How to support New Grads....?

[Darknights]

Our DON has admitted that morale in our hospital has decreased over the last two years and is now rock bottom. We have been critically shortstaffed and an attempt to address this was to hire a lot of New Grads. Due to the resignations recently it turns out we are still really shortstaffed and struggling to cope, but now it is worse because there are so many New Grads and we just don't have the time or ability to support them.

They get three shifts as supernumerary, then they are expected to function as any other nurse on the team. I've found that in the last two weeks the LPN and I working with the New Grad have seen a huge increase in the load we've had. Instead of three of us showering six patients each, two of us are doing up to 16 every shift. One shift it was 17. The New Grads are always keen to give out medications, but when they average half an hour per patient so that meds for six takes three hours, then a shower takes them the rest of the shift........what are you supposed to do?

I am told we have to support them. When I hear the New Grads are complaining to the DON about the lack of support they are getting I feel extremely frustrated. I know I can't be there to hold their hands every minute, because I am buried trying to do the work they can't do as well as my own work.

I suggested to my manager that perhaps we should forget about the New Grads giving out meds and focus on their time management with ADL's. Once they have mastered that we can start them giving out meds. She said we can't do that as they would really complain.

One New Grad has already upset the LPN's by telling them it isn't her job to do showers, her job is to tell them what to do. That might happen elsewhere but it doesn't happen here, there aren't enough LPN's to do the ADL's. She was the one who took half the day to give meds, then the rest of the shift to do one shower, after attempting to get the LPN to do it when I wasn't around.

The next morning the same New Grad didn't turn up for her shift. An hour into the shift my manager rang her at home. She said she'd slept in and now that she was awake felt like a day off so wouldn't be coming in. When asked if she'd told the Supervisor she wouldn't be coming she said she hadn't, but she might do that later.

We are really getting flak about our New Grads not being supported, and how they were hired to help us and we aren't treating them right etc. The nurses who already had extremely low morale just feel like this is yet another thing to knock them down.

I can't see a solution for how to get the ward to work with all these New Grads, and how to give them an experience where they feel supported. Obviously taking on the majority of their workload isn't an acceptable solution for them either.

FWIW, nursing students come out here and say they have a grand time. We determine within a few hours whether it is safe to let them loose or not, then have them on the ward as a functional member of our team. Unfortunately they are often counted as team members by admin, so we are forced to work our students hard. I always apologise to them, but they seem to like feeling needed.

I guess it is easy for us to do this when we don't have the fear of litigation like you do in the U.S. No patient has ever been harmed and our students usually leave after four weeks, able to take on the care of six patients.

We just don't seem to be able to do this once they become New Grads.

[ckh23, BSN, RN]

How does your DON let that behavior go unpunished? They are setting a bad precedent. New grads or not, that kind of behavior is unacceptable. You should really mention to your DON about trying to work on retention program to work on keeping nurses instead of hiring and saturating the workplace with new grads because with the attitudes you described it sounds like they might be scraping the bottom of the barrel. If your DON wants to hire a lot of new grads than there really should be some type of program in place that gives them support and gets them up to speed, but does not place heavy workloads and burdens on the current staff.

[kimmie4476, ASN, RN]

First off, for the load and duties you are talking about, 3 days of orientation are not enough for a new grad. You have to remember that new grads have NO sense of time management, that comes with experience, so you guys expecting that after 3 days they can handle the same load as you is unreasonable. How about something like a residency program or something like that for the new grads? Let them "graduate" to a full load of patients..you can even start them out with say 4-5 pts each (total care) for a week, add another pt the next week and so on and so forth. Remember that it is extremely overwhelming for a new grad (not to mention terrifying) to walk out onto that floor knowing that they are responsible for lives, and it sounds like you guys are basically using a "sink-or-swim" approach to training. Let me tell you a story about what it feels like to be a new grad (and maybe remind you how YOU felt) I got my LPN and immediately started work at a small community hospital..worked there for a couple of years, then continued working there all the way through the rest of the nursing program for my RN. Now you would think that after working at the same place for a few years that nothing would change after I got my RN I mean, after all it was the same job, it's just that now I could hang blood and give IV pushes right? WRONG! I was terrified for the first few weeks after getting my RN. Something about how you are now completely responsible for what happens I guess lol. Anyways, I couldn't imagine how much more terrified I would've been if I had to start out at a new place as a new grad.

[linearthinker, DNP, RN]

Take care of your own patients and let them sink or swim. Holding their hands isn't doing them any favors. The patients might miss a shower here or there, but the new nurse will catch on - or she won't and you get someone who can.

[OldNurseEducator]

Take care of your own patients and let them sink or swim. Holding their hands isn't doing them any favors. The patients might miss a shower here or there, but the new nurse will catch on - or she won't and you get someone who can.

Amen to that .

[Darknights]

I started here as a New Grad so L know what it is like. I graduated from university with a degree and 12 weeks practicum experience. I did 3 supernumerary shifts when I started my employment. My fourth shift was my first afternoon shift and I had a CNA help me to care for 13 patients. I had only those previous three shifts as experience in caring for surgical patients.

At the start of my second week L had night shift, with an LPN to help me care for the ward of 26 patients. When I'd said I didn't want to do the in charge night shifts L was asked why. IT was eight years ago but I still remember my words.....'What if something goes wrong and I don't know what to do. The patient might die.'

The ADON replied, 'patients die. If a patient is going to die it won't matter whether you are a New Grad, or a veteran, they will still die.'It didn't reassure me.

What happens to our New Grads is wrong. It shoudn't happen. But what I am asking is how the hell can we get all the work done every shift AND support them. Remember that the work they can't do is more work for us and we were struggling before they arrived and the staff were all fully functioning nurses. We now average two New Grads on a day shift with four other nurses. It is like working two short every shift and the four having to do the work of six.

I don't know what the answer is.

[hotflashion, BSN, RN]

Where are you located and what kind of facility do you work at? How acute are your patients? It sounds like you work in long term care? When I read stuff like this I think "union."

[netglow, ASN, RN]

You know I read this stuff, and I'm thinking that your DON keeps dumping the entire responsibility on to you. It is your DON's responsibility to make it all gel. Your DON needs to do his/her job (bet s/he can't). Your DON's job is to put an organized program for edu together complete with competency check-offs FOR EVERYBODY.

IMHO, nobody should be DON without proven record of management ability. DONs must be able to build.

[Isabelle49]

Where are you working? Sounds horrible. I think union too and if not, you should strike or walk out. So glad I'm close to retirement.

[Darknights]

I am working in a very remote hospital in outback Australia. It is a 5 1/2 hour drive to the next town. We have to fly critically ill patients interstate for care as we are too far from city hospitals in our state.

My ward is general Medical/Rehab. Our patient population is acute stroke and MI patients, chronic care patients, oncology, psychiatry, palliative care, dementia pts with behavioural issues who the one local nursing home refuses to take, detox, rehab.

The union doesn't get involved because we are so remote that nurses don't want to work here. However, I always say that if they looked after the nurses here they would actually stay. 4:1 ratios have just been approved for this state but we've heard our hospital will be 5:1. That seems a stupid move as it isn't going to encourage anyone to go remote. We've also been told that our ratios will depend on staffing and they can't enforce mandated ratios out here if there are no nurses.

We are a 70 bed hospital. Last year we were short 30 RN's -FTE. It became a news story when it was discovered that the hospital had never even advertised for more nurses.

[Simba&NalasMom, LPN]

O.M.G.!!! Not showing up for work just because you feel like you need a day off?!?! That has nothing to do with new grad vs. experienced. That is just not grownup behavior; even when I worked at McDonald's as a teenager we would have been fired for that kind of nonsense.

I, too, am sympathetic to what it feels like to be a new grad and scared green; however, this prima donna act is inexcusable. I'm sorry your management is being less than supportive of you.

While I'm not wild about the concept of throwing new grads to the wolves, I'm inclined to agree in this case with the poster who said to let them sink or swim on their own. Some people apparently just need to learn the hard way, and you have patients of your own to care for.

[Darknights]

O.M.G.!!! Not showing up for work just because you feel like you need a day off?!?! That has nothing to do with new grad vs. experienced. That is just not grownup behavior;

What programs are in place for New Grads in the U.S? Are they just given a couple of days supernumerary like here, or are there extended programs?

When staff are run off their feet it is ridiculous to expect them to hold a New Grads hand. Last week when we had two New Grads on day shift it was like being two staff short. So we ran around doing the extra work, while the New Grads did very little, then complained about our lack of support.

I'm also wondering what the nurse educators are doing and why they aren't helping the New Grads......