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.

[NicuGal, MSN, RN]

I have to agree with a previous poster about how they arrange classes and clinicals. We get students to observe in NICU while they are in OB/peds. But there is no rhyme or reason to how they place them. The logical order would be L//D, post partum, nursery, NICU, peds. How the heck can you spot abnormal if you don't know normal??? And they tell us they haven't even done their classes for this area...again, how can you know what you are looking at if you haven't learned it???

[Asystole RN]

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.

1-2 years of a residency for a registered nurse is a bit much. I had a vision of somewhere around 4-6 months depending upon specialty.

I would have gladly....ECSTATICALLY...worked for 1/4-1/3 pay if I was given a preceptorship in acute care out of nursing school. Instead I spent 6 months with ZERO income and another 3 months making $100 a week in a car lot in downtown Phoenix. I would have taken a residency in a heart beat.

How many "I'm being exploited" threads do you see compared to "I can't find a job anywhere" threads?

[Asystole RN]

What will stop hospitals from hiring new grads at a discount for a preceptorship, then firing them the last day?

Possibly contract and the fact that orientation/preceptorship periods cost the hospital money in the short run and make the hospital money in the long run if they retain the employee. New grads are investments, not discounts.

[LadyFree28, BSN, LPN, RN]

Possibly contract and the fact that orientation/preceptorship periods cost the hospital money in the short run and make the hospital money in the long run if they retain the employee. New grads are investments not discounts.[/quote']

:yes:

[nikkole318]

Wow, which hospital is this? I think that is an excellent idea.

[elkpark]

What will stop hospitals from hiring new grads at a discount for a preceptorship, then firing them the last day?

Nothing, and why shouldn't they have the option of doing this? (Not firing someone, necessarily, but making a choice about whether to keep the individual on or not when s/he completes the residency/preceptorship.) If, again, the model for this is medical residencies, it is certainly not a given, or even an expectation, that medical residents are going to continue on at the hospital at which they're doing their residencies. The residency is entirely separate from the rest of an individual's career -- it's part of your education, not your employment.

[nurseprnRN, BSN, RN]

What will stop hospitals from hiring new grads at a discount for a preceptorship, then firing them the last day?

Nothing, but they can fire anyone at any time anyway. I reiterate: some dollars is better than zero dollars.

[Not_A_Hat_Person, RN]

Instead of being a jobless new grad with no work experience, you could be a jobless new grad with 6 months of work experience. Not enough experience can be worse than no experience.

[FurBabyMom, MSN, RN]

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.

I agree 100%! I made a decent wage at my first job as a new grad but it was not safe for patients or staff. I took a 20% pay cut and drove 75 miles one way to work in order to gain more experience and keep moving on. Was it fun? Not at all. Did it work? Yeah. It really paid off and I learned a lot along the way.

I agree some sort of agreement could be made. My current job,I had an internship specific to my department. We were started at the going new grad rate (I was started slightly above that rate as I already had ~1 year of experience. You complete the internship and there's a small bump in pay. Hit a year with the hospital and you change job classes and get an auto raise. And we had to sign a contract for 2 years post orientation or we incur a financial penalty.

I would agree that many of the people in my generation wouldn't consider or accept the terms/conditions as in general as a generation we are indeed used to instant gratification. Generally, I try to be positive but some of the things I saw from students when I was working as a new grad were both appalling and embarassing.

[SleeepyRN]

I would seriously work for $10/hour for a solid year of training. I want to be the best nurse I can be, but there is only 1 hospital system in my area that has a residency program and countless schools in a 35 mile radius spitting out a few thousand new grads every year.

[Not_A_Hat_Person, RN]

I would agree that many of the people in my generation wouldn't consider or accept the terms/conditions as in general as a generation we are indeed used to instant gratification. Generally, I try to be positive but some of the things I saw from students when I was working as a new grad were both appalling and embarassing.

I would be reluctant to take an offer like that, not because I'm "entitled" (and I wonder what would happen if you'd said that about an older nurse) but because I wouldn't trust my employer to keep me on longer than my the internship period. Apparently, when 12-week new grad programs were new, they were usually unpaid, and the nurses were replaced every 3 months, regardless of performance. Some hospitals are still offering unpaid internships to new grads, with no guarantee of a paid position at the end. I refuse to work for free.

[trishmsn]

... I liked to make sure the students watching had an understanding of what was going on. I'd ask, "Have you learned about so-and-so yet?" only to find out that they take clinicals before they do the coursework. How does this even make since? Why in the world would you do Maternal Child clinicals in the Spring and then have the class next Fall? Apparently this is becoming the norm, though. I don't understand how this benefits anyone. We would learn about something in the classroom and hopefully see it that week or the next in the hospital.

That is patently absurd.....we often have to switch courses around within our program to accomodate the clinical slots we are given. For example, we usually teach mental health in the spring, but this year the only slots were last week! Therefore, we set med/surg aside and taught mental health BEFORE the clinicals!