Why such high new RN turnover?

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Miss Kitty00

85 Posts

Specializes in Med_Surg, Renal, intermediate care.

I'm taking care of my patients and baby-sitting the other departments. It just too much sometimes and that's why nurses are getting burnt out.

Miss Kitty00

85 Posts

Specializes in Med_Surg, Renal, intermediate care.
. I personally think that new grads don't fully understand that nursing is not cute scrubs, hanging out with cute doctors, and taking home a decent paycheck. If you put in perspective, the amount of time, work and responsibilities they do not equal the pay. I think this pays a hugh part in the new grad turn over. They have unrealistic expections and when reality hits, they bail.

My motto: there is more to nursing than cute scrubs, starting IVs and taking home a nice pay check.

cdsga

391 Posts

Specializes in ICU, PACU, OR.

from loby7641 "just from looking at these boards it seems like there is a lack of leadership developed and the leadership is silo'ed so you have each group thinking they are important..."

this is a critical point. in my experience, once taking a job as a nurse in a leadership job role, you are placed in classes to learn how to lead, delegate appropriately, be accountable, deliver evaluations and practice useful counseling techniques, develop teams, deal with conflict, hr issues etc, etc. the issue i see is not that the information and education is there or offered it is how you utilize that information once you have completed those classes.

there is a big disconnect in knowing that establishing yourself as a leader is a thankless job. your reward is seeing the team come together, work toward goals, and seeing some successes along the way. leadership is the crux of everything. it establishes trust in workers, provides direction for your departmental goals, provides continuous feedback for process improvement, helps establish acceptable behavioral guidelines, and allows people to do their jobs in a safe and supportive way. it's a very challenging job. if leadership is weak, the employees will behave in a way that causes much turnover.

even the most stressful jobs can be tolerable if leadership support is provided and a positive team morale is expected and monitored.

as an employee the best you can hope for is a leader who is tough but fair. you are not always going to like the assignments but a good leader won't leave you on your own without relief and is not involved in cliques or favoritism.

i can tell you that i have worked in the most horrible staffing situations in my career, but my entire group of icu and pacu nurses worked together on assignments and personal support that we became family. our patient care was exemplary and we did not want each other to leave-so turnover was negligible. we trained new nurses very carefully and gave feedback directly to the new employee and ensured that they would fit in and learn the tricks of the trade.

sad to say when i look back on my career i have had 2 times in 34 years where we had teams that cohesive. when you have that great team environment you learn to value it and seek it again and again. work load is lessened because you work together, and you actually can enjoy your work because you have help, less fear because you network, share and learn to seek help when needed, knowing that it will come.

i hope every nurse can find an environment where they can thrive and shine. learning new things daily is key, and being able to rely on your co-workers and they can rely on you is also the way to build teams and keep new employees from leaving. we all have been new at one time, and it is scary, exciting, and exhausting getting through that period. new nurses need to know from their peers what is expected of them, and they need to be checked when their behavior or clinical work is not up to par. we also need to get to know them on a personal level. you don't have to like one another, but there are commonalities in all of us.

i had a new nurse who was reported to be "stand-offish" "snobby" didn't say much to anyone and was having headaches everyday. when i counseled her she said she had nothing in common with anyone. she was an intern and we had invested much time and money into her, she was ready to leave. her lack of wanting to integrate herself on friendly terms with others on the unit was driving her off. i had to remind her that she did have things in common, if she had to go back to the basics, that she was a human being, she had eyelashes, fingers, toes-talk about something human! she had come across as a diva and as such she had placed herself on a pedestal and no one was worthy to even associate with her. as it turns out, she took these words to heart, starting making conversation, talked about her family, her hobbies, and found out that the unit supported her in those endeavors and shared similar interests. she liked to cook, and they liked to eat! blow me down. she's since had a baby, and now she has more in common with the rest of us than she realizes. sometimes you have to get back to basics.

Because nurses are smart.

RN, LAc

4 Posts

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?

I believe units are hiring the wrong graduates due to some bias around who should be a nurse. I see bias all the time on this site against those who did not choose nursing just out of high school. As if this makes someone a superior nurse.

I was a career changer in my mid 30's in nursing school. As a provider in alternative medicine, I used to treat 30+ patients daily. I had confidence, excellent organizational skills, assessment skills, knowledge of charting, how to speak to family members, etc. The patients were not acute as they are in hospitals, however, I had life experience and knowledge & experience of patient care. I am also very adept with procedures. During clinical rotations in nursing school, many RNs were asking if I was applying to their floor because they wanted to work with me.

The other "older" graduates and I watched in horror as the units gave job offer after job offer to the very young, inexperienced, nurses with a history of making errors, no life or clinical skills or experience of ANY kind. Older graduates are more likely to understand the job and what is expected of them. The posters complaining of the "whiny" new nurses who refuse to work weekends and holidays, night shifts, etc are no doubt speaking of younger graduates without any significant work history.

Don't know why this happens, but it frequently does. I never got the coveted first nursing job. Sometimes I feel like I dodged a bullet.

I think being a PCT for a while (I was one for 6 mo.) helped me a lot. Where I worked, the techs did a lot. They did vitals, baths, picked up trays (gave the trays to ones in isolation), emptied foleys, and at the time put the foleys in (they have since changed that policy), they got the tele boxes and hooked them up, they got the SCDs and hooked them up, trash/linen/ice, feeding patients, charted, and gave report. That shouldn't be any different really from any PCT/CNA job. But, think about it, you get familar with the equipment (I honest to God had zero hospital experience, so I had no idea what tele and SCDs and other equipment was until I had to use it on a routine basis; nursing clinical helped a little, but unless you had a pt needing this stuff, you never saw it); you have to learn time management, we got around 8-9 pts on a good day, and 11-12 when the floor was full; and it teaches the charting, which is something that most people have a difficult time with. In addition, I am a shy person normally, but I had to become more talkative. I still was shy after, but the more experience I got, the better I became. Plus, when I am done with my medication passes and whatever else, I try and help the techs out.

Anyway, RN turnover...I had an experience not too long ago that really made me think "do I really want to do this or am I cut out for this?" Another nurse was hanging TPN and I wanted to go and WATCH. Instead, I was supposed to hook it up. I had no clue what I was doing and it was obvious by me wanting to watch and that was the first exp. with TPN I had had. I got the lines tangled up and had to lay the bags down. Well, of course, that gets air in the line due to the bag being lower than the pump (none of the bags were infusing). Easily remedied by either re-priming or taking a syringe and removing the air. The nurse tried not to say anything, but actions speak louder than words. It was obvious she was angry. I felt terrible, but I had never dealt with TPN before. I couldn't help but think "I hope things get better or I have no idea how long I'll last" because I feel like experienced nurses don't remember what it was like as a new grad. We DON'T get experience in everything in school, especially because the schools are competing for spots (too many programs) in hospitals. They can only have so many students on the floor and between shadowing programs and other nursing programs and new grads, there's no room. So, then, we have very little clinical experience overall, yet we are treated like we should know everything. Part of nursing is on the job training. So, give your new grads a break and they will stick around. Too much lateral violence in nursing :(

Specializes in HD, Homecare, Med/Surg, Infectious Disease.

I think it actually is beneficial to have been a CNA first. I was a student nurse tech while in nursing school which was pretty much a CNA but w. the ability to do certain add'l things typically exclusive to the nurse. It helped me when I became an RN because I understood just how stressful being a CNA is and also it helped me understand that as the RN yes you should indeed help toilet your pts and at some times clean poop. I'm not a super seasoned nurse but the fact that I am always willing to help the CNA's I work with has created a mutual respect between us. I most certainly correct CNA's who think I am going to sit around and do their job for them, but I never tell them I cannot help them if I really can. Cleaning poop, toileting is still within your scope of practice and I think having done it prior to becoming a nurse humbles you quite a bit. It also opens your eyes to the stress they experience while at work. CNA's or any ancillary staff need to understand that while you can do their job, they cannot do yours. Therefore they must understand the times when you say "no" as long as it isn't all the time. If you have your CNA's back, they will have yours. Sometimes they will be the ones to save your hide. They will often notice things about your pt that you won't because they spend more time w. them. I cannot count the number of times when a CNA has told a nurse "something is not right with this or that pt." and when the nurse ignored them the pt. ended up coding and/or had to be hospitalized from an SNF. They are an absolute necessity. Respect and help them and they will usually do the same for you.

DoGoodThenGo

4,129 Posts

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?

IMHO a few reasons:

First so many persons have totally no clue as to what nurses do; that is the day in and day out grind of bedside/unit nursing. We live in such a sanitized culture today that our young people and even adults just cannot deal with goo,poo, and spew. There is a notion amoung many new nurses that dealing with such things is "aides work" and as nurses they won't ever be called upon for such tasks.

Next is the fact out of necessity and or design many nursing programs have cut back on clinical hours in favour of classroom and or lab work. This could be the result of things such as too few local hospitals or facilities to accomodate students, and or not enough instructors. Then there is the question of not just the quanity of clinical time but quality. Spending eight hours a day on a floor when several are spent just walking around or worse studying/doing other work rather than actual bedside nursing isn't going to help with one's exposure to the practice nor understand what is going to be expected post graduation.

Back in the old days when local state boards were only given once or twice a year, hospitals have newly hired graduate nurses (GNs) by and large considerable leeway and that included long orientations. They pretty much had to as the need for nurses demanded fresh recruits and that always couldn't wait six or twelve months for grads to pass the boards.

However today with the NCLEX given like clockwork virtually most facilites no longer hire GNs and expect newly licensed RNs to hit the ground running, or close to it as possible. This means that even a new RN who graduated with a 4.0 average, passed the board exam with

It has most always been that case that new grads needed time to bring themselves up to speed. Depending upon the type and quality of whatever nursing program they attended this could be weeks to months. Some of the old diploma schools were famous for producing grads that could go from student to professional nurse with what seemed merely a change in uniforms/caps and not missing a beat. Things such as time management, assessment, med passing and other skills do take time to master.

Finally there is the fact new grad or not a nurse these days seem to be only as good as their last error. There comes a time for any new grad when she or he faces the fact that person's lives are in their hands. One error no matter how small can cause an adverse reaction up to and including death. That is tremendous pressure to be under especially when one senses the facility does not have one's back. Many new nurses start, work and end their shifts with their stomachs in knots. With little or no support many feel it's best to leave before something happens and they are thrown under a bus by management.

cdsga

391 Posts

Specializes in ICU, PACU, OR.

Not to mention as soon as you get a process down, they change how you do it, telling you that the way you used to do it or was taught to do it is no longer the JCAHO way. So just a short time to learn a couple times to practice in real time, then be confused and overwrought thinking did everything I learn wrong? Only those who have been in the business long enough learn to roll with the punches and wait for the cycle to turn again. Remember team nursing, then primary care nursing, then back to team nursing? The list goes on and on. You have to be resilient nowadays.

DoGoodThenGo

4,129 Posts

Not to mention as soon as you get a process down, they change how you do it, telling you that the way you used to do it or was taught to do it is no longer the JCAHO way. So just a short time to learn a couple times to practice in real time, then be confused and overwrought thinking did everything I learn wrong? Only those who have been in the business long enough learn to roll with the punches and wait for the cycle to turn again. Remember team nursing, then primary care nursing, then back to team nursing? The list goes on and on. You have to be resilient nowadays.

Primary care in theory should produce the outcomes it was designed to address; better patient care via a single nurse per shift responsible for the total care with perhaps the assistance of an aide. However the stuff hits the fan when you try to run the scheme with team nursing staffing.

That is to say in order for primary care to work there has to be adequate and safe staffing ratios on an unit or floor. Assignments must also suit the nurse in question. New grads and or inexperienced nurses shouldn't be given more than they can handle and even then require supervision.

Rather than staff up to meet the demands of PC, hospitals and other facilities find it easier (and cheaper) to go back to the team nursing model. That way they can stick one, two or whatever nurses on a floor with horrible patient ratios and the word from management to the charge is "make it happen".

cdsga

391 Posts

Specializes in ICU, PACU, OR.

i really think that's what administration found out about primary care nursing. it took too many nurses to provide the care necessary to provide what the theory espoused. it is cheaper to have fewer nurses and more techs. therefore-back to team. theorists don't care about money-therein lies the crux of the matter-bridging theory into practice and profit, then nurses make it happen so they can maintain their employ and then the nurses burn out quicker hence the job turn. it's a win-win for the hospital, even though it costs reportedly 50k each nurse. [color=#454545]according to a leading healthcare [color=#366388]employee retention[color=#454545] expert, the number one hidden cost in the industry is nurse turnover – $50,000 per exit on average. and at least one study cites wide span of control – or a high number of direct reports below each manager – as being the highest predictor of staff turnover.1from “leadership, span of control, turnover, staff & patient satisfaction” by mccutcheon, and campbell, 2005[color=#454545]learn more about the impact of high manager/nurse ratios by downloading this free executive brief:

"how much staff turnover is ok because of extreme manager/nurse staff ratios?"

daconlon

4 Posts

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?

There is no simple reason for this problem. But there are some contributing factors that I can identify.

It seems that nursing schools, especially universities have little or no interest in producing a clinically competent graduate nurse. They focus on academic and higher level nursing concerns at the expense of real time in the trenches. I am now in grad school for nursing education and I am convinced that the professors feel that practical training is beneath them, and they have abdicated this responsibility. As a result, new grads do not have a clue about the day to day for a bedside nurse and they are shocked and disappointed. At my university, there is tremendous emphasis placed on the idea that new nurses move quickly to nurse practitioner role and leave the bedside. They seem to not care about training nurse educators or undergrads, either.

There is value for the student to work as a CNA for a few months, just to get acclimated to a busy med-surg environment, and to develop a comfort level with patients. It is not the same as real nursing but is one big component of it.

At a conference several years ago, a PHD nurse professor made a big point about the difference between "training" and "education". This is just more conceit on the part of the universities. This distinction helps no one at all. I am very fortunate to work for MD Anderson in Houston. They have a nurse residency program, which is sort of an extended hand holding period. The new grads love it and stay at the bedside longer. They are actually pretty good. Other hospitals don't always have such a thing.

Good luck

David

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