Experienced Nurses Should Leave Legacies to New Nurses

dudette10, MSN, RN · Jul 21, 2012

I have been a Registered Nurse for ten years. During these years, I've worked in many areas of nursing. My last position was Director of Nursing for Private Duty. I have attempted to mentor nursing students by explaining things to them that they may not have grasped in class. I remember what it felt like being a new RN. I had a lot of book knowledge but hardly any nursing skills.
I have seen experienced nurses refuse to help new nurses. I find this behavior appalling. I feel that we owe it to new nurses to teach them everything we know, so that our legacy of providing quality care is continued. Before I was DON, I usually was a charge nurse and preceptor. I encouraged new nurses to use the knowledge they had learned but also taught them nursing skills that they were unfamiliar or uncomfortable with.
Nursing is not a profession. It is a calling. We are there to provide healthcare to everyone. This healthcare must be above standard. I once went to work for a facility that did not fully orientate the nurses. They allowed new nurses to provide care to patients after only two to three weeks. As the head nurse, I asked the unit manager to please place certain nurses with experienced nurses to allow them to learn. But this never occured. I had to write so many incident reports regarding the substandard care that our patients were receiving. I actually was ashamed of this facility. I understand about nursing shortages, but seriously, let's teach the new nurses good habits to inculcate into their nursing practice. Let's teach them that all patients are our patients. I dislike the words, that isn't my patient. Let's take new nurses and even student nurses under our wings and show them the joy that nursing can bring.
As I have said, nursing is not my profession. It is my calling in life. I am tired of reading about nurses becoming burned out. If we teach them correctly the first time, they will be able to handle things.
I was very lucky when I was in nursing school. I had two nurses that I externed with. These nurses taught me everything that they could within what the law allowed. After I became a RN, I was fortunate to shadow several nurses who taught me so many things that I didn't learn in nursing school. This is the legacy we should leave to the new nurses. Let's help them reach their full potential.
As I look around at the open RN positions for most companies, I find it sad that nearly every ad states experience required. How can any nurse obtain experience if we do not invest in that nurse? So let's invest in the new nurses, teach them, guide them, mentor them, and let their superb nursing skills be the legacy we leave them.

I understand the overall gist of what you are saying. Some of the phrases and assumptions you used in your OP have sidetracked me and others from your original point, I fear. Things like "it's a calling," and your opinion that burn out wouldn't possibly happen if staff nurses just taught newbies the "right way" of doing things.

Other people have comments on the many factors that play into burn out, so I want to just address your overall point.

We need to be committed in our attitudes to teaching the highest level of care to baby RNs. I think that is your point.

I AGREE!

But that just isn't enough!

We cannot forget that the reality of nursing, the demands put on staff nurses, the amount of work we need to do often does not allow us to do the teaching job we should, and it spills over into the attitudes (sometimes...other times, the attitude just sucks without a real reason!)

Administration must also be committed to creating a teaching environment. Too many NMs feel that any nurse can precept without any reduction of workload or any special training. Tools for informing new RNs of the processes required to do administrative tasks (discharges, QA regulations, transfer, etc.) are not created. These important processes are expected to be passed on verbally, and many times, things are missed in training.

The medical profession is compared to nursing in length of training, wages, etc., with serious, different, but in many ways an equivalent responsibility. One thing we often miss is that the medical profession has also created a culture and effective method of teaching the newbies.

Someone mentioned upstream that residency programs are now the model of training RNs for a high level of care, but they fall short. Maybe the model needs to be rehauled. When a baby MD is trained, how often does he go "back to the classroom" for his training. NEVER! He is taught by doing, with multiple levels of practicing MD supervision.

In nursing, residencies tout classroom work and length of orientation, but what about the hands-on? One (or many serial) staff member(s), with a full workload, is entirely responsible for the training of a new RN, without the tools and support and culture to do it while on the floor.

Others have mentioned their own training while in nursing school. Old diploma programs had dorms on hospital campuses, the students ran the show, and they came out being RNs, not newbies. Yes, I wish it could go back to that, but it simply can't. Too much liability...no hospital would be willing to do that again. While I understand the frustrations of those who graduated from diploma programs comparing the new grads to their readiness some years ago, the frustration is pointless, and it is NOT the fault of new grads, nor, to some extent, the new model of nursing school education. Blame a litigious society for changing what clearly worked.

One of my doctors referred me to a specialist. He started out by saying, "He was my resident." I would love for nurses to also be able to say that: "He was my preceptee," with a sense of pride and assurance of great care. A huge culture shift is required to get to that point, and it starts with support of the floor nurses who are expected to teach the legacy.

cjcsoon2bnp, MSN, RN, NP · Jul 21, 2012

To the OP, you bring up some interesting points but I must disagree on a few things. While I don't consider myself an overly religious person I do believe that nursing is my calling. However, I also believe that nursing is a profession and not everyone is drawn to nursing as their "calling in life" that does not mean that they are any less of a nurse. On the next point, I don't think that everyone is meant to be a charge nurse or a preceptor. That dosen't make them a bad nurse, it means that they want to come in and care for their patients and not be responsible for having to train someone or be in charge of the whole unit. The final point is that I believe all of our problems with nurse satisfaction and retention are multifactorial and not soley due to poor orientation (although poor orientation can be one of the many causes).

!Chris :specs:

studentdrtobe · Jul 21, 2012

Someone mentioned upstream that residency programs are now the model of training RNs for a high level of care, but they fall short. Maybe the model needs to be rehauled. When a baby MD is trained, how often does he go "back to the classroom" for his training. NEVER! He is taught by doing, with multiple levels of practicing MD supervision.

Actually, that's completely wrong.

We "go back to the classroom" throughout residency training and beyond. During residency, we have mandatory conferences, grand rounds, journal clubs, and weekly didactics. Some residencies even have an entire day of the week dedicated solely to didactics and conferences. While, yes, it's not as much classroom learning as the first two years of med school, it's completely wrong to say that there's no classroom education beyond med school. Hard to keep up with changes in the basic sciences and mechanisms of pathophys/pharm/etc if you're only in the clinic doing hands-on work.

RN58186 · Jul 21, 2012

A number of years ago one of the RN's who oriented me to my first job retired. She was a wealth of knowledge and never too busy to answer a question. I remember looking at her on her last shift and saying "But you can't retire!! Who is going to teach the new nurses what they need to know?" She looked at me and laughed and said "It's like this. Jane taught me, I taught you. Guess what? Now it is your turn to teach the young ones." And so it continued. But that was years ago and so much has changed. The workload is horrendous, the demands have multiplied numerous times over. I don't work on an inpatient unit anymore, but I know the staff nurses don't have the time to teach the new nurses the way I was taught. I think that is sad really. I would not be the nurse I am today if it were not for the likes of those who came before me and shared what they knew with me. Things that I will never forget. I don't have the magic answer, but I wish I did.

Burn-Unit-RN · Jul 21, 2012

I think that we all enter nursing for different reasons. The OP mentioned that it is his calling, which is very well may be. I will clarify for the OP that nursing is in fact a profession, however one of may have a calling into a profession. On my unit, I work with one nurse who was severely burned as a child and subsequently entered the nursing profession after the comfort and compassion she received from the nurses while recovering. The OP sounds like a very passionate and motivating nurse and as a new grad it would probably be a pleasure to learn from him.

For those of you jumping down the OPs throat in stating that he would not consider it a calling if it were for minimum wage for free, that's not true. I volunteer on a homeless van 2 days per week which visits the poorest parts of the city to provide basic care for the homeless. I do not get paid for this. Could I pick up overtime at my job rather than do this? Yes. But I feel as though I have much to offer those who are not as lucky. Other nurses I work with volunteer in other respects. Just because you will not volunteer your knowledge and skills to those less fortunate does not mean others will not.

As far as the points the OP is trying to make about new grad orientation, many of those ideas are skewed and idealized. When I started on my unit, it will difficult for the other nurses to help me while they were busy. Some of our full body wound care and dressing changes can take hours. When I have my own dressings as do the other nurses, we can't make more time out of a 12 hour shift for them to both help me and get their work done. However, it would be great to provide these lengthy 1:1 orientations, it's just not possible!!

dudette10, MSN, RN · Jul 21, 2012

Actually, that's completely wrong.
We "go back to the classroom" throughout residency training and beyond. During residency, we have mandatory conferences, grand rounds, journal clubs, and weekly didactics. Some residencies even have an entire day of the week dedicated solely to didactics and conferences. While, yes, it's not as much classroom learning as the first two years of med school, it's completely wrong to say that there's no classroom education beyond med school. Hard to keep up with changes in the basic sciences and mechanisms of pathophys/pharm/etc if you're only in the clinic doing hands-on work.

Thank you for the correction. The didactics you speak of fall into my definition of "classroom," but the rest (except for journal clubs...not sure what that is) are expected of MDs throughout one's career.

Our conferences of late consist of "customer service" programs. At my facility, nurse educators are holed up in their offices (doing what, I'm not sure...haven't seen one since orientation) except for a very good diabetic nurse educator who comes around quite often.

The biggest point I was trying to make is your model of learning and the culture within the medical world that supports it. We don't have that consistently, and at some facilities, not at all.

wooh, BSN, RN · Jul 21, 2012

Too many NMs feel that any nurse can precept without any reduction of workload or any special training.

I've been told just to talk about what I'm doing as I do it. As if that takes no extra time.

The ridiculous thing is, it's not just that we don't get a workload reduction for training. We'lll often get more work piled on because we have "help."

allnurses Guide · Jul 21, 2012

For those of you jumping down the OPs throat in stating that he would not consider it a calling if it were for minimum wage for free, that's not true. I volunteer on a homeless van 2 days per week which visits the poorest parts of the city to provide basic care for the homeless. I do not get paid for this.

That's a wonderful thing to do, but I don't think we were talking about volunteering or giving back to the community. We were talking about doing a regular job that puts a roof over our heads and food on our table. Mixing those two things together sounds like an attempt to hint that people who rightfully expect a paycheck just aren't altruistic enough and that is not fair.

I think you'll find it quite common that people enter nursing because of a transforming event they or a member of their family experienced. In my case it was the care my little brother received after he was was diagnosed with leukemia.

WildcatFanRN, BSN, RN · Jul 21, 2012

thank you for the correction. the didactics you speak of fall into my definition of "classroom," but the rest (except for journal clubs...not sure what that is) are expected of mds throughout one's career.
our conferences of late consist of "customer service" programs. at my facility, nurse educators are holed up in their offices (doing what, i'm not sure...haven't seen one since orientation) except for a very good diabetic nurse educator who comes around quite often.
the biggest point i was trying to make is your model of learning and the culture within the medical world that supports it. we don't have that consistently, and at some facilities, not at all.

this model sounds good, but what hospital would be willing to put in that kind of educational support towards new nurses like they do for new md's? many places i've applied to tout the fact that they are teaching hospitals, meaning they have residencies for multiple medical specialties. some seem proud of the expertise and education they provide for their nursing staff as well as the baby docs, some not so much. i think it would be wonderful if hospitals were as eager to advertise how big their nurse residencies were as much as they are for their medical residencies. also, the baby docs have the support of thier profession.

allnurses Guide · Jul 21, 2012

Medical education is so completely different. The strict pecking order involved there would have the "nursing eats it's young" people immobile with apoplexy.

wooh, BSN, RN · Jul 21, 2012

Medical education is so completely different. The strict pecking order involved there would have the "nursing eats it's young" people immobile with apoplexy.

Goodness, can you imagine the NETY people going into the police force? "I have to walk a beat before I get to be a homicide detective????" Becoming an attorney? "They expect me to do document review before I get to sit first chair for a homicide?" (Yes, I watch too much L&O and only think about homicide. I especially think about homicide when I'm at work, is that bad?)

GinginRN · Jul 21, 2012

I enjoy precepting others, however I do not feel everyone is cut out to precept. It takes patience, perseverence, and a good working knowledge base to be an effective teacher.