Why such high new RN turnover?

Jennerizer, ASN, RN · Mar 13, 2012

A lot of the hospitals here in Florida are getting rid of the patient care techs....so if you plan on being a nurse, you better make sure you're ok with doing a lot of what a typical CNA would do for the patients. I can understand why turn over is high for new grads....it is crazy out here. I've been a nurse for over 7 years & even I am getting fed up with the shortstaffing, poor pt to nurse ratios, the constant berating of HCAHP scores & how we (the nurses) need to do better.....even though the hospital chooses to keep us running with as few nurses as possible. Our poor new grads are started out on med/surg with 7 patients, no techs and no secretary. If I had started in an environment, I would have turned around & ran the other way.

I don't think it's so much that older nurses are eating their young......rather they are too overwhelmed themselves to help very much. I am not jaded towards nursing.....nursing is a fine career. It is when administration thinks because a nurse "can"...that they "should" do everyone's job. We put in our orders, we are doing respiratory treatments, now they are telling us to make sure we clean the rooms on a daily basis.....as well as emptying the trash & laundry. Cater to not only the patients, but their families also...because 60% of the patient satisfaction surveys are filled out by family members. Remind doctors to do this or that. Call doctors with results of tests....and in turn get yelled at by these doctors for bothering them with results.

Where is the nursing in all that? We are being turned into a jack of all trades & then blamed when something doesn't go right. Lab messes up a time or a order....well, the nurse should have caught the mistake & corrected it....or the nurse should have noticed no one from lab drew the blood at the exact time & the nurse should have made a call to remind lab to draw the blood. The doctor orders the wrong test or doesn't give a reason why a test is ordered....the nurse should figure it out or follow up with the md. MRI is ordered but the dept is taking awhile to get the patient...the nurse should call & find out why they are taking so long. Pharmacy is questioning medications, have the nurse call the MD to clarify & then call the pharmacist to follow thru on clarification. Pharmacist still doesn't agree? The nurse should keep calling until it is resolved. Why can't the doctor & pharmacist talk to one another? No one around to answer the phone, the nurse should drop everything to answer the random unit phone calls. It goes on & on & on. Put the nurse in the middle & then blame the nurse for everything that isn't perfect. That is not nursing!

Esme12, ASN, BSN, RN · Mar 13, 2012

mar 12 by rn per diem mar 12 by rn per diem a member since dec '06 - from 'apex, nc, us'. rn per diem has '14' year(s) of nursing experience. posts: 2,160 likes: 2,071

awards:

as a new grad, i was overwhelmed and didn't realize that the feeling would pass with time and experience.

i didn't know that i would feel that way in almost any setting as a new grad.

i was convinced that the grass was greener elsewhere.

i was hoping for a slower pace, and fewer patients, less responsibility and less paperwork.

i was looking for a job that didn't exist.

medscape: medscape access"unrealistic expectations. many, although by no means all, new graduates are holding on to unrealistic expectations about the type of nursing position that they will be able to find. nurse recruiters report that they often interview new graduates who state that they are seeking only a day shift position, or one with minimal weekends. others want to work part-time, right out of school, which is generally not acceptable to the hospital that must spend money to orient, or extensively train the new graduate, depending on the clinical area. some new graduates even go into the interview requesting a position in critical care, the operating room, or other specialty area -- areas that typically hire few, if any, new graduates. demands of this nature will significantly hinder the new graduate's chances of landing a job." mar 12 by lemon indiscretion

we put in our orders, we are doing respiratory treatments, now they are telling us to make sure we clean the rooms on a daily basis.....as well as emptying the trash & laundry. cater to not only the patients, but their families also...because 60% of the patient satisfaction surveys are filled out by family members. remind doctors to do this or that. call doctors with results of tests....and in turn get yelled at by these doctors for bothering them with results.

where is the nursing in all that? we are being turned into a jack of all trades & then blamed when something doesn't go right. lab messes up a time or a order....well, the nurse should have caught the mistake & corrected it....or the nurse should have noticed no one from lab drew the blood at the exact time & the nurse should have made a call to remind lab to draw the blood. the doctor orders the wrong test or doesn't give a reason why a test is ordered....the nurse should figure it out or follow up with the md. mri is ordered but the dept is taking awhile to get the patient...the nurse should call & find out why they are taking so long. pharmacy is questioning medications, have the nurse call the md to clarify & then call the pharmacist to follow thru on clarification. pharmacist still doesn't agree? the nurse should keep calling until it is resolved. why can't the doctor & pharmacist talk to one another? no one around to answer the phone, the nurse should drop everything to answer the random unit phone calls. it goes on & on & on. put the nurse in the middle & then blame the nurse for everything that isn't perfect. that is not nursing! 5:56 am by jennerizer

.........for all the reasons above.

nursing schools are churning out new grads at an alarming rate in homage of the almighty dollar. :bowingpur the schools are failing the students by not giving them the reality of the nursing world. heck the schools are still spouting out the rhetoric that there is a nursing shortage! really??? :uhoh3: all in the worship of the almighty dollar. in days gone by there was more clinical time spent on the floors, and before anyone says it i was at a college based program, we spent far more time clinically at the hospitals than programs today. now nurses are being taught (in some/most instances) not by clinical experts but by college educated degrees that have never stepped foot on a floor, teaching the bedside skills, spouting the laurels of "evidenced practice" when the have little or no evidence because they have never practiced. :bugeyes:

the program i attended was a diploma program that was lifted from the hospital that closed the program and placed it on the campus of purdue university. we worked saturdays and evenings. we went at 4 or 5 am before clinical that day in order to send off the surgical patients, insert foleys/ngt's in the or. our clinical instructors spent a ton of with us each and every day. i would have clinical all day and have classroom/lecture at 5 pm. if you didn't like it? get out.....there was a list of people dying to take your place.

we weren't given any false illusions by nursing faculty of what the realities of nursing was as they were still working as rn's themselves. when we graduated we were fully aware of what our expectations were......we never felt that bedpans and bathing was beneath us because we had a college degree. we were the protectors of the patients, their last line of defense to keep the medical machine from doing them harm.

we called the md, we called the pharmacy, we yelled at lab....because we were the ones smart enough to know better. :nurse:

now all i hear is how that is not nursing job. my question is......then who's job is it? i really think that too many right now are going into nerd=sing because they have been told about the "pot-o-gold" in healthcare being recession proof and really don't want to be a real nurse (rn). they graduate and realize what those of us already in the field already know and that is that "they don't pay me enough to put up with this crap" but first and foremost...we love being a nurse.

i know many will not agree....but it is just my :twocents:

Merlyn · Mar 13, 2012

My understanding is that new nurses (recent graduates) are the most likely to leave the field. If true, why is this? Is it because they underestimated the job's demands?

I may be wrong, but I have observed that the Nurses that come from a school that does not have a work time ( time when the student actually works on the floor as a nurse tend to drop out sooner. They poor souls don't have a clue to what is expected of them after they leave the hollowed halls of learning. To witness this is extremely painful. I once had a supervisor that had just graduated from one of the better schools. When an incident went down she was so full of anxiety that she stood in the middle of the floor and kept shouting, "Where is my resource person!" She quit the next dy, after preparing to be a nurse for four years. I know there are great nursing schools out there. But it has reached a point were learning to be a nurse and the realities of nursing clash.

Patti_RN · Mar 13, 2012

Esme wrote, "We called the MD, we called the pharmacy, we yelled at lab....because we were the ones smart enough to know better."

I see many of your posts, and I usually agree with most of what you say, but the 'yelling at the lab' because you're so smart (smarter than the lab employees?) leaves me confused.

First yelling at anyone is inappropriate. Second, as part of my master's program I had to shadow a non-nursing medical professional; I chose one of the medical technologists because I never actually saw what they did. I spent two weeks seeing the chaos of their jobs and the incredible stress they're under. They may appear to be just sitting gazing into microscopes, but just because they aren't on their feet running, doesn't mean they aren't stressed. Yes, they do have slow times, just like we do, but they often miss meals, don't have time to run to the bathroom, and stay late to help the next shift (and often don't get paid to do so).

Some of the job is routine (just like much of nursing is routine). It's when it's not routine that the lab has stresses and problems. And, when the floor is busy, the lab is busy. When the ED is busy, the lab is busy. When the OR is busy, the lab is busy... get the connection?

In some lab duties (like blood banking) there is zero tolerance for mistakes. And, because of the critical importance of not ever making an error there are multiple and redundant fail safes to eliminate the common causes of transfusion errors. What are these common errors? The errors have little to do with the lab, instead they are virtually always cross match errors traced to nurses drawing the wrong patient or transfusing the wrong patient or using blood labeled for another patient. So, who makes these errors? The nurses. And what does the system do to prevent further errors in the future? They incorporate more rules and policies to prevent future mistakes, for example having two nurses draw blood on the patient at two separate times and send those samples to the lab to be typed and crossed. So, what does the overworked nurse do? She, herself, draws two samples from the same line and slaps two labels on, one with her own initials and one with her colleagues initials. How does this prevent errors? It doesn't, it only doubles the work of the lab (they have to type and cross both sets of tubes--remember this policy is in place because so many samples were drawn on the wrong patients--if you have two nurses doing two draws independently the chance is remote that they will both draw on the wrong patient. If the same nurse draws on the wrong patient--then pulls another set of tubes, the real patient two rooms down will receive blood crossed with this patient's blood type).

While I was shadowing in the lab I saw the other side of the story about the 'stupid lab' people (a term I've heard used a thousand times from dozens of nurses). The technologists have B.S. degrees, the technicians have at least a two-year degree. They must pass state boards, just like nurses. They work shifts and holidays, just like nurses. And, they may not have direct patient contact, but the patients are 'their patients' just like the patients are 'our patients'--they have the same feelings of responsibility and the same legal responsibilities we do for these patients. And, when the lab insists that nurses follow the rules about blood draws, quality of the specimens, etc., they are being patient advocates.

It may come to a shock to nurses who dismiss the lab employees as lazy, stupid, or difficult that this is the opinion some lab employees have of some of the nursing staff. Calling the lab demanding to know where the results are only slows them down and keeps you from getting your results that much longer. The lab isn't just dealing with your critically ill patient, they are dealing with dozens of other critically ill patients from other floors, units and departments. They don't have enough hours in their days when all hell breaks loose and your phone call 'yelling at them' is adding to their burden.

Nurses may be patient advocates, but they aren't the only patient advocates. Nurses may be the 'protectors' keeping the 'medical machine' from harming patients, but they aren't the only protectors. And, many times, it's the nurses who patients need to be protected from.

So, when you're overwhelmed and you're waiting impatiently for results, or you're mad because the lab rejected your sample, or you think a safe-guarding policy is ridiculous, do the patients a favor and don't call the lab (or the pharmacy or some other department) and yell at them. It's unprofessional, but more importantly, it's counter-productive. The lab professionals have their job to do and they are doing it according to the rules in place, according to hospital policy, and to keep their patients safe--and they are doing it as fast and efficiently as possible.

Mandychelle79, ASN, RN · Mar 13, 2012

Being thrown to the wolves so to speak. Was put in charge my first day off orientation. Not being able to spend the time with the patients like I want to. Unrealistic company expectations. The whole its all about me mentality of some of the patients have.

But I worked in health care for years before getting my RN and my mom is also a nurse so I knew these things did happen so it was a shock to me. Some of my classmates, it was a shock.

cdsga · Mar 13, 2012

There is a vast difference between school and actual work reality. I do believe they should bring back the Student Nurse work license so you can get get a better sense of what the work routine is. Being a nursing assistant CNA is NOT the answer. When you have the designation of working as a student nurse (at least in my ideal world) you are being apprenticed to things besides changing bed pans. Yes you get the experience of doing procedures, but there are other things that at least I got to do when I worked as a student nurse. As we got acclimated we learned assessment, nursing care plan implementation, proper written and oral communication, prioritization of work assignments, spent time with patients, and helping the team members on our med/surg units.

Some students who showed great skill in surgery were allowed to scrub and assist with scrub duties and developed skill in that area. In the diploma program we were given so much clinical work during our education we were able to decide where we were best suited and made plans to interview for those areas that we felt we could "shine". When I finished my nursing education I was very well adapted and made the transition easily.

The hospital where I was hired put us through specialty training that extended the basic nursing education and was difficult, we were again working as a grad and waiting for our license and during that time we learned even more-I think the system has failed those in nursing school by not allowing them to work as a student nurse or graduate nurse while waiting for licensure. This is valuable time lost-and it is shocking when faced with the expectations of hitting the ground running.

The workplace is staffed so lean now, and many don't have time to properly precept the new nurse. It is no wonder that the drop out rate of new nurses is so high. Somebody needs to REALLY revise the criteria and make a better plan for new nurses. Just passing the NCLEX does not make you highly skilled. It may just set the new nurse up for failure. All nursing education is not equal. Some of the accounts from new grads that I have heard is minimal clinical exposure and lots of paper writing.

New nurses, from my experience with interns in the OR, is about 40-50% success, that is not good. Especially when you interview, spend money training/orienting new nurses. It has been quite disturbing and exhausting.

On a positive note though, the nurses who did stay one year from hiring have been very valuable to our unit and have advanced in their careers.

Esme12, ASN, BSN, RN · Mar 13, 2012

Esme wrote, "We called the MD, we called the pharmacy, we yelled at lab....because we were the ones smart enough to know better."
I see many of your posts, and I usually agree with most of what you say, but the 'yelling at the lab' because you're so smart (smarter than the lab employees?) leaves me confused.
First yelling at anyone is inappropriate. Second, as part of my master's program I had to shadow a non-nursing medical professional; I chose one of the medical technologists because I never actually saw what they did. I spent two weeks seeing the chaos of their jobs and the incredible stress they're under. They may appear to be just sitting gazing into microscopes, but just because they aren't on their feet running, doesn't mean they aren't stressed. Yes, they do have slow times, just like we do, but they often miss meals, don't have time to run to the bathroom, and stay late to help the next shift (and often don't get paid to do so).
Some of the job is routine (just like much of nursing is routine). It's when it's not routine that the lab has stresses and problems. And, when the floor is busy, the lab is busy. When the ED is busy, the lab is busy. When the OR is busy, the lab is busy... get the connection?
In some lab duties (like blood banking) there is zero tolerance for mistakes. And, because of the critical importance of not ever making an error there are multiple and redundant fail safes to eliminate the common causes of transfusion errors. What are these common errors? The errors have little to do with the lab, instead they are virtually always cross match errors traced to nurses drawing the wrong patient or transfusing the wrong patient or using blood labeled for another patient. So, who makes these errors? The nurses. And what does the system do to prevent further errors in the future? They incorporate more rules and policies to prevent future mistakes, for example having two nurses draw blood on the patient at two separate times and send those samples to the lab to be typed and crossed. So, what does the overworked nurse do? She, herself, draws two samples from the same line and slaps two labels on, one with her own initials and one with her colleagues initials. How does this prevent errors? It doesn't, it only doubles the work of the lab (they have to type and cross both sets of tubes--remember this policy is in place because so many samples were drawn on the wrong patients--if you have two nurses doing two draws independently the chance is remote that they will both draw on the wrong patient. If the same nurse draws on the wrong patient--then pulls another set of tubes, the real patient two rooms down will receive blood crossed with this patient's blood type).
While I was shadowing in the lab I saw the other side of the story about the 'stupid lab' people (a term I've heard used a thousand times from dozens of nurses). The technologists have B.S. degrees, the technicians have at least a two-year degree. They must pass state boards, just like nurses. They work shifts and holidays, just like nurses. And, they may not have direct patient contact, but the patients are 'their patients' just like the patients are 'our patients'--they have the same feelings of responsibility and the same legal responsibilities we do for these patients. And, when the lab insists that nurses follow the rules about blood draws, quality of the specimens, etc., they are being patient advocates.
It may come to a shock to nurses who dismiss the lab employees as lazy, stupid, or difficult that this is the opinion some lab employees have of some of the nursing staff. Calling the lab demanding to know where the results are only slows them down and keeps you from getting your results that much longer. The lab isn't just dealing with your critically ill patient, they are dealing with dozens of other critically ill patients from other floors, units and departments. They don't have enough hours in their days when all hell breaks loose and your phone call 'yelling at them' is adding to their burden.
Nurses may be patient advocates, but they aren't the only patient advocates. Nurses may be the 'protectors' keeping the 'medical machine' from harming patients, but they aren't the only protectors. And, many times, it's the nurses who patients need to be protected from.
So, when you're overwhelmed and you're waiting impatiently for results, or you're mad because the lab rejected your sample, or you think a safe-guarding policy is ridiculous, do the patients a favor and don't call the lab (or the pharmacy or some other department) and yell at them. It's unprofessional, but more importantly, it's counter-productive. The lab professionals have their job to do and they are doing it according to the rules in place, according to hospital policy, and to keep their patients safe--and they are doing it as fast and efficiently as possible.

Unintentionally, I seem to have touched a nerve. Enough for a 7 paragraph response about yelling at lab. Good I like passion! :yeah: It is always best to walk in someone else's shoes to truly understand their position. I mean this with sincerity and with nothing but kindness. "Yelling" was a figure of speech.....I didn't mean that I "Yell" at them.....even though I have had a few discussions with MDs, lab, x-ray....that I have made my displeasure perfectly clear and that their behavior is unacceptable.

However.....I meant no disrespect. It was a figure a speech. I have never doubted the education, contribution, dedication and importance of the lab personnel. Never once have I believed them to be lazy nor stupid and I have no doubt that the lab harbors those feelings about another departments.....which is similar to how the ED feels about the floors and ICU, that the ICU feels about the ED and the floors, that the floors feel about the Ed and the ICU. It seems to be an epidemic that the assumption of incompetence against another department is rampant in the medical field ie: hospitals. Personally I believe that any clots for hold or products should be done by lab for safety and accuracy should be done by lab with very few exceptions....because of careless mistakes by nurses.

My reference was to the previous poster about what is and should not be a nurses responsibility in the poster post that nurses are a safety cap for the patient and our importance to the patients care regardless to the apparent simplicity of the task. A tongue in cheek reference about how important we are to the patients care and outcomes, which has been studied over and over again, and the schools failing entry level grads.

The inference to my statement that we are smarter is similar to a quote form a respected lecturer in the nursing profession. Laura Gasparis Vonfrolio tells about being asked by shouting physicians where she got her medical degree she would respond......

"Harvard, but I decided to further my career so I went on to be a nurse!"

I am also perfectly aware that there are many layers to a patients safety but I was referring to the importance of these menial tasks like calling the doctor, as in the previous posters post, being an important part of the nursing responsibility. I acknowledge that posters reference to the list of necessary importance of the nurses role and what the truly entails......... once again emphasizing the inadequacy of the preparation of nurses in school leaving them surprised when they graduate and disillusioned so that they leave the profession. I am also perfectly aware, after 33 years at the bedside, that if one department is busy that it trickles to the winter hospital and it usually starts with the ED.

My response was to draw attention to the importance of all nursing duties even the ones that are menial and don't involve the exciting and includes the less glamorous roles. Peace...:loveya:

Patti_RN · Mar 13, 2012

Ha! Esme, I knew I liked you!! You responded to my 7 paragraph tirade with a great 7 paragraph response of your own!

Yes, you did hit a nerve. I hear so many comments from nurses who ridicule and undermine other professionals I finally let loose! I've sat in meetings, classes and symposiums where I hear the same trite comments from different nurses, "We are the true patient advocates", "Nurses are the only ones who care about the patients" I sometimes wonder if these nurses even know what they're saying.... They seem to just repeat these mantras to make themselves feel good.

No, I wasn't responding to your overall comments about the burdens of nursing, the difficulties encountered by nurses and the reasons we become frustrated. The 'yelling at the lab' comment struck a chord (yes, in your case figuratively, but too many times, literally).

eyeball · Mar 13, 2012

Very few places willing to pay for appropriate training. Many new grads are thrown to the wolves. Nursing schools now teaching students based on passing the nclex, not actually being a nurse. A lot of people get into nursing based on what it used to be, not what it is today. Today it is long hard shifts with bare bones staff and a lot of liability. Oh and in some places, the nurses are not welcoming to newbies. Newbies need help and have lots of questions, which with todays staffing rates, drains the already stretched too far thin nurse. When orientation is too short, they need more help. Also as a newbie it is hard to get that first RN job in parts of hte country. So the ones that will take a new grad are often the worst of the worst kind of places to work. One of my classmates was hired at a snf, 40 patients and 3 days orientation as a new grad. She is now bartending.

I couldn't have said it better...This post nails it.

Altra, BSN, RN · Mar 13, 2012

From the number of posts I see that make reference to "getting my one year in ..." before doing whatever else is in the individual's career plan ... I would conclude that at least some portion of this turnover is planned, and not an unexpected occurrence.

cdsga · Mar 13, 2012

Since my 5 year run at surgical services educator I know that historically hospitals trend turnover rates. Their goal is to at least keep nurses one year. The theory is, by historical data, that if you pass the one year mark you will normally stay for 5. Then if you stay 5 you'll stay 10 etc. Of course nursing in general, since majority are female, have a tendency to move with husbands, better money, or stay long enough to get experience. Ex) one year experience in ICU before entry to anesthesia school. So a success for hospitals is one year. They start to sense a problem if the turnover rate is a high percentage during the first year of employ. This is where a large amount of money is spent on orientation etc. I believe they say 30-40K per new hire? So of course they then look at different things to retain new employees.

They look at exit interviews, trends in departmental turnovers, then work to resolve issues. There is also a statistical expectation through years and years of tracking, that lets you know the national trend. So it's not unusual to expect a certain amount of turnover. The hospitals set goals to retain and work on bonuses, monetary incentives in specialty areas that seek out certain types of nurses. They work harder on the interview process to weed out what might be some red flags before they have a resignation. They also do surveys and sometimes find resolutions to those issues that have been recurring themes on retention of employees.

The new hire now is more self loyal, they don't want to give to an institution. If the institution does not give them what they want when they want it, they leave. They look for greener pastures. There is no sense of paying dues as a new employee like in the old days when you got the evening or night shift first, the unit that needed the most help, or where you had to work to wait for a slot in a department that you desired. They don't want to work overtime, they don't want to take call, they don't want to work extra UNLESS it benefits them. I don't blame them, but on the other hand, I didn't have a choice when I took my first job. I was glad to get it and always was aware of the resume' killing "job hopping". I knew then and there that would be a red flag to future employers. Sometimes you have to "pay the dues to sing the blues" so to speak.

classicdame, MSN, EdD · Mar 13, 2012

The job is harder than most believe. Research over the past 20 years has shown that new grads are likely to move from their first job within 2 years, thinking the grass is greener elsewhere.