How does your unit handle new graduates?

RNPATL, DNP, RN · Aug 15, 2004

I'm a new grad and will be starting on the floor tomorrow with a preceptor. I believe on the med/surg floor I will be working, has a wide range of experienced nurses, from 1 year to 15 and 20 and I am looking forward to learning from all. It's sad to see that some of the older nurses are feeling like they are not needed by the newer nurses in some areas.
If it's any consolation at all, please don't view all new nurses like that, because many of us appreciate and value your experience and advice more than you know!!

Thank you for your post on this topic. I agree, not all new nurses feel this way and in fact, I think most new nurses are happy to work with the experienced nurses and learn as much as they can.

The only difference between a new nurse and an experienced nurse is a couple of years and a couple of crisises. Good luck tomorrow and please come back and tell us how your first day went! :uhoh3:

TraumaQueen · Aug 18, 2004

We are always orienting new graduates, each graduating class.... except one, that I can remember.

Hardly any 'experienced' nurses apply to our unit. We are an incredibly intense unit with lots going on.... and I think most of the nurses that have worked in nursing for a while are done looking for challenges (not all) and ready to find something more suitable for a relaxing lifestyle. (I know I will be when I'm older and nursing has taken its toll on my body) We do have several older nurses that have worked in our unit for many many years... but they are slowly dwindling away (retirement, switching to less work/stress areas)..... and, while they are a great resource for learning, so are the younger nurses.

Not all of our orientees make it off orientation, but the ones who do usually do exceptionally well. We're incredibly organized and focused on the learning we expect them to do while on orientation.

Is it scary that most of our nurses are new? I'd be lying if I said there weren't nights when I look around and think... dang, our most experienced nurse has been here for 3 years. But, when I look around at the nurses that are there, and have survived our orientation, and have been doing well in our unit for 2-3 years.... I know that I'd trust any one of them to care for me or my loved ones, because I think that's how good of a job we do with our orientees in the long run.

And, barefootlady has brought up an interesting point as well. I've overheard managers of units say they prefer new grads, because you can mold them to be the way you want them to be..... no bad habits, no attitude.... fresh and excited and they're like damn sponges. :) Personally, I think it takes a mix of old and new to make it work. :)

cnyrn · Aug 18, 2004

13 new grads since May, most failed their boards and are working as aids til they try again, a few of them are okay, most have an attitude, feel that "with the nursing shortage" any behavior is acceptable (poor work ethic, unprofessionalism, carelessness) because the hospital is desperate. If their preceptor expects accountability, they run crying to administration (and return with their tail between their legs) All in all, a bunch of losers, we'd rather work short. Honestly, they are already complaining about having to work Christmas, checking to see who worked last year, feeling entitled to special privileges.

gaulkari · Aug 18, 2004

Our floor hired five new nurses last December myself included. Two failed their boards twice and are gone. Of the three of us left two are on days and one on nights. Speaking for myself, for the most part I feel very supported by the experienced nurses. There are times when our floor is crazy and I feel bad having to ask for help from one of them. They have always been willing but I know that it can be a strain. I always thank them, and help them out when they are busy to show how much I appreciate them and the spirit of teamwork on our floor. We now have a hiring freeze on new grads untill all of us are able to do chemo etc. so as to not overload the exp. nurses. Yes I have heard a few comments from some nurses about our inadequacies and a comment or two has been made about theirs but overall we all get along well and respect eachother for what we have to offer..

RNPATL, DNP, RN · Aug 22, 2004

I actually think that the majority of experienced nurses are thrilled to have the help. There are those stick in the mud experienced nurses that could care less if the newbie's lived or died .... but that goes for them whether they have to orient an experienced nurse or a new grad. :angryfire

I know on my floor, the great majority are thrilled to have a new grad Yes, new grads take time, but they come with excitment, enriched with new and innovative ideas and a passion to make a difference. This new blood is always great. :balloons:

So when you stop and ask a lot of questions .... know that it is ok .... and know that you are doing so, so you can learn and take better care of your patients.

westminster · Sep 24, 2004

hi everyone,

Just thought I'd have to share my experience with you.

I have just returned to nursing after a break of 10 years !! took my NCLEX in May and passed and was hired by my local hospital on the understanding that I would have a 6 weeks orientation program. Had my first day on Med/Surg floor yesterday !!! Busy day !

The RN I worked with was great and really watched over me - I felt like a first year student again and was terrified by all the new technlology but still managerd to give some IV drugs without messing up !!

I used to be a senior nurse on a Oncology ward so still have skills buried somewhere !! (trained and worked in the UK!)

I think the biggest change for me is there is SOOOO ! much computereized stuff !!! All the charting is computerized !

I'm looking forward to the next 6 weeks as a challenge.

I hope I won't feel so terrified at the end of it !!!

Thanks for listening. :rolleyes:

Pediatric Critical Care Columnist · Sep 24, 2004

Our unit hires a lot of new grads. The Transitional Graduate Nurse Recruitment Program was one of the methods the province of Alberta chose to deal with the nursing shortage, and the health authority I work for was the only one in the province to see the potential of the program. The pilot project (2001-03) was so successful that HR and the managers responsible for hiring are continuing to hire new grads. I and many other experienced nurses are happy to help these newbies into the routines of the unit, but we are all having some misgivings, particularly with the most recent crop.

New grads are given a 16 week orientation in our unit. For most of them, this is adequate, but not really quite enough. For some, a year wouldn't be enough. The unfortunate part of that is that our probationary period by contract is 503.75 hours and orientation is closer to 600 hours. If it becomes apparent toward the end of a nurse's orientation that the job is still too much for this individual, it's too late to extend the orientation, and it's too late to send them somewhere else. One new grad this year has still not obtained her license and is therefore unable to do a large number of day-to-day things on our unit, such as giving IVP meds and neuromuscular blockers, troubleshooting pressure lines, changing EVD collection bags, collecting CSF specimens from EVDs, taking verbal orders... the list goes on. I was one of the people to preceptor this nurse, and when I presented my evaluation of her near the end of her orientation to management, I was put in my place. So now she's independently responsible for the "stable" patients (when we have them!!).

Another thing that keeps happening is that the assignments given to these new grads are inappropriate. They should be assigned to the type of patients they are likely to be responsible for when they are independent, such as the chronic trach-vent kids, the long-stay cardiac patients, post-op monitoring type patients and the more stable traumas. As time goes on and they become comfortable with caring for this type of patient, and comfortable with the routines and degree of assessment and organization needed to work PICU, then they can move up to the somewhat sicker kids. Instead they're being assigned, with a preceptor, to fresh Norwoods, fresh transplants, recent TBIs with drains and pressors, infants with open sternums, and very sick medical patients. Then once off orientation they're being given sicker patients right off the bat.

I've been a PICU nurse for 7 years and can look after anyone that comes through the door. On Monday night, I was assigned a little post-op who had some respiratory issues and was intubated. Her main problem was keeping her sedated enough to preserve her tube. In the next room was a new grad who came off orientation a month ago. Her patient was a teenager with multiple trauma, a very severe TBI and sepsis, who still needed inotropic support (epi, norepi and dop), frequent fluid boluses and treatment for ICPs, who is coincidentally enrolled in the HYP-HIT research study... What were they thinking? The assignments should have been reversed and she should have been allowed to observe and help as needed. Instead, when the patient's CPP was noted by the CN to be 47 mmHg, she wasn't able to completely understand what the issue was, since the BP was within the desired parameters. I felt very bad for her, being made to run before she could walk.

Because of the issues we "older", experienced nurses have raised about the new grad orientation, the entire unit orientation is being overhauled. Hopefully we'll see some positive changes, and the poor new grads won't be set up to fail any more.

nursbee04 · Sep 29, 2004

well....i am an experienced nurse who overheard the "younger less experienced nurses" on the unit make the following statement about "the older nurses"...and i quote:
"....prefer to work with nurses in our own age group than work with the older nurses. we (meaning the young nurses) know more and have fresher newer perspectives...yaddy yaddy yaddy...."
they had no idea i was that much older than they, so when they finished yacking, i told them i was an older nurse who had no problem learning from them and no problem teaching them -- that we should all be open to learning from each other.
that's just a taste of the drama i overheard, so i've chosen not to work on that particular unit since those nurses are not "older nurse friendly".

when i started on my unit, i got eight weeks with a preceptor as a extern. i started as soon as i graduated as a gn, then for the last half of my externship i had my rn.

i have been an rn since june of this year. by the end of july, i was charge nurse for the first time on my unit with a short staff and two patients going bad, blood products to give, and several other high acuity patients. i would have given my right eyebrow for an experienced nurse to turn to, for the staff that night consisted of me, two new lpn's, and a float who had never done floor nursing before.

we got through the night, the patients survived and everyone told me that i handled it extremely well, but i still feel like it was a very unsafe situation.

as a new nurse, i got eight weeks with a preceptor, which was good, i felt prepared, but i do not feel that a new grad should be placed in charge.

you can bet i was in my nurse manager's office the next morning (with a nervous twitch and an overwhelming need to pee) to have a long talk with her. things have changed for the better since then, due to the complaints of many.

Kathy T · Oct 4, 2004

:imbarI can empathize with you in regards to this issue. On our nursing unit, Approx 90% on our new hires are new grads and the remainder minus a very few exceptions are nurses with no med-surg experience although they've been nurses for years. We have a bridge program that involves class time as well as time on the unit. When the new nurses come I show them a little black book I have made that is always in my locker and accessible to them. It contains various items including how to calculate heparin dosages and a checklist to be performed with the administration of chemo etc;.. We also embrace our new nurses and let them know we are open to their questions and there is no stupid questions. My whole unit basically treats these new nurses that way. Make them feel welcome so they will stay. We have actually obtained nurses from other units because the other units didn't embrace their new nurses. The night shift is where most of the new nurses go and scheduling is done to make sure there is always a seasoned nurse (at least one) to facilitate the new nurses transition to becoming independent. Some are naturals and some take > year to become independent. One step at a time. I believe the key is nurturing our new nurses and no negativity is allowed!!!

Over the past few years, there has been a real shift in our new hires. I have noticed that we are not seeing many experienced nurses coming through the door. This has resulted in many more new graduates being hired. I love the newbie RN's and their compassion, vigor as well as fresh perspective and ideas. However, I am growing more and more concerned that we are going to have more new graduates (RN's with less than 1 year experience), than we have experienced nurses.
How is your unit handling this? My unit has a total of 3 experienced nurses on the day shift. Our manager has hired a number of new nurses (all are scheduled to begin over the next 3 weeks). Once the new nurses get on board (and I have to say I am thankful they will be here soon as we are sooooo short staffed), there will be more new grad nurses than seasoned nurses. I for one am going to thank them for coming to work with us and hope they stay and become a part of the experienced core team. :roll
What is happening on your unit and how are you all dealing with it?

nuttyRN · Oct 4, 2004

I have only been an RN for a 1.5 year and I have to act and be the one that knows alll. Not that I am actually ever given/paid charge nurse wages. We have a unit that is ICU stepdown and stroke unit certified. It is difficult to staff sometimes: but on the other hand we have great retention and training for our new grads. A lot of new grads do not want to come to a neuro floor due to false beliefs; but our neuro floor wants to see new changes and is welcome to the changes. :rolleyes:

cbreezen482 · Oct 19, 2004

As a new RN (graduated in May), I really look up to the "older" nurses in my facility. They don't make us feel stupid for asking questions or wanting a little guidance the first time we do a procedure.

But the problem where I work is that they have hired a total of 6 new grads, and stuck all of us on nights! Thankfully one of the new RN grads worked on the unit during nursing school and and he now is a charge. But he's preparing to transfer to ICU. Our other Veteran night charge has only worked in the facility for one year, and while she's an excellent nurse and really helpful, she's gone on personal leave for the time being. So basically we have all new grads running the night shift on our floor and at times I've been put into the Charge role, which is something that I personally am not comfortable with at this point in my career!

RNPATL, DNP, RN · Oct 19, 2004

As a new RN (graduated in May), I really look up to the "older" nurses in my facility. They don't make us feel stupid for asking questions or wanting a little guidance the first time we do a procedure.
But the problem where I work is that they have hired a total of 6 new grads, and stuck all of us on nights! Thankfully one of the new RN grads worked on the unit during nursing school and and he now is a charge. But he's preparing to transfer to ICU. Our other Veteran night charge has only worked in the facility for one year, and while she's an excellent nurse and really helpful, she's gone on personal leave for the time being. So basically we have all new grads running the night shift on our floor and at times I've been put into the Charge role, which is something that I personally am not comfortable with at this point in my career!

Wow, that is interesting that your unit is staffed with all new grads on the night shift. You all must be some pretty talented new nurses! I would imagine that it is tough to get answers when you are challenged with a difficult patient situation. Does house supervision support the unit when there is not an experienced nurse working? Good luck in your current situation!