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.

I graduated in 2012 and have an RN License, my daughter graduated this year as a LPN. She knew much more than I and had much more experience in actual procedures than I. That said she is practicing as a LPN while I chose to jump back in to the IT world. It pays more with very little stress for me.

Maybe one day I will get in to Nursing.

You are absolutely right. We had extensive clinical experiences the entire 3 years of school. This included all areas in the hospital setting as well as community/outpatient. We also used current nursing theories it all wasn't technical as some folks seem to think. While I didn't know everything when I graduated (and still don't) I hit the ground running after school. I think that if nursing students were given more of a realistic experience, it would help to make some students to seriously consider changing their academic goals before making such a costly investment. We see those folks posting on AN all the time about "I wouldn't have done it if I knew".

How about they pay new grads their regular wage during the orientation period and then after orientation pay them a better fraction of what they are really worth.... There is no way in hell a Registered Nurse should make in the 20's as a base wage. Mid 30's base pay rate not including differentials with benefits should be the norm in low cost of living areas.

I think all staff positions should add on about $15 extra and agency/Prn $25 or more.. You can not run a hospital without nurses.

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.

When I went to engineering school, nearly every engineering class had a lab to go along with it... hands-on labs with real equipment... A typical class was 4 units: 3 hours per week of lecture and 3 hours per week of lab.

Nursing school labs... "skills days" they called them, were few and far between... and my school was better than some in that we at least practiced IV starts on each other and began passing meds in first semester and pushing meds in second semester.

My school also used a pretty decent sim lab.

Still, there was far too much emphasis placed on care plans and nursing theory and all that drivel and not nearly enough emphasis on hard science, scenarios, role playing, simulation, and actual skills practice.

How about they pay new grads their regular wage during the orientation period and then after orientation pay them a better fraction of what they are really worth.... There is no way in hell a Registered Nurse should make in the 20's as a base wage. Mid 30's base pay rate not including differentials with benefits should be the norm in low cost of living areas.

I think all staff positions should add on about $15 extra and agency/Prn $25 or more.. You can not run a hospital without nurses.

That is interesting. I'm willing to take a pay cut so they can hire more nurses for a better nurse to patient ratio

Diploma programs are awesome because they churn out the quickest practicing grads......however in this new era of formalizing higher education and professionalism people want to see that minimum entry of a bachelors degree. People want to see that you took philosophy, English, religion, history, economics, political science etc to show that you are well rounded and not simply a product from a tech program.

While nothing is wrong with the tech/diploma idea I think the bachelor's route is the way to go in terms of a general education PLUS nursing. So what if I have to do a 3 month residency, I can tell you about the 16th century Papal demise and U-boat warfare in WW2 :D

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