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.
Interestingly, this topic has been on my mind since I got the latest AJN.
I was going to quote some of my favorite lines from this post (#53) ... but there were just too many of them. Brilliant, GrnTea ... absolutely brilliant.
What nursing really needs to do is figure out if it wants to be a trade or a profession.
The one thing that always baffles me about nursing: I've been involved in various professions in my life and nursing is the only one I've been involved in where some members of the profession actually look down on others with MORE education.
The question that needs to be asked then is this: Do nurses want nursing to be a trade or a profession? Doctors, lawyers, accountants, therapists, psychologists, teachers, economists - are professionals and are expected to know the technical and theoretical back ground of their practice. They don't graduate practice ready - there is often orientation periods, mentoring, a period of being a "junior whatever" before they take the lead in their occupation.
The problem with nursing isn't graduating practice ready nurses - though I do believe there should be educational and training standards and a standardized entry to practice like the other "professions". It's creating programs and mentorships and methods for new graduate nurses to gain hands on working experience (like residency programs, like internships, like transition to practice programs, like excellent orientation) so they can successfully take their theoretical knowledge and be able to apply it to the technical skills learned in practice.
Ok, that makes a lot of sense. A single educational entry into professional nursing is long overdue. I thought you were suggesting that a doctorate level degree be said entry point....
I wonder what a RN residency would look like? Would it be hospital based? Can the job market support have "attending" RNs overseeing "resident" RNs for periods permutably much longer than a preceptor would traditionally train an orientee?
Most likely the residency would look a lot like a formal preceptorship program. My hospital has a new grad program where a dedicated preceptor nurse (all they do is precept and split patients with new grads) guides the nurse through the hospital. They all start on med surg but after the 8 weeks of med surg orientation they move to their specialty area where they were hired into with the preceptor until they finish that orientation period,.
I do understand that I'm not a professional in the true sense of the word. LPNs are not professionals. I know that likely offends many of my fellow LPNs, but there it is. The full title of a RN is "registered professional nurse". My full title is "licensed practical nurse". These titles say a lot about our respective roles in nursing.
As JustKeepDriving eloquently put it, a professional in a field is expected to know the technical and theoretical background of their practice. Anyone calling themselves a registered professional nurse needs to have the academic chops to back that title up. As a LPN, I do not require that level of expertise for my level of practice. My education is intended to prepare me to perform the more practical aspects of nursing. Hence the "P" in LPN. (and "practical" in this sense means
practice vs theory)
With all that said, I'll hasten to add that I don't view myself as a "tradesman", either. The comparison to welders suggests that I perform my nursing interventions purely out of rote memory, without any clinical judgement involved. This isn't the case. No, I don't have the same level of background knowledge as to the "whys" when I administer a med or change a dressing as a RN would. But to imply that I have little to no understanding of why I'm doing what I'm doing is false.
A smart man once said that a little learning is a dangerous thing. And many smart people have quoted that ever since. But the fact is, there are different levels of education, and a level that focuses on the practical aspects of nursing with a moderate amount of theory to back it up is often exactly what is called for in certain clinical settings.
Of course it would be ideal if every LTC facility could afford to have a university educated, registered professional nurse to oversee care 24/7. Of course that would be the ideal. We don't live in an ideal world. We live in a world where it is often economically and logistically necessary for the nurse overseeing such care to be a practical nurse.
Nursing will always have some vocational aspects. At the same time, it will continue to evolve professionally as APN roles continue to develop. Saying nursing has to be one or the other seems so much to me like throwing the baby out with the bathwater.
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.
Couldn't have said it better myself. I am a career switcher with a family to provide for. I went to a hospital based diploma program (most clinical hours around) in the Evening/weekend option. Graduated in Sept, licensed in Sept also - I am applying left and right for any RN job (though just about every one is either experience preferred or required). My only option currently is a GN OR Residency which is for 3 or 6months, but only pays $15/hour. I would take a pretty hefty pay cut (currently am a bookkeeper). My brain is all over the place. Should I take this leap of faith? Is it my only shot at the dreaded “experience required”? How can I justify this pay cut, with no guarantee of employment when this residency ends?
It’s a very bleak market for new graduates. Not sure if it's just my major metro region, or this is a norm. I fear as each day passes that I have less and less of a chance to be hired since basically I am “losing skills”every day.
Couldn't have said it better myself. I am a career switcher with a family to provide for. I went to a hospital based diploma program (most clinical hours around) in the Evening/weekend option. Graduated in Sept, licensed in Sept also - I am applying left and right for any RN job (though just about every one is either experience preferred or required). My only option currently is a GN OR Residency which is for 3 or 6months, but only pays $15/hour. I would take a pretty hefty pay cut (currently am a bookkeeper). My brain is all over the place. Should I take this leap of faith? Is it my only shot at the dreaded "experience required"? How can I justify this pay cut, with no guarantee of employment when this residency ends?
It's a very bleak market for new graduates. Not sure if it's just my major metro region, or this is a norm. I fear as each day passes that I have less and less of a chance to be hired since basically I am "losing skills"every day.
What is a new grad to do?
If you need to pay the bills you will simply have to take the job you need, instead of the job you want. I spent two years in LTC before I was able to get into acute care. An OR residency is gold, you would be silly to turn it down.
I will graduate with my ASN in May. I don't feel like I will be perfectly "floor-ready," but I DEFINITELY feel confident enough to take whatever job I am offered. Why? Because I have had fantastic clinical instructors. All of my instructors have had good relationships with the staff at our local hospitals and those in my clinical group have had opportunities to spend a clinical day in at least one other department (ER, OR, cath lab, burn unit, hospice, and more) once we showed proficiency in the standard rotation we were completing.
My current instructor told us why she became an instructor. Teaching students is not her first love, but as a working RN, she was fed up with the caliber of the new graduates she was seeing -- she knew she could gripe, gripe, gripe about it or shut up and DO something about it. She enrolled to become a teacher and brother, am I ever glad she made that choice!
As a nursing student (or any kind of student for that matter), find out who the most feared, hardest instructor is and GET IN THEIR CLASS. Iron sharpens iron.
I was going to quote some of my favorite lines from this post (#53) ... but there were just too many of them. Brilliant GrnTea ... absolutely brilliant.[/quote']
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.
I find it very relevant as this is one reason new nurses job hop as stated. It then becomes a problem when it comes time to put that job on an application because a short employment period looks bad. Experienced nurses need to realize that these "tired old tales" are not "old" to us new grads. It is still new to us. I myself quit my first nursing job after 2 months due to bullying. I was literally confronted at change if shift when leaving for the day by 7 staff members berating me. After 2 more weeks and my DON and ADON doing nothing about it, I resigned. The DON and ADON lied right to my face when I spoke with them of the situation. They stated they had not heard of the incident, when I knew they HAD in fact heard of it and tolerated their behavior. Horizontal violence is a real issue, and it definitely causes nurses to job hop. Better coping skills is part of the solution, but calling this a "tale" is innacurate and insulting to those of us who have endured true bullying behavior. By "true" I mean situations that aren't attributed to over sensitivity on the nurse's part.
Most likely the residency would look a lot like a formal preceptorship program. My hospital has a new grad program where a dedicated preceptor nurse (all they do is precept and split patients with new grads) guides the nurse through the hospital. They all start on med surg but after the 8 weeks of med surg orientation they move to their specialty area where they were hired into with the preceptor until they finish that orientation period,.
There's lots of discussion here at various times about preceptorships/residencies for new nurses that would resemble medical residencies. Physicians complete medical school and then spend anywhere from a few to several years working full-time (well, working plus continuing their education) while being paid a fraction of the salary of a "full fledged" physician. Part of the problem with so many hospitals balking at hiring new grads is that they are expected to pay a full nurse's wages to someone who can't carry a full load and is a financial liability to the organization rather than a benefit, while the hospital bears the expense of teaching them stuff that the hospital (legitimately or not) feels they should have learned in nursing school. But, to continue your comparison to medical residencies, how many new graduate nurses would be willing to work for 1/4 - 1/3 of the standard RN wages (in their location) for a year or two in a full-time residency? New graduates on this board are frequently complaining about feeling exploited or ripped off by the nursing wages they are getting offered already.
There's lots of discussion here at various times about preceptorships/residencies for new nurses that would resemble medical residencies. Physicians complete medical school and then spend anywhere from a few to several years working full-time (well, working plus continuing their education) while being paid a fraction of the salary of a "full fledged" physician. Part of the problem with so many hospitals balking at hiring new grads is that they are expected to pay a full nurse's wages to someone who can't carry a full load and is a financial liability to the organization rather than a benefit, while the hospital bears the expense of teaching them stuff that the hospital (legitimately or not) feels they should have learned in nursing school. But, to continue your comparison to medical residencies, how many new graduate nurses would be willing to work for 1/4 - 1/3 of the standard RN wages (in their location) for a year or two in a full-time residency? New graduates on this board are frequently complaining about feeling exploited or ripped off by the nursing wages they are getting offered already.
Fewer dollars per hour is better than zero dollars per hour. Perhaps this could be made to work, at, say, a 25% discount for six months ... if the entitlement generation can do delayed gratification. I see little evidence of that, but I am heartened that it's not NO evidence.
Fewer dollars per hour is better than zero dollars per hour. Perhaps this could be made to work, at, say, a 25% discount for six months ... if the entitlement generation can do delayed gratification. I see little evidence of that, but I am heartened that it's not NO evidence.
What will stop hospitals from hiring new grads at a discount for a preceptorship, then firing them the last day?
llg, PhD, RN
13,469 Posts
I was going to quote some of my favorite lines from this post (#53) ... but there were just too many of them. Brilliant, GrnTea ... absolutely brilliant.