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.
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.
i agree.
also, it used to be that a graduate could take the nclex only three times. if they failed a third time, they had to repeat their nursing program, or at least complete some type of remedial education.
now, graduates can apparently flunk and retake the test endlessly.
putting on my flame proof-scrubs here-
if graduates find that they are repeatedly failing the nclex, this indicates a problem- and it's not that the test is "too hard."
i am also dismayed at the number of incoherent posts written by nursing students. in the past, people with such poor basic grammar and writing skills would not have made it into a nursing program.
i am also dismayed at the number of incoherent posts written by nursing students. in the past, people with such poor basic grammar and writing skills would not have made it into a nursing program.
i think this may have to do with the 'text-messaging' generation. their constant texting has affected their grammar and writing skills.
Wow, I think and hope that my OP began a good discussion here. And I think a lot of you ARE onto something.
I do feel coming from a 2nd degree program, that our clinical time was very minimal, that I did NOT learn much of the basics, that theories and academics were stressed, and that I came out of it just not knowing a whole lot about how to be a floor type nurse. I think much of this is really accurate.
And exactly, you cannot place blame on students for this at all. How could or would we know what we were supposed to be learning?
(But I do take issue with whomever said many can't write or write incohrently. Many of my colleagues in the 2nd degree program were talented writers and also held degrees in many different disciplines -- accounting, business, history -- you name it. Some at the master's level. I myself have a degree in journalism, so writing was always the easy part for me.
Now the younger, way younger generation in their early 20's -- that might be a different story.)
I do want to report that since our floor preceptor came on (sort of an overseer to my preceptor), things are much better. She's holding our preceptors accountable, and I find things are just going much smoother and I can get a few more straight answers.
But, you all are right -- we probably don't come out of school with enough training -- don't know what the answer is. However, I did do 5,000 practice questions from Aug to Oct '07 to pass the NCLEX.
i am also dismayed at the number of incoherent posts written by nursing students. in the past, people with such poor basic grammar and writing skills would not have made it into a nursing program.
i'm glad to know i'm not the only one who noticed that on this board. text-messaging generation or not, some of the posts are downright illegible.
i mean, some of the students don't even know how to spell drug names! that has nothing to do with text messaging....
Wow, I think and hope that my OP began a good discussion here. And I think a lot of you ARE onto something.
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I want to compliment you, SoundofMusic for your attitude within this thread. Some people may have taken offense at some of my comments -- and taken them personally. But you have engaged us all in a great conversation and helped us avoid a flame war in the process. You sound like a very caring, conscientious person with an open mind who wants to learn. I would be happy to work with someone like you.
Now ... back to the ugly issues we are trying to deal with.
About closing bad programs. Have you tried to actually do that elkpark? It's not easy in any state -- though it may be harder in mine than in yours. I don't know. There are a lot of considerations. How do you prove that it should be closed when there is not minimum standard for their NCLEX pass rate? What if their NCLEX pass rate is actually OK because they do so much test prep and don't let people take boards until they pass HESI? What if the program in question is a state school that focuses on the education of minorities and students from underpriveledged backgrounds? What if the program is the local community college that has thousands and thousands of alumni? etc. etc. etc.
I had a private meeting with one of the State Board inspectors. They know that some of these programs are weak -- but can not do anything until a violation can be proven that is so bad that the public will support the BON in taking action. Until then, we wait and hope that the schools improve themselves. So far, that's not happening.
As for blaming the students ... I don't blame all the students. I think most students are pretty clueless when it comes to picking a school. However, I read an awful lot of posts on allnurses.com that say things like, "I'm looking for the quickest route to becoming an RN." .... and ... "C=RN" .... and .... "Just choose the quickest, cheapest ADN program you can find and let your hospital pay for you to go back and get your BSN." "I have kids and don't have time to do all those clinicals." .... and "I already have a BS in something else and don't want to spend a any more time in school than I have to." ... "I've already spent 2 years in school with another major and I don't want to spend any more time or money than necessary to get my basic RN." "I want to finish as quick as possible so that I can get on to grad school as soon as possible." etc. etc. etc. Yes, those students have to bear some of the responsibility for the fact that they end up with poor educations.
I had a great RN1 orientation: Harborview Medical Center in Seattle.
HMC is not some hoity-toity suburban hospital either - it's the county hospital and level 1 trauma center - the kind of place that when you tell people you work at there they have instant respect for you. "Whoa! Dude, you work at Harborview?!"
They told us when we started that if we survived our first summer at Harborview, we'd "made it," then the nursing ed department made sure we survived.
I can definitely understand the OP's frustration with new grad orientation. I feel I have, in general, been fortunate with my orientation experience, but I have seen glimpses of the flaws the OP points out.
I am doing an internship where I rotate between 4 different units over 3 months or so. My first rotation went smoothly -- one preceptor every night. My second was a different story. Long story short, the unit was supposed to move to a larger space, and hired extra staff in anticipation. The week before the move, admin decided not to move the unit for another 6 months, leaving them incredibly overstaffed. Staff could choose to permanently float to one unit for 6 weeks at a time, or get floated regularly (once every 3rd shift or so). My preceptor chose the latter.
So I had the option to A) float with my preceptor constantly, or B) stay on the unit and work with different people every day. I chose option B at first, thinking "well if I want to work on this unit, I want to actually be here." But I quickly grew frustrated (my first day there I was told my preceptor wasn't scheduled to work, then found out she had floated, so they stuck me with another nurse who got floated at the last minute, so they stuck me with a third nurse who ended up getting floated 8 hours later). Every time I worked with a different person, I had to reexplain what I could/couldn't do, what I did/didn't know. I had not been checked off to do in-line suction as a nurse yet but my temp. preceptor thought I had and told me to suction and before I could say anything, left the room (and left the floor). I ended up finding another nurse to help me with the suctioning.
I got sick of that and felt I would learn more, in general, by sticking with my original preceptor, wherever she happened to be. I think of the 12 shifts I was scheduled to be on the unit, I was there about 5 days. But I did get floated to a variety of med-surg units I would not otherwise have visited, and did a few things I may not have done elsewhere. And I was working with someone who knew me, what I was capable of, and was able to help me progress, rather than starting from square one every day.
Whew, what a novel. Anyway, I totally understand the frustration with the rotating preceptor game. It's really difficult to learn when you're put with different people who may not want to orient you, and don't have any idea where you are in the orientation process. My one recommendation is pretty common sense, in my opinion. Pick a preceptor for an orientee, and schedule the orientee to work on all the days that preceptor is scheduled to work. That way, unless the preceptor calls off or takes PTO, they will always be paired together, and consistency can become a more concrete possibility.
About closing bad programs. Have you tried to actually do that elkpark? It's not easy in any state -- though it may be harder in mine than in yours. I don't know. There are a lot of considerations. How do you prove that it should be closed when there is not minimum standard for their NCLEX pass rate? What if their NCLEX pass rate is actually OK because they do so much test prep and don't let people take boards until they pass HESI? What if the program in question is a state school that focuses on the education of minorities and students from underpriveledged backgrounds? What if the program is the local community college that has thousands and thousands of alumni? etc. etc. etc.
I had a private meeting with one of the State Board inspectors. They know that some of these programs are weak -- but can not do anything until a violation can be proven that is so bad that the public will support the BON in taking action. Until then, we wait and hope that the schools improve themselves. So far, that's not happening.
As for blaming the students ... I don't blame all the students. I think most students are pretty clueless when it comes to picking a school. However, I read an awful lot of posts on allnurses.com that say things like, "I'm looking for the quickest route to becoming an RN." .... and ... "C=RN" .... and .... "Just choose the quickest, cheapest ADN program you can find and let your hospital pay for you to go back and get your BSN." "I have kids and don't have time to do all those clinicals." .... and "I already have a BS in something else and don't want to spend a any more time in school than I have to." ... "I've already spent 2 years in school with another major and I don't want to spend any more time or money than necessary to get my basic RN." "I want to finish as quick as possible so that I can get on to grad school as soon as possible." etc. etc. etc. Yes, those students have to bear some of the responsibility for the fact that they end up with poor educations.
Heavens, I wasn't accusing you of anything, llg :), I was just curious. No, I haven't ever tried to get a program closed -- it just seemed to me, based on my experience and observations in nursing academia in my own state, that the kind of programs you described wouldn't be able to survive in my state (and, of course, every state's regulatory process is different), and I was surprised they would be able to survive in any state. I'm not sure what you mean by "there is not a minimum standard for their NCLEX pass rate." That really jumped out at me, since, right before I came to work this evening, I was looking at my latest BON bulletin/magazine (came in today's mail), and it included the list of schools in the state that have been put on probation for having NCLEX pass rates that are too low, and the article about that explained exactly how the BON determines the minimum acceptable passing rate they use. Does your BON not do that? Again, I guess that's something that varies from state to state, but I didn't realize it varied that much from state to state ... I was vaguely aware that my state has higher standards and tougher enforcement about a number of things than lots of states do, but I never heard anyone really explain how differently things work in another state (I don't mean that to sound stuck-up or superior :chuckle, I'm just still trying to wrap my head around the nursing school situations you've described!)
Also, I am right with ya on all the comments about the "quickest," "easiest," and "cheapest" way to become an RN -- and my personal favorite on this board, some variation on "Why does nursing school have to be so HAAAAAARRRRD?????" (Well, ummm, because being a nurse is "haaaaarrrrd" ....) Those comments also make me cringe, knowing what I know. But I can see the argument that others have made here -- when legitimate, well-respected schools with good reputations are offering these streamlined, abbreviated, watered down programs, why wouldn't potential students assume that the programs must be okay? I know that, when I was "shopping" nursing schools, a hundred years ago :), I didn't have any way of drawing any intelligent conclusions about which school was "better" than another (but I didn't ultimately decide based on which school was quickest or easiest, either ... :uhoh21:)
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 was preparing to post on this thread with some pithy comments about NCLEX pass rates and accreditation, but I got called away before I finished. Now I see you've beaten me to it. Well, fair enough, but I was also going to offer some keen insights based on my previous career, as a carpenter. RIP OFF! I spent all those years driving nails, and you get to use my keen insight? It ain't fair! (However, I do find myself in agreement with your points, so, clearly, you are very astute.)
If I might expand a little, in carpentry, a journeyman is one who can work independently and perform most tasks with little or no supervision, but a master is one who can do all that while supervising and instructor others. It isn't easy to do your own tasks, keep a project running, and teach newbies how to measure a board or drive a nail, but you aren't a master carpenter until you can do it.
"See it, do it, teach it," is a saying I first encountered in nursing. In my case, it's more "See it, see it again, try it, see it done correctly, do it sort of marginally okay, see it one more time, get better at it, and teach someone what not to do..." I used to worry for my patients, but they're a resilient bunch and usually survive.
The point is, for whatever reason, not many new nurses can hit the floor running--not at full speed, anyway. My instructors used to say almost daily that education is an important part of nursing. Sometimes I felt like pointing out that education was also an important part of education, but I reminded myself why my father always said they don't send donkeys to school: nobody likes a smart ass. In retrospect, my instructors did the best they could under the circumstances, and I learned more than I realized, but I think maybe they should have emphasized that nurses not only educate patients, but other nurses, as well.
I don't know. Maybe those grouchy, grumpy nurses really didn't need as much help, starting out. But, it seems to me, the floors need to be staffed, so the choice comes down to either helping today's newbies or driving them off, then facing the same problems with tomorrow's newbies.
As for my fellow newbies who might be thinking someone should have applied Maslow's heirarchy to nursing education--get the basics, like starting IV's, dropping NG's, emptying bedpans, then worry about the higher levels, like critical thinking, all I can suggest is that if you can't hit the floor running, be ready to hit the floor willing to work hard and listen. I once heard one grumpy, grouchy nurse remark, "The only thing I can't teach is work ethic. If they show up with a good work ethic, I can teach everything else. If they don't, they'll never be any good."
As I read this thread I can't help but to feel a little apprehensive about entering my new grad position on a telemetry unit. I want to know, how can I prepare myself to meet my preceptors half way and make the best out of my experience. I want to be a great nurse and if it means tapping into outside resources that will provide the training that I may not get either in school or during orientation.... I WILL DO IT, because ultimately someone's life is in our hands and I want to save lives.
As I read this thread I can't help but to feel a little apprehensive about entering my new grad position on a telemetry unit. I want to know, how can I prepare myself to meet my preceptors half way and make the best out of my experience. I want to be a great nurse and if it means tapping into outside resources that will provide the training that I may not get either in school or during orientation.... I WILL DO IT, because ultimately someone's life is in our hands and I want to save lives.
An EKG course and ACLS training would be excellent. My hospital required neither when I started on a tele floor, and by getting those on my own, I was much better off than some of the others coming in fresh to tele. Other than that, read up all you can on the cardiac meds. Plavix, Coumadin (antiplatelets and anticoagulants versus clotbusters) are helpful to know also. Know the patho for CHF, MI. Know what the following procedures are and why they are done: 2DE, TEE, Cardiac Cath, stent, balloon angioplasty, fem-pop, D-Dimer, CT Angio.
I was also going to offer some keen insights based on my previous career, as a carpenter.
I appreciate hearing from someone who actually has experience with another profession, and even the one I happened to choose as an example!
If I might expand a little, in carpentry, a journeyman is one who can work independently and perform most tasks with little or no supervision, but a master is one who can do all that while supervising and instructor others. It isn't easy to do your own tasks, keep a project running, and teach newbies how to measure a board or drive a nail, but you aren't a master carpenter until you can do it.
In school, they kept saying how we'd need to be leaders and to be responsible for the work done by those we delegate to and to recognize questionable MD orders and to stand up for proper care... yet meanwhile, we barely learned the practical WHAT that we were to be leaders of and taking responsibility for and delegating. Without experience, only the most egregious of orders would be noticeable to a newbie, and who allows newbies time to look up every new order to check if it's okay? Finally, proper care? Isn't that a detailed 5 page care plan? No?
"See it, do it, teach it," is a saying I first encountered in nursing. In my case, it's more "See it, see it again, try it, see it done correctly, do it sort of marginally okay, see it one more time, get better at it, and teach someone what not to do..." I used to worry for my patients, but they're a resilient bunch and usually survive.
That sounds like me! Seriously, it takes me awhile and several repetitions to really "get" something. To pass clinicals in school, we had to check off that we'd done certain skills at least once. That by no means means that I could just do that without any help or review next time.
My instructors used to say almost daily that education is an important part of nursing. Sometimes I felt like pointing out that education was also an important part of education.
So true!
Maybe those grouchy, grumpy nurses really didn't need as much help, starting out.
Nursing education used to be a lot more clinical intensive. Students would live at student dorms adjacent to the hospital and work several shifts... they got to learn and become licensed while hospitals got cheap help. By the time they graduated, they were supervising the lower level students and practially running the floor themselves. So, they were actually experienced with full nursing responsibilities by the time they graduated.
Now that's going way back and I don't know how many of those grouchy, grumpy nurses actually had THAT kind of training. But it seems that over time, the clinical portion of school has changed from turning out proficiency to giving an introduction.
As for my fellow newbies who might be thinking someone should have applied Maslow's heirarchy to nursing education--get the basics, like starting IV's, dropping NG's, emptying bedpans, then worry about the higher levels, like critical thinking,
Yeah, that!
But, it seems to me, the floors need to be staffed, so the choice comes down to either helping today's newbies or driving them off, then facing the same problems with tomorrow's newbies.
Hope so!!
I'm very interested in questions of nursing education but am not sure where to get started in finding out more or becoming involved somehow. ANA?
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Valerie Salva, BSN, RN
1,793 Posts
i agree.
also, it used to be that a graduate could take the nclex only three times. if they failed a third time, they had to repeat their nursing program, or at least complete some type of remedial education.
now, graduates can apparently flunk and retake the test endlessly.
putting on my flame proof-scrubs here-
if graduates find that they are repeatedly failing the nclex, this indicates a problem- and it's not that the test is "too hard."
i am also dismayed at the number of incoherent posts written by nursing students. in the past, people with such poor basic grammar and writing skills would not have made it into a nursing program.