Do New Graduate Nurses Need a Formal Residency Program? - page 3
After four years of nursing school, do nurses need this additional training? To answer this question, it is prudent to examine the traditional four year baccalaureate nursing curriculum. In general,... Read More
Jul 6, '14Quote from Dennis88That is a very interesting concept! Better clinical prepared nurses would possible not have a hard time finding a job because hospitals would not have to pay as much to train.I haven't seen anyone comment on the biggest issue -today does not prepare you to be a nurse, it prepares you to pass the NCLEX. The experience that you can get through a good residency or the six- or 12-week new grad orientation is experience that student nurses should be getting in school.
Jul 6, '14This is a beautiful and well crafted piece.
As a new grad in a residency program that genuinely I believe at my facility is a fancy title for "we'll do our inservices all up front and you'll have 5 more weeks with a preceptor", I feel like the level of detail you describe necessary is a bit disheartening. For a few reasons.
First - if truly prepared us, rather than gave us baseline NCLEX knowledge, we wouldn't require the educational complements of residencies as much. Hospitals being required to put in so much of what we hope to get from nursing school when, as you say, turn over is so high, is a terrible leap of faith that they will stop investing in eventually. As a new grad, I WANT my residency, in spite of it not really being the most well-rounded, well-developed experience because I know I need these training wheels.
Second - turnover. When they interviewed, they were very clear that we would not choose our own floor. Now, my preceptorship was on my currently-employed-at unit. It was quite the gamble when I went in guns blazing, but during my interview I was extremely open about the type of person I am and what I'm looking for. Thankfully it was a fantastic gamble because I won. Another person in my group got on a unit that is traditionally ortho post OP and she is quite disappointed. I'll be shocked if they retain her. I know they want what is the best fit in THEIR opinion but when the employees opinion has nothing to do with placement, you just aren't going to keep them. Of course there are the issues already noted in your article, but that one thing is a big deal. We're told in school - if you specialize right out of school you will never get out. But if we don't go where we want to, we aren't going to stay. It's a terrible double-edged sword. It sort of makes me wonder if non-generalist nursing program availability could solve this and the scared newbie problem.
Third - the non-uniform concept of residencies. You can stick a listing on your website that says "residency" but what does that even mean??? My group had a non-new grad with us the entire time. I'm all for him getting the education he needs, of course, but why tell us that we're an isolated group of new hires that will be given this special program if it was actually open to other new hires? Beyond that the only thing different about the residency is the extra precepted weeks. We all have the same exact check lists. This should be formalized. This should be a well defined concept. When we were going through the interview/new hire process, they really made it a big deal that there were nearly 300 applicants and we were the chosen few for this amazing opportunity.
All that complaining aside, I genuinely am thankful for the little bit extra we have gotten and simply having employment is quite a gift. I hope my critique doesn't come across as purely ungrateful complaining. Whether school or hospitals fill this gap, clearly it is NEEDED. I believe this resource needs to be more refined, improved. If it's done right, with employees having the ability to choose from available placements, and with residency being a formalized concept, retention would be better. The investment would be worth it.
Jul 6, '14Quote from CamwillThe clinical requirement for nursing schools is less than 800 hours, and up to 25% of that can be lab simulations. (I know of at least one school in the Denver area that is doing simulations in lieu of actual clinical time because they can't get the clinical placements.) Hospitals are reluctant to hire new grads because they have to provide the training we should be receiving in school. Most practicums are five weeks when they should be a full semester. There was a lot to be said for the old diploma programs that were based in hospitals.That is a very interesting concept! Better clinical prepared nurses would possible not have a hard time finding a job because hospitals would not have to pay as much to train.
Jul 6, '14Quote from ixchel, rnI agree. In school, everyone tells you to do a year or two of med-surg and then you can transfer anywhere. But a lot very good nurses don't like med-surg. My psych clinical instructor told us that if we want to go into psych, we should still do med-surg first so we don't lose our skills. Our reply was that we didn't have any skills to lose because you don't learn them in school.I know they want what is the best fit in THEIR opinion but when the employees opinion has nothing to do with placement, you just aren't going to keep them. Of course there are the issues already noted in your article, but that one thing is a big deal. We're told in school - if you specialize right out of school you will never get out. But if we don't go where we want to, we aren't going to stay. It's a terrible double-edged sword. It sort of makes me wonder if non-generalist nursing program availability could solve this and the scared newbie problem.
Jul 18, '14I have never thought about these downsides to nursing residencies; I agree that such programs should be regulated (like medical residencies) so that they are actually meaningful. I had a few classmates that did nurse residencies; they seemed happy enough with them, but we didn't have anything to compare them with.
I'd love to see well-thought-out residencies for nurses, but I can't think of how you would do it for some of the weird specialties, like my beloved PACU. Unless you work in a HUGE hospital, there just isn't the repetition that you need to hone clinical skills in a 3- or 6-month period (to wit: in 2 years, I have placed one Foley, drawn labs off one PICC, had two craniotomies requiring cranial nerve assessments, etc.), so I'd worry that it would be yet more hours in the sim lab and less with actual patients. I've sort of forged my way with a group of supportive colleagues that pull me in to do the unusual stuff!
I also know that learning those skills is only part of becoming a nurse, and that's not what really matters to the patients (even though not knowing how to do something can really slow you down)--it's the experience to think, ask the right questions, and understand what's going on. That just takes plain old time, whether in a residency or just on the job.
Jul 19, '14I wish I'd been able to do a new grad residency. I graduated in 2008, just before the economic collapse. Hospitals wanted a BSN, which I didn't have, and even SNFs wanted 1 year of experience. It took 10 months to find my first job, at an ALF where I spent 90% of my time passing meds. In the jobs I've had, orientation has ranged from 2 hours to 2 weeks.
Nurses of yesteryear were able to hit the ground running because they had a lot of clinical time. When hospitals ran nursing schools, students were the evening shift. They also didn't have nearly as many practice restrictions. I managed to get through school without drawing blood, placing a foley (though I did 1 in-and-out cath), or a lot of other things. I volunteered in an ER, and applied for summer practicums (my school didn't offer one), but I graduated feeling like my skills were shaky. Whenever I expressed anxiety about my missing skills, I was told "You'll learn that on the job."
Jul 24, '14Something has to change, and since the schools and employers call the shots, I expect them to step up and do it. I work med surge, got a 12 week orientation, and continually got told I was doing great, even though all of the work couldn't possibly be completed correctly by a newbie. Now, off orientation, having not experienced many things (how could you?) and having 7 patients, they want to come to me and ask why things are being missed?? Did you really expect to take me from a know-nothing student to an experienced RN in 12 weeks? I'm amazed that there are aren't more problems.
Feb 17, '15@Camwill, do you mind me asking which residency program you are attending? I know I'm a few months late seeing this...so how do you like it as of now?
Mar 21, '15Greetings!
Question: To those who have applied to the UC Davis residency program or any other residency program, how are you placed in a specific area/speciality? You do list your top choices like medical school residency and then they choose who will be interviewed and placed in each position?
I'm still in nursing school and trying to get a clearer picture of my future options. Thanks ahead to any insight provided!
Mar 21, '15Quote from Not_A_Hat_Person"Yesteryear" meaning WWII, maybe. It's been a v. long time (many decades) since hospitals have been allowed (by regulatory and accrediting organizations) to use student nurses as free labor. In the hospital-based diploma program I attended in the early 1980s, the focus was on our nursing education and our status as students was carefully protected.Nurses of yesteryear were able to hit the ground running because they had a lot of clinical time. When hospitals ran nursing schools, students were the evening shift.
However, we did a gazillion more clinical hours and had a much broader, deeper range of clinical experience than students get in ADN or BSN programs, and we did graduate ready to enter practice and function as RNs. I got a much better nursing education than students in any of the ADN or BSN programs which with I've had experience since then have gotten. TPTB in nursing went to a lot of trouble to move nursing education out of hospitals and into colleges/universities, and I'm not sure that's been a good thing for nursing or new nurses.
People always like to talk about residencies for new grad nurses based on the medical model. Residents are getting paid a fraction of what "finished," practicing physicians make, the physician equivalent of minimum wage, and they are (practically) free labor for hospitals. How many new grad nurses would be willing to sign up for extended new grad "residencies" that would pay $8 or $9 an hour? New grads want to get paid the same as experienced, functioning RNs, but they are a financial liability for hospitals and other healthcare employers for at least the first year or so.
I don't blame hospitals for balking at hiring new grads and spending a lot of time and money teaching new graduate nurses stuff that they (the hospitals), rightly or wrongly, feel that people should have learned in nursing school. Esp. with the new nurse turnover rate higher than it's ever been. IMO, nursing education has "thrown the baby out with the bathwater."