Hiring experienced nurses vs hiring new graduates

[edogs334]

As a recent graduate, I've noticed that many hospitals- especially the large academic systems that everyone wants to work for- hire few new graduates while continuing to post umpteen positions for experienced nurses. One hospital I looked at was even offering several thousand dollars in hiring bonuses to nurses who had >2 years of experience. Hence, if hospitals still have a need for nurses, then why have many of them developed a moderate allergy to new graduates? I know new graduates are initially a liability to health care organizations and are expensive to train. That's probably one of the reasons why, in this economy, hospitals have restricted how many graduates they hire per year. I still don't understand, however, why many hospitals continue to want to hire experienced nurses while basically closing their doors to the majority of new graduates? If they claim that they don't have the money to hire graduate staff, then where does the money to hire experienced staff come from? I think that the aforementioned hiring practice is quite myopic, because: 1)there are only so many experienced nurses to go around and I'm sure many of them aren't moving; and 2)when the economy gets better, nurses who came out of retirement will retire, nurses who work FT will go back to per-diem status, and the baby boomers will begin to retire in droves. Hence, I dare say that nursing executives who engage in this hiring practice will be in a hiring conundrum in a few years. So instead of severely restricting the number of new graduates hired, why don't nursing executives make a more concerted effort to recruit and retain the current graduates of today? Why don't hospitals turn more of current nursing vacancies into new graduate positions? That way, those new graduates would not only be able to fill needs for experienced nurses (within at least 1 year), but would also be able to act as preceptors for other recent graduates down the line. I'm sure there is a lot of information regarding this issue that I don't know, so any information you may have from a management perspective would be appreciated. I wrote this posting to seek out information, not to be one of many of whine about the lack of jobs available to people like me.

[llg, PhD, RN]

You answered your question within your post. New grads are much more expensive to train. Not only is it the direct cost of the education itself, it is having to pay for extra staffing while waiting for the new grad to get up to speed. It takes several months for a new grad to "carry her own weight" on the staff -- and in the meantime, existing staff are stretched thin, heavily burdened, and sometimes paid overtime rates to "fill the holes" that remain on the schedule while the new grad completes her orientation.

Also ... many new grads don't stay in their first positions for more than 2 years. By the time the new grad gets enough experience to be really helpful, they are gone. They don't stay around long enough to "pay back" the hospital for all the on-the-job training. An experienced nurse might not stay any longer -- but they were fully functional as a staff nurse more quickly.

It's not pretty ... but it's what's going on today. Hospitals strapped for cash are choosing to hire the people who can step in quickly and be fully functional in the shortest amount of time to save money in the current fiscal year and next year. They'll gamble on new grads when they have to -- but not if they don't have to. They are playing it safe for now.

I'm sorry that is not what you wanted to hear ... but it's the truth new grads need to understand today.

[edogs334]

You answered your question within your post. New grads are much more expensive to train. Not only is it the direct cost of the education itself, it is having to pay for extra staffing while waiting for the new grad to get up to speed. It takes several months for a new grad to "carry her own weight" on the staff -- and in the meantime, existing staff are stretched thin, heavily burdened, and sometimes paid overtime rates to "fill the holes" that remain on the schedule while the new grad completes her orientation.

Also ... many new grads don't stay in their first positions for more than 2 years. By the time the new grad gets enough experience to be really helpful, they are gone. They don't stay around long enough to "pay back" the hospital for all the on-the-job training. An experienced nurse might not stay any longer -- but they were fully functional as a staff nurse more quickly.

It's not pretty ... but it's what's going on today. Hospitals strapped for cash are choosing to hire the people who can step in quickly and be fully functional in the shortest amount of time to save money in the current fiscal year and next year. They'll gamble on new grads when they have to -- but not if they don't have to. They are playing it safe for now.

I'm sorry that is not what you wanted to hear ... but it's the truth new grads need to understand today.

In terms of why many hospitals aren't hiring new graduates, I did answer my own question- especially in terms of what's going on in the here and now. I understand that many hospitals are doing what they feel is necessary to stay financially viable while keeping (relatively) safe nurse-patient ratios. But your answer, just like the current staffing practices of hospitals, doesn't address what's going to happen to the state of nurse staffing in the long term. Although some hospitals are still hiring limited numbers of new graduates, it seems like hospitals are operating in contingency mode by hiring mostly experienced nurses. Hiring in this manner will still not address the predicted mass shortage in a few years- when more nurses who are around my parent's age retire or go back to pt/pd status. We all know that addressing any type of problem with a contingency solution is never viable in the long run. Hence, I think we as a profession need to take a good, hard look at how we hire and train our graduates once they get out of school- especially because new graduate retention rates, as you mentioned, continue to remain low. I'm sure that in your 31 years of experience, you've seen multiple cycles of this staffing phenomenon occur with economic upswings and downturns. And I'm sure that new graduate retention has always been low, on average. But it's too easy to sit back and say that low new graduate retention is just "the nature of the beast" and that it's "just the way things are going to be." There must be a better way of training and retaining our new graduates.

Also, thanks for not sugar-coating your answer. I never expected a sugar-coated answer from anyone and appreciate real, genuine opinions and view points a lot more than responses laden with half-truths and false hopes.

And one more question: Where are all these experienced nurses coming from (the ones that fill the positions only open to experienced nurses)?

[edogs334]

I also wanted to say that my motivation for starting this conversation wasn't fueled by bitterness at not yet having a job. Rather, it was out of concern for the future: a few years from now, I might be one of those experienced staff nurses who has to fill multiple scheduling holes because of the staffing shortage. Hence, we as a profession need to think more in the long term about what we're going to do before the shortage really hits.

[elkpark]

Hence, I think we as a profession need to take a good, hard look at how we hire and train our graduates once they get out of school- especially because new graduate retention rates, as you mentioned, continue to remain low.

I would argue that we need to take a "good, hard look" at how we "train our graduates" before they get out of school -- that is the crux of the issue for many hospitals. I worked as a surveyor for my state for several years recently, traveled all over my state and talked to nursing administration and education people in all kinds of facilities -- big university teaching centers, little community hospitals, and everything in between -- and the subject of new grads came up frequently in conversation. It isn't just the current lousy economy -- many hospitals were starting to balk at hiring new grads even before the economy tanked. Hospitals are v. tired of spending a lot of time and money teaching new grads stuff that they (the hospitals) feel people should have learned in nursing school -- basic, everyday, hands-on stuff that you need to know to function at a basic-entry level on an acute, inpatient unit of any kind -- and they feel that lots of new graduates present with an "entitled" attitude that is unjustified and v. annoying (like they're doing the hospital a favor by being willing to work there, instead of vice-versa (the hospital is doing them a favor by hiring them). Also, the low retention rates for new grads are a fairly recent phenomenon as well (they are much lower than they've ever been before). Look around just this site, at how many threads there are (not very recent, but from before things got so very bad for new grads) where a new grad is saying, I've had this job for a few months now, and I'm not really enjoying it (and their concerns sound mostly like just typical "new grad transition" anxiety, but, apparently, people also aren't prepared in school now for how difficult and painful that first year of practice is going to be) so I'm thinking I should change jobs -- and there are lots of people here who encourage them to do just that (and a few of us old fogeys who urge them to stay in one position for at least a full year and get acclimated before making a change -- but even that is a change; you used to be expected to remain in positions for at least two years to avoid being labeled a "job-hopper.") You used to graduate from nursing school expecting to take whatever job you could get, probably a shift you didn't want on a unit you didn't particularly want, and work your way up to your "dream job" from there -- in more recent years, nursing has seen the rise of new grads who come out of school expecting to get offered the shift they want in the specialty they want in the hospital they want, and, if they don't get that, they're being mistreated and they should look for a better deal somewhere else. Obviously, not all, or even most, new grads present like this, but there are enough that they've made a lot of hospitals wary of new grads in general (the attitudes combined with the general lack of clinical skills). The hospitals would rather hire someone with a proven track record, and you can hardly blame them for that. A lot of hospitals feel they've had really bad experiences in recent years with new grads, and they're "voting with their feet" -- and, especially in this economy, they can afford to do that.

I've been in clinical practice and nursing education (ADN and BSN programs) for almost 25 years now, and I think we really need to examine how we're educating nurses -- the "system" seems to be reaching a breaking point.

[Music in My Heart]

The ironic thing is that the hospitals have created the very problems that they lament.

Due to historically lousy working conditions and compensation, nursing was not considered a generally desirable career choice my many college-bound folks. Simultaneously, many of the experienced nurses were getting fed up and moving on. Hence, the purported shortage.

The hospitals responded as businesses do by improving things enough to staunch the "bleeding." We ended up in a situation where new grads were being actively courted, offered multiple positions, signing bonuses, tuition reimbursement, and the ability to choose their starting unit. Now people wonder from where the prima donna attitudes have derived. Duh...

The hospital lobbiests and the opportunists in the education industry responded by dramatically increasing the number of seats in nursing schools which has supersaturated the market with new grads while also diluting the available educator talent, the available clinical sites, and providing more opportunities for less talented students to become nurses. And people now lament the sad state of affairs regarding nursing grads. Duh.

Add to that the continual push toward nursing theory and writing papers over hard science and clinical skills. And again... duh.

[llg, PhD, RN]

There is plenty of blame to go around here. Yes, the hospitals are partly to blame for the situation ... as are the schools ... as are recent new grads who have felt no sense of obligation to the employers who give them 3-6 months of paid orientation/education for entry-level jobs .. as are current students who think that a college-level education should be possible when they are only willing to make a minimal committment to it.

We're not going to make much progress in improving the situation of EVERY one of those groups recognizes the mistakes that THEY have made -- and stop just pointing their fingers at everybody else.

[wife&mommyRN]

kudos to you for addressing this topic in such a matter a fact way

i will be a new grad soon, maybe the "new grad perspective" is a different perspective. in nursing school they stress ebp to the point of no returned, yet we enter into the hospitals for clinicals and none of these practices are being implemented. i have worked in settings where there are adn nurses that have 30+ years on the job, yet i am showing them the current assessment skills that their facilities are practicing, yet they are unaware of. in my eyes, "new grads" bring a freshness. we are easy to mold into whatever the hospital desires. in addition, majority of us are willing to further our education. not to offend anyone, but i have seen nurses that can barely walk down the hall without gasping for air, how are they able to care for patient's and they need to care for themselves. i saw a woman that has worked 35+ years in the nicu the alarms started going crazy for her baby, the "new grad" was the one that responded in the nick of time to save her baby, while she was still struggling to get out of her chair. the truth is i have seen safety concerns just as a student with nurses that have remained on the floor for 30+ years and have not furthered their education. their bodies are worn down, not to mention their work ethic and desire to care for the patients. there is an obvious difference in the work ethic of a new grad and nurses that i mention (which would u want caring for u?). i know it is expensive to train new grads, but the truth is you have to spend more for better quality, sometimes. yes, a new grad may stay at that specific unit1-2 years, but if the hospital is trying to retain it's students then more than likely the grad will just transfer to another floor. i don't understand how hiring a nurse that hasn't worked in the last 5 years is more desireable than hiring a new grad, the new grad may change units, but that nurse is going to return to their home life once the economy pics up . now, the hospitals that i have found to recruit new grads are those that are trying to transition to magnet status. don't get me wrong i am not speaking for every new grad, i would never hire a good 80% of my class let alone give them an ant to provide care for . it is up to the managers to pay attention to the student's and really determine those that would fit good with the practices of their hospitals. student's are in the hospitals all the time, pay close attention to the seniors.

jmo :)

[outcomesfirst, BSN, RN]

Thirty plus years and the rhetoric has not changed..........when will nursing get a grip on this? Innovate, redesign, think out of the box, and change this self destruct pattern.

[vanlo001]

Oh my. Oh my. New grads take years to become proficient. Talk to a couple of nurses just off orientation they a scared s*it-less. And if they are not their ego is so big they don't realize what a liability they are.

I love new grads. I love teaching new nurses. I love young nurses and appreciate their breath of fresh air. But don't get arrogant.

"I saw a woman that has worked 35+ years in the NICU the alarms started going crazy for her baby, the "new grad" was the one that responded in the nick of time to save her baby, while she was still struggling to get out of her chair."

Really?? Some experienced nurses are out of shape that doesn't make them less worthy. And that's exactly the type of thought processes that these people are talking about. Hiring experienced nurses is solid financial sense. They can hire this years new grads after someone else has trained them. Really. You don't know what you don't know. There articles out there that talk about evidenced based practice and how by the time it's researched and published it's out of date. We get new grads want jobs and I'm sure this glut will pass just as it has in the past. But your not helping the cause by thinking your the answer to the universe. Nursings been around a LONG time. Gone through numerous shortages. This will turn around too but take some of these womens advice. Respect those who cane before you and be grateful and give back to the hospital that invests in you.

[jlcole45]

I'd like to address the poster who referred to the experienced nurses as broken down and essentially lazy.

Perhaps you've not noticed that many of the new grads are equally overweight and out of shape, so age has nothing to do with physical tenacity. I've been doing this a long time an I am still within my healthy weight range for my height and I can run circles around the newbies at my hospital. There will always be a "bad apple" in the bunch - the one who makes the rest look bad. I can guarantee that if you are working with a lazy experienced nurse that he or she was just as lazy when the were a new nurse.

The point of this thread had to do with hiring practices of the management. I agree with some of the earlier posters, it's hard to turn down hiring an experienced, competent, energetic nurse over a new graduate (new grads aren't they only ones who can move quickly and greet their patients with a smile). But don't worry the nurse shortage will rear it's ugly head again, because we just can't keep enough people in nursing.

BTW 1 year experience does not make an "experienced" nurse, it takes years to build up the knowledge, competence, and confidence it takes to be an experienced nurse. After a year you've only just graduated from a tricycle to a bike with training wheels .

[nursel56]

purplern2b;4077054]kudos to you for addressing this topic in such a matter a fact way

i will be a new grad soon, maybe the "new grad perspective" is a different perspective. in nursing school they stress ebp to the point of no returned, yet we enter into the hospitals for clinicals and none of these practices are being implemented. i have worked in settings where there are adn nurses that have 30+ years on the job, yet i am showing them the current assessment skills that their facilities are practicing.

what new skills have you been able to teach the nurses at your clinical site who have over 30 years of experience?

. . .have seen nurses that can barely walk down the hall without gasping for air, how are they able to care for patient's and they need to care for themselves.

if i was really sick, or a family member was really sick, i'd carry the nurse down the hall myself if need be. experience can be the difference between life and death for a patient. if you can hop up out of a chair really fast, you can work at burger king. it takes much, much more to be a good nurse than that.

i have seen safety concerns just as a student with nurses that have remained on the floor for 30+ years and have not furthered their education.

how do you know they haven't furthered their education in 30 years? i hope you asked them all, because if you didn't, your statement isn't evidence based. it's quite improbable that they haven't learned anything new in 30 years. i'd say it was impossible.

their bodies are worn down, not to mention their work ethic and desire to care for the patients. there is an obvious difference in the work ethic of a new grad and nurses that i mention (which would u want caring for u?)

:rotfl: :rotfl: :rotfl: not trying to be rude, but. . you were talking about all those new grads who sit at the nurse's station texting their friends and checking their facebook pages, right? see: threads "texting at work" "get off freakin'facebook" and "new grads are scarfing all our do-nuts" well maybe not the last one the person i want taking care of me is alert, aware and competent whether they are 19 or 99. also, who has an accurate impression of her steep learning curve, leading to the realization that they can learn from experienced nurses much more than they can learn from her, if anything, because, you know, you can keep up just as well, if not better, without the school's wall around you!! it's true!

i know it is expensive to train new grads, but the truth is you have to spend more for better quality, sometimes.

ummmm. . . nevermind