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

Nurses New Nurse

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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.

Specializes in Oncology/Haemetology/HIV.
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.

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

Life changes=I want to follow my boyfriend to his new job. I got pregnant out of wedlock and need to live nearer to my family. I am getting married/divorced/pregnant/domestically partnered. I hate the snow/rain/cold/hot/hurricanes/earthquakes here. I can't tolerate rotating shifts/lifting/ working weekends/ holidays. I live too far away. I hate living in the city/country/desert/mountains. I miss my parents/kids/ex.

Shall I go on?

Thus is the reason many places are requiring contracts.....so that employs think a bit before job hopping.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
life changes=i want to follow my boyfriend to his new job. i got pregnant out of wedlock and need to live nearer to my family. i am getting married/divorced/pregnant/domestically partnered. i hate the snow/rain/cold/hot/hurricanes/earthquakes here. i can't tolerate rotating shifts/lifting/ working weekends/ holidays. i live too far away. i hate living in the city/country/desert/mountains. i miss my parents/kids/ex.

shall i go on?

thus is the reason many places are requiring contracts.....so that employs think a bit before job hopping.

good answer!

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

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.

many people -- very few of them experienced nurses -- labor under the mistaken impression that students or new grads are a helpful presence on the unit, an extra pair of hands or in some other way lighten the workload. this is rarely the case, and usually only if the preceptor isn't doing it right. if you're a good preceptor, you're taking the time to ensure that your student or orientee not only knows what to do (the procedure for placing an ng tube, for example, or sterile dressing change) but why they do it that way and what can happen if you do it the wrong way. the good preceptor makes sure that the orientee not only draws the labs at the proper time from the right patient and in the right tube, but understands why you're drawing the ptt at midnight (6 hours after the change in the heparin drip) rather than with the rest of the am labs at 0400. then they make sure the orientee checks the lab results in a timely matter, knows which ones are abnormal or outside the therapeutic range, knows who to contact with that information, what sort of orders to anticipate and why, and how to record, interpret and carry out those orders.

doing a foley cath might take me five minutes, but it takes you forty because i have to make sure you know why we're doing it, have read the procedure, located and gathered the supplies, explained it to the patient and psyched yourself up to do it. then i have to talk you through it and if you mess up, i have to address that as well. i can walk into the room, introduce myself to the patient and chat about the weather or what's on tv for a couple of minutes and i've made a number of assessments including level of consciousness, whether the patient is oriented, short of breath, moving comfortably, able to speak clearly, whether the pumps are plugged in, the iv bags are likely to run out, what the monitor is showing me . . . . . you introduce yourself, chat for a few moments and then start your assessment.

orienting a new grad takes time, effort and experience to do correctly, and while you're doing it that preceptor isn't working her own assignment. in our unit, our new grads get six months of orientation and most of them leave within two years to go to anesthesia school, because their fiance is transferred to sitka or because they had no idea they'd actually have to work nights or touch poop. a new nurse is barely competent when they get off orientation, and by the two year mark they're actually starting to pull their own weight. few of them last that long.

a new grad who gets six months orientation, is pulling her own weight at two years and beginning to learn the more complicated equipment, procedures, devices and who is doing charge or precepting at three years is a net gain. anyone who doesn't stay that long is a net loss.

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.

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

Life changes are what it sounds like, an event or decision that alters one's life.

In the "old days" this was was mainly limited to by not exclusively when a nurse married, had her children (in that order *LOL*), later the one followed without the other. Then you had things like becoming a widow and finding out there wasn't enough in the estate's kitty to "keep you in the manner you've become accustomed to" (read feeding yourself and perhaps the children, keeping a roof over your heads.....). Divorce had the similar effect. Finally there was perhaps what we see allot of today, a nurse's husband either was out of work, could no longer work, was on strike, etc and for whatever reason there was hole in the household's budget that needed filling.

Today as "CarolLadyBelle" points out it can be anything from the above to simply "I met someone on Facebook last week who lives.... so I'm moving"

As for the 2 out of 9 new grads not cutting it, IIRC the number reported once was around 1 in 10, but make no mistake the numbers of grauate nurses on average who are discharged from their first gig is going up not down.

Quite allot has to do with these girls/guys simply have *NO* idea what they are getting themselves into. Claims of low clinical hours aside, many programs seem more concerned to teaching their students to pass the boards than anything else. While that is all fine and well, it can make for something of a shock when one hits the real world of nursing.

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.

Federal funding for nusing education.

Recently purchased a new computer and did not migrate many files and bookmarks from the old system. However the link below explains a bit how Medicare funds nursing education.

http://www.rwjf.org/reports/grr/035448.htm

Specializes in Oncology/Haemetology/HIV.

There is a law from "The House of God" that I paraphrase.

Show me a new grad that doesn't double my workload and I will kiss their feet.

It is much harder and takes much more time to teach someone new how to do something, than it would be to just do it myself. The preceptor and new nurse together are invariably taking a much lighter assignment than the precepting nurse would be taking by herself if she was not precepting.

Specializes in Pediatrics.

There are some great replies (with rationales) here, from experienced nurses who have precepted, educated or managed new grads.

New grads: this isn't a thread to insult or bully anyone. It's the truth. If you were able to function at 100% you wouldn't need that 6 month orientation that many of you say you dint get (and certainly deserve). As an educator, I can absolutely say that a new grad is not ready to fly solo a month after graduation. As stated by another poster, if the orientation is good, the hospital should be losing $$. A preceptor should not have a full assignment. They should be taking extra time to orient. It is definitly not 2 people doing the job of one nurse (and the aide, which I am sure is the perception as well).

To me, the lack if loyalty is akin to sports players these days. Unless your name us Jeter, you have no lifetime alliance to a team (even he had a scare last year:) ). I am guilty of it too. We often give the excuse of it being "not the right fit". My dad worked for his employer for 25 years: miserable as heck (he states) but stayed there until he retired.

I would LOVE to know the actual stats of new grad orientation success stories. Someone must be keeping track of that!

Specializes in Rodeo Nursing (Neuro).

Training new nurses is assuredly an expense. I think whether it is a net loss or net gain depends a lot on a.) whether we're successful and b.) how long a view we're taking. On my floor, orientation is typically 9 weeks. During that time, new nurses receive base starting pay (no diffs) and are paid from the education department's budget. So, from my manager's budget, they are, in a sense, "free" help, but the facility loses money on them. That loss is an investment, though: in the long run, a new nurse is gained and the investment is recouped. Of course, if the new nurse is let go or leaves, the investment doesn't pay off. Most investments do entail an element of risk.

One of my facility's performance improvement goals this year is to reduce turnover among first year nurses. It doesn't appear to me that our turnover is terrible, but it would certainly improve our bottom line to reduce it further. At first glance, I was tempted to view that as mainly a management goal with little relevance to staff nurses.

I've re-thought that over the first few months of the year, though. We do have significant input into whether new nurses stay, and we do gain when they do, in the form of more competent and capable coworkers. Without meaning to disparage anyone, it's just common sense that second-year nurses are more helpful to have around than first-year nurses.

My unit's latest crop of newbies was a big one: three men and three women. All did well in orientation and are adjusting very well. One, a male, did leave due to life changes, and I think the other two males will move into critical care at their earliest opportunity. Which could still be a gain for the facility, if not our unit. I'm more optimistic about keeping the women, although it seems in our culture women are more apt to move on r/t life changes like marriage and child-bearing.

As far as any debt on the part of new hires, I view the cost of training them the same as the cost of gauze bandages. If you can't bear the cost, open a car wash. Not every nurse who leaves is feckless, and most of us know we can be let go at any time it suits our employer. I, personally, do feel some loyalty to the unit and the facility that made it possible for me to move from an entry-level job to a profession, and I am confident they wouldn't fire me on a whim, but I also believe it's their place to earn and maintain that loyalty. Frankly, I suspect some of the places wanting new hires to contract for the cost of training them probably were, and will be again, offering sign-on bonuses in return for a commitment to stay. Ours is not the only industry with administrators who can't see beyond Wednesday in economic trends.

During the depths of the recent recession, our CNO saw fit to remind us that we should all be glad to have jobs. I actually agree--we should always be glad to have jobs. But if the intent was to intimidate, it might have made sense to consider that our local unemployment rate was 2.4%. Our facility should be glad to have us, too.

Specializes in Critical Care.

It depends on what period of time. At my facility, we spend about $15,000 train a new grad. If we replace a Nurse on the upper end of the pay scale with a New Grad, it takes only 4 months for the cost of the New Grad training to be paid off by the savings that result from the salary difference between the two ($25/hr for the new grad vs $50/hr for the Veteran Nurse).

We currently have an early retirement incentive program; They'll give you cash to retire so they can hire a (cheap) new grad; even with the cash payout to the retiring RN and the cost of training it's still cheaper in the long run to hire new grads with a very short break even point.

Robert Woods Johnson report. Not sure this is same as above or just using the same data:

http://www.rwjf.org/files/research/revlewinevalrnturnover.pdf

Specializes in Med Surg - Renal.
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.

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

I assume hospitals count the $80,000 both ways? They lose it if the trained person leaves, but they gain it when they hire a person already trained.

I would wager hospitals are hiring way more trained RNs than providing training to green ones.

So they are WAY ahead of the game, right?

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