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.
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.
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HRSA and Robert Wood Johnson Foundation (RWJH is a private foundation of course) to name just two. The reality is, a huge portion of the working budget of hospitals comes from grants, loans, and donations. Guess what...hospitals also get quite a bit of money for providing clinical spots to students. Billions of dollars are given to facilities across the country for training, research, and employment support programs. This is a good thing...otherwise new grads could never get jobs!!!
If hospitals incurred a net loss on orienting nurses, hospitals would be failing right and left because they were losing money every year.
Instead, the costs of training new nurses are one, among hundreds of factors affecting the profitability of hospitals, including: overall staffing costs, reimbursement rates, costs of equipment, supplies, and staffing, executive perqs, stockholder dividends, taxes, licenses, fees, inspections, certifications, regulatory compliance...
We might as well ask whether hospitals lose money on buy equipment and supplies until they have been fully utilized, or if they lose money courting investors, administrators, physicians, public relations personnel..I.
Does it cost money? Sure. But if hospitals invest nothing in developing future capacity, they won't survive to reap profits in the future.
If you want to focus on something that really affects hospitals - figure out how becoming health insurers affects the financial characteristics of hospitals: http:www.afn.org/~mathstat
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.
So, NicuGal, were you never a new graduate nurse? lol
I believe, in the long run, if a new graduate is trained and is treated like a NURSE by the other nurses and not like a lower life form on the floor, that nurse would be more inclined to feel included in the TEAM on the floor and, therefore, the new nurse would be more inclined to stay on after orientation and beyond. It's the nurses who forget that they were once new graduates that create the problem of losing money on hiring new graduates. I think if lateral violence and bullying among nurses is addressed in a hospital and protocol was in place to prevent it, many new grads would stay on, making it worthwhile for hospitals to precept new grads.
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!!!
Far as one knows the only funding from the federal government for nurse training/education comes via Medicare and or Medicaid and is set on the 1950's or so model, that is diploma schools.
Hospitals are awarded funds if they wholly own and run a nursing program. Then they are reimbursed some costs, nothing huge but guess every little bit helps.
Last time one looked Texas and one other state took a large portion of the last distribution of such funds, and even there it was for LVN programs.
Since hospitals by and large have shuttered or sold off their nursing schools (Long Island College Hospital's school in Brooklyn, NY seems to be next around here), they do not qualify for said funding. Now there *might* be another pool of money out there, but nothing I am aware of.
As a not quite new grad anymore but still new RN, If I had any chance of being hired to a nursing floor that I was interested in working for long-term, I would be way less likely to leave once I had proper training. But the way things are now, us new nurses must take whatever we can get increasing the chances we will leave our first job once we get some experience. I hate that I must begin my career under those circumstances but that is reality for new nurses right now.
So, NicuGal, were you never a new graduate nurse? lol
I believe, in the long run, if a new graduate is trained and is treated like a NURSE by the other nurses and not like a lower life form on the floor, that nurse would be more inclined to feel included in the TEAM on the floor and, therefore, the new nurse would be more inclined to stay on after orientation and beyond. It's the nurses who forget that they were once new graduates that create the problem of losing money on hiring new graduates. I think if lateral violence and bullying among nurses is addressed in a hospital and protocol was in place to prevent it, many new grads would stay on, making it worthwhile for hospitals to precept new grads.
If hospitals incurred a net loss on orienting nurses, hospitals would be failing right and left because they were losing money every year.
Instead, the costs of training new nurses are one, among hundreds of factors affecting the profitability of hospitals, including: overall staffing costs, reimbursement rates, costs of equipment, supplies, and staffing, executive perqs, stockholder dividends, taxes, licenses, fees, inspections, certifications, regulatory compliance...
We might as well ask whether hospitals lose money on buy equipment and supplies until they have been fully utilized, or if they lose money courting investors, administrators, physicians, public relations personnel..I.
Does it cost money? Sure. But if hospitals invest nothing in developing future capacity, they won't survive to reap profits in the future.
If you want to focus on something that really affects hospitals - figure out how becoming health insurers affects the financial characteristics of hospitals: http://http:www.afn.org/~mathstat
For any business including healthcare the cost of training any new employee is balanced by how long the person stays with the place producing labour that brings the place revenue. It is the future income or potential of it is where the profit or loss in terms of hiring anyone comes into play. This is one of the reasons being hired for any sort of employment goes through so much detail, and that increases the higher up the job is on the ladder.
In the past after a decent orientation period a hospital could on average count on "X" amount of years before a nurse either reduced her hours or left the profession often because of marriage/children.
What has happened within the past ten years or so the quality of new grads has varied and many are either discharged for poor performance or leave of their own accord because they "didn't go to nursing school for this" within the first year or less of hire. Once this happens it is a net loss for the hospital since not only has the time and funds spent orientating gone down the toilet, there will be increased costs in terms of hiring a replacement and or staffing coverage.
So while hospitals may not be "closing left and right" over losses due to training new grads, they have found ways to limit their exposure. Taking on only experienced nurses, laying down the law to local nursing programs as to what is epected of new grads that arrive at their doors, the endless pharma/math and perhaps skills testing, pre-hire shadowing, and endless interviews are all ways hospitals are trying to ensure they take on the *right* nurse who is not only qualified but will stay on.
Essentially correct except that to assess whether a hospital loses you have to know what the break-even point actually is. In all likelihood the break-even point is months, not years. All industries employ people that may not work out, and these costs are well understood, so nursing is no different.
If hospitals feel that their turnover rates are excessively high they have the same options as any employer: Make their working environments more attractive: Higher pay, career ladders, better benefits, better patient care, modern equipment, educational programs, sign-on and/or retention benefits, loyalty.
Hospitals, like most employers, would like an endless supply of high quality, low cost, compliant nurses. They would like to be able to keep salaries down, benefits low, and the ability to move patients through their facilities like slaughterhouses move cattle. Committed, caring, and professional nurses tend to interfere with such plans because they have higher expectations than disinterested, uncaring, and unprofessional nurses.
But hospitals use RNs, regardless of whether they are new or experienced, to meet minimal staffing standards. So even nurses that do not work out help hospitals meet regulatory requirements, so it isn't as though there are no benefits from day 1...
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.
So, NicuGal, were you never a new graduate nurse? lol
Not quite getting what the problem is here? Would you care to elaborate on that?
Sure I was a new grad a long time ago and I can tell you things are 100% better now...we were used as extra hands, no doubt about that. If you are referring to my "regular" staff line, we never treat anyone any different and as a part of a management team, I can tell you that we lose money...we don't get any incentives or kick backs that is for sure. I surely DO NOT appreciate you alluding to bullying in my workplace because that doesn't happen where I work. We have the lowest turnonver of any unit in my hospital because we are good to our new people. But, it takes time to get those people up to speed and if we are investing time andeffort into getting you there and then you quit to take another job, then that is a slap in the face to us.
I graduated in Dec of 2009 and started my job in January of 2010. My dept had never hired a new grad and all the people in the dept had been there 15 yrs or longer. I had a preceptor for 8 weeks and then cross trained to 2 other depts. I work independently now but still ask questions. I have the same patient load as other staff, but make significantly less per hour. So the hospital benefits in the end with new grads I think, since the base wage is so much less than with nurses who have been there a long time. But I think it is great to have people with experience working and new people too
Here in Ontario, Canada we have a new graduate initiative where the hospital applied for funding from the government to train a new graduate nurse. They then can hire a nurse and train them with the intention of transitioning them to a full time or part time position. The initiative lasts up to 6 months of orientation paid by the government.
I am currently just over 3 months into my orientation and I think it is such a great benefit to have, to help me get comfortable working.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
so, nicugal, were you never a new graduate nurse? lol
i believe, in the long run, if a new graduate is trained and is treated like a nurse by the other nurses and not like a lower life form on the floor, that nurse would be more inclined to feel included in the team on the floor and, therefore, the new nurse would be more inclined to stay on after orientation and beyond. it's the nurses who forget that they were once new graduates that create the problem of losing money on hiring new graduates. i think if lateral violence and bullying among nurses is addressed in a hospital and protocol was in place to prevent it, many new grads would stay on, making it worthwhile for hospitals to precept new grads.
alissa, rn in ma
that's a load of bullpuckey.
most of the new graduates i meet take the job knowing that they're planning to stay the barest minimum of time required to get into anesthesia school or to graduate from a np program. they have no intentions of staying long enough for the hospital to get a return on investment on their orientation.
lateral violence and bullying is not nearly the problem that a lot of folks here make it out to be. it's much easier to say you quit (or were fired) because you were bullied than to say you couldn't handle the workload or learn the drugs or critical think your way out of a paper sack. although i don't know every one and every situation, every single new grad that i know who says they left because they were bullied actually had problems with their work. many of them believed that any negative feedback was "bullying" or "lateral violence", and that's an issue. not an issue of lateral violence, but an issue. many of them went through multiple preceptors and "second chances" but still didn't get it. some of them (read the "fired for no reason" thread) actually believed they were awesome nurses who were just being picked on yet failed to recognize it when they made some really basic mistakes. (and some really huge mistakes.)
the folks who want to blame "lateral violence" or "bullying" for every negative interaction that occurs in the workplace trivialize it for those few who actually do experience it, and that's wrong.
cindyloowho
143 Posts
HRSA and Robert Wood Johnson Foundation (RWJH is a private foundation of course) to name just two. The reality is, a huge portion of the working budget of hospitals comes from grants, loans, and donations. Guess what...hospitals also get quite a bit of money for providing clinical spots to students. Billions of dollars are given to facilities across the country for training, research, and employment support programs. This is a good thing...otherwise new grads could never get jobs!!!