Can nursing programs graduate practice ready nurses?

Nurses General Nursing

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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.

That is terrible. They should be offering advice and support to new nurses who are willing to learn, not eating them alive. It's better to ask a "stupid" question than to perform a skill without the knowledge/experience to back it up and then make an error.

I agree that nursing schools should focus more on skills. The university I attended prepared us well for the NCLEX. They told us that was their goal. My graduating class had a 100% pass rate on NCLEX, but there were so many skills I'd never even seen performed, let alone performed myself. I even requested to observe certain skills during my clinicals so that I wouldn't feel incompetent after graduation.

Nursing is a forever learning field, so there is no way to fully prepare a new nurse for life as a "real nurse", but I think nursing students should have more opportunities to learn and grow. I don't know how your nursing clinicals were, but mine were 90% taking vital signs, making occupied beds and assisting patients to the bathroom. I was a CNA for years, so I don't feel like I learned much and I did not feel prepared when I started my first RN job.

Couldn't agree more......out of nursing school I felt lost when it came to skills. All my time was spent making beds, taking vitals, running and getting any patient food/drink requests......I was lucky if I witnessed a new skill.

Specializes in Pediatrics, Emergency, Trauma.

My BSN program provided well rounded realities of the new grad market; there were rotations in clinics, home health, and hospital, including SNF units; LTC was not offered; although many schools in the area do have their first semester clinicals at nursing homes.

I think that the onus is on the hospitals and nursing schools as well as other facilities to create an action plan on having a stronger workforce; that includes having staff members of these particular faculties as nursing instructors (my program had this experience). I also think that area nursing schools need to have the onus and responsibility in NOT graduation TOO MANY students that can not obtain a job; it will be difficult, especially if people are not wiling to start in home care or an outpatient setting, and want to work in a hospital.

The onus is on facilities to ALLOW nursing faculty and schools to be able to take on a full assignment by graduation, shadow the charge nurse, have a feel of being precepted by senior year (I had this experience in my senior semester); also allow for more preceptorships to give a feel of being an entry level nurse (my area has co-OP programs and have agreements with three area hospital; one university has this working agreement; it is limited to a few students vs the the 1000 students that are graduated per year.) unfortunately, most facilities see nursing students as LIABILITIES; you have a litigious society working against you.

I went through nursing school TWICE: PN program; I rotated through LTC, hospitals; was able to hit the ground running in home health and at a rehab hospital; my senior leadership was being a charge nurse in LTC, full cart, shadowed the WOCN. This was in 2005 I graduated and back then in my area, LPNs and RNs were able to hit the ground running.

I completed my nursing program in 2011; was a charge nurse for 1 week; had 4 patients, mock preceptorship in the ER for two weeks of clinical for my last semester; I had a few classes to completed before graduating in May. When I hit the floor in a PICU, It was over 1 YEAR that I was in a hospital setting; the hospital was very upfront on their issues in precepting new grads, and it was known that their new grad residency was not the best like other area new grad residencies; I was not a quitter, but it was not a great fit; I'm still in good standing with this facility fortunately; I rather return when getting more experience.

I have a very extensive background in nursing; I needed more experience in my expanded role, so it took me four months to get another job (still was working as a nurse at an pediatric extended care facility-ALWAYS have a back up job) and I am a shift supervisor-I have taught wound assessments on preceptors that were new grads; ask for my expertise in many interventions although I have been an RN for one YEAR. I have been in this position and administration see the experience and what I am tying to do as a novice; difference between me and the first job, probably ME.

I had the same experience at the first job, I have very strong qualities as a nurse; I also have internal issues that I have struggled with, yet I also have an established practice that I started each time I was in nursing school; not every facility can "fit" with YOU in a given time in your career; that's why there is the "never burn your bridges" adage as well.

It's not just new grads, it's a generation of nurses that are struggling; HOWEVER it is the onus on the NURSE to be willing and open to cast their net wide in getting the experience and advancing their practice from novice to expert; my point is it is EVERYONE'S responsibility to help change the direction of nursing; it is going to take a collaborative approach and a ton of courage to start making the changes by leading by example; unemployed, underemployed, even employed.

We must strengthen programs and approach nursing education and the transition to practice and nursing practice by the Patricia Benner model, IMO. Now, who's up to the challenge??? I've been doing it for eight years, as a LPN and now as a RN...who else is ready?

I agree that Diploma RNs are awesome. There is a lot to teach in nursing school. I have been around a long time so I can honestly say patients are sicker and go home quicker. Any L & D Rns remember how long moms used to stay? Point being I think if nursing schools would change teaching methods it would make a difference. The problem as I see it nursing programs are geared to enable graduates to take the NCLEX, not practice nursing.

Specializes in critical care, ER,ICU, CVSURG, CCU.
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.

of course i only graduated from a diploma school saturday at 12noon, charged ccu that evening at my hospital..3p-11p.....but that was "back in the day", moved to memphis, tenn, 2wks later and hired into a major university teaching hospital in ccu :sarcastic:

Specializes in critical care, ER,ICU, CVSURG, CCU.
In Massachusetts there used to be many hospital based schools of nursing. I attended one and was expected to be able to hit the floor running the day I graduated. There is one hospital based school left...Brockton Hospital School of Nursing. I hire new grads all the time and the difference between the grads from Brockton and any other school is amazing. The hospital school grads have a wealth of experience. Do they know everything? No, but neither do I and I've been an RN for more than 30 years. But, they are certainly far better prepared to take care of patients than the BSN grads I hire. And before anyone says anything about there being too many nursing programs, the BSN grads I hire are graduates of UMASS...a program with an excellent reputation.

amen sista :yes:

Specializes in MedSurg, OR, Cardiac step down.
Although many of us were taught to swab the patient's fingertip with an alcohol prep pad prior to obtaining a finger stick blood glucose sample this step is unnecessary and might actually skew the result upward.[/quote']

We were also taught that it could skew it. So to wipe it with sterile 2x2 or wait for it to dry

The same pt told me that she didn't really think anything of it until she did it with her heparin shot too. :/

And what did they do for those three years?

Pipe: Mormon Missionary Mom: Nursing School

This was very interesting to read. Thank you for posting it.

Specializes in geriatrics.

Much of the problem lies with academia, which is so far removed from actual nursing. Aside from my nursing core courses and the psych electives I took, I often skipped the fluff courses in favour of going to labs or doing more clinical hours.

Schools need to re-organize the cirriculum to reflect additional clinical time, instead of the various electives that BSN nurses are forced to take. Geography of food and endless semesters of nursing theory do not adequately prepare graduates for practise.

I've only been a nurse for 9 short months. BSN. I still ask a ton of 'stupid' questions. But I feel confident in my questions that I lessen my risk of mistake. Frankly I'm frightened by some of the new nurses that started with me that know everything already, yet when they aren't so sure say just do it that way. Scary to think what they do in a room when they don't really know what they are doing, just guessing?? Or when I hear another say she try's to talk pts out of their heparin shots so she doesn't have to do them. Or when a pt tells me she had to tell the previous night nurse to use alcohol before pricking her finger for a BS. This scares me dearly.

For some reason this post rubs me wrong?Do you understand why that may be?

There is no way to teach a nurse experience, only experience begets experience.

One goes to school to develop an educational foundation, then you have to apprentice to gain hands on education.

Unfortunately, nursing as a profession has a weak grasp upon the educational requirements to enter the profession. To contrast this, look at medicine. The physician goes to school and gains a broad educational background. All physicians graduate with a minimum of a MD/DO or other doctorate equivalent. What is the nurse standard of education into the profession? Once graduated the physician has a residency where they gain real world hands-on experience and may follow that up with fellowship.

Once a nurse graduates what does their "residency" look like? A 2 week orientation? 6 month preceptorship? Very few hospitals have structured programs for nurses and fewer have quality programs. Physicians bring money into the hospital while nurses just cost money. No wonder facilities do not want to invest in nursing.

I am a BSN grad, and I'm glad I was...mostly because HR departments want those letters on your resume. And it's one less thing to do later. I worked with plenty of non-BSN nurses who were great, and some that scared the crap out of me. But some BSN nurses scare me too.

I went to a BSN school with the most hours of clinical practice in it's program of any program accredited in our state (diploma, ADN/ASN or BSN). The school has a great reputation. And I still felt like it was a wash. We had the most hours, but the facilities were a HUGELY limiting factor. Most of my clinicals were in nationally or regionally ranked hospitals, with wonderful reputations. But the limits they set on what we could do with our instructor or working 1:1 with one of their staff nurses was crazy. The facility I got to do THE MOST with was a rural community hospital, and during my preceptorship. I started out small and worked up to taking the same patient assignment as my preceptor and her coworkers. It was a specialty area, and we had a list of things for me to learn to do, and as I mastered each, I gained a little more independence in organizing what I needed to do and in what order. It was the most practical experience I got of all my clinicals, I learned so much. But I do think that the facilities students are having clinicals in are limiting the education of students.

I also think that clinical instructors are limiting (or can limit) students. Some instructors are wonderful and others, well, aren't. I think the quality of the people schools are paying to educate the future workforce needs examined. I'm not sure that saying MSN only nurses is the key (my school required MSN to work with clinical groups), but I'm not sure that someone who works in a clinic with outpatients is the best person to be the instructor for a clinical group in a critical care or stepdown area. They're not exactly the same thing, I think we need to examine getting students placed with more "experts" in a clinical area/specialty, and that clinical groups need to be smaller. I noticed as a new nurse that some clinical groups are ENORMOUS. Our school limited it to about 5 per group, but some groups we had on our unit were 10+. I'm not sure how an instructor keeps track of that many people, and I'm not sure how much someone learns in groups that big.

I also think there is an issue with the work ethic of some of the students in nursing schools today (though it applies to other majors and trades too, I think it's reflective to some extent of this generation, and I say that as someone of this generation). Some of the students I worked with as a floor nurse, refused to do anything that wasn't related to a medication. Flat out refused to do things that are also relevant to patient care, and things that nurses end up doing fairly frequently. There's an element of being what you make of it, and what (some) people are willing to put into their own education is embarrassing.

I worked as a UAP/PCA/SNA at a nationally recognized hospital during nursing school. Two nights a week, overnight (usually 7p-7a, Fridays and Saturday nights). I was in the house float pool, and my assignments could change q4 hours as the needs of the hospital/house acuity changed. I learned anything that I could and asked as many questions as possible. At work, not just at clinical. I knew many of the staff nurses on a lot of the floors, and the working relationship, and my willingness to learn, they always helped me learn whatever they could, and if any of the patients had interesting/rare things going on, and if there was something unique to assessments on that patient they shared with me (with the patient's permission, generally things like heart murmurs and such).

I moved 3 hours from home to take a job as a new grad. It involved moving to another state. There were a lot of things that were unsafe about the unit I started working on, and it was a reflection of how people chose to practice (it wasn't just a "fit" issue - there were many things wrong with the hospital, and organizationally). My second job was tons better. I learned a lot. I asked questions. I researched, and wrote notes about things I learned, I looked things up all the time. I took charge of my own learning above and beyond orientation. My orientation at both my first and second jobs were less than 8 weeks, if I recall, 6ish weeks including hospital orientation, nursing orientation, intro to charting system, and any required classes - EKG and critical meds etc.

My current job, I work in a procedure area. My orientation was about 7.5 to 8 months before I was on my own (I also had to sign a 2 year contract, 2 years after I was off orientation). I didn't have to complete the hospital's "residency for new grads" program as I'd worked for about a year as an RN prior to starting this job.

Specializes in NICU, PICU, PACU.

I graduated from a diploma school and I look back and wonder how I survived lol by time we were in our last 12 weeks, Leadership, we were taking a full team of patients (up to 15) with an LPN and aide. I learned quickly how to prioritize and delegate. Our first two years we did 8-12 weeks in different places, such as peds/OB and critical care, psych ( on real One flew over the cuckoo nest floors! ), rehab, med/surg and OR. We spent 1 solid week in the OR holding area putting in IV's, foley's, etc.

I have found that a lot of our new grads need help with basic procedures. I have found that a majority of the accelerated program nurses are coming out with poor to no skills. I feel badly for them as it is no fault of their own :(

And when I was doing my BSN classes, I really couldn't believe how fashion history was going to make me a better nurse lol

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