Do you feel more people are entering nursing only to become APRN's? - page 4

I am not a nurse yet, but I'm an EMT, have worked in and around the hospital, and I am currently finishing my last two prerequisite courses before applying for ABSN programs. It seems like 90% of my... Read More

  1. by   JKL33
    Quote from Ruby Vee
    Unfortunately, I'm at one of those academically inclined magnet teaching hospitals.
    Add this to the list of contributing factors.

    Elements of it are great and elements of it have been disastrous. I'd say the disasters outweigh any decent intentions anyone might have had.
  2. by   KatieMI
    Quote from Ruby Vee
    I don't know of any place that routinely treats new grads either poorly or unsafely. In fact, the core of new grad orientation programs seems to operate on the idea of "Treat them well and they will stay." To the point where RNs with hard-won seniority have been asked to give up many of the percs they achieved only through seniority (choice of holidays off, first dibs on vacation time, seniority as criteria for bidding into more desired shifts or rotations schedules, etc.) in favor of new grads who were just hired. "If we don't let them have some of those percs right now, they will leave." And they leave anyway.

    New grads aren't poorly treated. Many of them are just too special to realize that working nights, weekends and holidays isn't evidence of poor treatment, it's just part of the job.
    That sounds very unfair. (and regarding calling parents... there I truly feel sorry for you.)

    BTW, it is also not likely to lead to much results. I can only speak from the point of "too smart" person, but what would hold someone like me in place would be chances to develop as a clinician, not working schedule my way. Free subscription for AANC classes for the first year, for example. "Perks" like you describe have little to no attraction for really smart people who know for sure what high-rank nursing grad school entails.

    Did anyone of your administration actually try to speak with or poll recent new grads or students in local schools to know what their expectations, beliefs and preferences and make correlations by their experiences and educational achievements? If no, that could be a nice capstone project for some in Ed/Leadership program and results can be used by your facility.
  3. by   llg
    Quote from JKL33
    It wasn't always this way. What do you think has changed?

    I will reluctantly engage in this conversation again because I think there has been a blatantly obvious negative change - and it pre-dated the situation in which we now find ourselves by a long shot. .
    You make some good points. There is a, "Which came first, the chicken or the egg?" element in this situation. I believe all "sides" of the situation evolved simultaneously. It's more complicated than "1 aspect caused another."

    But ... now that we are in this mess ... we have to consider all of the elements simultaneously in order to move forward. Anyone, looking at any angle is likely to make matters worse by focusing on only 1 aspect of the situation.

    1. Yes, some nurses have been treated very badly by the many elements within the health care system. That needs to stop.
    2. Some nurses come into hospitals with woefully inadequate preparation for the complexities of the job they have accepted. That also needs to stop.
    3. Some schools have the hidden agenda of wanting to recruit their undergraduates into their graduate programs -- and do so at the expense of their preparation for hospital-based careers. I talk to many, many students who have NO knowledge of career pathways "up the ladder" for hospital-based nurses. The only things they have even heard about are the programs offered by the school they attend. We should try to stop that, too.
    4. As alternative roles have become more available to nurses, we need to rethink the basic career advice given to students about the necessity of "1-2 years of bedside experience." I have heard many experienced nurses say that -- both hospital-based nurses and faculty members. That philosophy is hurting our hospitals' finances severely and causing more strain on the staff nurses who work at the bedside. New models of education/training are needed. We can't keep counting on the hospitals to provide such education to people who have no interest in working in the hospital.

    A lot of work needs to be done and many different fronts to address this problem -- both to make hospital roles more attractive -- and to get those people with no interest in hospital work out of our hospital education programs.
  4. by   llg
    Quote from WestCoastSunRN
    I think you're both right. And I think the answer lies in solutions that speak to all the angles.
    I agree. See the post I just made.
  5. by   llg
    Quote from CKPM2RN
    Hey hiring managers with high turnover--hire people like me! This is my second career, I have an ADN and I plan to stay in one place until I'm at least 65--that's fifteen years. I want to be "only a bedside nurse", no aspirations for advancement.
    Great. But are you willing to get that BSN? We need nurses with BSN-level knowledge to take care of the complex patients we have at our tertiary care center.
  6. by   llg
    Quote from SurfCA40
    You've had parents call....you're kidding me, right? Aye....
    I've had parents call me because they didn't want their precious babies to have to get immunizations prior to employment.

    I've had parents come with their new grads for job interviews and be offended because I wanted to interview their baby privately.

    I've had parents call as THEY tried to fill out the employment application for their precious baby.

    Such parents are shocked when they are told that we need to deal directly with the RN applicant -- and if their precious baby is interested in the job, she should get in contact with me herself.
  7. by   SurfCA40
    Wow. I'm not really sure what to say about that other than its rediculous.
    Last edit by SurfCA40 on Sep 15, '17
  8. by   KatieMI
    Quote from llg
    I've had parents call me because they didn't want their precious babies to have to get immunizations prior to employment.

    I've had parents come with their new grads for job interviews and be offended because I wanted to interview their baby privately.

    I've had parents call as THEY tried to fill out the employment application for their precious baby.

    Such parents are shocked when they are told that we need to deal directly with the RN applicant -- and if their precious baby is interested in the job, she should get in contact with me herself.
    One word... WOW.
  9. by   JKL33
    Quote from llg
    You make some good points. There is a, "Which came first, the chicken or the egg?" element in this situation. I believe all "sides" of the situation evolved simultaneously. It's more complicated than "1 aspect caused another."

    But ... now that we are in this mess ... we have to consider all of the elements simultaneously in order to move forward. Anyone, looking at any angle is likely to make matters worse by focusing on only 1 aspect of the situation.

    1. Yes, some nurses have been treated very badly by the many elements within the health care system. That needs to stop.
    2. Some nurses come into hospitals with woefully inadequate preparation for the complexities of the job they have accepted. That also needs to stop.
    3. Some schools have the hidden agenda of wanting to recruit their undergraduates into their graduate programs -- and do so at the expense of their preparation for hospital-based careers. I talk to many, many students who have NO knowledge of career pathways "up the ladder" for hospital-based nurses. The only things they have even heard about are the programs offered by the school they attend. We should try to stop that, too.
    4. As alternative roles have become more available to nurses, we need to rethink the basic career advice given to students about the necessity of "1-2 years of bedside experience." I have heard many experienced nurses say that -- both hospital-based nurses and faculty members. That philosophy is hurting our hospitals' finances severely and causing more strain on the staff nurses who work at the bedside. New models of education/training are needed. We can't keep counting on the hospitals to provide such education to people who have no interest in working in the hospital.

    A lot of work needs to be done and many different fronts to address this problem -- both to make hospital roles more attractive -- and to get those people with no interest in hospital work out of our hospital education programs.
    Good thoughts.

    5. We can begin efforts to repair some of the damage done (from within) to the general respect given to the position of bedside nurse. Honestly - - why can't bedside nursing be a well-respected "goal" from within nursing - - at least as respected as other things like Infomatics, Infection Control, Unit Educator, etc. I think something is very wrong when you can't get very far on the "clinical ladder" or enjoy much respect for "merely" being an excellent bedside nurse. I admit it makes me a little flabbergasted (at the world, not at you, llg) because the need for nursing care is THE reason patients are hospitalized - [I'm simplifying but that is generally true] - and they need excellent care! How is Staff RN the lowest possible rung on some ladder?

    6. We do need to figure out what happened to experienced bedside nurses - why they chose to go away or why they weren't wanted, however we want to look at it. Their absence affects many things like stability of the unit and especially teaching newer nurses to provide excellent care. The general situation we're discussing is going to grow bigger before we can get a handle on it merely by the fact that advanced intermediates or "competent" new nurses a) cannot adequately teach someone just a little less experienced than they themselves are and b) will have a very hard time trying to survive a "patient load" + precepting obligation. And they are starting to be the only ones left around to precept and orient others. I don't know, but I would think this only accelerates the hemorrhage...
  10. by   KatieMI
    Quote from JKL33
    It wasn't always this way. What do you think has changed?

    I will reluctantly engage in this conversation again because I think there has been a blatantly obvious negative change - and it pre-dated the situation in which we now find ourselves by a long shot.

    I very honestly and sincerely believe your basic premise is wrong. You are focusing on the fact that it may not matter as much now what we offer newer nurses - that no matter what we "invest" in them we can't get them to stay. That is because the tide has turned and the word has spread.

    Nurses have already spent the better part of a decade or so (more or less depending on location) hearing things like, "The need to think critically is where errors happen. We must reduce this need. We are looking at all possible areas where we can eliminate your need to employ critical thinking." Yes, I have sat in group upon group where non-nurses told us this very thing and much more. Our nursing leaders went along with it. The direct result of this is that anyone who wanted to be a nurse for the art (heart) and science (mind) of it now finds this situation intolerable and unethical. It certainly doesn't compel anyone to aim for being an acute care bedside nurse.

    The "best and brightest" nursing has to offer do not enjoy entertaining crazy ideas like scripting. An intelligent person does not find such ideas acceptable, generally-speaking. Do you think new and experienced nurses, alike, enjoy being told point blank that no one here wants them to employ critical thinking? What about any of the other countless bad or even unethical ways we are told to perform our jobs these days? What about "improvements" (barriers) that are thrown down just for the sake of "change" or "optimizing our value stream?"

    I will assume you have seen the post here on one of the subforums where a non-nurse "guru" has come asking how he can make our lives easier and "reduce nurses' stress" by using technology to help us recognize which patient we are caring for and what room we're in and what kind of isolation precautions are needed, and inquiring about problems we might have with isolation signs. This sort of "thing" is going on everywhere now. But...nurses are intelligent people of ethics. I believe the crowd has spoken and they/we aren't buying it. In fact, nurses are fed up with it and done. As you are seeing. They now want to work at the bedside only as a means to get somewhere else. I think that's a pretty logical and expected reaction.

    llg, with all due respect, I will implore you once more to see that you have this backwards. You are looking at the fall out of some very bad decisions and (I believe) coming to incorrect conclusions.

    This doesn't matter for argument's sake, it matters because no correct interventions can be deployed without considering this angle/premise. Acute care units, generally-speaking, serve the sickest patients in the country. It behooves all of us to be painfully honest about this situation. Nurses' intelligence has competence has been completely de-valued.
    I think you're absolutely right.

    This is an overall tendency, as I can see. There are not many areas of well-organized human activities left in developed world where critical thinking, flexibility, creativity and strive to discovery and implementing new and non-standard things remain welcome and valued qualities. If a manager of fast food restaurant cannot use shriracha till The Big Fat Powers of Corporation tell him to do so, although every second customer is asking about it, it is the same story as when a nurse gets written up for using second pulseox on a leg of patient who is on watch for the limb ishemia because "we never do like this here". It is situation when policy-kissing substituted for common sense. It is when people continue to do the same things even if they are invariably lead to the same results. It is when requiremetns and conditions are clearly not possible to follow, yet enforced with draconian force. It is when whatever can be done with a human being as long as it could be made looking like "professionally".

    I do not know when it will end, but 100000+ people dying every year in US hospitals due to "preventable" medical mistakes plus the fact that the population of the USA shares "general level of health" with some third-world countries look like quite a clear evidence that system is not working satisfactory on any level. I wonder why so many RNs are still hold on the worst parts of it like on the last straw.
  11. by   CKPM2RN
    Quote from llg
    Great. But are you willing to get that BSN? We need nurses with BSN-level knowledge to take care of the complex patients we have at our tertiary care center.
    Let's see...enter a BSN program...pay 25-35k for said program...work another 10 years after that. I'd rather not since it doesn't pencil out well. Perhaps I will take the less glamorous job in your step down unit or telemetry. Med-surg sounds good too. (I use the word glamorous as a jest related to other subjects on this forum.)
  12. by   WestCoastSunRN
    Quote from JKL33
    Good thoughts.

    5. We can begin efforts to repair some of the damage done (from within) to the general respect given to the position of bedside nurse. Honestly - - why can't bedside nursing be a well-respected "goal" from within nursing - - at least as respected as other things like Infomatics, Infection Control, Unit Educator, etc. I think something is very wrong when you can't get very far on the "clinical ladder" or enjoy much respect for "merely" being an excellent bedside nurse. I admit it makes me a little flabbergasted (at the world, not at you, llg) because the need for nursing care is THE reason patients are hospitalized - [I'm simplifying but that is generally true] - and they need excellent care! How is Staff RN the lowest possible rung on some ladder?

    6. We do need to figure out what happened to experienced bedside nurses - why they chose to go away or why they weren't wanted, however we want to look at it. Their absence affects many things like stability of the unit and especially teaching newer nurses to provide excellent care. The general situation we're discussing is going to grow bigger before we can get a handle on it merely by the fact that advanced intermediates or "competent" new nurses a) cannot adequately teach someone just a little less experienced than they themselves are and b) will have a very hard time trying to survive a "patient load" + precepting obligation. And they are starting to be the only ones left around to precept and orient others. I don't know, but I would think this only accelerates the hemorrhage...
    yes, yes, yes! The bedside nurse being at bottom of clinical ladder is a problem, for sure. There needs to be incentive to continue in education -- especially hospital-based educational offerings/ and certifications for bedside nurses to grow into true experts. Nobody educates other bedside nurses like an expert who is still on the front lines. If you could keep experience at the bedside, you could have higher standards for preceptors. Honestly, there could/should be a certification for it with minimal clinical hour and continuing ed. requirements. Also incentives for staff RNs to participate in committees and have REAL input on unit policies, norms and culture.
    Safe staffing is a HUGE aspect of respecting/protecting patients and nurses alike. Getting the consumer on board in getting safe standards to get passed, nationwide, is worth the effort.
  13. by   Susie2310
    Quote from llg
    Great. But are you willing to get that BSN? We need nurses with BSN-level knowledge to take care of the complex patients we have at our tertiary care center.
    BSN level knowledge needed to take care of complex patients at a tertiary care center?? May I ask what you perceive are the components in BSN nurses education that make nurses with a BSN better qualified to take care of complex patients than ADN/Diploma nurses? I ask genuinely, as a nurse with an ADN and a BSN. You do know that nurses with an ADN/Diploma take care of complex patients? Tertiary care isn't rocket science.

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