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

Nurses New Nurse

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.

Specializes in Oncology/Haemetology/HIV.
Obviously the two professions are not the same! However its the idea behind residency. Specialized skills deserve specialized training, if the facility wants skills beyond the med/surg level they should train not expect the nurse to shoulder all the responsibility! There are nurse residency programs out there now, they are not common and hard to win.

The point is that , MDs "pay" for their specialized training by: poor conditions, substantial lower pay, a grueling schedule for 3-6 years or more of their life. They to a certain extent, are contracted help, unable to go easily elsewhere (when one tries to leave a residency, fewer teaching facilities will accept them for another one, and they may have to start over from scratch, if if they can find one that will even take them. And if they "fail" at residency, there are few to no second chances. It is a permanent blot on their rep. And will follow them for quite a while. And while some life changes do alter their schedule, you will find plenty of new parents, pregnant MDs, and those with sick kids - finding a way to deal with it rather than calling off, or begging for easier hours. For some reason, they actually find ways of dealing with fiancees that live acroos country for 1-2 years.

Yet, new nurses, in my experience, are hardly likely to accept 3 year contracts, with no full weekends off, having to work abysmal shifts, being frequently floated to other units, conditions that interns have to accept. And if they do, the first time another offer comes along, they take off. One gets pregnant, or starts dating someone 100 miles away, and they are trying to break contract, or just leave. After one year , they want day shift, and special hours, etc.

MDs pay in low pay, lost time with friends and loved ones, and some of the prime years of their lives for their special training. Are new grad nurses as a whole (not just some of them) willing to do the same?

If not, don't compare them.

Jeez Caroladybelle are you a nurse or DR? or married to a resident? Sound sexist? so does your description of graduate nurses.

I believe that residents and nurses are different( DUH) However due to their importance to healthcare nurses should be respected and trained to reflect that they are key players and just as important to patient outcomes as the Resident. A nurses training Vs Dr training are apples and oranges, are they both fruit yes, are they the same no, can they be compared yes! If hospitals are having trouble with new nurses leaving they should be more selective when hiring, there are enough out there to pick from!

If facilities would learn to retain staff by treating them like cherished employees, they wouldn't need to worry so much about the net loss from continuing to train new nurses, over and over and over again. Seems simple enough to me.

Specializes in Oncology/Haemetology/HIV.

I am a nurse. I am not an NP. I am not a PA. I certainly have never married, or ever desire to date an MD or a resident or a PA or an NP, at any time in my life. The very idea turns me cold. Did you even check my age?

And I am a feminist.

If you bothered to review my long history here, you would probably be well aware of much of that.

I consider nursing to be a very valued profession and one of the finest arts. And I recognize the major differences between medicine.

But if you read the thread, you would note that i was responding to a poster that said that MDs get specialized training, so nurses should- I agree. But what did not get discussed is the sacrifices that are expected and endured by MDs for that training that nurses don't have to deal with and in cases would refuse to deal with.

I was not the person originally trying to compare them- i was trying to explain that situations are not comparable.

As far as sexism, at least half and often more of those Interns, residents, fellows, and new attendings that I help train, work with, and team up are female. And for some reason, they do not spend time on BBs, discussing how strict Nursing school is, how unfair it is to not round up scores to passing, that you actually have to know basic math and add simple numbers without a calculator, and how can they possibly survive without their personal at work. And many work 80 HR weeks, well into pregnancy, knowing that there are limited options if they don't.

Try hearing a group of new nurses chit chat about how quickly that they can get to NP or CRNA with the least amount of experience or dirty work and contrast it with first year interns of the exact same gender that are trying to pick up more experiences so that they may perfect and improve on their care, even if it does put more burdens on their personal life.

It is not sexist to point out the difference between the two groups and attitudes.

If nurses want more specialized training, they should be prepared to make sacrifices for it.

But I do find it sexist that a poster assumed that I must be an MD, or DATING ONE to bring up how intense internshipis........without even doing a minimum amount of research into my data.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
if facilities would learn to retain staff by treating them like cherished employees, they wouldn't need to worry so much about the net loss from continuing to train new nurses, over and over and over again. seems simple enough to me.

if only it truly were that simple. of the nine new grads that started in my unit in december of 2009, one has already left to become an np. she was in np school already when she started with us, decided bedside nursing wasn't for her and left to go to school full time. five applied to anesthesia school in fall 2010 and three got in. three more are going to anesthesia school this coming fall. oh, yeah. and one left due to "life changes." but that still leaves seven new grads who started a job approximately 18 months ago knowing they didn't intend to stay.

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

as far as sexism, at least half and often more of those interns, residents, fellows, and new attendings that i help train, work with, and team up are female. and for some reason, they do not spend time on bbs, discussing how strict nursing school is, how unfair it is to not round up scores to passing, that you actually have to know basic math and add simple numbers without a calculator, and how can they possibly survive without their personal at work. and many work 80 hr weeks, well into pregnancy, knowing that there are limited options if they don't.

try hearing a group of new nurses chit chat about how quickly that they can get to np or crna with the least amount of experience or dirty work and contrast it with first year interns of the exact same gender that are trying to pick up more experiences so that they may perfect and improve on their care, even if it does put more burdens on their personal life.

it is not sexist to point out the difference between the two groups and attitudes.

this is one of the more accurate statements about the new nurses and the new doctors i encounter daily. when i started in nursing decades ago, the only male nurses i met were gay, former seminarians or (most often) both. female residents weren't common, either. these days, there are many more men in nursing -- and folks don't even understand where the "male nurses are gay" stereotype came from! doctors make up more than half of the graduating class of our affiliated medical school, and i understand it's been that way for a few years.

the female physicians i meet are for the most part smart, motivated and eager to learn. they're willing to put in the hours and actively seek out new experiences, new procedures and new opportunities. the new nurses i meet are all too often looking for the quickest way into anesthesia school with the least amount of actual dirty work, or are already in np school before ever having worked a day on the unit. i meet a few hard working, motivated, smart new nurses, too, but the balance has sadly shifted. it shifted years ago, and i was slow to notice. there have always been the new nurses who couldn't believe they'd actually have to work nights, miss christmas eve or touch poop -- but they were so few and far between that they were remarkable. now they seem to be the majority, and it's so common to hear them trying to weasel out of unpopular shifts, unpleasant tasks or unpopular assignments that no one even comments about it anymore.

it's really sad, but no one seems to want to work at the bedside anymore.

Specializes in Rodeo Nursing (Neuro).
if only it truly were that simple. of the nine new grads that started in my unit in december of 2009, one has already left to become an np. she was in np school already when she started with us, decided bedside nursing wasn't for her and left to go to school full time. five applied to anesthesia school in fall 2010 and three got in. three more are going to anesthesia school this coming fall. oh, yeah. and one left due to "life changes." but that still leaves seven new grads who started a job approximately 18 months ago knowing they didn't intend to stay.

so, is the problem the new nurses, or the system that treats your (our) profession as a stepping-stone? two of my newest co-workers are getting experience in med/surg so they can go into critical care. at least there's a chance my facility will benefit (and i really do think some m/s experience is a good idea). three of our newest are young women (woo-hoo!). one already has a fiancee, and as far as i know plans to live here after marriage. the other two don't know who their future fiancee is, yet, so there's a distinct possibility of those infamous "life changes" on the horizon. and lately some of our experienced nurses have been getting knocked up. on the whole it seems like males and post-menopausal females might have an advantage in interviews. i'm not sure where we post-menopausal males fit in. statistically, i may be due for a "life-change" of a less voluntary and possibly more permanent nature, although i personally plan to get hit by a truck while crossing the street for a pack of smokes on my 90th birthday.

as far as those who start work and abruptly realize that bedside nursing isn't for them, i'm not sure how much we can blame people for being smarter than we are. there are most assuredly aspects of this business that are not as good as they could be. not all of the poop we deal with is human, and cutting back some on the bovine excrement really might help with retention. (not that even that is necessarily "simple." a lot of the bs originates outside the hospital.)

So if I was in HR, or a Nurse Manager why would I hire somebody who was applying to another program?? Why would I hire a green 21year old with no medical experience? Why when there are so many new nurses to choose from? As for people not wanting bedside nursing, perhaps its because alot of hospitals are rotten to work in? In a perfect world nurses would have the power and unity to demand good working conditions, but we all know this world is far from perfect.

Specializes in Oncology/Haemetology/HIV.
If facilities would learn to retain staff by treating them like cherished employees, they wouldn't need to worry so much about the net loss from continuing to train new nurses, over and over and over again. Seems simple enough to me.

The facility that I work, is considered one of the top in the nation. It has the best, bar none, ratio for my specialty that I have seen in 18+ years of nursing, and over 20 hospitals (I was a traveler for a time). And I have worked at 5 of the top 10 hospitals in the nation. Management is supportive, our manager does not believe "the customer is always right", supports her staff, and does not put up with bad behavior from visitors, MDs, pts. Orientation is extensive and there are literally over a hundred hours of basic onco training, paid chemo course, paid ACLS and at minimum, 150 hrs of class time for critical care, 12 weeks minimum of orientation, 144 hrs additional of critical care orientation, 60 of charge nurse orientation, 72 of op training, in addition tonpaid time for hospital/nursing basic orientation, and plenty of paid optional education.

After a few years here, you can pretty much get a job anywhere.

It doesn't matter. Despite multiple interviews, a share day, we encounter new employees, old and young that "forget" that they were scheduled to work - during the first few weeks of employment, or show up repeatedly 2-3 hours late, live on their cell phone or Facebook.

right, I've seen so MUCH lateral violence in the workplace during my clinical rotations (NOT where I currently work), that new grads actually RUN away from the job. And they WERE great nurses with a solid foundation upon which to be built a really awesome seasoned nurse - but were constantly belittled and whispered about because apparently should have known every single hospital policy 1 month into their jobs, among other things, NicuGirl.

And as far as the response stating what I said was bullpuckey (whatever that may be - not in my vocabulary). If a graduate is precepted and orientated WELL by a preceptor, then there shouldn't be any problems. Perhaps the preceptors don't know how to teach and that's why their preceptees are incompetent? That's what my boss says anyway (nursing director). You have to have a certain personality to be a good preceptor and perhaps you two should not ever be placed with a new grad.

IMO, if a strong preceptorship program is instated in a hospital, then there is a net GAIN in training a new graduate nurse. The hospital where I work has a great preceptor protocol and I've never been in a hospital full of mainly female employees (the hospital is roughly 85% female, including the president and VP's) where there is almost zero GOSSIP or whispering and secrets and everyone works TOGETHER and actually WANTS the others to be GOOD at their job.

And I know I'm correct about new grads leaving after 6 months to 1 year - it's usually due to the "seasoned" nurses trying to eat them alive. I've heard stories time and time again.

Remember that new graduates can sometimes teach the seasoned nurses something new. Open your ears and your hearts and lift up the nurses around you rather than try and beat them down. Nursing is a difficult job and having a bad attitude only makes it that much more difficult.

SMILE

Love to all the hard-working nurses (RN's, LPN's/LVN's, CNA's, Nurse Tech's, etc) and remember it's a TEAM effort, not an "I can do it better than you" effort.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
right, i've seen so much lateral violence in the workplace during my clinical rotations (not where i currently work), that new grads actually run away from the job. and they were great nurses with a solid foundation upon which to be built a really awesome seasoned nurse - but were constantly belittled and whispered about because apparently should have known every single hospital policy 1 month into their jobs, among other things, nicugirl.

and as far as the response stating what i said was bullpuckey (whatever that may be - not in my vocabulary). if a graduate is precepted and orientated well by a preceptor, then there shouldn't be any problems. perhaps the preceptors don't know how to teach and that's why their preceptees are incompetent? that's what my boss says anyway (nursing director). you have to have a certain personality to be a good preceptor and perhaps you two should not ever be placed with a new grad.

imo, if a strong preceptorship program is instated in a hospital, then there is a net gain in training a new graduate nurse. the hospital where i work has a great preceptor protocol and i've never been in a hospital full of mainly female employees (the hospital is roughly 85% female, including the president and vp's) where there is almost zero gossip or whispering and secrets and everyone works together and actually wants the others to be good at their job.

and i know i'm correct about new grads leaving after 6 months to 1 year - it's usually due to the "seasoned" nurses trying to eat them alive. i've heard stories time and time again.

remember that new graduates can sometimes teach the seasoned nurses something new. open your ears and your hearts and lift up the nurses around you rather than try and beat them down. nursing is a difficult job and having a bad attitude only makes it that much more difficult.

smile

love to all the hard-working nurses (rn's, lpn's/lvn's, cna's, nurse tech's, etc) and remember it's a team effort, not an "i can do it better than you" effort.

i can't decide if this post is serious (and seriously ignorant) or sarcastic. on the off chance that it's serious, let me just say that the preceptor is only half of the equation. no one, no matter how good she is at precepting, can teach anything to someone who is convinced that they already know everything or who refuses to study and look things up or who just doesn't give a rip. sadly, there are many such new grads.

i can't decide if this post is serious (and seriously ignorant) or sarcastic. on the off chance that it's serious, let me just say that the preceptor is only half of the equation. no one, no matter how good she is at precepting, can teach anything to someone who is convinced that they already know everything or who refuses to study and look things up or who just doesn't give a rip. sadly, there are many such new grads.

http://www.nursingsociety.org/sttievents/leadershipsummit/documents/the%20high%20cost%20of%20lateral%20violence%20in%20nursing_stanley_4-24-2010.pdf

statistics show that lateral violence in nursing causes most new grads to quit their 1st nursing position wsithin 6 months to a year. sorry to say but, if you believe you are not part of the bullying / lateral violence problem, your post calling another nurse ignorant is considered lateral violence. so, you, my friend, are definitely part of the problem - that's why you don't see it. so you see, i am not the ignorant one.:D

+ Add a Comment