Why Do I Care?

Ruby Vee, BSN

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!

Why Do I Care?

About Ruby Vee, BSN

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