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.

[Libby1987]

I agree with enuf. We used to have a similar model of nursing education, and TPTB in nursing worked diligently to drive them out of business as much as possible, to move nursing education in colleges and universities, and to focus on theory and "critical thinking" instead of a solid clinical foundation. And now we're seeing the results of a few decades of that approach.

It didn't seem to be as much of an issue when I graduated as it is these days though.

[fifita2010]

Yes. I was thinking of diploma education as I did that then went on for BSN. The BSN studies for me probably taught me more about being professional. To this day I would never wear jeans to a conference. So what does that do for my ability to care for patients, probably nothing, but they did teach me to stand up for myself in the professional sense, where in diploma school it was to give up your seat for the doctor.

I still work and for me it is amazing how difficult the work load is. Managenent should factor technology into the staffing matrix as I am on the computer more then with my patients. And I miss really being with patients.

[elkpark]

... they did teach me to stand up for myself in the professional sense, where in diploma school it was to give up your seat for the doctor.

That was not the experience I had in my diploma program. Our program director told us the first day of school as incoming freshman that we should never take any crap from a physician. We were expected to be cordial and collegial (to everyone we worked with, not just physicians), but not particularly deferential and certainly not submissive. (We were also taught about the importance and value of a professional appearance, and I didn't need to return to school to know not to wear jeans to a professional conference.)

[canigraduate]

I quoted snippets of your post.

Years ago there were actually programs that taught nurses how be functional in a hospital setting on day 1 of their job. They were called hospital based diploma programs. A few still exist but the ADN vs BSN argument has many people forgetting diploma grads are still around.

Nurses of these programs were still new nurses but came to work knowing how to give injections, IVP meds, hang blood and care for complex patients because they did it frequently in school. We also took a full team of patients on night shift while in school so we knew how to handle a full patient load and team lead. People who couldn't function didn't pass the program to move on to failure at their first job.

Yup, in my diploma program, I had a full patient load for the last semester during my preceptorship. I was on a true Med-Surg, with medical and surgical patients, and I had a four to five patient load on day shift with fresh post ops, drains, chest tubes, IVs, heparin drips, NG tubes, wound vacs, tele monitoring, the whole shebang. By the end of my preceptorship, I was the primary nurse and my preceptor was there as a resource only.

It was a small rural hospital with one dedicated patient floor. Half was true tele, the other half was the catch-all unit that I worked on. There were only 4 ICU beds when I was there, and they were down the hall. It was so cool.

I hit the ground running.

[fifita2010]

It was the 70's. I'm so glad the culture has changed😀

The BSN program was the 80's and a lot changed by then and I'm glad about that as well.

[Dyingbreed]

I have been around for a long time in this field, 20 years to be exact. I started ER when I was young, just turned 40. Take this whatever way you want but the problem at hand is a great majority of new grads especially the ones over the last few years are lacking too many essential skills in not only the clinical aspect but life/social aspect. A new grad is a great asset to the department (not 10 at a time), I was the only new grad accepted into my ER and trained a lot longer by the entire staff for years to gain skills and experience. Nurtured, disciplined, and molded into what is to be expected of a true ER nurse. My hospital was a very busy high acuity intercity trauma center and the department was made up of nurses who earned their stripes and the privilege through many different avenues of nursing to be a part of this elite team. I had some previous experience in EMS and that's the only reason I was allowed the opportunity to be considered for this team. Don't get me wrong I needed a lot of guidance and training but I had the basic skills and knowledge of what healthcare, emergency medicine and general human interaction in a medical setting that was at minimum required. My unit built me into what I am today. Like many before me many came after. The thing my unit did right was limit how many they brought in at a time. That is not how things are today. I was everyone's baby and we all had a mutual respect for one another. They were proud to help me grow and when I cross paths with them today we laugh how their baby is all grown up. There were shortages then, travelers, agencies, people left and others came as they do today. This is nothing health care hasn't seen and won't see again. Healthcare is different these days and quantity overruns quality. Nursing standards have been going down hill long before COVID and the quality of what the schools are producing is shameful to this profession. Hospitals are hiring too many new grads at a time for what the department can handle and yes, we all have to start somewhere but what the graduates aren't understanding is they shouldn't apply for a job because it's available if they are not qualified. Society seems to think it's acceptable to bring someone with absolutely no idea of basic life skills let alone nursing skills into an environment that is understood to be a critical setting and can be at times a matter of life or death for the patients. The new generations feel entitled to blindly apply for a position they have absolutely no entry skills for. That is disrespectful to the profession and cocky. They certainly know better but exhibit no regard to the ethical aspects and lack self awareness. Next thing you know the staff feels obligated to train mass amounts in a short period rather than wanting to train for the better. That puts a lot of weight on our shoulders and I can say I am blown away at the competencies deeming them qualified to enter any healthcare setting let alone a critical one. Yes it is our assumed we hold a responsibility as medical professionals to nurture and teach our future colleagues but also disheartening to be considered responsible for producing something great based on what is coming in as our young. Many aspects of the system are to blame and it's certainly not the students fault the schools are not like they used to be. You don't know what you don't know still applies but these candidates also had some type of training prior and what are they thinking? They studied and practiced and have to have some idea of what they are trying to become but who is allowing them to believe suddenly after you pass the boards magic happens?!