I'm sorry, but this needs to be said. I hope there are some nursng management types reading this:
I graduated from nursing school last August. I went to one job and the experience was so horrible I found another position on a more med surg type floor in one of the so-called "Top 50" hospitals in the nation. Now, granted, this position seemed to come with a better orientation process and they at least try to orient us in some ways with special classes and pull outs, but it still SUCKS.
Hospitals, administrators -- you are failing at orienting us. Just look at the unhappy posts here by dozens of new grads. The typical experience seems to be: You walk on the unit your first day, no one is expecting you, none of the other nurses bother to introduce themselves or welcome you (they usually think you're a travelor or a float nurse), you are given an "official" preceptor, but then in the following weeks, you may never see this official preceptor again. You then follow ten different nurses who do things ten different ways, and in total, have about 30 different personalities between them all.
You are left to flounder around for hours on the floor, and if you attempt to ask your Preceptor of the Day a question, you get the look and that attitude that you are just plain stupid and how dare you even ask such a question because, well, "you should know that by now," or some other such comment. Many times you are treated with outright hostility when you are just an honest person trying to do an honest job, and busting your butt in the process.
Come on, hospitals - take a look at corporate America or some other large institution, and try to figure out a better way to train the BACKBONE of your business!!! I mean, I can't figure out why it isn't any better than this?? Do you EVER wonder why nursing retention rates are so POOR?? Can't you find nurses who CAN educate us with respect and make them the consistent "preceptors," and not just throw us in with the nurse of the day?
Coming from a prior career, I am just astounded at what nurses are responsible for, yet how poorly they are trained, how poorly they are treated, how nasty some of the nurses are that we are supposed to be looking to for guidance, and how little respect is given to individuals who were not only accepted to rigorous nursing schools, but managed to graduate, even managed to achieve very high marks in these schools of nursing. I mean, you're being given the most quality individuals around, yet you can't seem to teach them in a way that is professional, thorough, consistent, and even the slightest bit enjoyable.
In my own experience, my own management "team" did a really slick sales pitch for their unit. Once I joined the unit, it seemed their personalities changed almost overnight -- all smiles and wonder at the sales pitch, and all nasty, rude and demanding once you've been on the floor for a few months.
So, in summary, I hope it changes someday. I am really taken aback by just how unprofessional many of the nurses are -- the gossip and backstabbing is just pure evil, there is no morale or cohesiveness in the units, especially with all the travelers, and many of the management types just walk around like prison wardens, yet never bothering to take a patient of their own for a day to remember what the demands are like.
Do I plan to stay in nursing? No FREAKING WAY. I want to return to the corporate world where I came from in some capacity, where professionalism and respect for employees is the norm -- I have yet to find this in the nursing profession. Yes, perhaps I am one of the whiners, and need to change jobs, but it seems I'm hearing this from more than one person here, as well as many of my classmates.
God help the state of nursing and healthcare in this nation. ..something just needs to CHANGE.
I guess I see the word "teaching" and think of nursing school.
I don't put the blame on the hospital so much; their main focus is not on teaching nurses. I had a pretty solid orientation and preceptorship.
I wonder if nursing school needs to be extended to graduate new nurses who are really ready to work. In the olden days when every day was a clinical day, nurses began their careers with little orientation needed.
You make a good point. I graduated from a 2nd degree program where we didn't get much clinical time. I think that is a lot of it -- I wasn't taught all the simple clinical stuff, and didn't get much time in school on a floor at all. By the time I was following a nurse in school and starting to pull it together a bit, it was time to graduate.
I'm STILL learning the simple stuff. I've got the theories and the patho, but struggle with simple things like diet trays, how to work the wheelchairs, the IV pumps, etc. There are a million things to learn that just come with time.
You make a good point. I graduated from a 2nd degree program where we didn't get much clinical time. I think that is a lot of it -- I wasn't taught all the simple clinical stuff, and didn't get much time in school on a floor at all. By the time I was following a nurse in school and starting to pull it together a bit, it was time to graduate.
I'm STILL learning the simple stuff. I've got the theories and the patho, but struggle with simple things like diet trays, how to work the wheelchairs, the IV pumps, etc. There are a million things to learn that just come with time.
BINGO! This is why a lot of the old, grouchy experienced nurses get frustrated with new grads. Many are coming to us with minimal preparation and expecting the staff nurses to compensate for their lack of education.
Not all new grads of course. Some are wonderful people who have been well-educated.
As the profession has tried to accommodate the desires of students who want "the shortest route to an RN," the quality of the education has often gone down. It's not fair to expect the overburdened staff nurses to compensate for that.
Maybe its time we lengthened the nursing programs ... instead of streamlining them.
I guess I should put on a flame resistent suit now.
BINGO! This is why a lot of the old, grouchy experienced nurses get frustrated with new grads. Many are coming to us with minimal preparation and expecting the staff nurses to compensate for their lack of education.
As the profession has tried to accommodate the desires of students who want "the shortest route to an RN," the quality of the education has often gone down. It's not fair to expect the overburdened staff nurses to compensate for that.
Maybe its time we lengthened the nursing programs ... instead of streamlining them.
I guess I should put on a flame resistent suit now.
"In my own experience, my own management "team" did a really slick sales pitch for their unit. Once I joined the unit, it seemed their personalities changed almost overnight -- all smiles and wonder at the sales pitch, and all nasty, rude and demanding once you've been on the floor for a few months."
Here is a joke I was told about nursing recruitment:
There was this guy who passed on and he was given the opportunity to decide if he wanted to go to He** or heaven. He was taken on a tour for an interview to both places. When he got to heaven it was quiet and and pleasant and certainly looked like a place he could be happy at. But when he went to He** they were all partying and friendly and so happy. Everyone was so glad to meet him and telling him what a wonderful place it was and begging him to come stay there. After all that he heard about He** he just couldn't believe what he saw. What a wonderful place! It wasn't hard for him to make his decision. On his first day in He** it was hot, every one was nasty and mean and treated him aweful. When he asked what had happened, why they were so friendly and nice when he interviewed them, the Devil told him "That was the interview, we are always like that when we interview. This is what it's really like here."
I heard that joke a little differently-
A NURSE died and was given the choice of Heaven or Hell.
She tried Heaven first- nice, but a little dull and routine. So, she decided to try Hell.
Everyone there was so enthusuastic and so happy to meet her- they all called her by name, greeted her with a smile, and all the inhabitants, including a number of nurses, couldn't say enough about how great Hell was and how much they hoped she's join them.
So, she picked Hell.
When she showed up the next day, things were totally different. Everyone had a nasty attitude, did not acknolwledge her, or were totally rude. Morale was terrible, and everyone seems resentful and angry.
She approached another nurse and asked- "What happened? Yesterday, everything was great- today this place sucks. What's the deal?"
The other nurse replied "Honey, yesterday they were recruiting you- today, you're staff."
BINGO! This is why a lot of the old, grouchy experienced nurses get frustrated with new grads. Many are coming to us with minimal preparation and expecting the staff nurses to compensate for their lack of education.
Not all new grads of course. Some are wonderful people who have been well-educated.
As the profession has tried to accommodate the desires of students who want "the shortest route to an RN," the quality of the education has often gone down. It's not fair to expect the overburdened staff nurses to compensate for that.
Maybe its time we lengthened the nursing programs ... instead of streamlining them.
I guess I should put on a flame resistent suit now.
My friend, the "thanks" button isn't enough for this one. I couldn't agree more. It's very fashionable now to grumble about how rigid, backward, and unenlightened nursing programs used to be, but it seems to me that that system turned out much better-prepared RNs than we do now. I freely admit I don't know the answers, but what we've got now doesn't seem to be working very well ... (And I'm directing my comments not at any particular poster or nursing program, but just in general ...)
To anyone who wants a decent (not perfect) orientation, get thee to a Magnet-certified hospital that's using the Versant RN new nurse education model. I'm in the middle of my 18-week orientation and it's absolutely wonderful so far. The staff nurses overall (not just my preceptor) are very helpful and I'm feeling very supported. As I said above, nothing's perfect, but this definitely feels more like what I was hoping for.
My friend, the "thanks" button isn't enough for this one. I couldn't agree more. It's very fashionable now to grumble about how rigid, backward, and unenlightened nursing programs used to be, but it seems to me that that system turned out much better-prepared RNs than we do now. I freely admit I don't know the answers, but what we've got now doesn't seem to be working very well ... (And I'm directing my comments not at any particular poster or nursing program, but just in general ...)
Thanks, elkpark. I certainly harbor no ill will towards any individual either -- and I wish the original poster all the best. In fact, I was struck by her comment that she is struggling with the basic things like diet trays and wheelchairs. Yes, each hospital's equipment and procedures are a little different, but a new grad should be familiar enough with these things to adjust quickly. It's not the hospital's role to have to go back and teach Nursing 101. That foundation should be established in school.
I happen to live in a community in which there have been several new RN programs established -- and in which old programs have expanded beyond their capacity to do a good job. For example, a local respectable ADN program has recently expanded beyond the number that they can find pediatric faculty for. Their solution? Graduate a cohort with NO peds inpatient clinicals! Another program has graduated several classes in which students only got 1 or 2 of the specialty rotations -- either peds, or OB, or psych -- but not all of them. We have a local trade school that spends most of its very limited clinical time doing "observations" because they are not in any one place long enough to get sufficiently competent to actually do any care -- and their faculty are not qualified to supervise complex inpatient care.
Based on what I see locally and what I read on allnurses -- there are a lot of programs that are now not actually teaching nursing. Instead, they have turned into test prep centers. They take the students' money ... give them the bare minimum legally required courses to sit for the NCLEX ... and then focus on test prep so that they can keep their NCLEX pass rates high enough to stay open. Students are going to these programs (and paying big bucks) because they don't want to invest the time to get a proper education. Being properly educated as a professional nurse requires many hours of practice and that is inconvenient and expensive. So ... they pick the quickest program with the fewest requirements -- the test prep programs.
Then the hospitals are stuck with RN's who never really learned how to be nurses -- and the staff nurses and unit leadership get blamed when these new grads struggle through orientation and decide to leave.
Instead of offering a real, long-term solution to the nursing shortage ...these "fast tracks" are making the problems worse by adding to the burden at the unit level and costing everyone lots of time, energy, and money that could be better-spent.
Thanks, elkpark. I certainly harbor no ill will towards any individual either -- and I wish the original poster all the best. In fact, I was struck by her comment that she is struggling with the basic things like diet trays and wheelchairs. Yes, each hospital's equipment and procedures are a little different, but a new grad should be familiar enough with these things to adjust quickly. It's not the hospital's role to have to go back and teach Nursing 101. That foundation should be established in school.
I happen to live in a community in which there have been several new RN programs established -- and in which old programs have expanded beyond their capacity to do a good job. For example, a local respectable ADN program has recently expanded beyond the number that they can find pediatric faculty for. Their solution? Graduate a cohort with NO peds inpatient clinicals! Another program has graduated several classes in which students only got 1 or 2 of the specialty rotations -- either peds, or OB, or psych -- but not all of them. We have a local trade school that spends most of its very limited clinical time doing "observations" because they are not in any one place long enough to get sufficiently competent to actually do any care -- and their faculty are not qualified to supervise complex inpatient care.
Based on what I see locally and what I read on allnurses -- there are a lot of programs that are now not actually teaching nursing. Instead, they have turned into test prep centers. They take the students' money ... give them the bare minimum legally required courses to sit for the NCLEX ... and then focus on test prep so that they can keep their NCLEX pass rates high enough to stay open. Students are going to these programs (and paying big bucks) because they don't want to invest the time to get a proper education. Being properly educated as a professional nurse requires many hours of practice and that is inconvenient and expensive. So ... they pick the quickest program with the fewest requirements -- the test prep programs.
Then the hospitals are stuck with RN's who never really learned how to be nurses -- and the staff nurses and unit leadership get blamed when these new grads struggle through orientation and decide to leave.
Instead of offering a real, long-term solution to the nursing shortage ...these "fast tracks" are making the problems worse by adding to the burden at the unit level and costing everyone lots of time, energy, and money that could be better-spent.
Wow, wow, and wow! This is it! So very, very well said!
Based on what I see locally and what I read on allnurses -- there are a lot of programs that are now not actually teaching nursing. Instead, they have turned into test prep centers. They take the students' money ... give them the bare minimum legally required courses to sit for the NCLEX ... and then focus on test prep so that they can keep their NCLEX pass rates high enough to stay open. Students are going to these programs (and paying big bucks) because they don't want to invest the time to get a proper education. Being properly educated as a professional nurse requires many hours of practice and that is inconvenient and expensive. So ... they pick the quickest program with the fewest requirements -- the test prep programs.
I wouldn't only place blame on the students. The fact that such programs exist is a problem as well. Often the accelerated programs are offered by big name schools with overall shining reputations, so potential students figure that they wouldn't offer such a stream-lined program if it wouldn't be sufficient for entry-level practice. I went to a traditional BSN program with 2 years of nursing coursework and still didn't feel it provided a strong clinical foundation. Looking back at how we rushed through thousands of pages of nursing texts, I now realize that our lectures & texts were to meet the NLN educational content requirements. And looking back at those strange mulitple choice test questions that didn't seem to really reflect lecture or text materials I realized they were written to approximate the NCLEX. We had the required hours of clinical time, but I remember being worried about the ability to check off the pages of clinical skills because we had so few chances to practice many of those skills.
I think a big part of the problem with the development of nursing as profession has been it's strenuous efforts to make it appear more academic than it need be. The nursing profession has traditionally been a skill-based one. Of course, you must use you mind as well in the application of those skills. But so does any professional. Carpenters don't just mindlessly saw and hammer. But they don't insist on a unique theory for carpentry or a language to differentiate carpentry from construction. You can study carpentry as a profession and measure it's influence on the construction industry without getting a PhD in carpentry.
Another more recent issue is liability. Hospitals, staff nurses, clinical instructors, and schools don't want to take on too much liability for students. I think that may be another reason clinicals have become pared back. And then as others have noted, there's a demand to educate more nurses but available clinical time for students is limited. More students can mean less clinical time as schools compete for clinical space. The high per student cost of clinical instructors also creates limitations as groups of 8-10 students must share the clinical instructors and patients and staff on any particular unit.
Anyway, I'm off on an tangent. I'm not sure what the answer is to the current nursing education conundrum. How prepared should new graduates be? I'm not sure who should be responsible for that. MDs don't graduate ready to "hit the ground running." They get paid (albeit a relatively low amount) for their first years of practice. Many nursing schools now explicitly say that a new grad isn't expected to "hit the ground running." But many hospitals don't seem to be in agreement in regard to the minimum required skills for a new nurse. What to do?
I just want to be very clear that I don't place ANY blame on the students -- I see them as victims in all of this. It is the professionals and educators who bear the reponsibility to not mislead potential students into believing that they are enrolling in an educational program that will provide them with a good, basic preparation in their chosen field. It's not the students' job to know what they need in a basic nursing education and make sure they get it ...
llg, I don't understand how the programs you're talking about can stay in business -- what about your BON? I know every state is different, but in my state, the BON educational consultants are very active about surveying nursing programs and making sure that they meet the minimum requirements. Clinical sites have to be surveyed and approved to be used as clinical sites, you have to show the BON that you're providing the minimum required clinical experiences in all the required specialty areas, and you have to provide documentation that all your faculty meet the minimum requirements. Do things work differently in your state?
Specializes in NICU, PICU, PCVICU and peds oncology.
I happen to live in a community in which there have been several new RN programs established -- and in which old programs have expanded beyond their capacity to do a good job. For example, a local respectable ADN program has recently expanded beyond the number that they can find pediatric faculty for. Their solution? Graduate a cohort with NO peds inpatient clinicals! Another program has graduated several classes in which students only got 1 or 2 of the specialty rotations -- either peds, or OB, or psych -- but not all of them. We have a local trade school that spends most of its very limited clinical time doing "observations" because they are not in any one place long enough to get sufficiently competent to actually do any care -- and their faculty are not qualified to supervise complex inpatient care.
That's exactly what's happening here. It's really frightening to think that the people the BONs exist to protect are basically being defrauded not only by the nursing education world, but also by those BONs who are permitting these programs to proliferate and their graduates to become registered.
Based on what I see locally and what I read on allnurses -- there are a lot of programs that are now not actually teaching nursing. Instead, they have turned into test prep centers. They take the students' money ... give them the bare minimum legally required courses to sit for the NCLEX ... and then focus on test prep so that they can keep their NCLEX pass rates high enough to stay open. Students are going to these programs (and paying big bucks) because they don't want to invest the time to get a proper education. Being properly educated as a professional nurse requires many hours of practice and that is inconvenient and expensive. So ... they pick the quickest program with the fewest requirements -- the test prep programs.
Ditto! That describes what our university nursing programs have become. Besides that, you should read some of the Canadian forum threads, especially those we've moved to the International forum about foreign-educated nurses wanting a fast-track to licensure in Canada.
Then the hospitals are stuck with RN's who never really learned how to be nurses -- and the staff nurses and unit leadership get blamed when these new grads struggle through orientation and decide to leave.
Instead of offering a real, long-term solution to the nursing shortage ...these "fast tracks" are making the problems worse by adding to the burden at the unit level and costing everyone lots of time, energy, and money that could be better-spent.
I had the opportunity to spend a night shift overseeing a nursing student who is doing his senior practicum in our PICU. He had already worked a half dozen or so 12 hour shifts with one of our other nurses. I was amazed at the gaps in his knowledge and his clinical skills, even basic things. Then a few shifts later I got report from him; his primary preceptor was in the room but took no interest in what he was telling me. I had major egg on my face more than once that day because there were things that hadn't been passed on in report that should have been. I found an antibiotic order that had been transcribed and actioned by the day nurse at 1835 the preceeding evening, but no evidence that the med had been given. I found it mixed in with the meds for the other patient in the room. AND there were RSI drugs drawn up for my patient sitting on the supply cart in the room that were only labeled with what was in the syringes, and not who they were drawn up for or when they'd been drawn up. Basic nursing! I spent more than an hour filling out incident reports.
RNperdiem, RN
4,592 Posts
I guess I see the word "teaching" and think of nursing school.
I don't put the blame on the hospital so much; their main focus is not on teaching nurses. I had a pretty solid orientation and preceptorship.
I wonder if nursing school needs to be extended to graduate new nurses who are really ready to work. In the olden days when every day was a clinical day, nurses began their careers with little orientation needed.