Nurses attack 'shameful' training - page 2

SUE Jenkins says there are times when she is almost ashamed to be a nurse. A Queensland nurse with more than two decades of experience, she says she is increasingly witnessing horrific incidents... Read More

  1. by   finchertwins
    Many things have changed the dynamics of the hospital and nursing enviorment. For one there are fewer nurses, second there are many more patients, and they are ushered in and kicked out at an alarmingly fast pace. I am a RN student entering my final semester. When I was looking for a school to go to I asked other nurses and they stated the ADN program at the school I go to was the best in the area and sent out better nurses then the other schools. That was some of the best advise ever given to me because I have been in clinicals with other schools both university and 2 year and for the most part I have had greater freedom and accountability. This aside, nursing has changed, the hospitals are responsible to stockholders now and nurses look for better pay often to help justify the stress we are now forced to work under secondary to a shortage of nurses that is only getting worse. Nurses are a very independant group of individuals and in some hospitals this will be a wonderful work enviorment and others will be a culdron of hell. We as nurses or to be nurses have a greater power now then ever to form an enviorment that can be tolerated because we are no longer a dime a dozen. Yes this seems a little ideal but I am not new to the work force and understand the effects of positive initiative..... sorry for misspelled words I am good at science and suck at english.
    Last edit by finchertwins on May 5, '04 : Reason: poor grammar
  2. by   Q.
    I think there are numerous factors which can contribute to the perception that new (or younger) nurses are poorly trained or lack initiative. A few posts touched on some of those other variables.

    One strong one that I wholly agree with is the difference in generational beliefs. For example, one post relayed the value of respecting your elders. I can tell you that is an ideal that is typically reminscent of baby boomers, etc. Sure, I was taught that also but there are times when I think, hey, age does NOT equal automatic respect - especially in the work environment. Your chronological age does not gain my respect; your work ethic, your attitude, how you treat me and what you bring to the table does.

    Another is that typically the younger generations do not hold a loyality to their employer like their older counterparts do. Many younger nurses (myself included) put work-life balance top priority.

    And yes, high acuity and low staffing I would think has a MAJOR impact on ANY nurse's ability to be efficient and cheery. Many nurses that I train in orientation sit in my class for 8 hours and then report for PM shift immediately after, and are scheduled for class again the very next day. These nurses are tired and overworked from day one - thanks to our organization and our staffing situation.

    To blame university training for the attitudes of "young" nurses is short-sighted and smacks of ageism.
  3. by   RNPATL
    Quote from Susy K
    hey, age does NOT equal automatic respect - especially in the work environment. Your chronological age does not gain my respect; your work ethic, your attitude, how you treat me and what you bring to the table does.
    I totally agree with your position here. People have never merited my respect because of their age. I believe that when you are in the work environment, you must earn respect by your attitidue, how you treat people and your willingness to move ahead and change as changes need to be made. Nothing is more irritating to me than having the older nurses refuse to make changes in practice because they do not want to change the way they have always done it. Evidence based practice is a real need here.

    Another is that typically the younger generations do not hold a loyality to their employer like their older counterparts do. Many younger nurses (myself included) put work-life balance top priority.

    While I can respect your position here, I think thgis has been an age old issue for many people. I am sure that other generations also desired to balance work and life. I think the issue is really the loyality or lack of, that the employer is showing the nurses today. It use to be that nurses were taken care of. They received decent pensions and benefits that helped their families. Today's nurses are working with health insurance rates that take almost 10% of each of their paychecks. Many nurses barely get 3-4 holidays paid and as far as time off ... well, not much. In addition, there is always the threat that if census drops, they will be called off or worse yet, their unit will close and they will be downsized. These are very different challenges that nurses today are dealing with. Nurses in the past did not have to deal with such extremes. This might be one reason why the loyality on the part of nurses is simply not there.

    To blame university training for the attitudes of "young" nurses is short-sighted and smacks of ageism.

    Call it ageism, call it want you want .... nurses coming our of ADN and BSN programs are NOT prepared to be functioning nurses on the floor. End of story! The reason for this is the possibility of lawsuits. Universities and colleges give nursing students that very basic education and then expect the hospital to continue their education and prepare the nurse for the floor. Problem here is that most hospitals do not have adequate resources to provide the kind of clinical experience and the time needed to get these new nurses up to speed. Besides, the industry is in such terrible shape that I am not even sure there is a way to prepare a new nurse to work in nursing today. It is a crazy place out there.
  4. by   Q.
    Originally posted by RNPATL
    Call it ageism, call it want you want .... nurses coming our of ADN and BSN programs are NOT prepared to be functioning nurses on the floor. End of story! The reason for this is the possibility of lawsuits. Universities and colleges give nursing students that very basic education and then expect the hospital to continue their education and prepare the nurse for the floor. Problem here is that most hospitals do not have adequate resources to provide the kind of clinical experience and the time needed to get these new nurses up to speed. Besides, the industry is in such terrible shape that I am not even sure there is a way to prepare a new nurse to work in nursing today. It is a crazy place out there.
    I agree and disagree with your statement above.

    I come from the mindset where I expect new graduate nurses to lack many things in order for them to function independently on the floor. What they receive in any nursing school (ADN, BSN, whatever) is just what you stated: the basics for beginning practice. The problem is that our profession (in part due to hospital organizations as well) generally treats these new grads like just another nurse to fill a staffing hole - and find their learning needs both an annoyance and a hinderance. And then the blame is shunted to the universities.

    Problem is, our profession isn't unique in preparing it's young as novices. Medical students, upon graduation, have a 4 year residency. Beginning law students (called Associates after graduation) certainly aren't expected to sashay into a court room and handle a case; they usually clerk or follow an experienced attorney around for quite a while. Even in the IT industy (which my husband works) newbees hired into his group start off by coding and then gradually move into more complex projects. Why does nursing demand to be different?

    My point is that I would lay the blame for our nurses's attitudes and our crash-course training on "the health care system" - that entire conglomerate of problems that, in my opinion, is responsible for all the problems in health care today from the high cost/low reimbursement to the focus on tertiary care to the nursing shortage.
    Last edit by Susy K on May 9, '04
  5. by   RNPATL
    Quote from Susy K
    Originally posted by RNPATL


    I agree and disagree with your statement above.

    I come from the mindset where I expect new graduate nurses to lack many things in order for them to function independently on the floor. What they receive in any nursing school (ADN, BSN, whatever) is just what you stated: the basics for beginning practice. The problem is that our profession (in part due to hospital organizations as well) generally treats these new grads like just another nurse to fill a staffing hole - and find their learning needs both an annoyance and a hinderance. And then the blame is shunted to the universities.

    Problem is, our profession isn't unique in preparing it's young as novices. Medical students, upon graduation, have a 4 year residency. Beginning law students (called Associates after graduation) certainly aren't expected to sashay into a court room and handle a case; they usually clerk or follow an experienced attorney around for quite a while. Even in the IT industy (which my husband works) newbees hired into his group start off by coding and then gradually move into more complex projects. Why does nursing demand to be different?

    My point is that I would lay the blame for our nurses's attitudes and our crash-course training on "the health care system" - that entire conglomerate of problems that, in my opinion, is responsible for all the problems in health care today from the high cost/low reimbursement to the focus on tertiary care to the nursing shortage.
    I totally agree. I have often said that nurses should have the equalivent of a residency or some sort of program that allows them to transition from graduate to practicing nurse. However, like you said, hospitals simply do not offer this type of education and many times will throw the novice nurse to the floor with little to no preparation. I do beleive the universities also play into this problem. We can not simply blame the hospitals. Universities need to take a more active role in providing more clinical depth to the student's learning experiences and at least offering the student to develop skills that they will need when they are in practice. It is unacceptable for a 4 year BSN to come out of school having never catheterized a patient or having never dealt with a central line dressing change. These are basic skills that need to be taught and developed through school. Sure, it is fine for BSN's to have well rounded management theory, but lets get down to the basics and make sure these people have some reasonable survival skills for clinical practice. So, from my perspective, I would have to disagree with you and say that the educational system as well as the hospitals are both in the same boat when it comes to new grads attitudes.

    When I was conducting portions of the new graduate orientation at my old hospital, I would often tell the new grad. nurses that I was not going to teach them how to be nurses (it was my hope that after passing boards, they knew how to be nurses), rather, I was going to teach them how to apply their knowledge into clinical practice in accordance to our policies and regulations. I can not tell you how many times these girls and guys would come up to me after class and tell me that they thought they were going to learn certain types of skills. Of course, the program would assess their knowledge of assessment, etc. (the nursing process) and we would provide them with skills on our type of equipment, but we were not prepared to teach them how to be nurses or provide them with training on basic skills. However, many of them felt like they were poorly prepared to work as an RN. I agree with you that a residency program might be the way to go. However, something like this would need to be written into nursing law or it will never happen.

    Are any of these issues of concern to the ANA? Is there any form of legislation that the ANA is working on that will address this problem? I can not answer this question. I am not certain that the ANA is all that concerned with these issues. They are to concerned with their own agenda that typically has no reflection on the bedside nurse's practice. Perhaps it is time for the ANA to get off of its elevated perch and begin looking at the grass roots level and start listening to its membership. Maybe then something can be done on a national level to promote new grad transition programs.

    Thanks for the debate.
    Last edit by RNPATL on May 9, '04
  6. by   PeninsulaRN
    I agree that there is much to be done to transition the graduate nurse to a competent staff nurse. Many larger (often university-based) hospital systems have residency and internship programs lasting anywhere from 4 months to a year to assist in the transition through clinical, didactic, and OJT... this is usually through close partnership with a clinical nurse educator, unit managers, preceptors, etc. Unfortunately, many rural or smaller hospitals cannot offer the same programs. I've seen new graduate nurses orient for 4-6 weeks and then be considered regular staff. Some do well. Others flounder, and their coworkers are generally too busy to help them stay afloat. It would do a lot for the state of bedside nursing today if we thought our graduate nurses were important enough to afford them the time they need to become confident and competent members of the healthcare team.

    Ah, but its all rhetoric. I think much of it is also generational differences. I feel much less loyalty for my employer than my parents do. Perhaps I'm a cynic, but I recognize that I am expendable. That my employer cares about me only as much as it cares about any other cog in the giant machinery of healthcare. Beyond that, I'm an annoyance. And so I feel no qualms in moving on to other opportunities, in trying new things, in resigning from one employer and seeking another. My satisfaction is worth more to me than loyalty to a company.

    I agree, it would be ideal if all employers offered internships or residency programs to GNs. Unfortunately they don't, and it is up to the individual graduate to seek out the employer that seems to best fit his or her needs.

    With an industry as constantly shape-shifting as healthcare, in these days of higher acuity and less staff, the old argument of whose training was superior is ill-advised, at best.
  7. by   fergus51
    I think the real problem is that nurses and hospitals haven't adapted to the changes of the last 30+ years. We are still expecting new nurses to be able to function like they did in the 60s, completely ignoring the fact that patients are sicker, stays are shorter, responsibilities have increased, technology has become more complex, and patient loads are heavier. To expect a new nurse today to function like they did in the 60s is just ridiculous. Smart hospitals have recognized this and provide real orientation programs. It seems completely counterproductive to complain about new grads as though their learning is a burden on us. When they are provided with a good orientation, which includes not making them feel like scum for not knowing everything, they become valuable members of the team.
  8. by   Q.
    Quote from RNPATL
    It is unacceptable for a 4 year BSN to come out of school having never catheterized a patient or having never dealt with a central line dressing change. These are basic skills that need to be taught and developed through school. Sure, it is fine for BSN's to have well rounded management theory, but lets get down to the basics and make sure these people have some reasonable survival skills for clinical practice.

    Ahh, and the debate begins. :wink2:

    I'll probably get myself in trouble, but here goes.

    I personally believe that those monkey skills (Yes. Monkey skills) are better learned on real patients in the actual setting. Cathing a manniquin only has so many benefits. And cathing of real patients depends on many, many things. You can have the best rotation in the world, but if you happen to have a patient who doesn't need to be cathed, or, cathed only ONCE, well, then you're poop outta luck.

    Looking back, I would be completely disappointed if my BSN program had focused on these things which I either a) picked up and learned in 4 months on the floor - after doing it day after day after day after day after day or b) never ended up using. Example: I never placed an NG tube in school and nor have I ever placed one in my professional life.

    Secondly, forget the new grads for a moment and let's think about experienced nurses. Let's say you have an L&D nurse of 15 years. She has a wealth of knowledge, no? Suppose she desires a change and decides to work in adult ICU or even a general medical floor. Would she not need to be trained again on how to do dressing changes, caths, NGs, etc even with her 15 years of professional RN experience? But what stays with her and is useful across any specialty? Her "BSN" education: the theory, the research, the management, etc classes that *typically* BSN programs "focus" on.

    Many times I hear Med/Surg nurses state that Med/Surg is actually a specialty within itself. If that's the case, why do we expect nursing schools who's aim is to produce generalist nurses to produce specialists?
    Last edit by Susy K on May 9, '04
  9. by   fergus51
    Can I get a big "Amen!" for the fact that med surg is a specialty?

    I suppose that's another thing that is changing in nursing... Hopefully we will one day recognize that med-surg is not the foundation of nursing anymore. It is one area, no more or less important than any other area. And the skills used there are no more or less important than the skills used in any other area. I've never put an NG in on an adult either, but it doesn't make me less of a nurse. I do know the theory behind putting one in and I could do it if I had to.... but sick adults are icky, so don't worry, none of you adult nurses will ever have to orient me to med-surg
  10. by   Tweety
    I'm not getting into the generational debate. Seems like in every generation it's "kids these days, when I was younger............" apples and oranges. There is a lot of benefit that comes with years, we had to learn our wisdom while our parents were saying "kids these days".

    There is so much to learn in school nowadays, so much theory, so much pathology, a&p, etc. that I agree if one comes out not knowing how to do a skill then teach to them. We had a large clinical group and it was a struggle to find ten patients during a rotation that needed dressing changes, catheterizations, etc. I managed to get through school not having changed a central line on a live person.....horrors.

    I think in the old days it nursing school might have been more clinical oriented.

    I agree with Fergus that things have changed. Patients are sicker. This generation is producing awesome nurses with awesome work ethics but are being thrown into sweatshop hospitals with unsafe staffing and without proper orientation.

    I remember posting a post many months ago about how our hospital takes RN graduates and uses them as secretaries and most of the replies I got were "what's the problem with that".
  11. by   RNPATL
    Quote from 3rdShiftGuy
    This generation is producing awesome nurses with awesome work ethics but are being thrown into sweatshop hospitals with unsafe staffing and without proper orientation.
    I could not have said it better myself Tweety .... however, I don't believe we can pin the entire problems of new graduates soley on the hospital. I do believe that the educational system also needs to take their share of responsibility. It is time for change within our profession. It is time that curriculum be modified and written to reflect the reality of our profession. It is also time for our professional organizations to get off their butts and start working on legislation that protects our young nurses and MANDATES safe staffing ratios as well as residency programs so new nurses can have a decent transition into practice.

    There are a lot of lumps to go around, the hospitals, education and the professional associations all share equally in my opinion. As experienced nurses, I guess we share in this as well, in that we MUST stand together and demand safer conditions for our patients, new nurses and for ourselves. I hope this happens in my life time and if it does, I will be on the front line of this change!
  12. by   RNPATL
    Quote from Susy K
    Ahh, and the debate begins. :wink2:

    Looking back, I would be completely disappointed if my BSN program had focused on these things which I either a) picked up and learned in 4 months on the floor - after doing it day after day after day after day after day or b) never ended up using. Example: I never placed an NG tube in school and nor have I ever placed one in my professional life.

    Many times I hear Med/Surg nurses state that Med/Surg is actually a specialty within itself. If that's the case, why do we expect nursing schools who's aim is to produce generalist nurses to produce specialists?
    I think my point is more directed at that lack of clinical preparation many nurses have today. Having taught many a new nurse, I can attest to the fact that there are many things these new nurses either do not understand or have never been exposed too. This places a large burden on the hospital and on the nursing staff to have to pick up where the schools left off and train these new nurses.

    I guess it takes me back to the point that we have discussed earlier, where nurses should be afforded a residency program. Perhaps this is the answer. At risk of repeating myself - please read my response to Tweety.
  13. by   Tweety
    Quote from RNPATL
    I could not have said it better myself Tweety .... however, I don't believe we can pin the entire problems of new graduates soley on the hospital. I do believe that the educational system also needs to take their share of responsibility. It is time for change within our profession. It is time that curriculum be modified and written to reflect the reality of our profession. It is also time for our professional organizations to get off their butts and start working on legislation that protects our young nurses and MANDATES safe staffing ratios as well as residency programs so new nurses can have a decent transition into practice.

    There are a lot of lumps to go around, the hospitals, education and the professional associations all share equally in my opinion. As experienced nurses, I guess we share in this as well, in that we MUST stand together and demand safer conditions for our patients, new nurses and for ourselves. I hope this happens in my life time and if it does, I will be on the front line of this change!

    True there are a lot of lumps to do around. I think the expectation that colleges should sent out fully functioning nurses with unrealistic. Or even if we learn something in school, and do it in clinical, doesn't make us proficient when we hit the floor. I had to start dozens of IVs before I felt comfortable and confident. We should allow new nurses that and give them orientation and exposure and re-exposure to things.

    But to say that this generation doesn't have the same work ethic isn't true in my experience. Sure there are plenty of lazy new grads coming from nurses school, and they make the majority of bright eyed ready to learn and work new grads look bad. But when I look around me at work, the laziest one with no work ethic is in her 50s. I'm not going to judge an entire generation based on a few of lazy baby boomers I see. Nor an entire class of new grads either.

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