Nurses attack 'shameful' training

But how much of that attitude is perpetuated by the fact that there is no commitment on the part of the employer anymore. I have also been a nurse for 21 years and can tell you that when I graduated, hospitals took care of their nurses, offered reasonable benefits and very rarely, if ever down sized and let experienced nurses go. Sure, the new grads today are different than they were when we were new grads. But there are many things that are different today as well. New technologies ..... nurses are now educated in colleges and universities and they know very little. Most of these kids are graduating and are scared to death.

I could never imagine being thrown to the wolves after I graduated like they do today. My training was alot better and I still struggled to develop decent survival skills.

So, yea, the new grads are different than we were, but so is our industry and so are the employers. No loyality from employers generally equates to no loyality by empoyees. I am happy that nurses have greater options today. Hope it continues. But you are right ... things have changed in a big way.

gee you don't think this doesn't have something more to do with increased acuity and reduced staffing?

I wonder if we can ever really compare patient outcomes relating to nursing care in different eras? I don't know if patient care from nurses resulted in better outcomes then or not.

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.

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.

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.

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.

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.

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.