Why Do Nurses Quit? - page 4
Jamie looked at the framed group photo on the wall of Cohort 22, the 24 new grad nurses who started a year ago in 2015. They all look so happy and eager. Where are they all now? Of the 24, 16... Read More
Dec 15, '16Quote from Kate_PedsSpeaking as a crusty old bat, I certainly haven't forgotten what it was like to be a new graduate. I doubt anyone else has, either. I have actually communicated with new graduates about why they are leaving -- perhaps 10-15 of the 30 or so who leave our ICU ever year never intended to stay in the first place. They only wanted the minimum amount of ICU experience they could use to get into anesthesia school. Another 5 or so hadn't set their sights on anesthesia school when they applied to our unit, but since everyone else was going, they thought they should as well. Several leave every year because they miss their family back home, their boyfriend back home or because their new boyfriend is being transferred to Milwaukee. There are some who leave because they cannot do the job, don't want to do the job, or were very surprised to find out the job actually involved direct patient contact, responsibility and accountability. Some leave to go to graduate school to become CNS or NPs because they're shocked that they're actually expected to work nights, weekends and holidays at the bedside and they expect to have more prestige or better hours in an advanced practice role. (The nurses who go on to become CNS or NP because they understand that role and look forward to the new challenges don't seem to be new grads; they seem to be nurses with more than the minimum experience.)I would encourage everyone to remember what it is like to be a new graduate. Hopefully that way the line of communication will remain open. The issue of new grads leaving is not just the topic of a popular gossip session, it's a very real problem.
I think the best way to find out why new graduates are leaving is to communicate with them about their experiences. I commend Nurse Beth for asking those direct questions, and, as unpopular as the terms may be, saying what needs to be said. We can sit around with our eyes shut and our hands over our ears because we don't like a particular phrase, but in the end, if this is what new grads are saying is causing them to move on, we would be foolish to assume that syntax is the cause.
The new graduate who felt she was being eaten because someone spoke to her about leaving a patient without IV access could possibly have been experiencing a senior nurse having a bad day. More likely, that same nurse had already explained to her, possibly more than once, that you don't leave your patient without IV access when they're on the monitor, or NPO, or when the next shift has an IV med due within an hour of their start of shift.
Dec 15, '16Quote from Spidey's mom.A few months ago our entire system went down for a few weeks and we had to paper-chart. Hallelujah! I was so happy.
A few years ago when one of many downtimes occurred a coworker freaked out and bemoaned her lack of ability to chart/pass meds. We had paper MARs again and she said, "What am I going to do?" in a high pitched and pitiful moan.
"I am going to actually go and take care of my patients." I passed my meds with nary a mistake and made notes on a notepad in my pocket as the downtime was to be short lived. I left on time too.
Dec 15, '16Quote from Ruby Vee.(The nurses who go on to become CNS or NP because they understand that role and look forward to the new challenges don't seem to be new grads; they seem to be nurses with more than the minimum experience.)
I agree with everything in your post but I kept this part of it in as a quote because that's me. I'm not as experienced as many here (to whom I look for insight and advice and whom I admire), but I've put in 15 years as a nurse and 3-4 before that in unlicensed assistive roles (lab, monitor tech, tech-retary, et al.). I love what I do and I am excited for the challenges to come as an advanced practice nurse.
I graduated nursing school and began work on the same floor as my pre-nursing peers, so I had that advantage but I remember the hazing type of behavior of some nurses, and the support of others. It came from all ages and backgrounds.
One had nothing to do with my role but my marriage. I'm in a very "old-fashioned" southern state and have a nontraditional union. (Which now is more traditional than what non-traditional means today.) One old biddy passive-aggressively asked, "And what did your parents think of that." I knew she was goading me because of my inter-racial marriage but I answered sweetly and honestly, "Well they didn't like that I was 18, but they love him."
The hardest time I had as a new nurse was time management and that was addressed. By some, the constructive feedback offered strategies to improve, from others it was like being yelled at everyday. And I mean yelled. I remember being on my 4th of 7 patients for med pass and the charge nurse opened the med room and in front of the two other nurses in there told me in a very loud and irritated, condescending tone that whatever patient has called out for the third time for his pain meds. I said, 'OK! OK! I heard you!" She, meanwhile, did not offer to help and sat back down at the desk.
I understood right then that she was the one not ok, not me. And instead of letting that resentment formulate my perspective of my profession I sat with the knowledge that people are people, the good, bad, and ugly, no matter where you go. That moment brought me to tears because of the embarrassment, and because I was so rattled she forced me to go and take a few minutes. (Thus further delaying my timely med pass.) I have only had two more moments where I needed a moment to decompress in the past 20 years of working in this field. That was the first.
From my observation the younger nurses leaving do so because of better opportunities or higher ambitions. The older ones of my acquaintance left for a variety of typical life reasons, the least of which are disillusionment of the profession, although that was present. Mostly it was health or relocation.
Dec 15, '16I think nurses quit because at some point they realize their personal quality of life is more important. Nursing affects your whole life, your health, your well being, hell it even affects your family. At some point, you have to put yourself and those you love first.
Dec 15, '16Quote from MrNurse(x2)It is a scary time to be a new nurse-and overwhelming. I'm curious about your observation that new grads have the same amount of orientation as an experienced nurse.The cost to develop a new nurse is no more than an experienced nurse today because there is no difference in orientation time. That leaves the new grad in a position to fake it until they make it, a very dangerous place for the nurse, patients and coworkers. It really is a scary time to be a new nurse.
In my community, new grads receive significantly longer orientation than experienced nurses. Is this not the case elsewhere?
Dec 16, '16I think part of the reason "new" nurses quit isn't any different than any other occupation. They just simply have that option b/c they can find work. If the job market is tight-they will stay. Some are just young and don't know the value of patience. Some get scared and hate it so that justifies quitting until they find out they will "hate" every new job for a while then might like it--that's just called "work". Others do what we all do and take the anything until what we really want comes along. Either way there is a high turnover and it even extends to mid-levels and physicians in big cities. Health care saturated markets just see a lot of moving around. Hard to turn down the next employer giving you $10/20/30K or more a year just for quitting one job and starting another. I never understood why they just don't make tiered salary bands for nurses vs just hourly rate...get a contract, give them a high salary and make them stay.
Dec 16, '16Quote from Ruby VeeI was talking about new nurses and experienced nurses. I am well experienced like you and have found the hospital environment to only get worse every year that passes. Part of it is society in general, but other factors like increased technology, (like others have stated) work phones that never stop ringing, increased paperwork, increased workload in general, patient (oops customer) satisfaction, family satisfaction, etc...many of these were nonexistent or very minimal years ago. So yes, new nurses are not properly trained as what to expect, and experienced nurses are tired of all the PC stuff that gets in the way of good patient care, thus new and old nurses alike are leaving...I have been a nurse for nearly 40 years, and nurses have ALWAYS been held accountable for the lab not coming, meds not being delivered by pharmacy, PT or OT didn't come, the physician didn't round, the meal wasn't what was ordered, the physician made the patient NPO without explaining it to the patient, the blood isn't ready, the interventional lab is backed up, surgery was delayed, the TV doesn't have the channel I want to watch, my family isn't here . . . The difference is that people used to be more polite and understanding about it. Now they're not. If you think that there was some particular "golden age" of nursing when nurses weren't accountable for everyone else's job, please be advised that there wasn't.
Dec 16, '16Quote from MrNurse(x2)It is scary although in some places new grads get a longer orientation than experienced nurses. Often not long enough.The cost to develop a new nurse is no more than an experienced nurse today because there is no difference in orientation time. That leaves the new grad in a position to fake it until they make it, a very dangerous place for the nurse, patients and coworkers. It really is a scary time to be a new nurse.
Dec 16, '16Quote from chiromed0I agree, but there are a lot of other reasons I am leaving after my residency is through. Not Nursing per se, but definitely the department I oriented to, the "hospital life" and the geographical area (see Chiro's response for this one)I think part of the reason "new" nurses quit isn't any different than any other occupation. They just simply have that option b/c they can find work. If the job market is tight-they will stay. Some are just young and don't know the value of patience. Some get scared and hate it so that justifies quitting until they find out they will "hate" every new job for a while then might like it--that's just called "work". Others do what we all do and take the anything until what we really want comes along. Either way there is a high turnover and it even extends to mid-levels and physicians in big cities. Health care saturated markets just see a lot of moving around. Hard to turn down the next employer giving you $10/20/30K or more a year just for quitting one job and starting another. I never understood why they just don't make tiered salary bands for nurses vs just hourly rate...get a contract, give them a high salary and make them stay.
NETY is alive and well, and I think everyone here knows it. Whether you PRACTICE it, that's not the issue. I had an exceptionally lengthy orientation, 6 months. After one month, it was clear that my preceptor was in it to get his CNIII and climb the ladder, nothing else. He set me loose and would literally leave the unit without saying a word (I'm ED), getting his co-workers to "watch over" me.
(80+ bed ED here, folks. just putting a little context out there)
When I was asking to get some trauma experience, which is what my preceptor was supposed to be teaching me---I LITERALLY was told (by preceptor) "Well, get in there!"
Oh. <slaps forehead> THAT'S all I had to do? Just "get in there"?! I know I truly would trust a trauma RN that had that kind of teaching under her belt!
How about a girl who graduated a cohort behind me, who had the CNIV come to her 2 days after she got off of precepting, he sat down, crossed his legs, and slid a piece of paper across the desk to her.
They had "studied" her first self schedule as a brand new "on your own" RN...and determined that she had not opted to take >2 days of OT per week....and on that slip of paper were the dates/shifts (some not her regular shift of 2p-2a) that THEY decided that she should take.
That same CNIV, who told me that I was not permitted to take any classes on my off time---even if they had everything to do with Nursing---because if I had "spare time", I should be using that towards chipping away at the short shifts in the dept.
And that is just an everyday run-down. The pay sucks. That's geographical, and I am doing something about that at 1 year. I don't get lunches or pee breaks (common), but I also don't ever get a single word of guidance.
Know why? Because the "senior RNs" feel that since I will "probably" be gone after a year, like all the others, they aren't investing in me fully.
It's not a marriage, folks. It's a job. Putting your "heart and soul" into training someone? That's nonsense. It's a job. If you are precepting by choice, then it's a job YOU signed up for. Do it. And act as if that person you are precepting may be taking care of your parents or your kids. If you are being tapped to precept against your will? Still do the best you can. Again...that RN may be in a position that they're taking care of YOUR loved ones.
It's a JOB. Not a popularity contest--your personal opinion of any other employee is irrelevant. If their skills are up to par, then you need to keep your "personal" opinions of them to yourself. That's where the "lateral violence" comes in.
One of my cohort made a simple mistake in putting a foley cath in a female pt and inserted the catheter into the wrong orifice. <snicker snicker> yeah wasn't that just hilarious? especially being the patient, i'll be she thought that was just so funny to have her hoo-haw out there for the senior RN to snicker at the new grad.....and then, not to be outdone by her disgusting behavior at bedside embarrassing the NG, senior RN goes and spreads the story around. Classless and gauche.
Oh, but dark humor! No. It's lateral violence, and it's showing your butt to the patients as well. I wouldn't EVER allow that RN, senior or not...to EVER touch one of my family or friends.
There's just no line with some RNs. Oh, but I'm senior and I'm having a bad day. Well, I'm an NG and I'm having a bad day. We're even. I don't get to act like a classless jerk, neither should you.
Respecting each other in the workplace isn't a function of how LONG you've been there. THAT is what NETY is all about. Senior RNs feeling that they have "earned the right" to act like jerks.
I wasn't told in nursing school that I would get a preceptor that sits on his phone all day while I do his pt load, and when I ask a patho question I get, LITERALLY, a dumb stare and a comment like, "i have no idea. i don't keep those things in my head." To complain to management....preceptor's longtime friends? LOL. Yeah. I'll do that.
Which is why I am of the Robert Downey Jr school of thought..."Listen, smile and agree...then do whatever the **** you were gonna do anyway." Which is learn what I can, read everything....and then bail. Go to someplace where the pay is 3x what I make now (same experience level)...there is a union that protects my rights and my pee breaks....and let the NETY senior nurses sit around and wonder "why oh why" the NGs aren't interested in staying.
Dec 16, '16Quote from Ruby VeeI have several years of research data from my hospital that says pretty much the same thing -- and not just for the ICU. Approximately 1/3 of all the RN's in their first week of employment say that they plan to leave the job they are orienting to within 2 years. Realizing that so many of our new hires view their jobs as just "short term," we are questioning the wisdom of providing lengthy orientations and lots of additional education within the first year of employment.I have actually communicated with new graduates about why they are leaving -- perhaps 10-15 of the 30 or so who leave our ICU ever year never intended to stay in the first place.
Their department has nothing to do with how we treat them. They are planning to leave before they even start their jobs with us.
Dec 16, '16If you work in a ltc , then its very easy to list why nurses quit. Poor pay , sometimes you make less than you would working in a hospital. Very very short staffed which leads high patient ratios. Very poor orientation which may make you less marketable than your counterparts who trained in a more acute setting.
Dec 17, '16Nope. I got a measly six weeks while some experienced nurses received ten.
I stayed at my first job in med-surg ft for eight months before becoming PRN.No one wants to stay it seems and the most senior nurse on nights has graduated fnp school. After her, the next one has less than two years of acute care experience.
Quote from Nurse BethIt is a scary time to be a new nurse-and overwhelming. I'm curious about your observation that new grads have the same amount of orientation as an experienced nurse.
In my community, new grads receive significantly longer orientation than experienced nurses. Is this not the case elsewhere?