Why Do I Care?

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    When one new nurse jumps ship after just a few months, it's none of my business. When it becomes a pattern, it hurts everyone: management, the patients, the new grads themselves and (believe it or not) the crusty old bat tasked with precepting them.

    Why Do I Care?

    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 resume that reflects job hopping or never learning the basics of nursing because they never stay in one place long enough to be able to learn them. Why is it any of my business?

    When one new nurse makes an ill-considered decision with consequences that she personally is going to have to live with, it's none of my business. No matter how much I like the new nurse, no matter how much I was looking forward to working with her when she was off orientation, it's really not my business. One of my orientees quit while I was off work with medical leave. Later, we met for lunch and she told me her reasons for leaving. "I know you like me, Ruby. But Mary (her other preceptor) didn't, and I was afraid I was going to get fired." When pressed, she had no reason for believing that Mary didn't like her, or that she was in danger of being fired. She was just anxious, and without me there to smooth the processes for her and alleviate her anxiety about how she was doing, she couldn't hack it. It probably reflects badly upon me that I was her lifeline and I hadn't managed to keep her expectations realistic. I was so disappointed -- but none of my business. My former orientee and I are now casual friends, meeting occasionally for lunch and conversation. I enjoy the relationship, but would have enjoyed it more if we still worked together.

    When the majority of our new nurses leave in less than two years, that's a problem that affects all of us. The majority of nurses that come to our unit do so to get ICU experience for their CRNA school applications. We all know it, even if they don't announce it to the world on their first day (as many do.) Others come here because it looks good on their resume, or to get tuition reimbursement for their NP programs or because their SO is in residency here. Within their first month on the unit, most of our new nurses give us an approximate exit date that has nothing to do with our staffing, our patient population, how we are to work with as colleagues or anything else that has anything to do with anything other than their own goals. There may be a cure for that sort of thing, but not at the staff nurse level.

    We have a 30 bed ICU, so our staff is large. That means that we are CONSTANTLY orienting new nurses, and because our core staff of seasoned nurses is finite, that means if you've been there for more than two years, you're going to be precepting. Of course that means that people who should NOT be precepting are forced to anyway. People who are lazy or poor teachers or difficult to get along with are foisted upon new grads as their preceptors -- which isn't good for anyone. But even those seasoned nurses who LOVE new staff and LOVE to teach get burned out with constant precepting.

    Precepting is difficult. It's so much easier to just go in there and assess that patient yourself rather than teach a new nurse how to do an assessment, discuss her findings and how they differ with yours (if they do) and what potentially that could mean. It easier to give the dang meds yourself than to wait around while someone else laboriously checks them out of Pyxis, looks them up, considers whether they're appropriate to give right now given whatever else is going on, and then gives them or holds them and notifies the provider. If you're doing it right, precepting a new nurse is one of the most difficult challenges you'll ever have as a nurse.

    Those of us who remain at the bedside, mostly do it because we love taking care of our patients. Precepting means that we aren't actually doing the work of taking care of our patients. We're teaching someone else to do it, holding their hands, providing feedback that is hopefully in a format they can understand and accept, documenting their progress and having meetings with management and other preceptors to keep tabs on how they're doing. We're not taking care of our patients, which is what we stayed at the bedside to do.

    Constant turnover of new nurses means that we rarely get a break from precepting. And when after all of our hard work with a new nurse, that new nurse leaves as soon as she can, that's demoralizing. In some cases, when you've nurtured a new nurse and mentored them and you know they're the perfect fit for our unit, it's heartbreaking.

    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!
    Last edit by Joe V on Dec 20
    secondlifen2b, cardiacfreak, hiphopRN, and 40 others like this.

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    About Ruby Vee

    Ruby Vee has '38' year(s) of experience and specializes in 'ICU/CCU'. From 'the Midwest'; Joined Jun '02; Posts: 8,615; Likes: 31,149.

    Read more articles from Ruby Vee

    109 Comments so far...

  3. 7
    As a New Grad seeking employment for almost 9 months now, I couldn't imagine turning down ANY kind of opportunity like that regardless of the circumstances, where I live it is beyond tough to find a job. I will be so grateful when I get an opportunity like that, I could definitely understand where your frustrations are coming from!
    bkm.sebigi, Jdoyle, imintrouble, and 4 others like this.
  4. 5
    Ruby, you can teach all of the nursing skills to anyone, but you can not teach someone how to be a nurse. These individuals think because they're aspiration is to move beyond the "RN" role they're automatically going to move away from patient responsibility at the bedside. I would hate to have a "NP" who couldn't even maintain her/his role as an RN delegating my care.
    NP(s) are well respected because they are seasoned nurses. I see this too will die out soon, which is why they're pushing for the DNP.
  5. 6
    Just echoing what many readers are probably thinking, but as a nursing student, it is my hope that I will land a job (in the ICU, funnily enough) where there are experienced nurses willing to pass on their knowledge to a new grad. As with many things in life, though, there are many people who won't know what they had till it's gone.
  6. 5
    As preceptors we do care; we care a lot.

    As someone who has been precepted, in the same boat as your orientee, we do appreciate it, I plan on returning, with experience and determination, don't count us out!

    I've been on both sides; I enjoy teaching, and giving back to the profession; I WANT to see my peers in the trenches as long as I can; I have at least another 15-20-plus years; I know many have other destinations, but a good percentage don't-I WANT US to succeed, and enjoy our business.
  7. 8
    All I'm seeing in this post is, "I care because it makes my job more difficult." I really thought this was going to be about how patient care is made more difficult and potentially less safe by a nurse constantly being in charge of the patients and preceptees in a high-acuity environment, but it's all about how "demoralizing" and "heartbreaking" the job is for the seasoned nurses where you work.
  8. 0
    I graduated in 2008. I hsve had jobs that has aspects I love and don't love. I want s hospital job so bad I couldn't imagine turning downd a job your describing. Where are you located. I'll apply. I'm not new. I have experirnce and I love nursing. I want to learn ss much as I can. I have learned a lot from every job I've had.
  9. 6
    Dudette, I figured the 'decline in quality/safety of patient care' was a given. Ruby's point of view is interesting and I think everyone is entitled to express their opinions and feelings here--we're here to vent or just talk in a relatively safe area. And hey, demoralized staff probably does affect patient care.

    I was one of those nurses who left my unit after less than two years. Even worse, I was the 'most' experienced. I know my leaving certainly didn't help conditions on my old unit, but I also didn't want to martyr myself at a place I didn't see myself staying long term. My new unit certainly requires sacrifice on my part, but it's one of my dreeeeaaaaam specialties---I plan on settling in for the long haul.
  10. 20
    Quote from dudette10
    All I'm seeing in this post is, "I care because it makes my job more difficult."
    So crusty old bats should care about making new nurses' jobs easier, by being super nice and supportive. But we shouldn't care when new nurses make the crusty old bats' jobs harder?
  11. 9
    What I get out of Ruby's post is that she is frustrated to be precepting nurses who are only in her ICU as a stepping stone to something else. Most are not there because they want to settle down in that unit. Precepting a continuous stream of nurses who are just passing through would be stressful; finding an orientee who would be a great team member only to see them move on would be disheartening.
    canoehead, Szasz_is_Right, jcbhappy, and 6 others like this.

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