Do hospitals incur a net gain or a net loss from the training of a new graduate RN?

Published

Many threads on this forum have dealt with the idea that hospitals lose a lot of money when a new graduate RN takes a position, goes through orientation, and then quits after six months to a year. There have even been reports of hospitals who require new graduate RNs to sign contracts that state they will pay up to $11,000 in "training fees" back to the hospital if the new graduate RN quits or is fired during orientation or even all the way up until 18 months after accepting the job.

This thread is designed to talk about whether you believe that hospitals incur a net gain or a net loss from the training of a new graduate RN during the orientation period. Although the new graduate RN is being paid during this orientation period, are they also not doing work? Isn't their presence on the floor as an "extra hand" a benefit to the staff? Or, do you believe that the trainee is a burden to the floor? Do you think the trainee RN slows down their preceptor because of time taken to explain and to teach, or do you believe they make a preceptor's job easier by assisting in tasks?

Use this thread to talk about your thoughts on new graduate RNs and the idea of whether they are a net gain or loss to the hospital, even during the orientation period.

Up Vote Up Vote ×
Specializes in NICU, PICU, PACU.

In our unit, we are paying 2 people to do 1 person's job. When we precept, we don't take a separate assignment, it is one assignment with 2 people. We don't use them as "extra hands", that is for sure. Sometimes, when we have multiple people on orientation (last year we had 8 at one time, all on one shift) it sure does make doing the assignments harder sometimes the "regular" staff get a heavier assignment than usual because of the requests we need to honor for the preceptors/orientees.

So, yes, we do lose money until they are on their own and able to take a full assignment.

Up Vote Up Vote ×

I'm fairly certian that hospitals who have new graduate programs get some funding kickbacks from government entities and so forth. Plus, the are started at lower wages and put in positions of high turnover so even though it costs a lot to train a new grad, things all even out. They don't train new grads for charity!!!

Up Vote Up Vote ×
Specializes in SICU.

It's a huge HUGE loss. Let me break down the difference in getting a new grad in the ICU and someone that already knows ICU from another hospital.

Orientation time

New grad is 12-16 weeks, which means the hospital is paying the wages of both the orienter and preceptor during this time that the preceptor could do alone.

Experienced nurse is 2 weeks to know the policies, where things are and the charting system.

Education department

New grad needs to have specialized education related to the ICU. This requires the hospital to hire and pay educators.

Experienced nurse does not require specialized education.

Working on the unit/floor

New grad is a danger to the patients and just as importantly a danger to the preceptors license. Some come out of nursing school, thinking that it school actually taught them how to be a nurse, it really doesn't. It takes a long time to understand how little you understand coming out of school.

Experienced nurse should know what they are doing and spend less time tied to my license.

After coming off orientation

New grad will only be able to take the easiest/stable Pt's for a time. They cannot look after anyone with CRRT, VADS or balloon pumps until almost a year out.

Experienced nurse should be able to look after any pt on the unit.

I was told that training a new grad into the ICU costs around $80,000, I believe it.

Up Vote Up Vote ×
Specializes in Med/Surg, Academics.

I think the key here is return on investment. But, we have to back up a little bit to understand how the ROI is more difficult to realize than it used to be.

The employee/employer relationship has changed in the past 30 years. Loyalty by an employee is no longer rewarded, and employers will kick an employee to the curb without an ounce of regret. The dynamics have changed, and those dynamics were driven by the employer.

Now, those employers are seeing the rotten fruits of their tactics. (Don't they always...after their bottom line has been affected?)

Employers will realize an ROI only if the new grad stays on for two years or more. That new grad, sufficiently trained, can then serve as a preceptor.

See the give and take? Sufficient training, adequate staffing = a new grad that can then become the expert to whom other new grads turn. ROI in a nutshell.

But, how many times have we seen that NOT happen, just through the postings here on AN. Insufficient training, inadequate staffing, and the new grad (who isn't even close to "expert") is drowning. He/she gets the hell outta Dodge, just to be faced with an expectation of the new employer about having "expert" skills because of the one year experience...and drowning yet again.

Businesses, as I've said before, are dangerously myopic. Reactionary instead of innovative. Kicking the individual to the curb rather than taking a critical look at the processes that influence mistakes made.

My post is probably more theoretical than you desired, but I believe a long, hard look at the bigger picture would solve some of our economic problems. Unfortunately, so many of our leaders (politicians, executives, Wall Street, etc.) can't see the forest for the trees. If anything, that will be the downfall of corporations, regardless of industry.

Up Vote Up Vote ×

All interesting views. I know orientation times differ from facility to facility, and especially are prolonged in specialty areas for new grads, but what would you estimate is the minimum time required to see a return on the investment in general med-surg?

As well, I also have heard that facilities receive substantial grants to hire and train new grads. Can anyone confirm this? If it is true, it might not cost facilities anything to train a new grad.

Up Vote Up Vote ×
Specializes in PCU/Hospice/Oncology.

Dudette10 I agree 100% I have seen it done countless times that hard working nurses are kicked to the curb after years of experience and dedication to the company just to fill in with faster, younger people. I myself am 27 and experienced such a thing personally. I was working 6 nights a week 3-11 for a LTC for almost a year when I became critically ill. I was kicked to the curb after a month of medical leave because I had to have surgery.

After that I have no allegiance to any company. I will work hard and do the best job I can do, but if I get a better offer I will take it. I know that the company, especially a large one, will see me as a number and not the dedicated worker I am. I learned that the hard way. I will of course be professional and do all the customarily appropriate tasks but if a different unit offers me better pay, more hours, ect.. I wont be feeling regrets!

And to tie it in with the OP since i got side tracked, yes the company loses $$$ for orienting new grads. Thats just the nature of the beast. Retention is really hard to come by these days due to nurse to patient ratios. I feel bad for those students who get duped into taking a few thousand bucks for a hospital position waiting for them at graduation.. Those jobs are usually night shifts on the worst units with the highest turn over rates... At least thats how it paned out for my fellow students who accepted them. Ouch!

Up Vote Up Vote ×
Specializes in Oncology/Haemetology/HIV.
I'm fairly certian that hospitals who have new graduate programs get some funding kickbacks from government entities and so forth. Plus, the are started at lower wages and put in positions of high turnover so even though it costs a lot to train a new grad, things all even out. They don't train new grads for charity!!!

Very few facilities have specialized "new grad" programs, and please name the government entity that pays those fees. My facility and most all that I have worked with, would live to recupe some of those fees.

And with benefits added in, new grads do not get paid that much less than experienced nurses.

In addition, a great deal of the turnover is well, quite frankly, new grads that can't cut it. In my current unit with an extended orientation, an excellent nurse-pt ratio, and a supportive staff, we have had two out of nine new grads that couldn't handle things after 3-4 months of orientation. In our area, that is about 35k down, not including fees for specialized classes, benefits, vaccinations, physicals. Add in the fact that the preceptor was "underutilized" so that she could teach/precept.

On our unit, because of the specialization and additional training involved, you are not fully trained until about 2 years out, independent in charge, critical care, cvvhd, chemo, transplant and op care. It takes about 3 years to recupe costs. At one point we lost 5 out of 18 before that point , after the new grad term. Most due to "life changes". But it does not change the fact that they benefitted from this training but never paid it back to the facility that provided it and took the risk of having a new nurse in these types of care.

.

Up Vote Up Vote ×
Specializes in Med/Surg, Ortho, ASC.
I'm fairly certian that hospitals who have new graduate programs get some funding kickbacks from government entities and so forth. Plus, the are started at lower wages and put in positions of high turnover so even though it costs a lot to train a new grad, things all even out. They don't train new grads for charity!!!

What government entities would those be? Particularly for a for-profit hospital?

Up Vote Up Vote ×
Specializes in ICU.

Well, that really depends. The orientation time is much longer, which is costly. However if this nurse sticks with the facility/unit, they will be cost-effective in the long run. The least on the pay scale, which makes the biggest difference if they are the ones who will be putting in OT. There is also the essence that they are more of a liability,which also needs to be taken into account.

At the last facility I worked at, we trained a new grad for 3 months. A month and a half off orientation he goes VERY per diem for another opportunity. Without a contract it hurts. Major money was lost on him, yet he got fully trained for future endeavors.

Up Vote Up Vote ×

This is an excellent question, I find the responses educational and insightful. Thanks for asking. I know I could just hit the kudos button but that doesn't begin to cover how interesting I find this post.

Up Vote Up Vote ×
Specializes in Med/Surg, Academics.
In addition, a great deal of the turnover is well, quite frankly, new grads that can't cut it. In my current unit with an extended orientation, an excellent nurse-pt ratio, and a supportive staff, we have had two out of nine new grads that couldn't handle things after 3-4 months of orientation. In our area, that is about 35k down, not including fees for specialized classes, benefits, vaccinations, physicals. Add in the fact that the preceptor was "underutilized" so that she could teach/precept.

Two out of nine new grads that can't cut it? Is this something that is new or has it traditionally been that way? If it is something new, maybe looking at the way nursing education has changed is warranted.

On our unit, because of the specialization and additional training involved, you are not fully trained until about 2 years out, independent in charge, critical care, cvvhd, chemo, transplant and op care. It takes about 3 years to recupe costs. At one point we lost 5 out of 18 before that point , after the new grad term. Most due to "life changes". But it does not change the fact that they benefitted from this training but never paid it back to the facility that provided it and took the risk of having a new nurse in these types of care.

"Life changes"...what does that mean?

Up Vote Up Vote ×
+ Join the Discussion