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andywolfe 1,159 Views

Joined: Sep 13, '12; Posts: 28 (64% Liked) ; Likes: 50

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  • Oct 22 '12
  • Oct 16 '12

    NOTHING compares to living in northern california... the "higher $tandard of living" is balanced by a higher standard of living - i can't be convinced otherwise.

  • Oct 16 '12

    How can one describe it? Nursing in my non-union state was always frantic and non-fulfilling because there were just too many tasks and not nearly enough time.

    Nursing in California was, "Ahhh, now this is how it's supposed to be. I get it now. I can function as a professional and not as a harried person."

    Unions work.

  • Oct 16 '12

    Which is why I will never work outside of California as a nurse. Taxes ARE high and housing IS high, but I think if you live in the right areas, the salary still offsets it. Esp the nurses doing crazy OT out here. Hope you can come back!

  • Oct 16 '12

    I don't get when nurses say they hate unions. Yes they are not perfect, but without them who is there to protect us? I WISH I was with a union.

  • Oct 16 '12

    Quote from VickyRN
    One of the top financial executives at a very large integrated health system in our vicinity told our nursing faculty (during a seminar on new graduate nurses) that it costs his organization between $40,000 and $60,000 to adequately train one new graduate RN. I think this executive would know. He had no reason to lie or skew the figures to us.
    Someone told him that, I'm sure, but the difference between $40K and $60K is pretty large. Which one is it? Asking him to break down the cost probably wouldn't elicit a specific answer.

    The post by NRSKaren is informative, but it also includes things that would have to be paid anyway. Also, it sounds more like the cost of a residency program, which most hospitals do not offer. To me, one needs to look at the cost for when the new grad is not included in staffing and those expenses associated with classroom work and orientation that are specific to a new grad, i.e. not provided for everyone who is hired.

    --The preceptor would be paid, regardless of having a new grad to train or not. Where I work, precepting does not get a differential. Why is that included in the cost of training a new grad?
    --Benefits and taxes? Only during orientation. As for myself, I was probably the cheapest new grad around as my husband carries all benefits. Plus, at a lower hourly rate of pay, the taxes are lower on a new grad compared to an experienced nurse.
    --That $10K indirect cost? What is that?! That's nearly 10% of the total calculated, without one iota of specificity.

    Other people are mentioning the liability to the hospital for new grads. I have to wonder about that because liability insurance for first year RNs is considerably less than the renewal premium in the second year. The professional liability actuaries can't be wrong in determining that there is actually less liability for a new grad than for a more experienced nurse. They are literally banking on it.

    Although the attitude in the OP's posts rubs me the wrong way, I have to agree with him. (Just because I don't like someone doesn't mean they are wrong!) Some people are deriding his posts based on his tenure as a nurse. His months of experience in nursing have absolutely nothing to do with how valid his opinion is on this topic.

    If you read the first year after licensure section, most new grads have 6 to 8 weeks in acute care. I would agree with him that length of orientation is the rule, not the exception. Residency programs are the exception.

  • Oct 16 '12

    I know lots of you would not like to hear this stuff because it makes you sad. Healthcare is a pretty sleazy business, and it matters not how old you are when you realize this. Matter of fact, if you've been in it for years and you still don't know ...I gotta wonder about you just a bit.

    It's easy to lie to a group of people who don't ever want to acknowledge that they fit the description of the type of person who is easily targeted.

    Guys, MOST of what you've been told has been heavily spun just for your little ears. Heck part of what I used to do for a living was help promote spin for your bosses or anybody actually. Basically a lot of you are similar to a group of kids who still believe in the Easter Bunny, actually - much to the continued pleasure of everybody I used to work for.

  • Oct 16 '12

    About the insurance thing, I also am a second degree nurse. I have worked extensively in the corporate world, long ago had cobra for a while after a lay-off, have had my own business for many years and purchased my own health insurance for years and used it in a serious way (had major surgery) while on it. While taking my prereqs for nursing, I did all interactions regarding insurance for a private practice. I have dealt with congressional contacts to force insurance to honor contracts. Yes, it's funny about how it's only about who you know ...suddenly things are different.

    So, I am an authority on the subject.

    Look, the whole insurance industry (like most other businesses) will set prices randomly - what ever is in their best interest. Usually those (corps) who they know can pay more, will. Yes risk is a factor, sure, but it's just really about how much they can get. Lets be simple about it, because it is. Same with "the rules" regarding policy, it's a dirty business.

    Also OP, the whole orientation thing is often a joke. Sure it is for most orientations. Some hospitals (very few, a handful) actually do have extensive educational resources that are dedicated resources for nurse orientation and continued training. There were more of these years ago. Pretty much, I'd say nurses are the bane of any hospital's existence. Nobody wants to pay us. Administration can't sleep at night because they just ruminate on how great it would be never to have to spend another dollar on nursing.

    I liken it to the olden days where new settling farmers out west on the prairie had a gazillion kids. If they couldn't have kids they bought poor orphans from the east and had 'em shipped out for labor. You didn't have kids for the love of them, you had them as free labor. These kids were of course, constantly reminded of the burden it was to train and feed them. This even though the farm would not exist without their hard work. The cattle however, were treated better as money could be made from them ...nurses are treated like they should be grateful for the crumbs they get. I see no difference.

  • Oct 16 '12

    I'm going to echo the "so what?" sentiment. Yes, orienting a new nurse is an expensive investment. Not something everyone doesn't already know. I remain flabbergasted any employee thinks they have to "pay back" their employer for the cost of orientation.
    If I find a better job offer that works better for my life, I'm giving two weeks weather I've been off orientation for two days or two years. We have to do what's best for our pocketbooks. Employers lay off employees at the drop of a hat if money's tight. Remember, theyd fire us all and replace us with minimum wage techs in a heartbeat if they thought they could get away with it. To THESE people
    we are obliged to pay anything back??? I think not.

  • Oct 16 '12

    This post hits home, especially after my shift last night. I picked up a 4 hr shift to give myself 40 hrs this week. We walk in to 12 pts and they gave us 3 nurses, a tech and no unit secretary. One of the nurses was charge so she is not supposed to take pts until after 2300 so she can get the chart checks done along with all of the other charge duties....well that didn't last. We wound up with 3 admits back to back...and without a unit secretary, we were there trying to get our patients taken care of and assessed plus putting in orders on new pts because our hospital has not started physician order entry yet I wound up staying until 0100 to help them catch up. This is beginning to be a typical shift. I love what I do, but I worry that with all the budget cuts, that this is the new normal and it's scary. It is not safe, not for us and not for our patients.

  • Oct 16 '12

    The way it is in Ohio, is the way it is in most states. There are more Ohio-ish conditions than there are California - ish conditions. As long as nursing keeps letting employers get away this, the employers will. That is the real business philosphy. The rest of this "stick up for business, that is the way it is, ADIET, customer service, CEO needs money to run business, the poor booh whoo nursing managers( get out the violin) and what those poor creatures go through has paralized nurses. It has clouded most of our thinking - which is what it is designed to. And when that doesn't work- threaten and intimate them. There one thing managers hate - a strong independent well informed smart nurse. That nurse becomes a threat and out the door they go. That's how managment gets away with this and keeps it submissive culture going. It's called " keeping the nurse in their place" Insults and mud is flug at the nurse who speaks out in the hope managment can publically humiliate that outspoken nurse into shutting up. look at some of these kinds of advisarial posts on AN and who makes them. Over most of our states- management has a nice little financial playground for themselves. The bedside nurse is being worked like dogs while managment reaps the financial rewards of your slave labor.

    Many years ago( in the late 1980's- early 1990's and we had a nursing union) I can remember a nursing supervisor saying to us, after negotiating one contract when our nursing salaries began to increase, "You staff nurses are making more than us managers".
    Managment has been on the warpath since then.
    The more we drink management's kool-aid and roll over and play dead like good little nurses, the more harm we do to ourselves.

  • Oct 16 '12

    Also, getting into a hospital's books isn't going to happen. Even a good number of those in upper mgt don't know what the controllers know about how funds are used and moved around. You'd have to get some hard and accurate (manipulation-free) data from the controllers. Yep. Like that is going to happen.

    You can't just look at what some tell you or what hospitals say. Hospitals are businesses, and business have internal as well as external PR mechanisms running all the time. So, you have to look at WHAT they DO. Follow the patterns. Sometimes you have to force your eyes open, even if it is in the midst of a sandstorm.

    With the churn-cycle of nurses, for example, I mean, what some hospitals were doing did NOT make sense--that is, until we observed the pattern many times over and figured out what the benefits were/are to the hospitals. The uppermost administration know and so do the financial controllers. I mean they are the ones doing the financial accounting.

  • Oct 16 '12

    Quote from 8mpg
    I feel like there is a lot of ignorance by the original poster and he just wants to be right. To take yourself and compare it to the rest of the nursing population is not a good idea. Just because you are a healthy 28 year old, that doesnt mean every other nurse is. My fiance is 27 and her previous policy that went Cobra while switching jobs was $800/month. Her current employer pays $700/month and she pays nothing out of pocket. Cobra insurance numbers are not made up.

    Your example of 6 weeks of training is a very low figure. My hospital does 10-12 weeks for most new grads in easier departments such as med/surg. Our critical care staff is 16-20 weeks. They also have to farm out some of their education to other hospitals as they dont have the full critical care educators in house. Combined with turn over rates, healthcare, 401k, taxes, etc. the company can spend $15-20k easy.

    They seem to make it work to their advantage, financially speaking. I don't think people are looking at all the fiscal data compared with the PR benefits related to the choices they make. There's more to this than meets the eye.

    I am willing to bet that in most cases, the upfront investment is minimal, and the years of using, say, nurses with less experience at cheaper rates, or using the "churn-cycle" works out for their bottom line right now. It may well not be so in the future, but that depends.

  • Oct 16 '12

    At my facility and unit, everyone has the same orientation period (the probationary period) and orientation classes, regardless of experience status. It can be argued then that experienced nurses cost more to orient than new grads at my facility.

    The claim of $60K or more for a new grad never sounded accurate to me either.

  • Oct 16 '12

    I don't buy that orientation is outlandishly expensive necessarily. Compared to many years ago, many things are loaded in systems so that new hires can go through the material via Intranet. This saves the class time and paying wages per hour for sitting in a classroom. Yes, somethings still require a classroom, but a lot of it has been cutdown.

    Insurance benefits are an issue, and it a HUGE part of the hiring freezes and moving from FTE to more PTEs in many hospital over the last several years. Still, if you hire someone, in most cases, you have to provide health benefits packages. This is part of the employee's compensation. But what I've seen places do is constantly rotate people through orientation and eliminate them right at the 3 month mark, when the benefits kick in. Why do that? Well, if you are Magnet and/or looking to become Magnet, you are looking like you care about safe staffing ratios and so forth, but you are making no commitment so to speak. Also, you can still give your preceptors patients while also giving the orientees patients, and after three months, get a new hire and continue with the cycle-supply. I have seen hospitals do this where they staff so many FTEs, PTEs, per diem, some % of travellers, and then they do the ole rotate new-hire RNs through--and it equals about the same time the travellers are contracted. When you have seen the pattern over and over again, it's hard to miss, and you know you aren't making it up.

    There's a lot of stuff that goes on that no one really talks about.


    About the cost of orienting, it may vary; but suffice it to say most places have really peeled those costs back.

    Sadly, nurses are too often treated as disposable units. I mean, as they say, it is what it is. If you work in or with a place that genuinely values you and sees each individual nurse as important to the whole--where you get the love, so to speak, consider yourself REALLY fortunate. I don't think you will see a lot of places trying to at least "appear" that way again until there is a very desperate need for nurses or unless they are trying to receive some kind of PR, advertisement, or recognition. Of course, my loyalty would go to the places that maintained the love in spite of the economy and current dynamics. Finding such places now is like finding a real diamond or bar or platinum on the beach. The one's that are genuine will be functioning this way no matter what, b/c the commitment is truly built into and throughout their values and ethics. It's not just something they say or put on paper. This is determined, more times that not, by the kind of ethos in leadership and administration. If the bigger leadership will not support a CNO in making such a commitment to values and ethics, that CNO will not be at the institution for very long. Well, CNO's get a nice salary, and so too often they go with the admin b/c of the money and title. It's about real integrity though, and integrity can cost you money, power, support in networking, etc. This is why I'm not so quick to judge anyone that has been "let go" or fired. Not fitting into the culture can, often enough, mean you don't play their games--leadership's games are at odds with your integrity--and this kind of thing can be an issue from the lowly staff nurse, all the way to the CNO.


    OP, sorry you had to move; but given the overall state of California, as pretty a state as it is, right now you may be much better off.

    Oh, also, you are right. As a newer nurse, you are cheaper than a veteran nurse--and this is also part of the reason veteran nurses aren't getting jobs if they left the field for a period of time. If they put an "internship" type program in place, they can still save a lot of money. They run it once or twice a year. In the internship, you may not be entitled to various raises, however small. The new grads that aren't getting jobs need to understand that if they aren't getting positions over experienced nurses that cost more, the spaces for FTEs are mega-tightened at the particular institution--b/c they are being told to limit hiring, especially of FTEs.

    And all these companies and hospitals are waiting to see how hard the changes in healthcare coverage are going to hit them. As the economy continues in the current state, businesses will continue to limit hiring and other expenditures. But I fully expect that as more positions open up, a good percentage of them will be filled by new grads, specifically b/c they are cheaper.


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