Can nursing programs graduate practice ready nurses?

[dnsonthego]

I was asked to conduct courtesy interviews for several new nurses who were not able to obtain a job as a nurse. These nurses had graduated in 2009, 2010 and 2011.

It was interesting to speak with them as they were hopeful that a job would come their way.

What did concern me was that these nurses did not understand that they are not practice ready. By practice ready, I mean being able to go on the floor, get report and get to work as either a staff or charge nurse.

The nurses I spoke with had their degree and a license to practice but no paid experience. Volunteer experience is a great way to make contacts but it is not the backbone of a resume.

I explained to the nurses how tight positions for nurses are and that more belt tightening will be occurring in healthcare in the region (NYC).

All the nurses were under the impression that once they got their RN they could do what they wanted professionally. The expectations they have about the nursing profession are very inflated.

The changes over the last several years are having a cumulative effect...schools are graduating too many nurses for too few positions. As new nurses are graduated, the previous years graduates become more unlikely to get a nursing job. Skills fade when not used plus employers would rather take a new nurse straight out of school rather than a nurse who has been on the side lines.

Nursing schools base their educational program on the assumption that their graduates will be employed in a hospital. The hospital will prepare the graduate nurse to function as a staff nurse via new nurse orientation programs and preceptor programs. Due to the problems in the economy which has been effecting facilities since the 2007 recession, positions have been reduce or eliminated, turnover is down, fiscal issues are becoming a priority effecting everyone in healthcare.

New nurses are expensive to train and orient. My personal feelings is that if the schools did a better job preparing students to practice, the graduates would have a better chance to secure gainful employment. We all know of nurses who got a job as a nurse in a hospital, went through a lengthy & costly orientation only to realize nursing is not for them. Some of these nurse will bounce from job to job hoping their next employer will be different. It sad to say but it is the same everywhere...just different characters. In the era of a nursing shortage, new nurses could do this, today it is a different ball game.

I told the nurses the standard advice: keep applying, volunteer, get a BSN or other training, etc. The sad fact is if these woman need to be working not on the sidelines hoping that jobs will be opening up in the next few months.

I firmly believe if the schools had prepared the nurses for practice, the nurses would have a better chance in the job market. I also firmly believe that nursing schools need to prepare nurses for the future of nursing practice...community health, home health, LTC, public health and outpatient and clinic practices. Schools don't play up these areas but these are the areas that nurses in the future will be working. Hospitals will become leaner with more treat and street services.

Anyway, this is my thoughts on this subject. I welcome comments.

[applesxoranges, BSN, RN]

I read an article that compared new grads of all majors with grads in previous decades. One thing they found was that new grads are less likely to move out of state whether it is they have a family commitment or just like the area. From what I've seen, this is very true.

I personally do not want to move so I am taking whatever job signs a contrac first. I want the stepdown job because it's basically an icu that most hospitals have. However, I'll take my part time ER job.

The stress is killing me. My classmates do not how bad it is. People who are not working are talkin about getting an ER or Icu job like they are candy. They say they will turn down a med-surg job. They are also surprised an experienced person who works in an ER would consider medsurg.

[jadelpn, LPN, EMT-B]

There are many, many hospitals that are phasing out more experienced nurses who hold a lesser degree than a BSN in favor of anyone who does. In some instances, new BSN's "training" newer BSN's. It is driven by dollars with little sense. With everything computerized checklists, scripting of patient interactions, reminder pop ups when meds are due--it has become less the art and science of nursing, and more the technical computer programming of nursing. Most want a nurse to just do, not think.

Nursing schools don't confirm nor deny that one is going to get a job out of the gate. Few colleges do. However, it seems like the trend is pointing to BSN only facilities. New grads = less pay, and they can shape them any way they wish.

With the healthcare reform, there is a huge push in keeping people in their homes longer. So home health would be were I would be looking.

[HeatherGurl84]

Or when nurse bullying comes in...making it hard for new nurses to thrive in fear of going to learn and being berated.

[roser13, ASN, RN]

Or when nurse bullying comes in...making it hard for new nurses to thrive in fear of going to learn and being berated.

Do you have personal experience of "nurse bullying"? Unless you do, I (if I were you) would hesitate to interject that tired old tale into a legitimate thread on new grads having difficulty finding positions. It is hardly relevant to the original post.

[HeatherGurl84]

Going into my first job out of nursing school, I was called "stupid" in front of a group of nurses by my preceptor-being the new nurse on the unit, when I asked a question about a procedure I had never done. If I hadn't learned how to do a certain skill or did not know something, I got eye rolls and the comment "did you even go to nursing school?" I would ask for help and either be told no to my face or was told to figure it out on my own.

And it making it relevant to the post, I do wish that nursing programs did focus more on skill sets as well as book learning before graduating new nurses.

[StJohnRiver]

There is no way any nursing program can prepare a graduate for what awaits them when they hit the floor. The best thing for hospitals to do is have a solid residency program. I was lucky enough to get into a hospital using Versant and am so glad I did. It was 18 weeks long, with classes, lectures, looping and floor duty all combined. By the time I hit the floor on my own, I was more than ready. I was jealous of my classmates at first, hearing about them being left alone after six or eight weeks while I was still doing classwork and being teamed with a preceptor, but then came their horror stories of feeling so overwhelmed. Nursing programs are designed (and judged) by success on the NCLEX. No way can they, or should they, be expected to turn out students who can step onto the floor with minimal assistance.

[DoGoodThenGo]

Can nursing programs graduate practice ready nurses?

Of course they can, diploma programs did so for decades before and after BSN and ADN programs came along.

Thing was diploma nursing programs were just about that, training/educating nurses. While the apprenticeship method is long out of fashion, the fact remains such programs turned out clinically competent grads that went from GN to RN often with ease and no more change of uniform/caps.

Old school hospital programs offered clinical experiences of two or more days per week with rotations in every area covered by nursing service. Contrary to popular belief many programs kept up with modern developments in the profession and were not merely producing automatons. Theory and rationale were covered along with incorporation of various other disciplines such as science and pharmacology.

Clinical competency is in no small way the result of doing, and doing, and doing things over and over again until one's brain becomes hardwired. Schools now seem to push this off and or hope it comes later at the hospital's expense during orientation, but the latter group is saying "not so fast".

Any person in possession of reasonable intelligence can study a nursing text book and after period of study know enough T&R and whatever to pass an exam; however you certainly wouldn't let them loose on a sick cat much less you and yours.

Problem today is college/university educated nursing students have many demands on their time. If they are to spend two or three full days per week at clinical rotations where does the time come from for classroom time? Not just nursing but the other subjects that are required by the college as a whole and or state for those seeking a degree. This is particularly a problem in the United States where students are used to ample and often long breaks in their school terms.

[DoGoodThenGo]

There is no way any nursing program can prepare a graduate for what awaits them when they hit the floor. The best thing for hospitals to do is have a solid residency program. I was lucky enough to get into a hospital using Versant and am so glad I did. It was 18 weeks long, with classes, lectures, looping and floor duty all combined. By the time I hit the floor on my own, I was more than ready. I was jealous of my classmates at first, hearing about them being left alone after six or eight weeks while I was still doing classwork and being teamed with a preceptor, but then came their horror stories of feeling so overwhelmed. Nursing programs are designed (and judged) by success on the NCLEX. No way can they, or should they, be expected to turn out students who can step onto the floor with minimal assistance.

While no program will prepare a GN for everything she will see upon graduation, it can get them darned close.

Historically grads from diploma programs needed the least orientation (especially if they were hired by the hospital that ran the nursing program), with BSN's the most and ADNs some where in the middle.

Initially many hospitals fought the creation of ADN programs and or movement of nursing education out of facilities. They argued the current system produced nurses that suited their needs. However the profession was looking more to other things and won the day. Also gradually hospitals began to see the benefits (especially fiscal) of not having to run a school of nursing and picking up already licensed/new grad nurses. Costs of orientation (which until rather recently in some places ran nearly six months or longer) were balanced out by not having those from running a nursing program.

For awhile this grand bargain held. Nursing programs by and large produced grads of a decent enough quality that with seasoning became good to excellent professional nurses. Somewhere around the 1990's or so things began to change in many markets. Hospitals began noticing a slight to large drop in the quality of new grads. We're talking new nurses that barely had what hospitals considered basic core knowledge. This translated into increased orientation costs which often came at a loss because one in five new grads did not for various reasons complete orientation.

The fiscal crisis and other factors hospitals find themselves facing today is either directly or indirectly causing the heartaches new grads today are facing.

Hospitals know they must have a certain amount of new grads, but have laid down the law to nursing schools and anyone else that listens what they want. There was a time as late as the 1980's or early 1990's in NYC for instance where you not only could get into a nursing program with a 2.5 GPA, but remain and graduate. Usually no HESI, TEAS, SATs, or NLN exams required for entry or retention either. No intern or extern programs as well. Yet if you graduated and passed the boards someone would hire you. That is now by and large over.

I submit that at lest form what one sees in NYC market schools are turning out some of the highest academically qualified grads in history. Everyone at 3.0 and in many cases a majority at 3.5 and above. However without some sort experience (volunteer, extern, intern, etc...) many places don't want them. This tells me at least hospitals are looking for something they can measure of clinical skills.

[OCNRN63, RN]

Can nursing programs graduate practice ready nurses?

Of course they can, diploma programs did so for decades before and after BSN and ADN programs came along.

Thing was diploma nursing programs were just about that, training/educating nurses. While the apprenticeship method is long out of fashion, the fact remains such programs turned out clinically competent grads that went from GN to RN often with ease and no more change of uniform/caps.

Old school hospital programs offered clinical experiences of two or more days per week with rotations in every area covered by nursing service. Contrary to popular belief many programs kept up with modern developments in the profession and were not merely producing automatons. Theory and rationale were covered along with incorporation of various other disciplines such as science and pharmacology.

Clinical competency is in no small way the result of doing, and doing, and doing things over and over again until one's brain becomes hardwired. Schools now seem to push this off and or hope it comes later at the hospital's expense during orientation, but the latter group is saying "not so fast".

Any person in possession of reasonable intelligence can study a nursing text book and after period of study know enough T&R and whatever to pass an exam; however you certainly wouldn't let them loose on a sick cat much less you and yours.

Problem today is college/university educated nursing students have many demands on their time. If they are to spend two or three full days per week at clinical rotations where does the time come from for classroom time? Not just nursing but the other subjects that are required by the college as a whole and or state for those seeking a degree. This is particularly a problem in the United States where students are used to ample and often long breaks in their school terms.

I get more than a little exasperated when someone mentions diploma programs with a finger-flick and an eye roll, as if someone who graduated from a hospital program is a lesser nurse.

My puny diploma program educated me well enough to work in multiple specialties, and helped me be capable of passing 5 specialty certification exams. We (diploma grads) learned a lot, and we got our fair share of college courses in our programs.

[TheCommuter, BSN, RN]

The three-year diploma nursing programs of yesteryear were graduating 'practice-ready' nurses who could hit the floor running immediately upon graduation with minimal orientation.

Sadly, there are very few of these programs remaining.

The nursing profession phased out these diploma programs with the hope of appearing more 'professional' by moving our education into colleges and universities. By doing this we've kicked ourselves in the teeth.

[DoGoodThenGo]

The three-year diploma nursing programs of yesteryear were graduating 'practice-ready' nurses who could hit the floor running immediately upon graduation with minimal orientation.

Sadly, there are very few of these programs remaining.

The nursing profession phased out these diploma programs with the hope of appearing more 'professional' by moving our education into colleges and universities. By doing this we've kicked ourselves in the teeth.

And what did they do for those three years?

Pipe: Mormon Missionary Mom: Nursing School