Is it possible that the shortened RN training causes more anxiety for new grads

Nurses General Nursing

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Specializes in RN, BSN, CHDN.

Over the past 5years or so I have noticed an increase in anxiety in new grads and I am wondering if the shortened training is causing more problems for them.

When I trained admittedly I trained many many moons ago I trained a full 3 years in a hospital, I know we did not have such hightened anxiety that the new Grads seem to have at the moment.

We got no preceptorship or mentoring and after 5 weeks I was in charge.

Nurse training changed because we complained we weren't support at all and the powers that be wanted to give new grads more support and education, taking them away from the floor for long periods of time.

We were more annoyed that we had so much work to do and the expectations were you hit the floor running.

It seems no different today the new grads hit the floor running with less knowledge and experience.

I know here in America we pay for our education so we want to complete the education in the quickest way possible so it costs us less money in the long run.

It is now more expensive to train the new grads on how to nurse which is great if they actually get the support, mentoring and training for at least 3-6 months but longer if they need it.

It appears that in the nursing profession we can not get it right!

I am an 8 month new nurse and it has not so gradually dawned on me that Nursing school did very little to prepare me for the job I am currently struggling in. My school wins awards and has a great reputation...translation: High NCLEX pass rate. The disconnect between school, orientation, and the day-to-day job is downright scary. I still don't feel safe as a nurse on a regular basis.

And my anxiety level is very high.

Specializes in RN, BSN, CHDN.

Eyeball I wish I could be your preceptor and help you through this horrible transition.

I promise you it will get better!

Specializes in Maternal - Child Health.

madwife,

I believe you are on to something!

My mom attended a 3 year diploma program in the 1950's. In terms of actual months of attendance, she had a longer program than I did 30 years later in obtaining my BSN. She went 3 solid years, save for a 2 week Christmas break. She had classroom instruction in science and other disciplines via a local university comparable to my general studies courses.

But she also had over 40 hours per week in every clinical setting imaginable, and like you, took charge even before graduating. She worked as both a psych nurse and L&D nurse in the first few years following graduation and needed no additional training for either job.

I believe the shift to college /university setting has had some advantages for nursing in terms of standardizing and improving the quality of science education, but has cost the profession plenty in loss of clinical access and limited clinical exposure of students.

Like the previous poster, I graduated from a BSN program of great reputation and virtually 100% NCLEX pass rate (in 1986), but without the ability to function independently in any clinical setting. We were told even back then that it was our employer's responsibility to prepare us for our jobs!

That has been the accepted norm for years, but is hurting new grads in this economy when employers understandably aren't willing to take the financial risk.

Some states have added an internship requirement of new grads. That probably helps, but extends the education period and costs, and takes the responsibility away from nursing schools where it really belongs.

I also bemoan the elimination of "graduate nurse" status by many states now that NCLEX results are almost immediate. The very best preparation I received for NCLEX was working as a GN. Review courses were unheard-of in my day, and completely unnecessary because we learned to act and think as a nurse in our first weeks on the unit before we took our boards.

Specializes in neuro/ortho med surge 4.

Graduated in 2008. Nursing school does not prepare you for the realities of nursing. We get less training in schools now and patient acuity is extremely high. People are living longer and their comorbidities are many. At least half of our admits are confused (change in mental status) old folks. It takes a huge amount of nursing time to keep these folks safe. Some days I feel like a babysitter rather than a nurse.

I received 3 weeks of clinical preceptorship as a new nurse and was told I would not get anymore. If I had my choice I would have went to a diploma program rather than the community college where I attended. My school has a great reputation also in regards to the NCLEX pass rate. I don't feel that a high NCLEX pass rate correlates to a confident new grad. I still have a lot of anxiety when I get out of the elevators to go to start my day and I have worked as a med-surge nurse for 2 years.

I totally agree with what everyone is saying. I graduated from a hospital based diploma program in 1996. I had some classes at a traditional university (A & P, microbiogy, psych, soc, etc) but all of my nursing classess and clinicals were completed in the hospital. It was 3 years of 40 plus hours a week with nothing but a Christmas vacation every year and a week off between semesters. We had a TON of clinical experience by graduation time. There was not much that I had not done during clinicals. I talked to a new BSN graduate one day last week and she had never even insterted a foley/straight cath during her schooling. But, she did assure me she is ready to assume a management position in our facility LOL

Please don't think that I'm bashing BSN nurses because I'm not. Diploma programs are not available in many places anymore so the main way to enter the nursing field is through obtaining a BSN. I have worked with many very good BSN nurses but I do feel they need a longer orientation to learn actual clinical skills than nurses who graduated from diploma programs or even some LPN schools.

It's so true, nursing school today (and I attended in the mid/late 90's) is in no way preparing new grads, both from ADN and BSN programs, for real world nursing. There is too little hands-on clinical time, and with 10-12 students per instructor just how many skills can realistically be learned? The emphasis was also too much on meds, although I found that as a new grad that aspect of nursing practice was the easiest to learn (and can be learned through independent study; just how many pills do you have to actually pass to become proficient at pill passing)? To the contrary, hands-on skills - inserting Foleys, IVs, NG tubes - cannot be learned via books alone and require a lot of practice. Practice that most students today get little or none of. Also, we never had a realistic patient load in clinicals. Not even close.

So we were woefully unprepared to face real world nursing, and if your first job had a lousy or non-existent orientation program, you didn't have a chance. Some new nurses did well, however. They were lucky because they actually got an internship and/or very supportive preceptor/orientation program. And many who did well as new nurses had learned their clinical skills as hospital techs/nurse externs (i.e., hospital employees) while in nursing school (this of course also helped them get a job as an RN). Pretty sad for the rest of us.

During the days of acute nursing shortage, it didn't matter quite as much. Hospitals eagerly hired new grads, knowing they would take a long time to come up to speed (and many wouldn't make it at all). Nowadays, however, with the glut of unemployed esperienced nurses and others delaying retirement, employers don't have to take a chance and invest heavily in poorly trained new grads. And, predictably, they don't.

It's a sad state of affairs for nursing. We can only hope that the (inevitable) new, severe shortage won't take too long to arrive ;)

DeLana

I think the problem is that schools are focusing not on clinical training, but rather on NCLEX pass rates. And you can be a dreadful practicing nurse and still do well on the NCLEX...such is the case with standardized exams.

In general, schools are turning more to a business model. For example, at my school (an ADN program) our entire curriculum is determined by a publishing company (Elsevier). This means that our exams, lectures, etc. are mostly determined by Elsevier. I imagine they did this so that they could have a numbers-based way of supporting their program and reporting their pass rates to the board of nursing -- and they could boast high NCLEX pass rates to get more students. In doing so, they have eliminated things like any sort of grade for clinical performance (which in a way causes students to just "get through" clinicals and labs and skills evaluations, because they aren't rewarded for doing those things well like they are rewarded for doing well on a multiple choice Elsevier test).

So I think it isn't just that the training is shorter. It is also that clinical performance is completely swept under the rug in favor of NCLEX pass rates and HESI preparation. I think back to my "Fundamentals" of nursing class...it was all about legal theory, communications techniques, and test taking strategies. As someone whose background was a BA in a non-medical field, I was baffled...3rd semester I asked my friend who had been an LPN "Um...are they going to teach us how to wrap a wound? Or when to start CPR on someone?" Surely, I could answer multiple choice questions where the right answer was "start CPR" and I think Elsevier/HESI considers that an "application" type question (ha!) but could most students actually feel comfortable *really* applying that? Probably not.

The emphasis is on theory and answering test questions right -- I fear that long-practicing nurses would be APPALLED if they saw what they didn't teach us in nursing school in terms of basics. I remember writing in my first semester evaluation that all I learned in fundamentals of nursing was how to answer NCLEX-style questions, and I really wish my teacher would have been able to teach us "actual" nursing. I gave up on arguing that point now that I'm about to graduate...our school has bought into this whole canned curriculum thing, and it's really unfortunate and scary to me that a person can be licensed based on what one publishing company finds pertinent.

I think the boards of nursing should stop accrediting schools that downplay real-time clinicals and skills in favor of NCLEX predictors and test-taking strategies.

Edit: I also wish the NCLEX had a skills/clinical component so that the schools would begin to value that and teach it. The trouble is you can't really measure clinical competence, so they measure it in terms of minimum hours spent in a clinical experience...it's easy to send 12 students to a hospital unit for 8 hours, but more difficult to assess how well they are doing there. And a note to practicing RNs: as students, we learn as much (if not more) from you than we do from our teachers. Be nice to us. Call us when you're doing something interesting, or something we should learn how to do. Don't use us to do things that UAPs are paid to do, because that's time we could spend learning how to do RN tasks. And THANK YOU to all the RNs who do make a special effort to include us students, no matter how annoying/green we may seem. :)

Great posts.

A good start would be to offer smaller clinical groups. But then the schools would have to hire more clinical teachers which means cutting into their profit...

Specializes in Acute Care Psych, DNP Student.

I may be taking this back further than you intended, but this makes me think of a conversation I had with a relative who is a retired nurse.

This relative practiced as a nurse in the 1950s thru '80s. She described the following to me. She said she made a single entry on the patient's chart in a shift. She did not have to deal with all the defensive practice we deal with now. She did not have to check medications out with things like we have now, pyxis. She just went and got their medication. There was no counting.

She mentioned they didn't have all the equipment requiring complex technical skills. She also said she always got a lunch break, and if one of the nurses had a headache, they'd just take a narcotic from the bottle of narcs at the nurses' station. Things were more simple. Nursing has become complex, but the education has not lengthened to match the increased complexity. Now add to that the student loans many students are taking out, and it's a recipe for high-stress. My relative? Her hospital sponsored her and even paid for her housing in a nurses' dorm. Today's students...most of them are working other jobs while in nursing school. Most graduate with student loan debt that burdens them and adds to their stress. Most do not start with a firm foundation from nursing school and a clean financial slate.

I think part of the issue has to do with moving nursing education from hospital-based training to academic education. The move to academic education was needed for nursing to be a true profession, but it compressed the much needed clinical experience. So what's the answer? Lengthening nursing education. I don't see that happening.

I feel exactly the same way. I have a BA in an unrelated field and went to a community college with a high NCLEX pass rate (that was the only standard I knew to inquire about). We had short "virtual" skills labs, and crowded clinicals only two days a week. I passed the NCLEX in half an hour, but had never started an IV or done other clinical skills except pass meds. I was unemployed for a year between nursing school and being hired for a telemetry floor in a big city hospital, and was supposed to be independent after 15 shifts with a preceptor. I have never had issues with anxiety before, but I am literally nauseous and shaking before each shift and dread going in, feeling that I am not experienced enough to have 4 acutely ill people in my care. The feeling is that if we express concerns, we are "problem nurses". I am considering quitting because I feel so unsafe, and I know from talking to the other new grads at my hospital that my feelings are not unusual.

It's possible but it's also possible that people are individuals and thrive differently in situations.

On nursing school, we can't entirely put the blame on them in having anxiety-filled graduates- they truly can only do so much.

I mean for the students to totally understand the magnitude of responsibilties in nursing, then they would have to have the patient load all by themselves( and we know there's a fat chance of that happening).

We have to take things in our stride and be ready to be absorbent and learn as much as we can at any given point in time.

Nursing school provides the education, students have got to be proactive too in their learning.

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