Why Do I Care? - pg.5 | allnurses

Why Do I Care? - page 5

Why do I care that new nurses leave our unit after less than two years -- often after less than one year? Why do I care, when they're adults. They're going to have to live with the consequences of... Read More

  1. Visit  llg profile page
    25
    Many of you have missed a key point in Ruby's series of posts. You are wrongly assuming that people are leaving her unit because of poor orientation, poor morale, bullying, etc. Her point is that an increasing percentage of new nurses have no intention of staying longer than a year or two no matter how wonderfully they are treated. A morale committee, etc. cannot solve that problem.

    As someone who works with a lot of senior level nursing students and with hospital orientations ... I am seeing the same phenomena. The career plans of many new nurses involves "1 year at this first job ... then move on." That is causing a huge problem for the best hospitals/units who try to provide the support needed by new nurses. We don't have the resources to keep providing that much support to a constant flow of new folks. And that causes hardship to all involved and compromises the quality of patient care along with compromising the quality of the work experience.

    That is why you see hospitals not hiring as many new grads as they used to. Is that what we want? Another possible solution is also being tried -- internships that pay extremely low rates to new grads until they are off orientation and pulling more of their own weight. Is that the solution we want to see? We need to discuss these things because they are the types of solutions that administrators have at their proposal. Higher pay, better schedules, easier work loads, will not solve this problem -- because. as Ruby is saying, those are not the reasons many people are leaving! (Sure, there are some terrible places to work and some people leave because of bullying, etc. ... but those are not the people we are talking about!)
    Crispy Critter, AOx1, Kipahni, and 22 others like this.
  2. Visit  nursepenelope profile page
    1
    What hospitals are hiring new grads? I graduated in 2008 and have not been able to get a job in a hospital?....I'm desperate...
    Not_A_Hat_Person likes this.
  3. Visit  OCNRN63 profile page
    8
    Thank you, llg. I was beginning to think I was reading posts other people couldn't see.
  4. Visit  dudette10 profile page
    3
    Quote from Ruby Vee
    Please -- if you have something to add about the subject of new nurses jumping ship immediately and how patient care is made potentially less safe, contribute it. I'd love to read it.
    I wouldn't know. I'm not precepting a constant stream of new grads.

    llg, your point is well taken. I too didn't take this as being a unit culture thing. I think Ruby has said before that her facility is well-known and attached to a major medical university. In my opinion, the resume boost that the ICU at her facility provides draws "stepping stone" nurses seeking to further their education. That is not something that can be changed, however, McLennan's post offers some concrete ways that the revolving door can be stopped. Hiring and interviewing practices need to be changed, and contracts need to be required. If the facility is such a high-profile, resume-boosting place to work (as I think it is), the contracts would not be a hindrance to recruiting good new grads. It might even make it more "exclusive" in that less openings would be available as people stay on to finish their contracts.
    Kipahni, mclennan, and LadyFree28 like this.
  5. Visit  dudette10 profile page
    0
    Quote from hey_suz
    One thing I have read recently (and I am not in a position to hire, fire, or anything like that) is: "hire for attitude, train for skill."
    What I like about that is, as many of those responding here have brought out, is it brings out that if your intention is to leave in a year, or two years, why work in a place with such a long learning curve as ICU? A new hire should mesh with the culture where he or she is hired. Certainly, some people will leave after a short time due to other factors. By and large, however, people should be hired to fit into the unit.
    Ironically, there was an article on AN not too long ago that pretty much was disdainful of "hire for attitude, train for skill." I'll see if I can find it.

    ETA: I found it, but I don't know how to link the article to here. It's written by The Commuter, and it's called "Hard and Soft Skills." After re-reading it, I determined that my characterization of it as "disdainful" was colored by my impressions from The Commuter's other posts. In and of itself, it's not disdainful of the new approach to hiring.
    Last edit by dudette10 on Feb 2, '14
  6. Visit  canigraduate profile page
    1
    Thanks, llg. I was thinking the same thing. My take is that people coming in and only staying a year is a trend that is not going to change, and is most likely going to increase.

    Honestly, I have changed jobs twice in the past 6 months and it had nothing to do with the unit I was on and everything to do with outside events not related to my job. Try explaining that to a recruiter!
    SoldierNurse22 likes this.
  7. Visit  subee profile page
    2
    This ICU of Ruby's sounds way to intense for new grads. I was lucky enough to orient on a busy med-surg unit before ICUs fully bloomed. Every nurse who worked on that unit wanted to be a mentor to a new grad who ALL went through these precepted med-surg units before going to specialty units. In exchange for the high patient acuity (some on vents- no running water in 4 bed rooms)it felt better staffed because there were always orientees available who didn't count as staff members. Some of the floor RN's were working on MSN's (this was during the 70's) and WANTED to work with new grads. All this and I only stayed a year. It was two subways and a substantial walk. I left for a place four blocks from my apartment. Feeling very bad now 41 years later
    Not_A_Hat_Person and RNGriffin like this.
  8. Visit  libbyliberal profile page
    8
    (1) I stopped feeling a sense of commitment and loyalty to my employer when the defined benefit pension plan was eliminated.
    There really is no incentive to stay in a position for the long haul anymore.

    (2) I am tired of training graduate nurses who come in clueless and then act like the king of Siam after a year. I am tired of teaching what should be part of a basic nursing education and critical care nursing skills in six months or less.


    (3) I deserve to be well compensated for having to monitor and try to educate a novice nurse in addition to a full assignment.


    (4) I will no longer invest my effort and knowledge in a trainee who is too lazy to look up a med or procedure. I am so over it.

    (5) Frankly, all I care about is my patients' outcomes and not getting my ass sued.
    NurseNightOwl, RNfaster, Marshall1, and 5 others like this.
  9. Visit  jpeters84 profile page
    4
    I understand your frustration. Anytime anyone leaves a floor it puts a strain on relationships, on resources, on the overall feel of a unit. I think the reason people leave so early in their career is a multi-faceted problem. I now have three years of experience so I feel close enough to being a new grad but have a little perspective. In nursing school they were doing their best to constantly scare us into thinking one mistake and we'd be fired, one person doesn't like you and you're out, one bad review with constructive criticism and you should fear for your career. I was in a constant state of anxiety in nursing school. And when I was a new grad it was worse. It created an lack of confidence even after I was competent in which I needed positive feedback on a regular basis or I feared that I wasn't cutting it. I constantly had to ask questions even when I knew the answer. And I was in a very supportive environment as a new grad. I wonder if nursing schools couldn't find a better way to impart the seriousness and importance of nursing while imparting a small earned confidence that is both humble and realistic for a new grad to have.

    Also, nurses are harsh to each other. Especially seasoned nurses that have been at their jobs in that particular hospital for awhile because they're human and they forget what it is like to be new. Being new is so incredibly hard. I think its easy to forget just how hard it is. And when you know your unit like the back of your hand and you can see things coming its easy to get frustrated or not understand why the new person is struggling. We need to change this somehow.

    Being in a unit where you are constantly precepting puts too much pressure on the staff. Your higher ups should really be looking at this problem and maybe put a hiring freeze on the CRNA swinging door phenomenon.

    Sometimes people just really need to leave. Its hard to summons up the empathy when its going to negatively impact your unit once again, but sometimes they just can't do it another day. For those people I wish them the best because that's a really hard spot to be in.

    At the end of the day I think creating a culture of welcoming and supportiveness of new staff both experienced and new grads is incredibly important even when everyone is burned out from precepting. I left a really great job after two and half years for my dream job in a large academic tertiary hospital. The staff was less than welcoming. Sometimes the grass really isn't greener on the other side. It has been the hardest experience of my life. Harder than being a new grad. I definitely see both sides. I wish you and your unit the best.
    Cal-Neva, Satori77, Not_A_Hat_Person, and 1 other like this.
  10. Visit  madwife2002 profile page
    0
    Quote from dudette10
    Ironically, there was an article on AN not too long ago that pretty much was disdainful of "hire for attitude, train for skill." I'll see if I can find it.

    ETA: I found it, but I don't know how to link the article to here. It's written by The Commuter, and it's called "Hard and Soft Skills." After re-reading it, I determined that my characterization of it as "disdainful" was colored by my impressions from The Commuter's other posts. In and of itself, it's not disdainful of the new approach to hiring.
    http://allnurses.com/nursing-and-pro...ls-898866.html
  11. Visit  prnqday profile page
    3
    Quote from llg
    Many of you have missed a key point in Ruby's series of posts. You are wrongly assuming that people are leaving her unit because of poor orientation, poor morale, bullying, etc. Her point is that an increasing percentage of new nurses have no intention of staying longer than a year or two no matter how wonderfully they are treated. A morale committee, etc. cannot solve that problem.

    As someone who works with a lot of senior level nursing students and with hospital orientations ... I am seeing the same phenomena. The career plans of many new nurses involves "1 year at this first job ... then move on." That is causing a huge problem for the best hospitals/units who try to provide the support needed by new nurses. We don't have the resources to keep providing that much support to a constant flow of new folks. And that causes hardship to all involved and compromises the quality of patient care along with compromising the quality of the work experience.

    That is why you see hospitals not hiring as many new grads as they used to. Is that what we want? Another possible solution is also being tried -- internships that pay extremely low rates to new grads until they are off orientation and pulling more of their own weight. Is that the solution we want to see? We need to discuss these things because they are the types of solutions that administrators have at their proposal. Higher pay, better schedules, easier work loads, will not solve this problem -- because. as Ruby is saying, those are not the reasons many people are leaving! (Sure, there are some terrible places to work and some people leave because of bullying, etc. ... but those are not the people we are talking about!)
    If this is the case, then Ruby should discuss this with HR, her NM or whoever else will listen. Perhaps she can help develop a new interview process to help weed out applicants that have no intention of staying at the bedside for longer than a year.
    Truth is, many nurses ( old and young), have no plans for staying in the bedside. I became a nurse at 20 and I'm now 25 years old and I honestly can say that I love being a bedside nurse. I have no plans of advancing my education other than getting a BSN to keep my bedside nurse job. Unfortunately, others nurses use the ICU as a stepping stone for their career advancement. This is NEVER change and will only get worse. Either Ruby can become part of the solution or she can continue working there under the current circumstances and "venting" on allnurses.com. I guess she can also start looking for a new job out of bedside. My point is, she has options. Once she gets sick and tired of being sick of tired of being a preceptor every six months then maybe she'll make a decision. Either she will continue to put up or shut up.
    Designer NP, mclennan, and Mulan like this.
  12. Visit  llg profile page
    5
    Quote from prnqday
    If this is the case, then Ruby should discuss this with HR, her NM or whoever else will listen. Perhaps she can help develop a new interview process to help weed out applicants that have no intention of staying at the bedside for longer than a year.
    That's a lot easier said than done. Changing the traditions of a profession are a lot harder than you may think. I am sure that Ruby has discussed these issues with her leadership teams. Everyone has. There are conversations going on about this topic all over the country. The problem is, the only solutions that people have found have been unpleasant and a bit controversial -- (1) Hire as few new grads as possible: (2) Require contracts in exchange for new grad orientations: and (3) Pay new grads very minimal salaries for the first several months to reduce their training costs.
    Kipahni, elkpark, OCNRN63, and 2 others like this.
  13. Visit  imintrouble profile page
    4
    I love Ruby's threads.
    They're absolutely guaranteed to be entertaining.
    The only problem is I have to read so many pages to play catch up.
    Crispy Critter, canoehead, Purplish, and 1 other like this.


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