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've been reading this thread and I had to throw in my 2 cents. Like Sound of Music, I graduated from an Accelerated BSN program. I had clinicals three days a week in three different nursing courses. There is no way those clinicals resembled a real nurse's day. I had 2 patients max. My critical care clinical was spent on a cardiac tele unit passing meds.
After graduating, I went to a trauma IMC, I was assured by the hospital that the orientation would be adequate. Wrong. I just followed another nurse around and it was assumed I would just pick it up as I went along. You are not only putting together everything you just learned as a student, but you now have to learn about the hospital-charts, policy, med teams, documenting, where things are, etc.
When I left school, they told us it would be difficult. That we would need extra time to learn skills since we had crammed 4 years of nursing school into 1 year. Orientations need to be more flexible since many students come from these types of programs. Otherwise you will have a lot of nurses that are not trained correctly, not happy and will leave and its a no win for everybody. :roll
. Orientations need to be more flexible since many students come from these types of programs. Otherwise you will have a lot of nurses that are not trained correctly, not happy and will leave and its a no win for everybody. :roll
I don't mean this to sound as argumentative as it may come across (really), but maybe it's the schools that need to change. Maybe they need to stop shortening the length of their programs and start providing the education that the students need to function as a new grad in a typical work setting.
Have you read the many other posts in this thread? We all agree that there is a huge gap between what the accelerated programs are providing and what the students actually need. Why should an employer be expected to foot the bill for the students' education -- unless that student is willing to sign a contract?
I don't mean this to sound as argumentative as it may come across (really), but maybe it's the schools that need to change. Maybe they need to stop shortening the length of their programs and start providing the education that the students need to function as a new grad in a typical work setting.
Have you read the many other posts in this thread? We all agree that there is a huge gap between what the accelerated programs are providing and what the students actually need. Why should an employer be expected to foot the bill for the students' education -- unless that student is willing to sign a contract?
Again, I completely agree. Also not trying to be argumentative or single out any particular individual, but why is it the hospital's problem that new graduates (esp. those from "accelerated" programs) don't know what they need to know??
Licensure is licensure -- once you have the letters "RN" after your name, there is no legal distinction between a new grad and a nurse who has been practicing 25 or 30 years. You have been deemed safe and competent to practice by the state in which you are licensed, and you (all of us) are held to the same standards and expectations -- of knowledge, skills, and judgment. And there is no legal requirement for hospitals to offer anything but the most minimal orientation -- actually, the rules in most states only require that they verify that new nurses are competent to practice.
Hospitals are trying to be "nice," but, as time goes on, new grads are coming to them knowing less and less, and needing more and more -- not even "orientation"; let's just call it what it is - education (dare I say it? training) -- in order to be able to do, at the most basic level, the job the hospital is already paying them to do. This process is extremely expensive for the hospitals, and they would be well within their rights to just refuse to hire new grads at all, or to simply fire new grads who weren't able to function independently at, at least, a basic level of competency within a specified, relatively short period of time. So far, they haven't gone that far and are trying to still "play well with others" :), but I think, again, we're (collectively) getting close to some sort of breaking point, when the hospitals are going to put their collective foot down and refuse to take responsibility (inc. financial responsibility) any longer for the widespread problems in nursing education ...
This process is extremely expensive for the hospitals, and they would be well within their rights to just refuse to hire new grads at all, or to simply fire new grads who weren't able to function independently at, at least, a basic level of competency within a specified, relatively short period of time. ...
It is very expensive to train new grads. And I was considered only because of my past healthcare experience.
But, whatever happened to people finding themselves the training? By that I mean a summer externship or some kind of nursing student role.
More and more, I see students not taking the externships, or the nursing intern (PCT) roles as side jobs. Even if it's only 2 shifts a month, it's still worth it.
I learned soooooooooooooooooooo many skills as a tech-foleys, dressing changes, appropriate vital signs, ekgs, phlebotomy, etc, etc. So in nursing school, I just focused on the skills that I didn't know. Then as a new nurse, I found that I didn't have to waste time on learning skills, but just learning how to be a nurse. For my orientation into the ICU, I got 6 months.
And I'm still here at the same job.
It should be a little investement on all our parts. Our schools, our workplace and ourselves. While people are waiting to start nursing school, they can even volunteer at a hospital. But more often than not, some nurses have never step foot in a hospital (except for clinicals) until their first day.
The purpose of accelerated programs is to get people that want to be nurses out in the field. Grant it, 1 year is not enough to learn how to be a nurse. But there is only so much you can do in school as a student. You use plastic people and pretend a lot. And yes I worked as a nurse tech and an EMT before I ever went to nursing school. I had the theory but not the skills.
So if hospitals won't hire new grads then who will? When I was newly licensed, I had the basics, not all of it had been actually done on a real person before but thats the difference between a new grad and a nurse with experience. The rest you learn as you go along. After all thats part of what nursing is about, learning and adapting.
But, we're talking basic nursing skills and basic assessments, like interacting with people, bedbaths, etc, etc that some new nurses are unable to do.
I had a nursing student last semester who was set to graduate in a few weeks. But she still couldn't understand the whole "IV Piggyback thing" (that's a direct quote!!)
Or one time I had a pt with an oblong pupil. I told the student (again, last semester student) to do her assessment and tell me what she thought. She did her assessment (lung sounds and heart sounds only) and missed the pupils. When I asked her "did you see her pupils?" She said, "no, I don't know how to do that" When I told her to use her penlight, she just stared at me, and said "I've never done that before.."
Or the other student who said that she was so lucky because she made it out of nursing school having never done a bed bath on a patient. And she was proud of it!
And these students aren't from an accelerated program either and they were all last semester!!
On a med surg floor, they have 6 weeks orientation (not enough IMO) to make up for what a summer externship or nurse internship could have covered.
But, whatever happened to people finding themselves the training? By that I mean a summer externship or some kind of nursing student role.
I learned soooooooooooooooooooo many skills as a tech-foleys, dressing changes, appropriate vital signs, ekgs, phlebotomy, etc, etc. So in nursing school, I just focused on the skills that I didn't know.
But more often than not, some nurses have never step foot in a hospital (except for clinicals) until their first day.
If previous experience is required to be a good nurse, then it should be required for admission to school. But most schools advertise that their program will *fully* prepare their students.
Keep in mind that not all areas have student nurse externships available, or if they do, spaces are limited. Also, in many places, nursing assistants don't do much more than vitals, bed baths, help with meals, and toileting - not dressing changes, EKGs, phlebotomy, etc.
If we expect students to get this kind of experience, it needs to be readily available out there, as opposed to having 10 student nurses competing for 1 such position and the others being out of luck. If such opportunities are very limited, you end up having only the best students getting the most experience and the others, who likely need more experience, getting less experience.
In addition, there's not much time to get outside student experience since you are only a student nurse for a year or two. That generally only leaves one summer for an externship, if you can get into one. During the school year, most students don't have the time or energy to take on much more training, and facilities may only offer part-time nursing assistant positions - which again may not offer the chance to practice anything more than basic care. Useful, yes. But nowhere near the responsibilities and skills that a new RN will need.
Finally, once a student has passed the NCLEX and has their license, there are few opportunities to build on weak skills. There are a few general refresher courses, but they tend to focus more on content than hands-on skills. If for whatever reason you aren't quite ready to take on a full-load, there are no half-load opportunities or ways to build up starting from fewer responsibilities all the way up to all of them. Usually, you've got 6-8 weeks as a new grad. Or you sign a two-year contract for a more extensive preceptorship and hope to heck that it works out.
I'd be willing to take lower pay to have a lower workload while I figured things out. If most new grads aren't REALLY competent til 6mo to a year, then we shouldn't be giving them full responsibilites until then nor paying them as a full-fledged nurse either. Maybe we do need some sort of transition licensing between student nurse and full-fledged nurse clinician or something like that.
And if schools don't always prepare well enough and hospitals aren't going to provide extra training, then maybe some sort of gap educational provider will eventually pop up. There likely will be some major changes one way or another in the profession.
. So far, they haven't gone that far and are trying to still "play well with others" :), but I think, again, we're (collectively) getting close to some sort of breaking point, when the hospitals are going to put their collective foot down and refuse to take responsibility (inc. financial responsibility) any longer for the widespread problems in nursing education ...
Wow. Great post.
My hospital is already being pretty selective in its hiring practices -- and we are getting close to "playing favorites" when it comes to making clinical slots available for students.
Hospitals are trying to be "nice," but, as time goes on, new grads are coming to them knowing less and less, and needing more and more -- not even "orientation"; let's just call it what it is - education (dare I say it? training) -- in order to be able to do, at the most basic level, the job the hospital is already paying them to do. This process is extremely expensive for the hospitals, and they would be well within their rights to just refuse to hire new grads at all, or to simply fire new grads who weren't able to function independently at, at least, a basic level of competency within a specified, relatively short period of time. So far, they haven't gone that far and are trying to still "play well with others" :), but I think, again, we're (collectively) getting close to some sort of breaking point, when the hospitals are going to put their collective foot down and refuse to take responsibility (inc. financial responsibility) any longer for the widespread problems in nursing education ...
I'm not sure how much "nice" has to do with it. Some, probably, in some cases. Judging by some posts on these boards, the "nursing shortage" is not so severe in some markets that new nurses can easily find jobs. In other markets, though, a warm body with an active license keeps the doors open. (My facility appears to be somewhere in the middle. We recruit from several nearby schools, including the one we're affiliated with, but there's enough turnover that finding a position isn't usually too difficult. I think were probably sort of in the middle ground on orientation, too. I was pretty satisfied with my orientation, and I think our administrators take our role as a teaching hospital pretty seriously, but I've read of programs that sound enviable. I give my employer due credit because I think they genuinely do want us to be happy, but I'm sure there's an element of enlightened self-interest to consider, as well.
Personally, I like the idea of a year, or even six months, of residency for nurses. I'd have gladly worked awhile at half-pay to have had a less stressful transition, and I had the benefits of a pretty decent program and a pretty decent orientation. After orientation, I was fortunate to have charge nurses who took my experience level into consideration when making assignments. I feel I've been treated well, before, during, and after school, but getting into nursing school was not easy, getting through was hard, and the first year of nursing practice was one of the hardest things I've ever done. I'm proud of my accomplishments and grateful for those who've helped me, but if there was a way to stretch out that steepest part of the learning curve, I'd be all for it.
Nursing has given me a route to get from "working poor" to "middle class," and I'm appreciative. I worked hard to take advantage of the opportunity, but I doubt I'd have been successful without the help I got from my employer and my co-workers. In return, my employer got a new nurse who isn't really looking to go somewhere else, and my co-workers got a member of the team who is willing to work as hasn't forgotten what they've done for me.
My unit includes nurses of a wide variety of backgrounds and experience level, but to a person, they say the best thing about our unit is the strong teamwork among the nurses. While our management does try to foster that, I think it has more to do with the leadership of our most experienced nurses. So, when I try to show "newbies" the help and support I was shown, it's partly because I'm a nice guy, and partly as a tribute to those who helped me, but mostly because I want to enjoy the same atmosphere of teamwork and respect even after our most experienced nurses have moved on.
I think we've had some good discussion of how things ought to be, and someday when Sound Of Music is a CNO, we may see them implemented. In the meantime, I think it's going to take a lot of nurses like Elkpark and llg holding the hands of idiots like nursemike to make this work.
and someday when Sound Of Music is a CNO, we may see them implemented.
LOl, No, Sound of Music will likely never be a CNO -- but I AM interested in this idea from a marketing standpoint:
And if schools don't always prepare well enough and hospitals aren't going to provide extra training, then maybe some sort of gap educational provider will eventually pop up.
It's the marketing person in me to want to develop the business/organization/model that provides that educational gap experience. :nuke:
Check out the thread, "Throw me to the wolves". This is why clinical hours look good on paper/accreditaion/whatever, but are actually sometimes useless in preparing students.
When I told her to use her penlight, she just stared at me, and said "I've never done that before.." 
mh356, BSN, RN, EMT-B
53 Posts
I've been reading this thread and I had to throw in my 2 cents. Like Sound of Music, I graduated from an Accelerated BSN program. I had clinicals three days a week in three different nursing courses. There is no way those clinicals resembled a real nurse's day. I had 2 patients max. My critical care clinical was spent on a cardiac tele unit passing meds.
After graduating, I went to a trauma IMC, I was assured by the hospital that the orientation would be adequate. Wrong. I just followed another nurse around and it was assumed I would just pick it up as I went along. You are not only putting together everything you just learned as a student, but you now have to learn about the hospital-charts, policy, med teams, documenting, where things are, etc.
When I left school, they told us it would be difficult. That we would need extra time to learn skills since we had crammed 4 years of nursing school into 1 year. Orientations need to be more flexible since many students come from these types of programs. Otherwise you will have a lot of nurses that are not trained correctly, not happy and will leave and its a no win for everybody. :roll