Why Do I Care? - page 7

by Ruby Vee 19,856 Views | 109 Comments

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 being out of work, or having a... Read More


  1. 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.
  2. 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
  3. 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.
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    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.
  5. 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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    Quote from llg
    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.
    Agreed. I can see why this is so frustrating for seasoned nurses. I too, have been a preceptor and it does add quite a bit of stress. Ruby has been doing this for 30 plus years and you're right, change is easier said then done. My question is, should she start looking for a new career opportunity because it seems as though she is simply burnt out. I would be to after working over 30 years.
    mclennan likes this.
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    "And then someone calls us mean and nasty, implies that we're just jealous of opportunities we haven't grasped for ourselves or says that the only reason we're against job hopping is because we're old dinosaurs who don't want anyone to have things better than we did. I have the job I wanted -- my dreaaaaaammmmm job. I'm happy with my life, with my job, with my colleagues. I'm exactly where I want to be. But I sure wish a few others would look a little harder, see what a great job this is and what a great place to work and stay awhile! "
    (RVee's original post)

    Burn out? I think not. But I wonder just how many people like you she taught how to function as a nurse. How about a little respect for the expert nurses who actually care about this profession?
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    Nursing is a profession with ill-defined pathways. I have read all these posts, and what I have gleaned is this: you are always going to have turnover, although for a variety of reasons.

    1. Anyone who wants to be a CRNA has to work a certain amount of time (2 years, I believe) in the ICU in order to apply to CRNA school. That is an absolute requirement. If someone wants to go that route, what are they supposed to do--lie in their interview? Stay longer and prolong their education? I agree that this wastes resources training them as ICU nurses, but it is really their only option. Perhaps CRNA programs need to incorporate ICU training into the first few years so that the expectation of the unit hiring the CRNA-bound new grad is correct.

    2. I've posted about this before, but while I disagree with med-surg being treated like nursing purgatory, it is a fact that a year or so of med-surg opens the door to other jobs within an acute care hospital. It just is. Again, make the pathways clearer, so that someone who actually wants to work in the ED/OB/whatever can just start there rather than wasting time and money training in med-surg and then leaving. OR, decide that all specialties require a year or two of med-surg, no exceptions, and then staff your med-surg depts to handle the training. It's like medical residency, or it should be.

    3. Sometimes it's just a bad fit. I had this happen to me. My exit was precipitated by a life event, but truthfully, I was counting down the year from day one. What could have prevented it? I should have shadowed in the department before accepting the job; I would have seen immediately that it was not for me. I will never again consider a job without shadowing in the department; I even shadowed in my current department after having been there for clinical! Anyway, at the old job, I was willing to stick it out for a year, but that was probably as long as I would have lasted. Fair to the department? Maybe not, but how long do you want someone miserable working for you? In any event, I left before I cost them very much money, and it was a good outcome for everyone.

    4. As I mentioned in 3, sometimes things just happen. We've gotten ICU nurses in our PACU because they just couldn't do the 12-hour shifts anymore. People leave our unit because they don't want to take call with little kids, childcare issues, etc. I left that old job because I had a family emergency that wasn't getting addressed because I was at work all the time. Yes, I am still a newish hire and I LOVE my job and have no plans to leave, but if something MAJOR happened with my family that necessitated a change, you bet I'd leave.

    On a side note, please don't assume that all older new nurses are in it for the income. I make less now than I did in my first computer training job in 1993, and I LOVE what I am doing. If I wanted a desk job or a high income, I would have stayed in IT. Every day I get to look someone in the eye, put a hand on their shoulder, and tell them that they are through surgery and I'm going to take care of them while they recover. And then I get to do that, over and over. I wouldn't go back to my old job for one minute. I may be the exception, but I'm not the only one. Please don't give up on us old newbies!
    libbyliberal, TexasRN75, nae312213, and 7 others like this.
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    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.
    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.
    Nice. How many times have you called a Rapid Response because your LPN/ADN education did not prepare you to stabilize a patient? How many times have you called for an ICU nurse to start an IV or read your EKG, run a stroke code or transfer your septic hypotensive pt or mix and bolus streptokinase and titrate Nipride Diltiazem Vasopressin Levophed and all while preparing for intubation and pushing sedation and paralytics and preparing for line insertion? Who responds first to your codes? You are so qualified to tell an experienced nurse how to manage the lack of a stable ICU staff! The next time that you need help, I suggest you just tell the expert nurse with legitimate concerns about competent and stable staffing that she can put up or shut up or start looking for a new job. I want to be there when she puts you in your place.
    Yeah your facility should have an ICU of ADN graduates with 2 years of M/S and no ICU experience and no preceptors. Great idea.
    ICULINDA likes this.
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    Other than for the writer's initial shock at the concept, I don't think the article was disdainful of hiring for attitude, training for skill. I'll have to go back and read the whole thread.


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