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.
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 plenty of us don't see the fact that people "want" to be nurses but don't want to invest the necessary time and effort to learn to be nurses as a good enough reason for selling nursing education down the river. There are plenty of people who "want" to be doctors or lawyers but don't want to spend the time and effort necessary to complete med school/residency or law school, too -- but I don't see the medical and legal communities falling all over themselves to develop new, streamlined, watered-down educational programs to accommodate those people ... Shoot, if that's a good enough rationale, why don't we just do away with nursing school entirely and just give anyone who wants one a license?? They can just learn everything they need to know after they start working ...
And there is plenty you can do in school as a student -- the problem is simply that too many schools are no longer providing those opportunities for students. You're right, you don't learn much by using "plastic people" and "pretending" (especially for only one year!! :uhoh21:) Up until fairly recently, most US nursing schools did a good job of preparing students for entry-level practice. You did know what you needed to know when you graduated, and were ready to start practicing in the "real world." Schools used to pride themselves on this -- then, somebody decided that nursing education needed to be "flexible" and "innovative." Now, your school tells you (as they deposit your tuition check :)), "Sure, you're not really learning anything in school, but that's okay, because you'll learn everything you need when you start working." I can't imagine why anyone, students or academics, considers this acceptable (I certainly wouldn't have when I was a student).
Specializes in NICU, PICU, PCVICU and peds oncology.
Shoot, if that's a good enough rationale, why don't we just do away with nursing school entirely and just give anyone who wants one a license?? They can just learn everything they need to know after they start working ...
You had to say that out loud, didn't you? There are too many internationally-educated nurses appying for immigration to North America who think that way already. I get a little short tempered with the ones who complain that they have to meet standards before they can be registered... it's so not fair that they can't just ask for a license and be handed one!
You did know what you needed to know when you graduated, and were ready to start practicing in the "real world." Schools used to pride themselves on this -- then, somebody decided that nursing education needed to be "flexible" and "innovative." Now, your school tells you (as they deposit your tuition check :)), "Sure, you're not really learning anything in school, but that's okay, because you'll learn everything you need when you start working." I can't imagine why anyone, students or academics, considers this acceptable (I certainly wouldn't have when I was a student).
Well, why the heck did it change and when did it change? I wonder what led to all these sort of changes in nursing education?
Could it be .... the nursing shortage?? As far as I understand, schools responded to the shortage by developing programs that could churn nurses out sooner.
But it seems in doing this, they've only put a band-aid on the problem.
And let me tell you, it would be nearly impossible WHILE attending one of these 2nd degree programs to do anything else besides attend class and clinicals. They usually have you from 8 to 5 p.m. everyday, and then from to midnight, you study. There is no extra time in your life while in one of these one-year wonders.
As I see it, the ONLY thng I can do is forgive myself for attending one of these schools, move on, and not let it get to my self esteem. Nothing is going to change until I start the "Sound of Music Bridge Gap Nursing Education Academy for post BSN studies." and start turning out truly prepared new nursing graduates. :nuke:
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.
I like the idea of a residency also, but hindsight is 20/20. How many new grads will think they need the residency? For instance, with all my EMT experience, my 10yrs of PCT, my externship, and my 4.0 in a good nursing school, I wouldn't have thought I needed the residency. I didn't even study for the NCLEX. Heck, I didnt' think it would be hard at all to be a nurse.
In restrospect, however, knowing what I now know about being a new grad I think it would be nice to have a softer, kinder orientation for most nurses.
For me, I didn't have to take a 2nd patient until my 4th month of orientation! How grateful I am and was for that. And yet, it was the most stressful year of my life.
I can't imagine the life of a new grad on med surg....
But, for hospitals to offer something like that would require something in return-a contract of at least 2 years. Which most people don't like to do. (and I totally understand why)...
Well, why the heck did it change and when did it change? I wonder what led to all these sort of changes in nursing education?
Could it be .... the nursing shortage?? As far as I understand, schools responded to the shortage by developing programs that could churn nurses out sooner.
The shift in education isn't all that new, though the proliferation of accelerated programs is. I graduated over 10 years ago (!?) from a regular BSN program where students were accepted as juniors. And I didn't feel my program was very strong in the skills arena. And in fact, I didn't feel like I *really* learned much except for how to write care plans, use nursing diagnoses and defend nursing as a profession. I mean, I was exposed to many things and had a cursory overview of many conditions and treatments, but I didn't *really* learn them. It was almost like two years of "introduction to nursing."
From my viewpoint, part of the change is due to the 'academification' of nursing. At least in the university setting, a heavy emphasis on skills training might look too much like vocational training. My school emphasized that nurses did SO MUCH MORE than bedside care and tended to brush off hands-on skills as "something you will easily learn on the job." They talked a lot about "critical thinking skills" but it seemed we were to somehow just magically develop them as we covered 1000 pages of text in 5 weeks. I'm thinking modern programs may also cover more breadth of topics... like not just 1000 pages of fundamentals and med-surg each, but also 1000 pages of maternity, 1000 pages of pediatrics, etc. Or maybe that hasn't changed.
Even those skills we did cover in class, instead of coaching us as we practiced, they'd leave us to practice on our own and then threaten to fail us with nitpicky critiques that seemed more about creating nervousness and fear of failure from any small, though harmless, deviation in procedure than fostering confidence and competence. Care plans were also often hit or miss, without clear guidelines on expectations and different instructors giving more or less emphasis to this or that point. If we'd ask what exactly they wanted, they'd say "use your critical thinking skills... what's most important?" Ugh!
Anyway, my point here is that the shift from graduating clinically competent, ready-for-the-floor nurses seems to have started some time ago. Perhaps part of the difference is the greater percentage of these new grads on the floor and the strong push to get them on their own ASAP due to short staffing, making their weaknesses all that more apparent and problematic. Or maybe I was at a "cutting edge" school... ha!
WOW, I'm a new grad on my 9 month; my orientations was fine. I had to fight for 6 wks, but I oriented with the same nurse and she was wonderful. I still feel completely comfortable going to her with any question. I started in a small hospital, 187 beds, and it has been a great place to learn. I'm learning how to be a nurse but also how to deal with different attitudes and the politics of nursing that are not taught in school. There are days that are bad and I go home wondering why I wanted to be a nurse but that comes with every job. I'm sad you spent so much time and effort for nursing school and don't like your job
I like the idea of a residency also, but hindsight is 20/20. How many new grads will think they need the residency? For instance, with all my EMT experience, my 10yrs of PCT, my externship, and my 4.0 in a good nursing school, I wouldn't have thought I needed the residency. I didn't even study for the NCLEX. Heck, I didnt' think it would be hard at all to be a nurse.
I agree -- that's why I think a program like that would need to be mandatory and pre-licensure. Nobody questions that medical school graduates need several years of residency to be ready to practice independently -- why not six months or a year for new nursing graduates, during which time they'd be paid significantly less than the licensed nurses (to reflect the extra costs they're generating for the hospital and their limited productivity).
I like the idea of a residency also, but hindsight is 20/20. How many new grads will think they need the residency? For instance, with all my EMT experience, my 10yrs of PCT, my externship, and my 4.0 in a good nursing school, I wouldn't have thought I needed the residency. I didn't even study for the NCLEX. Heck, I didnt' think it would be hard at all to be a nurse.
I agree -- that's why I think a program like that would need to be mandatory and pre-licensure. Nobody questions that medical school graduates need several years of residency to be ready to practice independently -- why not six months or a year for new nursing graduates, during which time they'd be paid significantly less than the licensed nurses (to reflect the extra costs they're generating for the hospital and their limited productivity).
ITA -- all of the above.
Hmmm, who exactly would we write to about this.
I'm serious about this. The BON for my state? Who would be a start I wonder.
I'll admit, I feel guilty about collecting this salary right now. Part of me loves it, of course, but part of me feels guilty. I am NOT doing what the pro nurses do -- not even close. I am just not that evolved yet and won't be for a long time. It will take time -- at least a year.
I dont know how such a residency would be set up. Ideas for that would also be very interesting to hear.
I think this has become my all-time favorite thread on allnurses.com -- and I've been involved in many good threads over the years!
Thank-you, everybody!
Obviously, I agree with 90% of what has been said here ... but I do want to be sure that we don't recommend "throwing the baby out with the bathwater." We need to be careful not to get rid of the academic aspects of nursing as we design programs that would provide a stronger clinical foundation. Nurses require both and that's the problem.
The only way to get both is to mandate longer training programs -- and people don't want to hear that now. People heard "shortage" a few years ago and immediately jumped to create programs that would enable students to sit for the NCLEX exam quicker. The grant money, political pressure, etc. has all been about the design of shorter programs, not better ones. But "shorter" and "quicker" won't solve the underlying problems.
Students don't want to hear "longer" either. Most also do not want to hear phrases such as "less pay during your residency" or "sign a contract" either. It's only after they have been working as a new grad RN for a couple of months that they realize what they should have wanted back when they graduated.
Perhaps hospitals could offer new employees a choice:
For example, they could say, "We have this great residency program for new grads. You can participate in it and take a reduced salary for a year to cover the costs of your residency ... or you can get full pay during that first year, but sign a contract requiring you to work for 2 full years." (or whatever ... I think you get my point.) They might even have 3 or 4 different "in-between" options that would involve only a slight decrease in salary combined with a shorter contract. etc.
The world has to accept the fact that if the hospitals are now going to be expected to provide the education that was once provided by schools (and paid for by students) ... it has to be economically feasible for the hospitals to do so. New grads can't expect to receive all that education for free.
For example, they could say, "We have this great residency program for new grads. You can participate in it and take a reduced salary for a year to cover the costs of your residency ... or you can get full pay during that first year, but sign a contract requiring you to work for 2 full years." (or whatever ... I think you get my point.) They might even have 3 or 4 different "in-between" options that would involve only a slight decrease in salary combined with a shorter contract. etc.
LOl, glad you've enjoyed the thread, LLG and others. I hope somehow it rises up to where it needs to go -- any administrators listening? Any schools listening?
I would have absolutely signed up for a reduced salary option, if it meant I'd get to go at a slower pace and be guaranteed to be a more "functioning" nurse at the end of the program. Hopefully such a program could be staffed by nurses who are experienced and LOVE to teach and are good at it.
It would be so interesting to see if such a program could actually be developed and implemented and what the long-term results would be.
I feel the way it could ultimately work would be to provide new grads positive reinforcement. Lots of repetition with small successes, small rewards, etc. In a job like this, you've got to receive lots of positive reinforcement to get that confidence -- and so far, what I see is that a lot of it is negative reinforcement. You try something and it doesn't work -- you have to bug a preceptor to get the answer, she/he scowls or gives you the short answer (negative). You try again and fumble -- more negatives. Or, you try your first day with 3-4 pts and it's a disaster, and you're "live" out on the floor and the pts are unhappy and you feel totally helpless -- I mean, how much more negative can it get?
Day after day of negatives leaves a person utterly drained and defeated.
Not that we don't get praise at work -- we do, but the admonishments always seem to outweigh it. Other nurses ignoring you -- also very negative reinforcement.
I also feel, along the way as you were building up your nursing skill "muscles" you could continue to do some real case studies on pts. on the floors. Once a week or so, do a case study -- that way you wouldn't lose the higher thinking skills, but would be learning the clinical skills along the way.
Confidence building -- that is what mainly I would hope to gain from such a program. A person who knows their skills, knows their resources well, knows how the system works, knows the hospital, knows the docs, knows the computer system well also.
And how about a course on time mangement? How about a course on life management while a nurse? I mean, the list could go on and on.
I'd sign up for the type of program you describe! I totally relate to what you say about negative reinforcement. Confidence building... ah, I'm dreaming...
LOl, glad you've enjoyed the thread, LLG and others. I hope somehow it rises up to where it needs to go -- any administrators listening? Any schools listening?
I would have absolutely signed up for a reduced salary option, if it meant I'd get to go at a slower pace and be guaranteed to be a more "functioning" nurse at the end of the program. Hopefully such a program could be staffed by nurses who are experienced and LOVE to teach and are good at it.
It would be so interesting to see if such a program could actually be developed and implemented and what the long-term results would be.
I feel the way it could ultimately work would be to provide new grads positive reinforcement. Lots of repetition with small successes, small rewards, etc. In a job like this, you've got to receive lots of positive reinforcement to get that confidence -- and so far, what I see is that a lot of it is negative reinforcement. You try something and it doesn't work -- you have to bug a preceptor to get the answer, she/he scowls or gives you the short answer (negative). You try again and fumble -- more negatives. Or, you try your first day with 3-4 pts and it's a disaster, and you're "live" out on the floor and the pts are unhappy and you feel totally helpless -- I mean, how much more negative can it get?
Day after day of negatives leaves a person utterly drained and defeated.
Not that we don't get praise at work -- we do, but the admonishments always seem to outweigh it. Other nurses ignoring you -- also very negative reinforcement.
I also feel, along the way as you were building up your nursing skill "muscles" you could continue to do some real case studies on pts. on the floors. Once a week or so, do a case study -- that way you wouldn't lose the higher thinking skills, but would be learning the clinical skills along the way.
Confidence building -- that is what mainly I would hope to gain from such a program. A person who knows their skills, knows their resources well, knows how the system works, knows the hospital, knows the docs, knows the computer system well also.
And how about a course on time mangement? How about a course on life management while a nurse? I mean, the list could go on and on.
elkpark
14,633 Posts
But plenty of us don't see the fact that people "want" to be nurses but don't want to invest the necessary time and effort to learn to be nurses as a good enough reason for selling nursing education down the river. There are plenty of people who "want" to be doctors or lawyers but don't want to spend the time and effort necessary to complete med school/residency or law school, too -- but I don't see the medical and legal communities falling all over themselves to develop new, streamlined, watered-down educational programs to accommodate those people ... Shoot, if that's a good enough rationale, why don't we just do away with nursing school entirely and just give anyone who wants one a license?? They can just learn everything they need to know after they start working ...
And there is plenty you can do in school as a student -- the problem is simply that too many schools are no longer providing those opportunities for students. You're right, you don't learn much by using "plastic people" and "pretending" (especially for only one year!! :uhoh21:) Up until fairly recently, most US nursing schools did a good job of preparing students for entry-level practice. You did know what you needed to know when you graduated, and were ready to start practicing in the "real world." Schools used to pride themselves on this -- then, somebody decided that nursing education needed to be "flexible" and "innovative." Now, your school tells you (as they deposit your tuition check :)), "Sure, you're not really learning anything in school, but that's okay, because you'll learn everything you need when you start working." I can't imagine why anyone, students or academics, considers this acceptable (I certainly wouldn't have when I was a student).