Hi, I'm an MBA that was not doing well in business and decided to become an RN to CRNA as fast as I can, so I can make Beaucoup bucks and have a guaranteed job", I will run screaming amok.

Well sister, stretch out those hammies and warm up those vocal chords cuz this joint is silly with 'em.

As a student about to graduate in May 2012, I can tell you that many of my classmates seem to have unreasonable expectations about the nursing profession. Many of my colleagues continue to make statements like "I can't work nights!" or "I refuse to work holidays.".

I'm not sure that they had a clear understanding of the profession when they decided to become a nurse.

It's because they don't realize the demands, crazy schedules, call-ins, responsibilities & fast pace that an RN is required. Many don't realize that they may have to work in a Nursing Home to get experience. They think they will be able to jump right into a hospital or doctor's office.

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