Why such high new RN turnover? - pg.7 | allnurses

Why such high new RN turnover? - page 9

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?... Read More

  1. Visit  aanwyn profile page
    2
    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.
    Aurora77 and cdsga like this.
  2. Visit  DoGoodThenGo profile page
    2
    Quote from Calder
    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 <80 questions and so forth does not have *that* long in some places to prove herself/ him self clinically. Indeed hospitals have made it quite clear to nursing programs that they are *NOT* in the business of educating new nurses. Yes, they will provide training to bring a newly hired nurse up to speed to work in *their* facility, but not to the extent of covering what they consider basic nursing education.

    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.
    workingharder and anotherone like this.
  3. Visit  cdsga profile page
    0
    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.
  4. Visit  DoGoodThenGo profile page
    0
    Quote from cdsga
    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".
  5. Visit  cdsga profile page
    0
    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?"
  6. Visit  daconlon profile page
    1
    Quote from Calder
    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
    cdsga likes this.
  7. Visit  brick195969 profile page
    1
    If you got into nursing to be the smartest person, best paid, or to denigrate other's by infering that nurses are the only providers who care about patients, nursing doesn't need you. Long hours, major responsibilities, major liabilities, missing your pets and loved ones, taking care of other's families and sometimes not your own, not to mention relationships suffering, thats nursing.
    The only reason to get into nursing is to nurse, you have to love it. I know alot of nurses are not going to like hearing this but to bad, I love nursing, I love being at work, and more than anything I care about my patients.

    I had a meeting for recertification for ventilators (LTV1150 to be exact) and tracheostomy care for home health patients , pediatric patients. The trainer made a comment in front of many nurses (not recerts but new to this type of care, the ratio of recerts to new to this area nurses was 10-1 in favor of the new nurses) that the parents of these patients are "crazy". I had to immediately defend the parents, stating that this type of blanket statement is terrible. Many parents could be specialized nurses in the field that their child suffers, based on their knowledge of their childs condition. The parents often know the ins and outs of treating the patient, they just lack nursing jargon. Broad brush painting is horrible, of course there are some parents more difficult to deal with than others, but unless they just do not care about their childs care, they are doing the best they can. I digress, but in a way it still relates to what we are discussing. Nurses adjust, period. Love what your doing and you can tolerate anything. Do your best every shift is my motto, keeps your nursing strong, keeps your liscense strong.
    Cuddleswithpuddles likes this.
  8. Visit  Cuddleswithpuddles profile page
    1
    Quote from brick195969

    I had a meeting for recertification for ventilators (LTV1150 to be exact) and tracheostomy care for home health patients , pediatric patients. The trainer made a comment in front of many nurses (not recerts but new to this type of care, the ratio of recerts to new to this area nurses was 10-1 in favor of the new nurses) that the parents of these patients are "crazy". I had to immediately defend the parents, stating that this type of blanket statement is terrible. Many parents could be specialized nurses in the field that their child suffers, based on their knowledge of their childs condition. The parents often know the ins and outs of treating the patient, they just lack nursing jargon. Broad brush painting is horrible, of course there are some parents more difficult to deal with than others, but unless they just do not care about their childs care, they are doing the best they can. I digress, but in a way it still relates to what we are discussing. Nurses adjust, period. Love what your doing and you can tolerate anything. Do your best every shift is my motto, keeps your nursing strong, keeps your liscense strong.
    Considering how shallow and rushed many of those ventilator certification courses are and how quickly any ventilated patient can turn for the worse, I would be a crazy parent too.
    Not_A_Hat_Person likes this.
  9. Visit  bradleau profile page
    0
    I have had medical students work at a nursing home, as a CNA, for experience and of course pay. You get to know your patient and the care issues. I was a relief nurse for this nursing home while the regular nurse was on vacation. My CNA's were very helpful in letting me know about changes in their patients. It seemed that all I had time for was making medication rounds and calling the doctor with lab results. I could not do assessments on 30+ patients other than a quick check when I passed their meds. It is up to you to decide what you would like to learn. CNA's have a very busy work schedule, feeding, cleaning, bedmaking,all the stuff that nurses have to do. I think with the work load pressure, it would get you into the mindset of logistics when a nurse. It is a whole new ballgame once you become a RN. I started out as a LPN/VN working several years in nursing homes, private duty, visiting nurse, and hospital nursing including the ER. I studied for my RN and worked several years on the same floor at the same hospital where I worked as a LPN. No problems with my advancement. We have had CNA's become RN's . They felt it helped a lot.


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