High Fail Rate for new Grads on Boards

Nurses General Nursing

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I work in East Texas and have noticed a alarming trend, our new grads are failing their state boards at a alarming rate (60 % from our local junior college). Moreover, all these new grads that were hired as GNs cannot be fired to make room for nurses that have passed their boards for a least 3 months ( when they retest).

Is this trend national or local in nature? Also, as a preceptor I have noticed that many of our new grads are competent in clinical skills ,but have no idea of what is going on with their patients (disease process). Can I get some feed back and possible suggestions on what can be done to fix this problem?

Thanks Jerry RN, BSN

Specializes in ICU, nutrition.

I'm responding to several posts, so be patient with me.

I'm a new BSN grad, just passed boards with 75 questions last month. I took a live NCLEX review and really got a lot out of it, although I wasn't expecting to. I felt that my nursing school had prepared me for the NCLEX but I know how terrrible my study habits are, so I figured it would be four days of forced studying, then I could go take the test and be done with it.

The main thing I got out of the course that I didn't get from nursing school is that the NCLEX expects you to answer questions like a NOVICE nurse. That is totally different from the expected answers on our tests in nursing school, where they were trying to teach us to think like EXPERIENCED nurses. So an expected abnormality (like an abnormal lab value because of a drug) would require the novice nurse to seek guidance from someone who knows more, but the experienced nurse would expect it. So if you encountered an NCLEX question that stated an abnormal lab and a particular drug therapy, the CORRECT answer would have to do with getting help, not expecting the abnormality.

I don't know how I would have done on my state boards if I had not understood this. We were taught how to think one way in nursing school, and then expected to think a different way for boards. This may have something to do with a high fail rate on the NCLEX, except for one thing: the national pass rate is in the 90s (the last time I heard). So either most graduates who take the test have been filled in on the little secret, or there are not enough questions on the test that experience vs. novice is the focus so it does not matter. It could be that most nursing schools are teaching toward the NCLEX and not worrying about whether or not their grads actually know what they are doing.

I got a lot of clinical experience in my BSN program, although I don't think it was enough. I'm working in ICU and the "seasoned" nurses (I'm certainly not going to say OLD!) agree that the thing that scares them the most about new grads is when they have the attitude of knowing everything. I know more than they think I know, but I do not have the attitude of knowing very much at all. If I've never done something, I'm honest and admit it. If I don't quite feel comfortable doing something, I get some help. There have been some things they expected that I knew how to do that I don't know how to do. For instance, I didn't know where the heart monitor leads went. I carry my IV book around with me and look stuff up ALL THE TIME, way more than I did in nursing school. If I just gave a drug last week and I can't quite remember something about it, I look it up again. I try to do things the way my preceptor likes (my first one liked IVPBs to go in over 30 min unless it was something like vanc, my current one likes them over an hour) if it really doesn't make a difference whether I do it my way or his way. I know once I'm out of orientation I'll be able to do some things my own way and I'll come up with my own routine of getting things done.

I originally thought I'd get my year of experience then go to anesthesia school, but I've realized I won't know enough to do well in anesthesia school with just one year of experience. But I have not marched in there and told ANYONE that I'm just there to get experience for anesthesia school. The person who posted that someone had said that to them must have been dealing with a real idiot! Besides, not many people manage to get into a CRNA program with one year of nursing experience, even though that's the MINIMUM requirement. And what does that say to your co-workers, who are training you only so you will leave for bigger things, and probably feel like you think you are too good to be a bedside nurse. I'll tell you something. I work with some INCREDIBLE nurses and I don't think I'll ever be as good as them, no matter what area of nursing I'm working in. They have a gift, something inborn that makes them just spectacular at what they do.

I need to get off here and catch a nap before my shift tonight! I really enjoy this message board!

Specializes in Critical care.

Mattsmom81

I am the CNS for hospital in south TX for their critical care services (Tele, SICU and CCU). I do a little bit of everything, mainly competency stuff, orientation program, help teach in the critical care course, help teach ACLS and BLS. But the main thing I have been working on is orientation packet that incorporates that PBDS stuff that has been discussed here on this BB not too long ago, and right now I am working on a plan to get all of the RNs checked off on competencies before their evals are due in April. I still help with patients if they are short, I will help transport patients out of the ICU and CCU, or go to CT or MRI with patients if there is no nurse available. I end up taking patients maybe once a month for 4 hours usually 3p-7p, though I have stayed til 11p on a few occasions. Many of the nurses think I do not like taking patients, but I really do not mind. I miss it sometimes. I miss the hourly pay, I'm salaried now, miss only working 3 days a week too. But I am lucky I have a pretty cool boss, that has let me do my own thing, so I get to set my own hours (this is the greatest benefit). I like my job, it keeps me busy.....

Specializes in SICU.

Konni, you sound like a new grad I'd like to precept. Unfortunately there are ones out there that are not quite so interested in learning from a "seasoned" nurse's experience.

As far as carrying a book around and what not, I STILL look things up. I get "brain cramps" and would never compromise a patient with the attitude that I know it all.

As far as those nurses that are there for the "golden year" for anesthesia school, what a LAUGH. I want to know who they're paying off to get in that soon. I work with nurses who have YEARS of ICU experience, and they're sweating entry. I'd like to know what anesthesia school REALLY accepts an RN with only one year of experience.

And now I'll climb down off of the soapbox. :)

JWRN, sounds like you have a NEAT job! I enjoy the 3 day /12 hour shifts too and that would be hard for me to give up too.

Kimberly, I'm the same way...I look stuff up all the time too and go to every seminar I can to keep current! Always something new out there...

Konni, I've got a feeling your ICU nurses are enjoying you! I also love precepting nurses who present with a mature and interested attitude. Guess I've been running into a few immature egomaniacs lately...LOL...and they tend to rub us 'oldies' the wrong way. Good luck to ya although bet you won't need it...you're right on target!

As far as the new NCLEX...how strange that sounds to me. Sounds like it must be confusing to totally switch gears like that. Reminds me a bit of my old LPN boards ---'tell/ask the RN' was always correct if it was a choice...even if we KNEW what to do we had to dumb down to pass the test. They didn't want to see 'too much' independent action and maybe this is where they're coming from with NCLEX too??? What's everyone else think?

Originally posted by Healingtouch

In my neck of the words, used to be pretty hard to get into ADN school. They only accepted 40 out of 280 applicants the year I got in (1994). Since then, according to one of my former ADN nursing instructors, both the quantity of applicants and the quality of applicants have dropped. The school is now accepting students they never would have dreamed of letting into the program just 8 years ago. Perhaps young women are now pursuing other options; perhaps all the bad press have turned off a lot of potential applicants.

When I was in nursing school, our community college had the best record in the state for passage of the Boards--100% passage rate for many years in a row. That has changed also :(

What state are you in???That sounds alot like my school....I chose my school because of their reputation for being very hard but with a 98-100% pass rate on NCLEX for many years....they've now dipped into the 70's??!!!! They told me the same thing about the quality of the applicants both for the reg. RN program and the LPN mobility to RN. They are closing the mobility program for just that reason. Here in Alabama the universityies pass rates have dropped right along with the community colleges so.......its got to be either the NCLEX itself(I heard its changed in the last 2 yrs tooo) or a problem recruiting the better qualified students. I wish the burned out nurses would keep their mouths shut, just because they burned out does not mean that nursing is a horrible profession, and we as happy nurses need to speak up!!!!!!!!!!!

Specializes in ICU, nutrition.

Mattsmom81 and SICU Queen, thank you very much! I think the reason I have a mature attitude is twofold: first, I'm a little older than some of the nurses they are precepting (28 instead of 22 or 23) and my mom has been a nurse for what seems like a zillion years, so I understand the gravity of what I am doing and the responsibility that I have. I am thankful for the preceptors who risked their license to train me while I was waiting to pass boards. I am glad I was able to work before I took the NCLEX (certainly helped the family budget!:D) but I'm not so sure its a good idea to allow graduate nurses to practice nursing under a temporary permit. Because I was doing well, my preceptor would often just let me handle things till I came to him with a problem. But he was potentially risking his license if I did something I wasn't supposed to. I think he knew that I would let him know if I didn't know what I was supposed to do in a situation, but what if I had given him the impression that I had everything under control and then I didn't? I remember back in my clinical days, there were some students who had the teachers convinced that they knew what they were doing, but they really didn't, and they were constantly having to be bailed out by classmates or floor nurses. Scary, isn't it?

Got my ADN at a TN school which emphasized test taking skills and gave plenty of practice tests. NEVER went to a lab to learn injections, dressings, etc. Said I would learn that on the job. They were right. Passed NCLEX first try but was really stressed out on first job. Now work in Longview and got BSN at UTT. Noted many students have poor reading skills. That could be a problem with test taking as the questions are not written like we talk. Maybe more emphasis should be taken on test taking skills. Ideal would be to balance that with practical skills but HEY, the school's real job is to prepare you to pass that test. Just my opinion

JWRN,

I hope your orientation package will include training on PBDS style. Situational learning. This is not taught in nursing school. The only thing like it that I have seen is the old ACLS megacode.

Specializes in ICU, ER, HH, NICU, now FNP.

Here all the pass rates for the Texas schools as of 12/2001 -

ftp://www.bne.state.tx.us/nclex10.pdf

Well, I CAN say that I have recently worked with students of the same nursing program that graduated me 14 years ago... and these girls have it a WHOLE lot easier than we did. I have also worked with students from other nursing programs and they also have a much, much easier path to their degree than we did. Back in my day, to prepare for clinical, we got our assignments the day before (2 patients), had to go to the hospital and for each patient, study the chart, write down EVERY SINGLE lab value, tell why it was ordered, what it was for, what the value meant, write a brief exposition on the diagnosis and the patient's h&p, get our own history and HTA, write that up, make up drug cards on every medication the patients were on (no pre-made ones, that was cheating), write up a care plan with at least 5 nursing diagnoses and cite author, title,page, and paragraph # of the book we got our nursing intervention from (and care plan books didn't cut it...had to be nursing texts)...

and if one of our patients was discharged, we had to do it again on another patient. We turned in our paper work the first morning of clinical, got it back that afternoon usually with a lot of red marks on the care plans that we had to go back and correct; and had to have that done and our interventions documented and evaluation also filled out on our care plan and turned in at the end of clinical the next day. The students I've worked with mainly observe, rather than take on patients and provide their care; the instructors are nowhere to be found (ours followed us and STAYED on our BEHINDS) and they take breaks with each other when they choose (breaks??what are those?). The students I've seen don't actually provide patient care until their preceptorship right before graduation...we hit the ground running back in our day.

Any question why new grads are having trouble adjusting to the work world and have insufficient clinical skills now?

Babs

I notice students in my area doing some very disturbing things---they are apparently allowed to get away with it today...it would NEVER have flown when I was in school, either Babs! Sounds like we attended the same school. My instructors were on me like fleas on a dog..LOL...and I was competent on graduation!

Students today call my nursing station, ask for the charge nurse then ask for a 'report' on an 'easy' patient 'on 'only 1 or 2 meds' for them to take tomorrow. I tell them get their butts in and research their own patients...not my job to do this for them. (I'm a grouchy ol' charge nurse...bwaahahah!) Who tells them to call me, I wonder???? As if I don't have enough to do....:(

Students also call me on the phone to ask me drug questions. I tell them "Look it up." Reply: "I don't have a drug book". Well, duh. Better get one, sweetie, you are going to need one...believe me...I am not going to spoon feed you this data...and I sure hope nobody else is either...

Are nursing schools today shirking their educational duties and short changing students in order to 'put out' a grad in today's nursing shortage?

I graduated with my ADN in May of last year. We had to go get our patient assignments the day before, spend hours with the chart and then all night looking up drugs, making cards, researching all the labs, pathophys reports, just like Babs did. Same kind of careplan too, with nursing diagnoses and rationales for every single intervention, referenced in APA format. I guess my program was "old fashioned"? But then again our school has a high pass rate also.

I am working in the ICU, have been since last July. There is still so much I don't know!! I think it will be at least 2 years before I can confidently call myself a "critical care nurse". The staff I work with is wonderful and honest, and the feedback I have so far is very good from them. Even the ones who don't think new grads should be allowed to go into critical care (and they will tell you to your face) say that they "got lucky" when they hired me. That makes me feel good! I am doing my best to learn more every day.

One "veteran" nurse told me she still learns something new everyday, that's the great thing about nursing.

Lots of people in my class were there for the wrong reasons, to capitalize on the shortage or as a stepping stone to working for a pharmaceutical company. And yes, many acted like they "knew it all" when the opposite was true. It was mostly the younger ones (I am 29). I hope the "real world" of nursing set them straight.

As for the money issue of it being cheaper to hire new grads, my pay rate is not very much below what the 15 year nurses are making (much to their dismay--- and they have every right to be paid much more than me). Plus the hospital paid for me to go thru a 3 month critical care internship program. I realize this did not come out of my nurse managers budget, but the cost had to be figured in somewhere. It is also true that I am more amiable and don't argue with the administrative changes and all the things the other nurses complain about---I am too busy learning to do my job safely and effectively---but that is changing quickly! Especially the other day when I had FOUR patients assigned to me. You betcha I was in her office about that one. So yes, at first we are more meek, but we catch on to what is going on and start speaking up within the first year :)

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