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.
My facility got a tax exemption for hiring me (New Grad RN)..The stipulation was that I had to have not worked for at least two years prior to them hiring me. Its called the HIRE Act and it started March 2010.
Yes training new nurses is expensive, BUT how else do you expect to train a new nurse? A quick 2 week orientation will not cut it! The new nurse will quit and the patients are not getting good or safe care. Nurses are specialists and need good training. I am surprised at the lack of empathy or support from the experienced nurses. If new nurses are not valued by their own, what does that say about nurses in general? How great a caregiver are you if you do not look out for your own? and if you chafe at the "caregiving" description of nursing, then how much of a professional are if if you do not value your own training? Hospitals run on the backs of nurses. We deserve good, and yes expensive training! However many studies on the subject show a significant ROI for hospitals who use graduate nurse programs. The length and quality of nurse training has a positive effect on turnover rates, so in the long run it costs more upfront BUT hospitals make money because turnover rates drop from highs of 70% to 11-12%. Before you ask, I did have the info on the stats but after I graduated in June I pitched all my research info! I am sure I can find it, if needed!
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.
so true about the remark i colored...lol... you probably wasn't being humorous but i couldn't help but laugh at that cuz that totally describes me....lol...
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
yes training new nurses is expensive, but how else do you expect to train a new nurse? a quick 2 week orientation will not cut it! the new nurse will quit and the patients are not getting good or safe care. nurses are specialists and need good training. i am surprised at the lack of empathy or support from the experienced nurses. if new nurses are not valued by their own, what does that say about nurses in general? how great a caregiver are you if you do not look out for your own? and if you chafe at the "caregiving" description of nursing, then how much of a professional are if if you do not value your own training? hospitals run on the backs of nurses. we deserve good, and yes expensive training! however many studies on the subject show a significant roi for hospitals who use graduate nurse programs. the length and quality of nurse training has a positive effect on turnover rates, so in the long run it costs more upfront but hospitals make money because turnover rates drop from highs of 70% to 11-12%. before you ask, i did have the info on the stats but after i graduated in june i pitched all my research info! i am sure i can find it, if needed!
i am not sure where you are reading a lack of empathy or support from experienced nurses. i haven't read any replies on this thread indicating that we don't value the new grads who come with a good attitude, willing to learn and willing to stay for two years before moving on. (and i'm not even saying new grads who do stay -- just those who come to us with the intention of staying two years.) what we are saying -- and i'll stand by this assertion -- is that training a new nurse for six months and then having her leave before her second anniversary date is not a net gain. that's not bullying or being unsupportive -- it's just true.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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!!!
No they don't train for charity. That is why many hospitals have cut their new grad programs because they are a huge expense and a huge loss when the new grad quits the job before a year is out. That is why MANY hospitals make new grads sign on for a specific amount of time or they have to re-pay the facility.
There are NO government kickbacks to educate new grads.....they just don't exist. I am curious, what made you think that there is government reimbursement in the costs to train a nurse. New grads are started at a lower pay to offset the education expense and the presence of another paid employee to orient and teach the new grad "the ropes" so there is 2 employees doing the job of one.
The training of any employee let alone a new grad is very expensive indeed.....:)
I agree Nurses who leave in or right after training are not a benefit. It seems to me that a huge number of people are coming into to nursing with unrealistic expectations.They do a small amount of clinical hours, graduate and expect to be an ER nurse! But that issue lies with the nursing programs taking large numbers of people due to the mythical nursing shortage!! Now there are too many graduates and no jobs. Perhaps if nursing schools were a bit more selective when it comes to medical experience, not just grades, graduates would be more realistic about what it really means to be a nurse. Most Graduate Nurse programs are extremely selective , you would think those selected would be the cream of the crop! and more likely to stay. If a new nurse leaves her position is it because of personal reasons( marriage, youth, lazy, terrified) or is the unit expecting too much for too little?? Some working conditions are awful, its up to us as a workforce to fight for safe patient ratios and overtime etc... It is frustrating to train a nurse, spend money and time, and then he/she leaves, but is it not right to lump all in one basket and say training programs do not benefit hospitals or nurses.
There are NO government kickbacks to educate new grads.....they just don't exist. I am curious, what made you think that there is government reimbursement in the costs to train a nurse.
Teaching hospitals get tremendous amounts of moneys from federal, state, and private funding sources...I'm actually appauled that anyone would think otherwise! Hospitals that have "training and development" programs get more money from the government because they are open to get more funding for grants and loans allocated specifically for T and D. Plus, private entities such as RWJF offer grants and loans for such programs as well. One of HRSA's major goals this last 20 years has been to decrease the nursing shortage across the country, and a good portion of their budget goes towards reimbursing the costs that are incured by facilities and nursing programs for the training and retention of new nurses. And have you heard of tax incentives??? Those play a role as well with regards to T and D programs. So basically, if you train new medical staff and you have an administration department that actually writes proposals, your facility will have more money coming in and less going out.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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
Although there is a lot of lateral violence in the profession and having practiced in MA......I have been personal witness in the passive aggressive, agressive-aggressive behavior and intolerance that seems prevalent to some facilities, so I hear and feel your pain. Many have the same aggression on the road as they do educating someone. EXAMPLE: If they let you merge onto the highway that put's you a head of them and they were there first!!!!!! So it's everyman for themself!!!!!!!! If they teach you anything you might get a raise and that would not be fair because they were there first!!!!! Besides why should they work harder and have more responsibility for a buck an hour????? See the similarity? Much of the lateral violence stemms from long standing lines of battle drawn between management and staff sometime during the revolutionary war and have yet to be removed. (not really but it sure seems that way).....of course that's just one persons opinion and opinions are like noses.....everybody has one in different sizes and shapes.
I really does cost a lot to train any employee let alone a new grad. That is why like I said many hospitals have sliced their orientation programs in half if not all together. The cost of the medical screening and the costs of labs, drug testing, and immuinizations if needed, the educator to teach you, the materials used, the money to pay you to be in the classroom, the certifications updated as required like CPR, ACLS,TNCC ect., the extra cost having 2 nurses to care for the same patients. (that's why many facilities try to cancel other nurses from the floor to "offset" the cost even though new grads aren't "counted") so now the floor views itself short staffed and have to work harder.......hence the attitude of the nurses to the new grads and the new grads leave for their dream job because they now have tha all important "experience" to get their foot in the door leaving the training facility holding the bag and having to start all over again. So, I believe it is a net loss to the facility to train new grads and employees.
And that is only a few of the reasons hospitals pray for someone else to train the new grad first......
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Teaching hospitals get tremendous amounts of moneys from federal, state, and private funding sources...I'm actually appauled that anyone would think otherwise! Hospitals that have "training and development" programs get more money from the government because they are open to get more funding for grants and loans allocated specifically for T and D. Plus, private entities such as RWJF offer grants and loans for such programs as well. One of HRSA's major goals this last 20 years has been to decrease the nursing shortage across the country, and a good portion of their budget goes towards reimbursing the costs that are incured by facilities and nursing programs for the training and retention of new nurses. And have you heard of tax incentives??? Those play a role as well with regards to T and D programs. So basically, if you train new medical staff and you have an administration department that actually writes proposals, your facility will have more money coming in and less going out.
Ouch! Harsh.......but that's ok......It has been my experience in the community setting is slightly different. I agree there can be tremendous monies for research, development, facilty improvement and training of MEDICAL STAFF in the academic setting. A lot of these monies are availible for large tertiary facilities and not small community hospitals being attached to research grants, trauma grants, and educational program grants, excluding the small community hosptals.
I completely agree about the monies for research, training and development but I have never worked for a communtiy facility that had access or used that money for nurses training per se..........when money became available it was to purchase equiptment like CPR dummies or new software, facility improvement and not nursing salary reimbursement or the hiring of the educational staff. Tax incentives are for the for profit facilities as the not for profit are already exempt.
Many of these incentives by HRSA and the like have the best intentions but are focused on large academic settings and the small community hospitals are getting left behind and end up being the ones cutting out their programs due to financial restraints in hopes that new grads ARE being trained elsewhere and retuning to them trained. Not everone has the luxury of working in, or training at a academic setting with all the monies available to the through these grants and incentives which has lead to another new trend of new grads obtaining their CPR, ACLS and so forth to make themselves more attractive to a hospitals because that is money that doesn't have to be spent in the grads training.
Right or wrong......this has been my personal exeprience......
I'm located in Southern California & when applying to well organized/structured New Grad programs, they made it known that you were signing a 2-3 year contract upon hire. That's at least one way of hospitals recouping their money while training New Grads.
I would assume that these hospitals would at least break even, if not experience a net gain from training a new grad.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
i agree nurses who leave in or right after training are not a benefit. it seems to me that a huge number of people are coming into to nursing with unrealistic expectations.they do a small amount of clinical hours, graduate and expect to be an er nurse! but that issue lies with the nursing programs taking large numbers of people due to the mythical nursing shortage!! now there are too many graduates and no jobs. perhaps if nursing schools were a bit more selective when it comes to medical experience, not just grades, graduates would be more realistic about what it really means to be a nurse. most graduate nurse programs are extremely selective , you would think those selected would be the cream of the crop! and more likely to stay. if a new nurse leaves her position is it because of personal reasons( marriage, youth, lazy, terrified) or is the unit expecting too much for too little?? some working conditions are awful, its up to us as a workforce to fight for safe patient ratios and overtime etc... it is frustrating to train a nurse, spend money and time, and then he/she leaves, but is it not right to lump all in one basket and say training programs do not benefit hospitals or nurses.
again, no one said training programs do not benefit hospitals or nurses. we're saying that it's costly and often a net loss when the person leaves right after finishing the orientation period.
Esme12, my original post was not meant to be taken as "EVERY facility that trains a new grad gets a check written to them by the government...I was simply adding a post to this discussion that talked about sources of funding for SOME facilities. I never said that my post applied to all rural, small, and community hopsitals as well as large teaching facilties...just was chiming in on the discussion and mentioning how some facilites off set their training costs. Sorry if you thought I was being harsh, but your response to my first post was harsh.
The cost of business associated with training a new grad will differ from facility to facility, and month to month as well! And while some grants that may be given to facilities may not be "specifically" delineated for new nurses, just having T and D programs in general opens up funding sources. All the money ends up in the same bank, but the more training available, the more money a facility can expect to get. The more money a facility has in general, the bigger and better they get to be!
I am sure I can find it, if needed!
Now there are too many graduates and no jobs. Perhaps if nursing schools were a bit more selective when it comes to medical experience, not just grades, graduates would be more realistic about what it really means to be a nurse. Most Graduate Nurse programs are extremely selective , you would think those selected would be the cream of the crop! and more likely to stay. If a new nurse leaves her position is it because of personal reasons( marriage, youth, lazy, terrified) or is the unit expecting too much for too little?? Some working conditions are awful, its up to us as a workforce to fight for safe patient ratios and overtime etc... It is frustrating to train a nurse, spend money and time, and then he/she leaves, but is it not right to lump all in one basket and say training programs do not benefit hospitals or nurses.
Hospitals that have "training and development" programs get more money from the government because they are open to get more funding for grants and loans allocated specifically for T and D. Plus, private entities such as RWJF offer grants and loans for such programs as well. One of HRSA's major goals this last 20 years has been to decrease the nursing shortage across the country, and a good portion of their budget goes towards reimbursing the costs that are incured by facilities and nursing programs for the training and retention of new nurses. And have you heard of tax incentives??? Those play a role as well with regards to T and D programs. So basically, if you train new medical staff and you have an administration department that actually writes proposals, your facility will have more money coming in and less going out.
If they teach you anything you might get a raise and that would not be fair because they were there first!!!!! Besides why should they work harder and have more responsibility for a buck an hour????? 
Illinurse2010
42 Posts
My facility got a tax exemption for hiring me (New Grad RN)..The stipulation was that I had to have not worked for at least two years prior to them hiring me. Its called the HIRE Act and it started March 2010.