Is it possible that the shortened RN training causes more anxiety for new grads

NurseBecks · May 15, 2011

This topic hits so close to home, and it saddens me that it's a nationwide problem (although I have to admit that it makes me feel a little better to know that it's not just me). I graduated in December, 2009, Magna Cum Laude, from a BSN program, and after having applied to over 50 positions and not being able to obtain a single interview, I was forced to move 3,000 miles from home just to get a new-grad nursing job. I have over $125,000 in school loans (taken out solely for my four-year BSN program) that need to be paid back, so waiting around to find something locally was just not an option. Out in central Virginia, I worked at two hospitals for about six months each, and the training was insufficient at both hospitals. My level of anxiety was through the roof, and I was all the way across the country from my entire support system (which I would NEVER recommend that any new nurse try; it was excruciating). I was literally making 1/3 of the salary that I would have made in the Bay Area, and because I had Bay Area-sized loans with a Virginia-sized salary, I couldn't make my loan payments. I'm extremely lucky that my parents have been willing and able to cover my payments this whole time; the thought of how many people out there who are in the same situation but without external support, makes me feel sick to my stomach. It's also a big blow to my self-esteem that I'm 34 years old and my parents are covering my student loans, even though I spend hours each day sending out my résumé, scouring Craigslist, applying to positions on every hospital website I can find, contacting so-called connections or referrals, and signing up with healthcare staffing agencies. Just finding a nursing job has become my current full-time job. Thankfully, the unemployment payments I'm receiving are helping cover my basic needs while I live with my mom and continue to search.

So here I am, back in California, and I'm busting my hump trying to get an interview or even just get my foot in the door somewhere here (I'm even applying to positions as a CNA!), and the fact that I only have one year of experience is absolutely crippling my efforts. I'm no longer a new grad, which I suppose is kind of okay, given that most of the hospitals in the Bay Area have eliminated their new grad programs, but I only have one year of experience (which, even worse, was split into two six-month stints in completely different units - a surgical/trauma ICU at one hospital, and the postpartum unit of another), and the issue I'm now encountering is that hospitals and offices alike want at least two, if not three or more, years of experience.

So herein lies the conundrum: how am I supposed to gain experience if I cannot get hired and trained?!?! I have always been told that it is the responsibility of hospitals to train new-grad nurses upon graduating, given that there's just no way to adequately train future nurses while they're in school (due to liability and the imperative need for more hours on the floor than a school can provide). If that's the case, then when are hospitals going to realize that the money they're spending on travelers and per-diem nurses should be invested in training us, given that they will ultimately end up with well-trained, highly-skilled, technologically up-to-date, enthusiastic, and loyal nurses?!?! This whole situation is so counterintuitive to me that I can't wrap my head around it!!!

So, to sum it all up, YES, the shortened (or nonexistent) RN training is DEFINITELY causing enormous amounts of anxiety for new grads. I'm staring to doubt that anything is going to change, and I cannot afford to lose hope right now. When (assuming they will) are things going to get better?!?!

nurseprnRN, BSN, RN · May 15, 2011

"Like the previous poster, I graduated from a BSN program of great reputation and virtually 100% NCLEX pass rate (in 1986), but without the ability to function independently in any clinical setting. We were told even back then that it was our employer's responsibility to prepare us for our jobs!"

First, no new grad should ever expect to be able to "function independently in a clinical setting." That was true when I went to nursing school back when Florence was a probie and it's true now. Anyone who either thinks that or believed it when somebody else said it is delusional. A new cop can't function independently, nor can a new architect, nor a new gardener. It is, in fact, the employer's responsibility to socialize new workers into the work world and orient them to the specifics of the job. This is more than inservice ed on the latest IV pump

.

It is no longer realistic for diploma programs to churn out worker bees to work the floors. For one thing, and I remember this very clearly, student nurses are no longer expected to work as auxiliary nursing staff on off shifts to supplement regular staff-- they cannot act in the RN role without licensure or presence of a clinical instructor. Gone are the days when they could come to work for pay and do every psychomotor task they did as students, wearing their caps, white stockings, and uniforms, while those of us who went to nursing programs across town were relegated to nursing aide positions. The board of nursing woke up to that dangerous fact in my area when day shift came on the surgical floor at the very famous local city hospital to discover one patient stone cold dead in the bed after a night shift that was completely staffed by junior students (only). By that I mean "cold," well along on his way to room temperature. Diploma schools in the area were instructed in no uncertain terms that a student is a student, and when they are not in supervised clinical rotations, they are nurses' aides. Paid shifts staffed by diploma students dropped precipitously at diploma hospitals after that. It just wasn't as much fun if you had to, like, practice to your actual licensure level and wear those stupid nurse aide pinafores.

Next, as noted, patient acuity in those years when diploma grads were the vast majority of nurses was different to a degree that current new grads will likely find difficult to fathom. Example: 55-bed med-surg floor, three IVs, one Gomco suction machine to an NG tube, three patients in traction for hip fracture, two or three diabetics needing urine testing one a shift for urine glucose (yep, that was how we monitored that), coupla Foleys. That was pretty much it for the high-intensity patients. I worked on that floor a long time. No monitors, no complex meds, no need for much vital sign measuring other than routine once a shift, because ... people were not as sick in the hospital. It was possible to work like that if you didn't have to assess for side effects of multiple medication regimens, run multiple IVs, do complex dressing changes, deal with unstable people who had radical surgeries not yet invented, and prepare patients for discharge home with complex self-care needs. This last because, basically, they stayed until there weren't too many self-care needs. Not saying that nurses in those days didn't do assessments and catch problems (and yes, save the intern's sorry butt on a cold and rainy night), but it wasn't nearly on the scale you have to do now...and of course a new grad can't do that independently yet.

Last, producing grads to pass NCLEX is not the goal of any nursing program per se. Yes, unless they do pass it, they won't be able to go out there and (keep) learn(ing) their profession, and faculty DO want to make more nurses. Remember the origin of the NCLEX test question pool: reports of errors made by new grads in their first year of practice. The NCLEX, at its most basic, wants to know if you are safe enough not to make too many of those. This is why many questions' correct answer is a variation on "seek more information." Nursing faculties wnt to have that happen. How do you think you, the new grad, do that? By getting support from your employer, via a staff development structure and adequate staffing so your mentors have time to bring you along. Research has also shown that while new diploma grads are better at manipulative skills than new BSN grads, AFTER THE FIRST YEAR the BSNs have caught up and surpassed the diploma grads in competence and beginning autonomy, moving faster along the path from novice to expert, because they are better educated overall. Nursing is so much NOT about tasks. We can teach tasks to anybody-- there are kids on vents at home managed by their moms, home hemodialysis, all sorts of things like that. However skilled at the tasks required, these parents are not nurses.

I welcome the research-based push to higher staffing ratios, in part because this will make for more jobs for new grads with more exposure to old ones to help them develop. It will make it more possible to have nursing residencies, like physicians have residencies, to teach them intensive clinical skills to supplement the academic prep they have endured to date. Then we'll have nurses that know even more about why they have to do what they have to do, and that will benefit us all.

DoGoodThenGo · May 15, 2011

In response to several posts above:

First not all diploma programs produced mindless drones. Just as with today's ADN and even BSN nursing schools there was and is a wide variety among graduates. Many innovations and practice models of care that are still in use today came directly from diploma schools.

Where diploma programs excelled is in their mission to produce highly educated and component professional nurses, *period* as they say. Contrary to popular thought diploma programs were not all stuck in the 1850's or even 1950's . You were taught and exposed to all manner and sort of patients of various acuity levels depending upon what the hospital or system had on their floors/units. You also were also exposed to whatever modern equipment,methods and procedures in current use at whatever hospital the school was affiliated with. After all assuming you graduated and passed the boards said hospital would be where you started your career.

Have several books from the estate of a deceased neighbour who was a graduate of the Lenox Hill Hospital school of nursing, including "Asking the Right Questions - A guide to Critical Thinking", so don't tell me diploma grads don't or didn't learn/possess critical thinking skills.

Theory & rationale, evidence based practice, nursing arts, or whatever your model du jour happens to be cannot and does not occur in a vacuum. One needs to reinforce "dat book lernin" with the associated tasks or skill sets for it to stick.

As with so many other reports/papers regarding BSN nurses, am quite sure there are many who can out perform an ADN or diploma grad after a year or so. What is universally known is that by and large diploma and many ADN grads, especially those from a certain era can run circles around BSN grads and quite a few new ADNs as well.

New grads of all stripes are bemoaning the fact hospitals are choosing experienced nurses over them, well they would wouldn't they? I mean if you have a spot in our budget for new hires who would you choose? A newbie that may or may not have a clue as to what she is doing versus a seasoned nurse who can hit the ground running without expensive orientation?

Everyone was in such a hurry to down play the task aspects of nursing in favour of more lofty and professional sounding practices, but guess what? It is those tasks hospitals expect and demand nurses be able to perform. You can call them by any name you like; but if you cannot drop a tube, hang a bag, insert a Foley, take a full load of patients and so forth without a long (and expensive orientation) you are currently neither use nor ornament to a hospital.

Hospitals no legal or even perhaps moral responsibility to train new nurses. They are in the business of providing healthcare which naturally extends to professional and competent nursing care, however how they arrive at the later is their own affair.

Yes after the big push started in the late 1960's or early 1970's to move nursing education out of hospitals and into colleges/universities (mainly via associate programs), hospitals did provide long orientations for new grads to compensate for any short comings in their education. You could also finish nursing school and work as a "GN" for the six months to a year before you took (and hopefully passed) the boards. But those days are long gone.

Hospitals today are run as a business, much as it pains anyone to hear this; and today all businesses focus on their core mission. Everything else is either dropped or farmed out. In house laundries, central sterile supply and whole host of other services/departments once common to all hospitals now longer exist. They have been replaced by contracted services or other methods for many reasons but the main one is they are non-revenue producing costs. Nursing , again as much pain as it causes one to say it and many to hear, falls under expenses as well.

Somewhere in a desk or computer file in every hospital or healthcare system there are the numbers. What it costs to recruit, train, retain and if necessary replace a nurse. There is probably another section on expenses directly related to new hires both fresh grads (orientation or residency), and experienced (probably orientation only), and am willing to bet the costs for the later are less, much less than the former. What is more the ROI on the experienced nurse is usually greater because not only does she/he know what they are doing it also isn't their first time at the rodeo, thus not likely to bolt for the doors after a few weeks.

New grads have every right to be angry about the current situation, however blaming hospitals is perhaps misdirected anger. The entire system of educating including post graduate training of nurses in the United States needs drastic updating. We are working with a model that is nearly if not >50 years old that was developed to suit a healthcare world that by and large no longer exists. No other business is required or expected to "train" post graduates at their own expense so why should we hold hospitals to this standard?

tiredstudentmom · May 15, 2011

This topic hits so close to home, and it saddens me that it's a nationwide problem (although I have to admit that it makes me feel a little better to know that it's not just me). I graduated in December, 2009, Magna Cum Laude, from a BSN program, and after having applied to over 50 positions and not being able to obtain a single interview, I was forced to move 3,000 miles from home just to get a new-grad nursing job. I have over $125,000 in school loans (taken out solely for my four-year BSN program) that need to be paid back, so waiting around to find something locally was just not an option. Out in central Virginia, I worked at two hospitals for about six months each, and the training was insufficient at both hospitals. My level of anxiety was through the roof, and I was all the way across the country from my entire support system (which I would NEVER recommend that any new nurse try; it was excruciating). I was literally making 1/3 of the salary that I would have made in the Bay Area, and because I had Bay Area-sized loans with a Virginia-sized salary, I couldn't make my loan payments. I'm extremely lucky that my parents have been willing and able to cover my payments this whole time; the thought of how many people out there who are in the same situation but without external support, makes me feel sick to my stomach. It's also a big blow to my self-esteem that I'm 34 years old and my parents are covering my student loans, even though I spend hours each day sending out my résumé, scouring Craigslist, applying to positions on every hospital website I can find, contacting so-called connections or referrals, and signing up with healthcare staffing agencies. Just finding a nursing job has become my current full-time job. Thankfully, the unemployment payments I'm receiving are helping cover my basic needs while I live with my mom and continue to search.

So here I am, back in California, and I'm busting my hump trying to get an interview or even just get my foot in the door somewhere here (I'm even applying to positions as a CNA!), and the fact that I only have one year of experience is absolutely crippling my efforts. I'm no longer a new grad, which I suppose is kind of okay, given that most of the hospitals in the Bay Area have eliminated their new grad programs, but I only have one year of experience (which, even worse, was split into two six-month stints in completely different units - a surgical/trauma ICU at one hospital, and the postpartum unit of another), and the issue I'm now encountering is that hospitals and offices alike want at least two, if not three or more, years of experience.

So herein lies the conundrum: how am I supposed to gain experience if I cannot get hired and trained?!?! I have always been told that it is the responsibility of hospitals to train new-grad nurses upon graduating, given that there's just no way to adequately train future nurses while they're in school (due to liability and the imperative need for more hours on the floor than a school can provide). If that's the case, then when are hospitals going to realize that the money they're spending on travelers and per-diem nurses should be invested in training us, given that they will ultimately end up with well-trained, highly-skilled, technologically up-to-date, enthusiastic, and loyal nurses?!?! This whole situation is so counterintuitive to me that I can't wrap my head around it!!!

So, to sum it all up, YES, the shortened (or nonexistent) RN training is DEFINITELY causing enormous amounts of anxiety for new grads. I'm staring to doubt that anything is going to change, and I cannot afford to lose hope right now. When (assuming they will) are things going to get better?!?!

I wish you the very best... Don't feel so bad. I am in an LVN program, full-time, living off of financial aid and my most awesome and generous parents and I'm 33 yrs old! What courage it took to move that far from anything that you knew...despite the risks. Please keep us informed of your progress through your job search. Best wishes to you. :nurse:

Psychtrish39, BSN, RN · May 15, 2011

I graduated in 2003 with my ADN from a community college. We did learn in Fundamentals of Nursing how to make a bed with and without a patient in it. Demonstrate Foley cath insertion and be videotaped to see if we didnt use aspectic technique . We did intradermals and IV starts on each other and oranges and our first clinical we took on patients total care baths to meds to treatments although only two.

Even though I got alot of experience in nursing school it didnt prepare me for the realities of nursing and what we have to deal with and do and I never thought starting out that I would have to deal with the disrespect of patients and family members and management to the degree I have had to endure. I was lucky my first acute care job was in a skilled nursing unit and I did work with top notch RNs that trained me on how to be a good nurse and they were always a resource for me . I was 38 and not naive by any means but the hospitals leave new nurses to drown luckily I was thrown a life preserver by fellow nurses that wanted to teach me and I wanted to learn. That was in the Midwest.

Where I live now I would feel sorry for any graduate nurse and we have one where I work now (newly licensed) and I and the other nurses even as busy as we are we are teaching her basic patient care such as enemas, doing IM vaccines, and time management. I have found I enjoy that and enjoy passing on the knowledge I was taught by other nurses. I wish there were hospital programs still but those days are long gone. I feel they made more clinically prepared nurses than what I was at the beginning of my career.

NurseBecks · May 16, 2011

In response to several posts above:
First not all diploma programs produced mindless drones. Just as with today's ADN and even BSN nursing schools there was and is a wide variety among graduates. Many innovations and practice models of care that are still in use today came directly from diploma schools.
Where diploma programs excelled is in their mission to produce highly educated and component professional nurses, *period* as they say. Contrary to popular thought diploma programs were not all stuck in the 1850's or even 1950's . You were taught and exposed to all manner and sort of patients of various acuity levels depending upon what the hospital or system had on their floors/units. You also were also exposed to whatever modern equipment,methods and procedures in current use at whatever hospital the school was affiliated with. After all assuming you graduated and passed the boards said hospital would be where you started your career.
Have several books from the estate of a deceased neighbour who was a graduate of the Lenox Hill Hospital school of nursing, including "Asking the Right Questions - A guide to Critical Thinking", so don't tell me diploma grads don't or didn't learn/possess critical thinking skills.
Theory & rationale, evidence based practice, nursing arts, or whatever your model du jour happens to be cannot and does not occur in a vacuum. One needs to reinforce "dat book lernin" with the associated tasks or skill sets for it to stick.
As with so many other reports/papers regarding BSN nurses, am quite sure there are many who can out perform an ADN or diploma grad after a year or so. What is universally known is that by and large diploma and many ADN grads, especially those from a certain era can run circles around BSN grads and quite a few new ADNs as well.
New grads of all stripes are bemoaning the fact hospitals are choosing experienced nurses over them, well they would wouldn't they? I mean if you have a spot in our budget for new hires who would you choose? A newbie that may or may not have a clue as to what she is doing versus a seasoned nurse who can hit the ground running without expensive orientation?
Everyone was in such a hurry to down play the task aspects of nursing in favour of more lofty and professional sounding practices, but guess what? It is those tasks hospitals expect and demand nurses be able to perform. You can call them by any name you like; but if you cannot drop a tube, hang a bag, insert a Foley, take a full load of patients and so forth without a long (and expensive orientation) you are currently neither use nor ornament to a hospital.
Hospitals no legal or even perhaps moral responsibility to train new nurses. They are in the business of providing healthcare which naturally extends to professional and competent nursing care, however how they arrive at the later is their own affair.
Yes after the big push started in the late 1960's or early 1970's to move nursing education out of hospitals and into colleges/universities (mainly via associate programs), hospitals did provide long orientations for new grads to compensate for any short comings in their education. You could also finish nursing school and work as a "GN" for the six months to a year before you took (and hopefully passed) the boards. But those days are long gone.
Hospitals today are run as a business, much as it pains anyone to hear this; and today all businesses focus on their core mission. Everything else is either dropped or farmed out. In house laundries, central sterile supply and whole host of other services/departments once common to all hospitals now longer exist. They have been replaced by contracted services or other methods for many reasons but the main one is they are non-revenue producing costs. Nursing , again as much pain as it causes one to say it and many to hear, falls under expenses as well.
Somewhere in a desk or computer file in every hospital or healthcare system there are the numbers. What it costs to recruit, train, retain and if necessary replace a nurse. There is probably another section on expenses directly related to new hires both fresh grads (orientation or residency), and experienced (probably orientation only), and am willing to bet the costs for the later are less, much less than the former. What is more the ROI on the experienced nurse is usually greater because not only does she/he know what they are doing it also isn't their first time at the rodeo, thus not likely to bolt for the doors after a few weeks.
New grads have every right to be angry about the current situation, however blaming hospitals is perhaps misdirected anger. The entire system of educating including post graduate training of nurses in the United States needs drastic updating. We are working with a model that is nearly if not >50 years old that was developed to suit a healthcare world that by and large no longer exists. No other business is required or expected to "train" post graduates at their own expense so why should we hold hospitals to this standard?

DoGoodThenGo,

Please tell me, do you offer any solutions for this problem, or are you just posting to make us new grads feel like the future is more bleak for us than we already do? I think the fact that medical care has become more about business than about patient care (and what it requires to provide good patient care) is nothing less than despicable. Nursing is my vocation, not just my profession. How do you propose we get experience in a healthcare environment like the one that now exists here? Your response sounds to me like someone who's been a nurse for too long to remember what it was like to be a nervous, scared, and inexperienced new-graduate nurse. Postings like yours do nothing but discourage me and make me angry.

Why is this system acceptable to you? Have you seen Sicko? It conveys, in an excellent and truthful fashion, just how misguided healthcare has become. I went to see the movie with my parents, both of whom are long-practicing physicians and were not expecting to like the movie. Save for a few points they disagreed with, both of them emerged from the movie impressed with how accurate and well-presented it was. My dad even went from outright disliking Michael Moore to respecting him for having the guts to tell the unhappy truth about our healthcare system. Anyway, I bring this movie up because you mention hospitals being a business, which the movie depicts. If they run the way they do, then of course there is no money to train new nurses!

I'm just so disheartened right now that I don't even think I'm getting my point across well. The bottom line is that I don't appreciate your attitude in your posting, and now I feel worse than I did before I entered this conversation.

manchmal · May 16, 2011

Welp, nursing education by way of academia has taken a turn toward the business model. And hospitals, too, are businesses. To me, this illustrates what happens when you let business/money dictate everything. Healthcare is a business. It is also a social service in many cases (and we can agree and disagree about to what degree it ought to be be a social right).

If schools (especially 4-year universities) are abandoning their commitment to clinical training in favor of academics and "critical thinking" (why does critical thinking have to be separate from clinical experience again? Oh right, because only "measurable, repeatable, definable" data means anything...), and if hospitals don't want to deal with the cost and hassle of hiring a new grad, there's really not much to say. One would hope that the state boards of nursing would consider this when they're accrediting schools, and that medicare would consider this when all the old-school-trained nurses retire and patient care suffers.

I'd say a good social AND business model would be to ensure a continuum of good employees. That means retaining reliable, competent nurses throughout their careers AND doing what they can do integrate new grads into the system, thereby investing in an assured constant supply of reliable, competent nurses. If I were the master of the hospital universe, I'd want both new and old people. Not only for that whole constant supply thing, but also because new nurses do bring a lot of good to the floor -- they are often enthusiastic, can take a look at things from a "fresh" perspective, are well-trained in technology, can relate to patients, etc.

Is it the case that hospitals are supportive of schools conducting clinicals there because this is a way of pre-training future nurses for that establishment? It seems that way in the system I do clinicals in -- after I graduate, I'll have 2 years of training in this hospital system, so I'll know the protocols, the staff, some practitioners, etc. Of course the down side is that I don't wanna work in this particular system...but it seems to me to be that to be hired there, you need "2 years of experience" or "to have done a really good job in your preceptorship and maybe know one of the floor supervisors."

NurseBecks you sound like a diligent person, and it seems like you're working really hard. Your post hit home here, because I'll be looking for jobs in a few months (though in a rural area, and with an ADN rather than a BSN -- i have a BA & MA in something else, so I still have the loans). The problem you're facing is a problem with new grads of 4-year colleges in general, not just nursing grads...universities are sort-of conning people into attending, taking out huge loans, and not really giving a good outlook on job availability. And 18 year-olds aren't much thinking about how to pay those student loans in 4 years (though I know you said you're not 18). Still, there seem to be nursing jobs for new grads available where I am located, though where I am located isn't really a place a lot of people want to move to like the bay area is.

A lot of kids in my ADN class are going straight on to get their BSNs, but they're doing so online so they can work as an RN at the same time. Knowing what i do now, this seems to be a good call rather than doing a straight 4-year BSN. Somehow nursing is being converted into a 4-year degree (which will, of course, increase the supply of BSN nurses such that I imagine diploma and ADN nurses will eventually not be wanted at all). I'd say use that to your advantage if you can. Aren't there a ton of hospitals that only hire BSN nurses?? Maybe that's where you want to focus. Good luck to you.

sjpns12 · May 16, 2011

I will graduate in May of 2012 from a community college and I can completely relate to this post, even though I am not even working as a nurse yet. Our class started with 46 students. We are now down to 19. A lot of them are for not maintaining the 77% to pass and many others were just annoyed at the program our school has. I am to far into it to go somewhere else. However, I am scared already to be a nurse with the "lack" of training I feel I am not receiving. I know I still have another year to go, and I hope that this feeling goes away. All we hear is that we educate you to pass the NCLEX. Is that not a scary thing. We are not training to be skilled, caring and supportive nurses - NO, we need to pass a test (in order to keep the schools 100% pass rate). Well I am sorry but, I would much rather have more experience on a floor then being lectured on passing the NCLEX.

DoGoodThenGo · May 16, 2011

DoGoodThenGo,
Please tell me, do you offer any solutions for this problem, or are you just posting to make us new grads feel like the future is more bleak for us than we already do? I think the fact that medical care has become more about business than about patient care (and what it requires to provide good patient care) is nothing less than despicable. Nursing is my vocation, not just my profession. How do you propose we get experience in a healthcare environment like the one that now exists here? Your response sounds to me like someone who's been a nurse for too long to remember what it was like to be a nervous, scared, and inexperienced new-graduate nurse. Postings like yours do nothing but discourage me and make me angry.
Why is this system acceptable to you? Have you seen Sicko? It conveys, in an excellent and truthful fashion, just how misguided healthcare has become. I went to see the movie with my parents, both of whom are long-practicing physicians and were not expecting to like the movie. Save for a few points they disagreed with, both of them emerged from the movie impressed with how accurate and well-presented it was. My dad even went from outright disliking Michael Moore to respecting him for having the guts to tell the unhappy truth about our healthcare system. Anyway, I bring this movie up because you mention hospitals being a business, which the movie depicts. If they run the way they do, then of course there is no money to train new nurses!
I'm just so disheartened right now that I don't even think I'm getting my point across well. The bottom line is that I don't appreciate your attitude in your posting, and now I feel worse than I did before I entered this conversation.

Am very sorry you feel disheartened and or object to my post, the intention was not to cause harm nor was there any "attitude" involved. Merely saying things plainly for god and the world to hear.

Though am not the final authority (or any such for that matter) on this subject, do know how to research and apply "critical thinking" skills to interpret data.

It does bother me that those seeking to enter the profession, and or those already in it accept blindly whatever popular theory the media throws out. There is ample published information regarding the evolution of nursing education including the role of hospitals out there, so am not spinning my "theories" out of thin air. Of course I always welcome debate!

Long story short to run hospital you need nurses, end of story. However how former arrives at the later has taken many twists and turns over the generations. Much of the "problem" (if that is the proper word) in the United States comes from the fact that unlike some other countries healthcare is a private (business) matter. Once you go down that route there are often several different interests, and not all of them are always on the same page.

There was a time in this country when a worker with only a high school education could catch the eye of higher-ups and be selected for promotion. He would then be scrubbed up, sent to college or "executive training" and so forth all on the company's dime. You no longer see that do you? Businesses now demand persons seeking a position within a company arrive with the necessary degree/basic skill sets required. They may "train" you in various aspects necessary for performing in that particular company, but by and large providing the basic education is not going to happen.

Being as this may there are some hospitals/healthcare systems that will pay for current employees to attend nursing or other programs (lab, x-ray, pharmacy techs and so forth), to suit future employment needs. Indeed CBS Evening News covered such a scheme run by hospitals in the Boston, MA area to address their predicted staffing shortages. These and other programs like them are local run initiatives from the private sector (sometimes in conjunction with state or local governments), which is what many will tell you is how things are supposed to work in the USA. It still leaves in place hospitals calling the shots in terms of how they acquire nurses, and what they willing to spend on their training.

There was a time when the federal government and insurance companies either outright paid hospitals for nursing education, or reimbursed them for the expense. Once that source of funding was cut off it began the process we are seeing today. For one thing it lead many hospitals to close their schools of nursing (Cornell's famous program was one named direct result), it also opened up the conversation (again) to just whose responsibility it was to provide education and or post graduate training to professional nurses.

The days of running a hospital with a group of nuns/dedicated servants and funded by bake sales and works of "charitable women" are over. The closing last year of Saint Vincent's Hospital in New York City, and countless others around this country before and since proves one thing: no matter how well intentioned the mission all that matters is if a hospital can operate in the black.

It is good that nursing is your vocation. Am so *VERY* happy to hear it and please keep up that spirit! :yeah: :yeah: Your faith and or belief in what you are doing (or going to do) is larger than a pay check will go along way in assisting you in getting through the many trails and bad days surely to come. All that I ask is you temper this with a clear eye to conditions as they are on the ground. For years the Sisters (and anyone else that would listen) were told they couldn't continue running St. Vinny's as they were, but the advice fell on deaf ears. Now that great hospital is gone and the space soon to become luxury housing.

manchmal · May 16, 2011

Wow, thanks for the history lesson! It's always really, really interesting for me to hear about how the field of nursing has evolved, and continues to evolve. I wish they taught us THAT in school. :) It's pretty fascinating, actually, especially when you consider how it relates to the whole capitalism vs. socialism debate, religious affiliations and business decisions, and the current economic climate.

Harrychandler · May 17, 2011

I graduated from a two year nursing program in May 2010 and let me tell you, it was the hardest thing I ever did in my life. The school was heavy in theory, skills testing and clinicals. I was disappointed to learn that clinical experience did not count. In my lasr semester, I had clinicals 4 days a week, 12 hour shifts (I felt was way too much) and 5 patients all by myself. It was on a renal floor and I thought I learned alot . But it still hasn't helped me to land a decent job.

madwife2002, BSN, RN · May 17, 2011

I graduated from a two year nursing program in May 2010 and let me tell you, it was the hardest thing I ever did in my life. The school was heavy in theory, skills testing and clinicals. I was disappointed to learn that clinical experience did not count. In my lasr semester, I had clinicals 4 days a week, 12 hour shifts (I felt was way too much) and 5 patients all by myself. It was on a renal floor and I thought I learned alot . But it still hasn't helped me to land a decent job.

So when you say you had 5 pts all by yourself a few questions

1/ Were you carefully supervised and mentored by a preceptor?

2/ Did you preceptor gradually build you up to 5 or were you just thrown straight in?

3/ What were your responsibilities?

4/ Do you feel your preceptor gave you the support you needed

What jobs have you applied too and how have you presented the skills you acquired during your work experience