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.
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.
The Nurse Practice Act of my state has no strict minimum pass rate requirement. And even if it did, the schools would get around it by only allowing those "graduates" who scored high on an exam like HESI take the NCLEX. That's the tactic that they are using now. Students complete the program and pass all their courses ... but the school won't send the paperwork to the BON for processing their NCLEX applications until the student achieves a certain level of success on HESI. The BON hates that approach, but it's not against the law. The schools say the students haven't really "passed their last class and finished the program" until they pass the test. They use it as sort of a "final exam" to their last class. I know of people who have finished their coursework over a year ago who still haven't been allowed to take boards. In the meantime, these students have to pay some tuition to keep their student status active while they figure out a way to pass HESI ... which will then let them move on to take NCLEX. Thus the school boosts its pass rate. I think it is immoral.
It's all so political. If a school gets closed, the alumni of that school will be furious and cause political problems that people want to avoid. And its not just the alumni of the nursing programs. It will be all the alumni of the colleges who are offended that the state does not think their school is good enough. The graduates of the community college will portray any discipline as an elitist plot to funnel resources to 4-year programs and a slap in the face to every state resident who ever got an Associate's Degree in anything. The graduates of the schools whose student populations include a lot of minority groups and/or disadvantaged students will say it is discimination based on race or culture -- again, a plot concocted by the elitist schools to funnel resources to themselves. The 2 local trade schools with new "quickie" AAN programs will say that the board is stifling its right to compete with traditional colleges -- a plot to prevent them from offering practical alternatives to working people for whom traditional programs are too difficult. etc. etc. etc.
It's a real mess.
In the meantime, we staff development folks are faced with a group of new grads ... some of whom come from programs that provided a strong foundation and who are ready to begin their careers ... and and a growing group of others who bought a diploma and passed the NCLEX, but never really learned much about how to actually do nursing. In the past, that 2nd group was very small and we could handle them: if they seemed like great people, we might give them a little extra attention and they would make it. If they did not seem like great people, they would be fired. But now, that 2nd group of poorly prepared students is growing beyond our capacity to deal with.
Specializes in NICU, PICU, PCVICU and peds oncology.
The nursing school I graduated from closed to new admissions the year I graduated. We were actually the last diploma class to complete our education there. But it wasn't because the school was turning out sub-standard nurses. Quite the opposite... the school had the reputation for providing the best education and turning out the highest-quality nurses in the province. It was considered quite an advantage to have graduated from St. Boniface when it came to that first job. The reason the school closed was because the provincial regulatory body had detemined that the Baccalaureate in Nursing was to be the minimum requirement for entry to practice. The last diploma nurses in the province graduated in 1998. Whereas the province annually had been graduating about 2000 new nurses through diploma, community college and university programs, they now had about 375 nurses graduating. By 2001, the community college nursing program had been rejigged and reopened, much to the dismay of the academic world... who bemoaned the 'fact' that the province had essentially dumbed-down nursing education and reverted to a blue-collar mentality rather than a professional one. They said the 23 month (continuous study... no extended breaks for anything) program would result in the destruction of the nursing profession. A side-by-side comparison of the college program and the Baccalaureate revealed that the actual number of hours of education differed by only a few dozen; the clinical portion was heavily weighted on the college side and the liberal arts on the university side. [Tell me again how a C+ in Intro to Earth and Planetary Science or The History of Textiles makes me a better nurse...] The college program included ethics, issues and trends in nursing, statistics, and a number of other university-level courses in addition to the clinical component so the students were not being short-changed educationally at all. The first year they could have filled twice as many seats as they had. Of course, the college program has once again been discontinued, and the province is actively recruiting new grads from ther provinces and countries to fill their vacancies. Let's not learn anything from our history...
This is a very interesting discussion and I'm glad it has remained civil. I didn't realize until I was working as a nurse for a while, the differences between nursing school experiences.
I would rate my ADN program as OK, but the BSN students at the university my hospital is affiliated with seem to see more things, have access to internships, externships, and have more clinical time than I did in nursing school.
I've been reading this thread for a while. I too enjoy the fact that everyone has been pretty much civil on the topic. I must say regarding degrees, an nurse with a BSN is no more qualified than a nurse with an ASN. It really has nothing to do w/the degree but more to do with the education behind the degree. I graduated with an ASN this past fall and am actively pursuing my BSN b/c I am young and had no idea when I transferred into this program that it was an associate degree program. I still spent the same amount of time in the nursing program as a traditional 4-year degree university, 2 years. I had the same clinicals. The only difference is the final clinical I didn't do a preceptorship. I think in the case of not getting to see as much, had mre to do w/the fact that I was at a satellite school of a major university in a smaller town, so our rotations were done at local community hospitals. Which anyone who works or did rotations at the smaller hospitals know you do not see as much, and that has nothing to do w/your education. I do not feel any less prepared to start my job b/c of the degree that I have, in fact I am only making a dollar difference as of right now. Critical thinking was emphasized ad nauseum in our program, so the arguement that ASN nurses don't have critical thinking skills doesn't apply in the case of grads from our program. Not to mention, that the BSN classes I am now required to complete our actually masters classes at any other program.
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.
Please bear in mind that people aren't as apt to post when their orientation was great, so you're apt to get a skewed view. You'll see an occasional "I love my preceptor!" thread, but like everything else, people tend to vent more than bubble. For the record, my orientation was great, although I did wonder if it might have to be extended until everyone got a chance to precept me. I worked on my unit before school, so I wasn't among strangers. But I worked a slightly odd schedule (nights/weekends) so I precepted with whoever was available. One night, our charge had to take a full patient load, so she took the easiest assignment on the floor and me as an orientee. So I basically did the assignment and she checked on me from time to time. It went very well, and I got to feel like I was actually contributing to the unit, which was refreshing.
If I had it to do over, instead of orienting with whoever was available on my schedule, I think I'd have asked to work 40hr weeks on dayshift. It seems to me that starting the shift and ending the shift are the hard parts--like flying a plane. If you can take off and land, the middle part is just cruising, unless something bad happens. And I agree with what appears to be the prevailing view, that continuity with a preceptor is important. Then again, as one CN observed, the first time (of many) I got a third different assignment on the third consecutive night, "Flexibility is the name of the game." (It's nice to get the same patients, night after night, but it doesn't always happen.).
The other thing to realize is that orientation is hard, in much the same way school is hard, because it has to be. You have a lot to learn in a short time. In fact, the whole first year is hard, and the second is no picnic. I love my stupid job, but there are two sayings I repeat to myself on a fairly regular basis: "I used to say my only problem was not having anything to complain about, but now I'm a nurse and my life is perfect"; and "If they wanted a good nurse, they should have hired one."
Work hard. Keep a sense of humor. Be confident. Be humble. Bear in mind that if you can survive this, truck driving school is going to be a piece of cake.
It hasn't been my intent to turn this into a "which is better, ADN, Diploma, BSN, or MSN entry" thread. In fact on of the worst programs in my region is a BSN program.
There are good quality programs -- and poor quality programs -- at every level of education.
My point is that some programs (at all levels) have turned into "factories" that produce people eligible to take NCLEX but who have not learned much about how to actually BE a nurse and DO nursing. That seems to be a fairly common response to the nursing shortage -- to create quick "short-cut" programs to get more RN's quickly and to provide "new, creative options" for students that may or may not provide the strong foundation needed for success in the field -- but they bring in money for the schools and produce large numbers of newly licensed RN's that make people look good.
Unfortunately, the new grads coming from some of these programs are unprepared for the real world of professional practice. They struggle with their role transition and create all sorts of problems in the practice arena. Many of them end up leaving their jobs -- blaming their fellow nurses and/or their employers when the real source of the problem is their lack of proper preparation.
Of course that's not the problem with every new grad who struggles ... but I am seeing it more and more ... and the profession needs to acknowledge it instead of pumping more resources into the creation of more sub-standard nursing education programs.
I appreciate hearing from someone who actually has experience with another profession, and even the one I happened to choose as an example!
I've thought for awhile that a trade model (apprentice/journeyman/master) makes more sense for nursing than a professional model. Carpentry is a science--proper joinery (even with nails) and structural integrity, but it's also an art (aesthetics). Sound familiar?
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?
I remember paging a resident, early on, with some (not too major) problem and getting, "What do we usually do for that?" Eek! (I'm secure enough in my manhood to occassionally say "Eek!") It's times like that you really appreciate mentors who continue to mentor even after orientation is officially done.
And don't get me started on delegation...a first-year RN delegating to a 10+ year LPN...well, it ain't like we learned in school. Luckily, I learned enough through life experience to know when to shut up and do what I'm told. Where I did most of my clinicals, they have "team nursing," where an RN, LPN, and aide share an assignment. Never had time to watch how that went, though, and I still don't fully understand the LPN I and LPN II business. At my facility, the LPN (if there is one) has her own assignment and an RN assigned to "cover" her. Usually, each RN covers a couple of patients, so the LPN might interact with 3 RNs. It's kind of messy, in a way, and I'm not 100% sure it's entirely legal, but once you get to the point where you do know "what we usually do for that," it gets to be more of a collaborative relationship, and it works.
One thing I've noticed is that LPN programs, around here, are one year of nursing school. My ASN was two years, but nearly half my courses had little if anything to do with nursing. I really enjoyed American Government.
The instructor was great, and the class was facinating, but it doesn't help a bit when I patient is going south. I guess I do have an insight into what to expect when the family sues my pants off, but I'd much rather know how to operate an ambu bag. So, really, graduate PNs have at least as much "practical" nursing as I did as a GN, and, at least starting out, the major extent of my "critical thinking" was to keep calling until I found someone who knows "what we usually do for that."
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.
I only know one Diploma nurse, and she has decades of experience, so it's hard to say how much of her skill comes from school and how much from OJT. What I do know, of her and our other very experienced nurses, is that they seem happy to teach anyone willing to learn, but they also expect you to start to stand on your own feet in a reasonable time. Which is pretty much exactly how I felt, training a new guy on a carpentry crew. It's worth the effort to gain a co-worker who'll be able to share the load, but if they aren't paying attention, who needs them?
Specializes in Gerontological, cardiac, med-surg, peds.
We are having a very difficult time in our college of nursing finding suitable clinical sites (especially in the specialty areas such as PEDS) for all our students. It is a challenge. The one quality pediatric unit in our area is overloaded with students.
We are having a very difficult time in our college of nursing finding suitable clinical sites (especially in the specialty areas such as PEDS) for all our students. It is a challenge. The one quality pediatric unit in our area is overloaded with students.
That's a major problem in my area, too. But a big source of that problem is the proliferation (and expansion) of programs that are of poor quality. They take up valuable clinical slots that could be used by the better programs. All those students in poor quality programs are making it more difficult for the high quality programs to get the slots they need.
I truly believe that we would produce more and better nurses (who would be successful in practice) if we would focus our attention and our resources on the better programs -- or at least only on the students with a little interest in those specialties. The region would produce a slightly lower number of new grads ... but the new grads produced would be well prepared to succeed and be more likely to stay in the profession. We can't afford to go on wasting the scarce resources.
I"d guess less than half of the students who come to my hospital for clinical rotations have a reasonable chance of being hired by us as new grads. The quality of the education provided by their schools is simply too weak. .... And yet, because of politics, we must give them access to our hospital to use as a clinical site.
That's a major problem in my area, too. But a big source of that problem is the proliferation (and expansion) of programs that are of poor quality. They take up valuable clinical slots that could be used by the better programs. All those students in poor quality programs are making it more difficult for the high quality programs to get the slots they need.
I truly believe that we would produce more and better nurses (who would be successful in practice) if we would focus our attention and our resources on the better programs -- or at least only on the students with a little interest in those specialties. The region would produce a slightly lower number of new grads ... but the new grads produced would be well prepared to succeed and be more likely to stay in the profession. We can't afford to go on wasting the scarce resources.
I"d guess less than half of the students who come to my hospital for clinical rotations have a reasonable chance of being hired by us as new grads. The quality of the education provided by their schools is simply too weak. .... And yet, because of politics, we must give them access to our hospital to use as a clinical site.
LLg, what do you mean by poor quality programs? How would you describe them?
I'm surprised that any nursing program would be described as "poor" - aren't there standards they all have to meet?
IMO, and it's only that, I believe in nursing school we could add on a class called "Basic Nursing." Here is where you'd learn all the itsy bitsy stuff that would be like the oil to your practice -- you'd learn how to operate wheelchairs, where things are located, how to operate machines, what to do about all the simple problems ... or, we could follow techs around for a few weeks. Because the drills we have to do during our clinicals do NOT focus on the small stuff. You're gearing up to do concept maps -- lots of that is done from the books and combing through a patient's chart, and a bit of assessment. However, you're still not learning how to make that patient comfortable, answer the million questions they have all day, etc -- all the stuff you really DO as a nurse, besides assess and manage their care.
Here's one example. I had a pt. the other day who was livid because he had to wait for his MRI so long. MRI even called me to say they were coming, only to cancel. Later I learned our gigantic hospital has only 2 machines, that ER gets them first, then oncology, etc, etc. Well, that small bit of info would have helped me out a lot to explain to him .. but I didn't learn it until later. I dont know -- I guess it's just knowing those small ins and outs that help so much. I'm not sure if a class would even help ...you just have to bug your preceptor/mentors to find out that info.
I feel many of the theory and patho type classes need to concentrate more on real life "case" situations -- lots more application and learning how to think critically and tie loose ends together. I remember doing about TWO cases studies in many of those classes --yet all day long as work each patient is basically a case study in themselves. We just need more emphasis on #1 -- survival and #2 -- critical thinking.
llg, PhD, RN
13,469 Posts
The Nurse Practice Act of my state has no strict minimum pass rate requirement. And even if it did, the schools would get around it by only allowing those "graduates" who scored high on an exam like HESI take the NCLEX. That's the tactic that they are using now. Students complete the program and pass all their courses ... but the school won't send the paperwork to the BON for processing their NCLEX applications until the student achieves a certain level of success on HESI. The BON hates that approach, but it's not against the law. The schools say the students haven't really "passed their last class and finished the program" until they pass the test. They use it as sort of a "final exam" to their last class. I know of people who have finished their coursework over a year ago who still haven't been allowed to take boards. In the meantime, these students have to pay some tuition to keep their student status active while they figure out a way to pass HESI ... which will then let them move on to take NCLEX. Thus the school boosts its pass rate. I think it is immoral.
It's all so political. If a school gets closed, the alumni of that school will be furious and cause political problems that people want to avoid. And its not just the alumni of the nursing programs. It will be all the alumni of the colleges who are offended that the state does not think their school is good enough. The graduates of the community college will portray any discipline as an elitist plot to funnel resources to 4-year programs and a slap in the face to every state resident who ever got an Associate's Degree in anything. The graduates of the schools whose student populations include a lot of minority groups and/or disadvantaged students will say it is discimination based on race or culture -- again, a plot concocted by the elitist schools to funnel resources to themselves. The 2 local trade schools with new "quickie" AAN programs will say that the board is stifling its right to compete with traditional colleges -- a plot to prevent them from offering practical alternatives to working people for whom traditional programs are too difficult. etc. etc. etc.
It's a real mess.
In the meantime, we staff development folks are faced with a group of new grads ... some of whom come from programs that provided a strong foundation and who are ready to begin their careers ... and and a growing group of others who bought a diploma and passed the NCLEX, but never really learned much about how to actually do nursing. In the past, that 2nd group was very small and we could handle them: if they seemed like great people, we might give them a little extra attention and they would make it. If they did not seem like great people, they would be fired. But now, that 2nd group of poorly prepared students is growing beyond our capacity to deal with.
That's the problem.