[ShellsNYrn]

My orientation was ok - but I also think it depends where you work; if it's a good team or not; I got pretty lucky with my unit, as when I got off orientation and started with my preceptor, they all were very helpful, plus we have instructors who are designated to certain floors and they checked in with us too frequently enough so we weren't feeling abandoned.

Original Poster - I wish the best for you, whatever you decide to do

[SoundofMusic]

I'm so sorry you're feeling at the end of your rope.....

Well, I may have been misunderstood here. I'm not at the end of my rope in any way and plan to finish out all of my obligations to the hospital that hired me. Maybe this is all in the cycle of how new grads feel, but is it really a part of a cycle or a true symptom of an illness that is ailing this profession?

Yes, nurses sure do get burnt out on precepting . .and I wonder why? In addition to their shift duties, they're supposed to TEACH another nurse along the way. Teaching is a skill in and of itself!!! It helps to know teaching styles, what motivates an adult learner, proper teaching principles, etc. If preceptors are not "taught" to be preceptors, then who and what IS exactly the teaching process here with new orientees? I know at our hospital there is a preceptor course of some kind, but it's completed in a matter of days whereas true "teachers" take years to develop.

In my case, it's get out there and do it, come to me with questions, and maybe I'll answer them, maybe I won't, depending on my mood and my own current level of stress and responsiblity (my own preceptor sometimes even is assigned as charge nurse on the days she's also precepting me.) Maybe I'll answer politely, and maybe it will be with disrespect and hostility, especially if you annoy me with a question I think you should already know or that I dont have time to answer because I've got a million concerns of my own. Not to mention, I'll warn you over and over that if you DON'T do as I say that your license is "on the line" and several errors will lead to the loss of it.

I mean -- what is this? Is this really teaching? I blame it not on nurses, but on hospital administrators/powers that be for loading nurses up with such a huge responsibility beyond their scope of duties and not paying them more and giving them the adequate training to do it. I think nurses are doing the best job they can with what they've been given to work with, as always. But it's really not fair to them and definitely not to new grads who really need a good foundation to start their careers.

Again, I will say this: my hospital does an outstanding job at allowing us to attend classes, of providing us all the information we need to do our job. I get handouts, notebooks, guidebooks, everything I need to succeed. But out on the floor, you can't keep running to the books. You need the guidance of a kind, firm, knowledgeable and patient nurse. At least for a little while. And when you make mistakes, you don't need a brow beating. Yes, if you're making the same one over and over, there's a problem -- but if its something you've never been exposed to -- allowing room for error at least once or twice would be the humane thing to do.

I also apologize for the essay -- I hope I don't sound like I have some huge axe to grind, because I don't. I'm just offering this in hopes that maybe someone will really listen to it and make change. Maybe I myself need to come out with this to my own adminstration and effect change in my own hospital. Probably should. I know managers must go through hell listening to all the whining from their staff, but it might pay them to listen to it once in a while and take care of it -- maybe they would ease up their own headaches with staffing if they did.

I am trying just not be point out problems, but to offer a solution: a solid "preceptor' corps, brigade, whatever you want to call it. Identify those who can teach without belittling, pay them extra, and develop a stronger orientation process. The solution is just NOT that hard!

[RNperdiem]

I guess I see the word "teaching" and think of nursing school.
I don't put the blame on the hospital so much; their main focus is not on teaching nurses. I had a pretty solid orientation and preceptorship.
I wonder if nursing school needs to be extended to graduate new nurses who are really ready to work. In the olden days when every day was a clinical day, nurses began their careers with little orientation needed.

[SoundofMusic]

You make a good point. I graduated from a 2nd degree program where we didn't get much clinical time. I think that is a lot of it -- I wasn't taught all the simple clinical stuff, and didn't get much time in school on a floor at all. By the time I was following a nurse in school and starting to pull it together a bit, it was time to graduate.

I'm STILL learning the simple stuff. I've got the theories and the patho, but struggle with simple things like diet trays, how to work the wheelchairs, the IV pumps, etc. There are a million things to learn that just come with time.

[llg]

Originally Posted by SoundofMusic

You make a good point. I graduated from a 2nd degree program where we didn't get much clinical time. I think that is a lot of it -- I wasn't taught all the simple clinical stuff, and didn't get much time in school on a floor at all. By the time I was following a nurse in school and starting to pull it together a bit, it was time to graduate.

I'm STILL learning the simple stuff. I've got the theories and the patho, but struggle with simple things like diet trays, how to work the wheelchairs, the IV pumps, etc. There are a million things to learn that just come with time.

BINGO! This is why a lot of the old, grouchy experienced nurses get frustrated with new grads. Many are coming to us with minimal preparation and expecting the staff nurses to compensate for their lack of education.

Not all new grads of course. Some are wonderful people who have been well-educated.

As the profession has tried to accommodate the desires of students who want "the shortest route to an RN," the quality of the education has often gone down. It's not fair to expect the overburdened staff nurses to compensate for that.

Maybe its time we lengthened the nursing programs ... instead of streamlining them.

I guess I should put on a flame resistent suit now.

[cardiacRN2006]

Originally Posted by llg

BINGO! This is why a lot of the old, grouchy experienced nurses get frustrated with new grads. Many are coming to us with minimal preparation and expecting the staff nurses to compensate for their lack of education.

As the profession has tried to accommodate the desires of students who want "the shortest route to an RN," the quality of the education has often gone down. It's not fair to expect the overburdened staff nurses to compensate for that.

Maybe its time we lengthened the nursing programs ... instead of streamlining them.

I guess I should put on a flame resistent suit now.

No flames from me! Well said...

[Valerie Salva]

Originally Posted by BrokenRNheart

"In my own experience, my own management "team" did a really slick sales pitch for their unit. Once I joined the unit, it seemed their personalities changed almost overnight -- all smiles and wonder at the sales pitch, and all nasty, rude and demanding once you've been on the floor for a few months."

Here is a joke I was told about nursing recruitment:

There was this guy who passed on and he was given the opportunity to decide if he wanted to go to He** or heaven. He was taken on a tour for an interview to both places. When he got to heaven it was quiet and and pleasant and certainly looked like a place he could be happy at. But when he went to He** they were all partying and friendly and so happy. Everyone was so glad to meet him and telling him what a wonderful place it was and begging him to come stay there. After all that he heard about He** he just couldn't believe what he saw. What a wonderful place! It wasn't hard for him to make his decision. On his first day in He** it was hot, every one was nasty and mean and treated him aweful. When he asked what had happened, why they were so friendly and nice when he interviewed them, the Devil told him "That was the interview, we are always like that when we interview. This is what it's really like here."

I heard that joke a little differently-

A NURSE died and was given the choice of Heaven or Hell.

She tried Heaven first- nice, but a little dull and routine. So, she decided to try Hell.

Everyone there was so enthusuastic and so happy to meet her- they all called her by name, greeted her with a smile, and all the inhabitants, including a number of nurses, couldn't say enough about how great Hell was and how much they hoped she's join them.

So, she picked Hell.

When she showed up the next day, things were totally different. Everyone had a nasty attitude, did not acknolwledge her, or were totally rude. Morale was terrible, and everyone seems resentful and angry.

She approached another nurse and asked- "What happened? Yesterday, everything was great- today this place sucks. What's the deal?"

The other nurse replied "Honey, yesterday they were recruiting you- today, you're staff."

[elkpark]

Originally Posted by llg

BINGO! This is why a lot of the old, grouchy experienced nurses get frustrated with new grads. Many are coming to us with minimal preparation and expecting the staff nurses to compensate for their lack of education.

Not all new grads of course. Some are wonderful people who have been well-educated.

As the profession has tried to accommodate the desires of students who want "the shortest route to an RN," the quality of the education has often gone down. It's not fair to expect the overburdened staff nurses to compensate for that.

Maybe its time we lengthened the nursing programs ... instead of streamlining them.

I guess I should put on a flame resistent suit now.

My friend, the "thanks" button isn't enough for this one. I couldn't agree more. It's very fashionable now to grumble about how rigid, backward, and unenlightened nursing programs used to be, but it seems to me that that system turned out much better-prepared RNs than we do now. I freely admit I don't know the answers, but what we've got now doesn't seem to be working very well ... (And I'm directing my comments not at any particular poster or nursing program, but just in general ...)

[sshannon]

To anyone who wants a decent (not perfect) orientation, get thee to a Magnet-certified hospital that's using the Versant RN new nurse education model. I'm in the middle of my 18-week orientation and it's absolutely wonderful so far. The staff nurses overall (not just my preceptor) are very helpful and I'm feeling very supported. As I said above, nothing's perfect, but this definitely feels more like what I was hoping for.

[llg]

Originally Posted by elkpark

My friend, the "thanks" button isn't enough for this one. I couldn't agree more. It's very fashionable now to grumble about how rigid, backward, and unenlightened nursing programs used to be, but it seems to me that that system turned out much better-prepared RNs than we do now. I freely admit I don't know the answers, but what we've got now doesn't seem to be working very well ... (And I'm directing my comments not at any particular poster or nursing program, but just in general ...)

Thanks, elkpark. I certainly harbor no ill will towards any individual either -- and I wish the original poster all the best. In fact, I was struck by her comment that she is struggling with the basic things like diet trays and wheelchairs. Yes, each hospital's equipment and procedures are a little different, but a new grad should be familiar enough with these things to adjust quickly. It's not the hospital's role to have to go back and teach Nursing 101. That foundation should be established in school.

I happen to live in a community in which there have been several new RN programs established -- and in which old programs have expanded beyond their capacity to do a good job. For example, a local respectable ADN program has recently expanded beyond the number that they can find pediatric faculty for. Their solution? Graduate a cohort with NO peds inpatient clinicals! Another program has graduated several classes in which students only got 1 or 2 of the specialty rotations -- either peds, or OB, or psych -- but not all of them. We have a local trade school that spends most of its very limited clinical time doing "observations" because they are not in any one place long enough to get sufficiently competent to actually do any care -- and their faculty are not qualified to supervise complex inpatient care.

Based on what I see locally and what I read on allnurses -- there are a lot of programs that are now not actually teaching nursing. Instead, they have turned into test prep centers. They take the students' money ... give them the bare minimum legally required courses to sit for the NCLEX ... and then focus on test prep so that they can keep their NCLEX pass rates high enough to stay open. Students are going to these programs (and paying big bucks) because they don't want to invest the time to get a proper education. Being properly educated as a professional nurse requires many hours of practice and that is inconvenient and expensive. So ... they pick the quickest program with the fewest requirements -- the test prep programs.

Then the hospitals are stuck with RN's who never really learned how to be nurses -- and the staff nurses and unit leadership get blamed when these new grads struggle through orientation and decide to leave.

Instead of offering a real, long-term solution to the nursing shortage ...these "fast tracks" are making the problems worse by adding to the burden at the unit level and costing everyone lots of time, energy, and money that could be better-spent.