Why Do I Care? - page 9

by Ruby Vee 21,732 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. 1
    Quote from Ruby Vee
    Orientation for new grads in my unit is six months; more if we feel that the new grad would be a good fit for the unit and just need more time. It's the best orientation program I've seen in 35 years of nursing. We have nurse educators, classes, a simulation lab -- all the support and resources you could think of and some that would not have occurred to me. I don't know what more we as a unit could do to get new grads to stay . . . a contract has to occur above the unit level.

    My frustration is not misplaced. It's not the institution or the unit I work on. It's the culture among new grads that say "I'll do what I want and it's no concern of yours," or "I'm going to do the best I can for MEEEE, and you're not my concern." I'm not saying all or even most new grads suscribe to that culture, but you see it here an awful lot.
    Hmmm. Sometimes I think employers have created the mess for themselves by cutting pay, benefits, staffing, pensions, etc. If employers have no loyalty anymore, why are we surprised that employees lack it?

    I hope, Ruby, that your unit/organization can help come up with a retention plan. I notice that some posters say that you work at a prestigious hospital (and that workers use your unit and the hospital as a stepping stone). Maybe your unit can harness this behavior to its benefit. Maybe by helping the folks achieve their goals (do you remember the days when an employer would pay for your entire degree?), they might stay a little longer....

    Maybe the way education is approached should be changed to meet the needs of the new generation of workers...(noticed you mentioned you have some impressive items at your disposal, e.g., SIM labs).

    I don't really care for contracts, but maybe that's an option. I also don't like the notion f paying new grads substandard wages. I think a large number of nursing employers can do better for their employees. I am not as certain about what's going on in your particular institution (or unit), as it sounds like it may be a top-tier institution. --Please keep us posted on what solutions you arrive at.
    LadyFree28 likes this.
  2. 2
    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 maybe, as other posters have said, the hiring manager could modify the screening process when hiring. There are many ways to find out what an employees goals are and if they are likely to want to stay. My manager asked me where I saw myself in 5 years and many other questions about my goals and what I hope to gain by working in the ED. She was basically trying to figure out if I wanted to work in the ED long-term and did so in such a way that it would have been very obvious if I were not passionate about working in the department. I am not sure how your department decides who to hire but I believe being more selective in finding nurses that are the right fit for the department might help with retention.

    When I graduated the job market was horrible. I wanted to work in the ED then but the hospitals were not hiring. I started in LTC, then acute care, learning as much as I could until I landed the "job of my dreams". I totally understand the frustration of training staff and them leaving but I can say without a doubt that I personally did what was best for me and my previous employers. I didn't love my job like I do now. I always gave 100% and was happy enough but I definitely wanted something else. Employers deserve employees that love what they do, especially in this field. I needed to take a job that I did not love initially because of the poor job market, $40,000 in student loan debt, and hungry children looking to me for food. Prior to becoming a nurse I had one job for many years. I am not the type of person who has job hopped through my adult life. Sometimes people need to move on for one reason or another. If employers try to hire people who have an interest in the specialty area and seem passionate about it hopefully the majority will stay. Especially if the other staff members are welcoming, encouraging, and positive.

    When I started at my current job they had just lost several nurses suddenly (2 injuries, cancer, and one moved). Morale was low because they had been working short but the staff was so happy to see new nurses. Everyone was nice to me, helped me, and made me feel welcome. From day one, my manager would say hello to me, address me by name, and ask how my day was going when she saw me. It kind of surprised me that she remembered who I was because the department is so large. Other nurses would and still do ask if I am "all set" or "need any help" when we work in the same pod and we all smile and say hello when we pass by one and other even when the day is horrible. Its not uncommon for a nurse to start an IV for another nurse without being asked or jump in and take report from EMS when a new patient arrives because the nurse taking the patient is busy. Everyone does it (help) so it just becomes natural to do it yourself. I think these things are some of the main reasons there is not usually a huge turn over rate in my department and could happen in any department.
    Not_A_Hat_Person and Fiona59 like this.
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    There Is Nothing Wrong With Nurses That Have Goals And Work Towards Them. Just Because They Leave A Job After A Year Doesn't Mean They Won't Have Skills. ThIs Is Very Silly To ME. Don'T Look Down On Nurses That Want To Move Forward And Continue Thier Education Other Places.
    kungpoopanda likes this.
  4. 5
    Quote from Ruby Vee
    It's the culture among new grads that say "I'll do what I want and it's no concern of yours," or "I'm going to do the best I can for MEEEE, and you're not my concern."
    It's a career. There is no reason anyone should sacrifice pay, prestige, vertical mobility, career advancement or happiness when an opportunity for any of those arise. I understand your frustration, but the quotes you put there are... nothing that raises question of cultural character of new grads. It isn't any of your concern... and people should do what's best for them in their careers. It makes sense, doesn't it?

    Good read though.
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    I love my preceptor who was tough but a phenomenal teacher and still a great mentor; I'll probably stick around on the unit as long as she is there.
    What qualities do you look for in a new grad that you find makes them successful and an asset to the unit?
    Last edit by tigerRN2013 on Feb 4
    Fiona59 and OCNRN63 like this.
  6. 0
    Quote from libbyliberal
    "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?
    Indeed. I have great respect for expert senior nurses. I definitely want to me like some of them when I grow up. However, I still stand by my previous comment. Unfortunately, there is a high turnover for new grads and nursing units in general at various facilities. This most likely will not change any time soon. Therefore, it is quite possible that some nurses who have 30 plus years of bedside exp. do get burnt out? Especially when having to precept so often for nurses who only stay for 6mons-1year.
  7. 1
    Quote from libbyliberal
    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.
    I started out in the CVICU so I was rapid response and the code team. When one of our expert nurses step away from her patient, I was the first responder to that code blue and did every thing I could to save that mans' life. I've started plenty IV's, assisted with insertions with Swans and CVP lines. I've given sedation and paralytics more times then I could count. Since I worked in CVICU, I've had my fair share of hypotensive septic patients on various pressors, while continually monitoring there Cardiac Outputs, maps, cvp, and so much more. Read EKG's, and able to let intervene when my patient went into v-tach. I'm not trying to tell Ruby how to run her ICU or her staff. I'm simply offering my opinion and suggestions like everyone else. No, I'm not an expert nurse and not sure exactly what you mean by your post. I'm also currently a RN, not that that matters. Once again, not sure where you were going with this.
    Last edit by prnqday on Feb 5
    Mulan likes this.
  8. 6
    Quote from prnqday
    Indeed. I have great respect for expert senior nurses. I definitely want to me like some of them when I grow up. However, I still stand by my previous comment. Unfortunately, there is a high turnover for new grads and nursing units in general at various facilities. This most likely will not change any time soon. Therefore, it is quite possible that some nurses who have 30 plus years of bedside exp. do get burnt out? Especially when having to precept so often for nurses who only stay for 6mons-1year.
    Your respect for senior nurses doesn't show through in all of your posts.

    I'm familiar with the signs and symptoms of burn-out and experienced in detecting them in myself. Yes, I've been through burn-out, and passed through it intact. But I'm not burnt out now and I do not appreciate being told I'm burned out when clearly I am not. It's condescending and disrespectful.
    libbyliberal, ICULINDA, canoehead, and 3 others like this.
  9. 1
    Quote from Ruby Vee
    Your respect for senior nurses doesn't show through in all of your posts.

    I'm familiar with the signs and symptoms of burn-out and experienced in detecting them in myself. Yes, I've been through burn-out, and passed through it intact. But I'm not burnt out now and I do not appreciate being told I'm burned out when clearly I am not. It's condescending and disrespectful.
    My level of respect may not have shown through this thread. I apologize for that, and for being condescending and disrespectful to you. That was not my intent at all, and it is hard to show intent when communicating online. I'm glad you are not burnt out yet because expert nurses are very much needed at the bedside so that is good to know
    Ruby Vee likes this.
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    Being a senior nurse makes you an expert nurse? Serious question.


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