It's a Myth that it takes thousands of dollars to train a new Grad RN

[andywolfe]

Let me begin by giving some background about my situation. I graduated from a nursing school with an ADN in May 2012 from a school in California. Academically I was # 2 in a class of about 60 students. I looked for a new grad RN position in CA; but, no one would hire me. I would like get some feedback on this myth that hospitals spend thousands of dollars in order to train a new Grad RN (here I am not talking about Versant residency or any training into special units like ICU, NICU etc).

I was hired by and I am currently working in a medical school affiliated hospital with a level 1 trauma center in the state of Texas. The unit that I am currently working in is the Cardiac Step down unit. It's one level below Cardiac ICU and one level above regular Med-Surge floor.

My current wage level is in the mid 20s with differential for nights, weekend, and afternoon. I have received a total of 6 weeks of training. I was signed off on almost all my skills during the first week of hire (Vent, Trach care, Med pass, Blood draws, IV start, Foley, NG etc, etc). During the last 5 weeks of my training my preceptor has been mostly reviewing my charting and helping other Nurses. Here are the hard numbers. I have received total wages of less than $6,000.00 for the 6 weeks of training (this also includes house orientation and computer training (lasted only 6 hours). I don't know how much my preceptor has earned in those 6 weeks; but, I can assume it wasn't more than 9k (70,000/52weeks X 6weeks). I have handled the same pt load as an experienced nurse after my first week on the unit. While most of the time my preceptor has been helping out other nurses on the unit.

I am not including the wages for the instructors for house orientation because there were more than 30 individuals including nurses, techs, dietary, HUC (secretary of the units), maintenance etc, etc. Moreover, since the hospital is in the process of going to computer charting, there were about 35 nurses including new hires and veteran nurses that were present during the computer training.

So the way I look at it, this hospital has spent about a maximum of 10K (wages that my preceptor received during the training) training me. If I wasn't there, the same number of pts would still be cared by an RN. The only difference is those pt were cared by a rookie RN rather than a veteran RN. Also again my preceptor was usually helping out other nurses during this training. It wasn't like she was hovering over me while I was providing care to the patients. Since very few hospitals will hire a new grad, for providing me 10K worth of training for 6 weeks, I will be working for this hospital for at least a year and the hospital will be saving about 20-30K in wages paying me instead of a veteran RN. So for this scenario in the end, the hospital comes out making a profit of at least 10k-20K. Furthermore, I will be replacing an expensive nurse from resource department along with decreasing the overtime wages for the whole unit. So that just goes to increase the profit margin for the hospital.

Finally, I have purchased malpractice insurance independently and the hospital also provides for malpractice insurance for nurses. So again I would like to know where is this myth of hospitals spending thousands of dollars to train a new grad coming from. What am I missing here????

[itsnowornever, BSN, RN]

That's what CHLA quotes also. I think it's unfair to say "Well, they are paying X amount of dollars for HR, and X amount for IT to process your information"....guess what? Those positions are ALREADY THERE! LOL! It's not like they hire a temp HR, temp vet-RN, temp-Charge Nurse, temp-Doctors....etc etc etc...those people are already there. The extra money they are paying out? Your pay. That's it. And it's STILL cheaper than if they were to bring in a travel/agency nurse!

[andywolfe]

I keep coming across this big myth and when I examine it closely, it seems to me that this myth has absolutely no basis in facts. I would really like someone to refute my point with only facts and not opinion.

[itsnowornever, BSN, RN]

I keep coming across this big myth and when I examine it closely, it seems to me that this myth has absolutely no basis in facts. I would really like someone to refute my point with only facts and not opinion.

Ummmmm I was agreeing with you :/

[andywolfe]

I am new to posting on forums and actually I wasn't trying to respond to your post per se. I was actually soliciting a response from someone who doesn't agree with my point of view.

[NickiLaughs, ADN, BSN, RN]

I think what they view as costing so much money is the addition of benefits.

After the initial training of the new grad (as some places have them on orientation 6 months to a year). And then after that it as they typically give new grads a "lighter" assignment, and try to keep an experienced nurse nearby for them in case they need any help. The problem is that most new grads stick around maybe a year, after they've spend the $ on the benefits (which end up costing a LOT of $) only to have the nurse they bothered to train leave shortly after.

My new grad orientation was 4 months in the ICU.

I made about 5k a month that's 20k, plus my experienced nurse probably made 6k/month. That's much pricier. Plus benefits.

So it depends on the job.

[TheCommuter, BSN, RN]

I was actually soliciting a response from someone who doesn't agree with my point of view.

Hello, and welcome to the forums!

While I do not necessarily agree or disagree with you, I am simply going to bring up some points that perhaps you did not ponder in your original post.

1. Some new grads receive the $10,000 worth of training, only to be terminated at the end of their 90 day probationary periods due to an inability to grasp critical concepts. Although you seem like a fast learner and good thinker, some new nurses never seem to get the big picture and are unable to practice safely on their own after having been trained and fully oriented to the unit. Hospitals lose money on these new grads who do not last because there's no return on the initial investment.

2. Some new grads knowingly accept job offers in specialties that do not interest them with the ulterior motive of hopping to another job as soon as possible. Some new nurses receive the $10,000 worth of training, stick around for a few months, and quit as soon as they receive a job offer elsewhere for their favorite unit or specialty. This represents a loss for the hospital due to the lack of return on initial investment.

3. It takes time to become a good nurse because the new nurse is minimally competent and still learning. With that having been said, it can be argued that hospitals incur increased legal costs resulting from units staffed primarily with nurses who possess less than one year of experience. The newer nurse sometimes does not detect subtle changes in condition that the experienced nurse could spot a mile away. The lack of experience can lead to sentinel events, which results in lost money (read = lawsuits).

[andywolfe]

First of all I had excluded all the specialty nursing positions ie ICU, NICU etc etc. See the end of the first paragraph. I have been interviewed for an ICU position 3 times and all of those 3 places had the ICU training lasting for only 6-8 weeks!!!!. However, they were community hospitals and not a level I or level II trauma centers. Furthermore, I also excluded Versant residency program (which can last up to 6 months). I am baffled by the reasoning behind such a long training for med surge floors!!!!! I can understand the extended length of training for an ICU type position; but, not for a med surge position. Anyway, almost 80%-90% of the hospitals in US provide only 6-8 weeks of training for med surge unit!!!!!

Now lets talk about the so called benefits. I receive standard medical insurance. It will cost me around $60.00/month. I can get the same type of insurance in the market place for about $200.00/month. So they are paying about $140.00 more per month for insurance for me. So it comes out to be $1680 more that they are spending on the health insurance for me. For this spending on health insurance, the hospitals do get a substantial tax break also. So in the end they probably pay out of their own income about $1,000-$1,200 for insurance.

The dental and vision coverage is nothing to get excited about either. My out of pocket cost of vision plan is $98.00/year. I can go to wal-mart and get an eye examination and get glasses or contact lenses for about $300.00-$400.00 total. So the benefit I am receiving is worth only $200-$300.00. For the dental, the 1st $150.00 of bill is covered completely, The next $151-$500 of the bill, I get reimbursed at a rate of 80%, the next $501-$1,500, I only get reimbursed 50%. Finally there is a maximum of $1,500 reimbursement per individual covered. Therefore, both the dental and vision benefits aren't great either.

Again the numbers that the hospitals claim that they spent on training new grads aren't adding up!!!!!!! Also these benefits are also provided to X-Ray techs, monitor techs, secretary's, dietary, maintenance personnell etc etc. It's not like new grads are receiving some kind of gold or platinum benefits that the other employees of the hospital aren't receiving!!!!!

[TheCommuter, BSN, RN]

Now lets talk about the so called benefits. I receive standard medical insurance. It will cost me around $60.00/month. I can get the same type of insurance in the market place for about $200.00/month. So they are paying about $140.00 more per month for insurance for me. So it comes out to be $1680 more that they are spending on the health insurance for me. For this spending on health insurance, the hospitals do get a substantial tax break also. So in the end they probably pay out of their own income about $1,000-$1,200 for insurance.

Every time I have separated from a place of employment, I receive a notice in the mail with the option to continue my benefits through COBRA. The COBRA statements tell the truth about how much your employer is really contributing to your benefits.

Believe me when I say that the hospital contributes more than $200 monthly for benefits, especially if you have a spouse and/or dependents. Add more money if you have a pre-existing condition that would render you ineligible for benefits in the free marketplace.

I am a single female with no spouse or dependents, and one of my former employers was contributing $1,000 monthly toward my health insurance (Blue Cross/Blue Shield PPO) while I was paying $200 per month. The COBRA statement told me all I needed to know.

[BuckyBadgerRN, ASN, RN]

There are costs associated with running a business, lots of behind the scenes costs that you can't even begin to imagine. Why don't you straight up ask someone in HR about this "myth" and see what they can tell you? Present your figures and see if they agree with you or can pull out the numbers that will add up to what you've heard it costs to train a new hire.

First of all I had excluded all the specialty nursing positions ie ICU, NICU etc etc. See the end of the first paragraph. I have been interviewed for an ICU position 3 times and all of those 3 places had the ICU training lasting for only 6-8 weeks!!!!. However, they were community hospitals and not a level I or level II trauma centers. Furthermore, I also excluded Versant residency program (which can last up to 6 months). I am baffled by the reasoning behind such a long training for med surge floors!!!!! I can understand the extended length of training for an ICU type position; but, not for a med surge position. Anyway, almost 80%-90% of the hospitals in US provide only 6-8 weeks of training for med surge unit!!!!!

Now lets talk about the so called benefits. I receive standard medical insurance. It will cost me around $60.00/month. I can get the same type of insurance in the market place for about $200.00/month. So they are paying about $140.00 more per month for insurance for me. So it comes out to be $1680 more that they are spending on the health insurance for me. For this spending on health insurance, the hospitals do get a substantial tax break also. So in the end they probably pay out of their own income about $1,000-$1,200 for insurance.

The dental and vision coverage is nothing to get excited about either. My out of pocket cost of vision plan is $98.00/year. I can go to wal-mart and get an eye examination and get glasses or contact lenses for about $300.00-$400.00 total. So the benefit I am receiving is worth only $200-$300.00. For the dental, the 1st $150.00 of bill is covered completely, The next $151-$500 of the bill, I get reimbursed at a rate of 80%, the next $501-$1,500, I only get reimbursed 50%. Finally there is a maximum of $1,500 reimbursement per individual covered. Therefore, both the dental and vision benefits aren't great either.

Again the numbers that the hospitals claim that they spent on training new grads aren't adding up!!!!!!! Also these benefits are also provided to X-Ray techs, monitor techs, secretary's, dietary, maintenance personnell etc etc. It's not like new grads are receiving some kind of gold or platinum benefits that the other employees of the hospital aren't receiving!!!!!

[Nurse Kyles, BSN, RN]

I think maybe the additional costs can be from the additional certifications and training besides the preceptorship. I am a newer grad (dec 2011) on a similar step-down unit, and our orientation is almost double yours (10-12 weeks). This of course increases the price. Also there is a lot of additional education besides the orientation. I know I have 100s of hours of computer based training and many, many classes. These include Care of cardiovascular surgery patient, care of thoracotomy patient, ICDs, Pacemakers, ACLS, cardiac drips, etc. I cannot even remember all the classes I have done, and I have 4 in the next month. This is a big investment by the hospital, especially if the nurses do not end up sticking around.

This is a little off your subject, but... It kind of sounds like you are getting a shoddy orientation. I think it is alarming that you are handling the full patient load with almost no assistance after just one week on the unit, especially on a cardiac step-down unit. I would think working at a teaching hospital the training would be better.

[andywolfe]

This is the response to the posting by the thecommuter

"1. Some new grads receive the $10,000 worth of training, only to be terminated at the end of their 90 day probationary periods due to an inability to grasp critical concepts. Although you seem like a fast learner and good thinker, some new nurses never seem to get the big picture and are unable to practice safely on their own after having been trained and fully oriented to the unit. Hospitals lose money on these new grads who do not last because there's no return on the initial investment."

My take on this is that this probably happens to about 2-3 new grads out of 10 new grads. So from at least 7 new grads, the hospitals are making about $20,000.00 X 7 = $140,000/year. They loose about $30,000 from the 3 new grads that are terminated at the end of their 90 day probationary period; thus, the hospitals still make a profit of at least $110,000 from the new Grad RN position.

"2. Some new grads knowingly accept job offers in specialties that do not interest them with the ulterior motive of hopping to another job as soon as possible. Some new nurses receive the $10,000 worth of training, stick around for a few months, and quit as soon as they receive a job offer elsewhere for their favorite unit or specialty. This represents a loss for the hospital due to the lack of return on initial investment."

Well let see for my case I am unable to even apply to another position in the same hospital until at least one year after I am done with orientation. So this doesn’t really apply to me. Furthermore, job requirements for all other specialty areas in a different hospital do require a minimum of 6 months to 1 year of acute care experience. I won’t be able to find a job in another hospital for at least 6 months past my orientation. For those 6 months, I am saving the hospital anywhere from $7,000-$12,000. So even If I leave right at the 6 months mark, it will cost the hospital a maximum of only $3,000.00. Again I don’t know where the hospitals are coming up with this number of spending thousands and thousands of dollars to train new nurses!!!!!!! Furthermore, for every new grad that leaves the unit after 6-months, there is at least 1-2 new grad that is still working in the same unit past the 1 year point. So in the end hospitals aren’t loosing any money in this situation either since they are making at least 10k-20K per new grad that stays on the unit beyond the year, while, it’s only costing the hospital only 3K if a new grad leaves after 6 months.

“3. It takes time to become a good nurse because the new nurse is minimally competent and still learning. With that having been said, it can be argued that hospitals incur increased legal costs resulting from units staffed primarily with nurses who possess less than one year of experience. The newer nurse sometimes does not detect subtle changes in condition that the experienced nurse could spot a mile away. The lack of experience can lead to sentinel events, which results in lost money (read = lawsuits).”

Again this doesn’t happen as often as you are hinting. That’s the exact reason why I have malpractice insurance and the hospital is carrying malpractice insurance for the same exact reason. Furthermore, after re reading my post I didn’t find any place where I advocate for staffing a unit primarily with nurses who possess less than one year of experience. My post was mainly about this myth that it cost thousands and thousands of dollars to train a new nurse.