I am currently a Junior nursing student (I will graduating next year). I read posts in the New Grad section of this website & always come across people saying how difficult nursing is when you start out. I read their frustrations and I get worried because almost everyone states how they have panic attacks, dread going in to work, and feel like they have no support from the other employees on the floor.
I wanted to pose a question for new grads and the more experienced nurses out there. My professors bring up in class about how the 'patient' has changed over the years, and in class today, one prof. made a good point that "Only the sickest of the sick are in the hospital, and everyone else is at home". People today are experiencing more chronic diseases at a younger age.
Do you more experienced nurses (nurse for 10, 20, maybe 30 years) feel like you've struggled as a new graduate? Do you feel as though the conditions that patients suffer with have increased with difficulty over the years? And finally, if you didn't particularly 'struggle' working as a new grad, do you think that the increasing complexity of patient issues are overwhelming new grads today?
New grads, what are the factors at work that make you feel as though you are sinking, so to speak? What can you do to improve upon those problems, if they are under your control?
Is there any particular area (oncology, med-surg, ED, ICU, etc) that you feel specifically challenging and difficult?
Just curious. I would like to have an idea on the thoughts of seasoned nurses and new grads. Thank you in advance.:redbeathe
I've been a nurse for over 20yrs in LTC and I agree with all the other "experienced" (ummm euphemism for old?) patients are sicker, they're stay in the hosp is shorter also. When I started as an NA in "86" about 90% of our admits were ltc placements. We didn't do CPR. I don't think we even had advance directives back then. Now, that 90% has dropped down to, (this is just a guess) maybe 20%. Acuity of care is much higher, requiring more skilled nursing. I've taken care of res with eviscerated chest wounds from by-pass surgery, a 3rd day post-op triple A repair, even a 2nd day post-op breast augmentation Nursing itself has changed. When I first started as a nurse, we didn't have pulse ox machines, ppl got O2 if they were SOB or kinda blue around the lips. Hell we didn't even have O2 concentrators, we were useing the big H tanks. Heres something that will blow you new nurses minds.....when I started as a nursing assistant ( you did need to be certified back then) we didn't have gloves!!! The only place you needed gloves was in the dirty utility room to rinse out soiled linens. What we had were finger cots( think condom downsized to fit a finger ) we had glass thermometers, you put the blue tip ones in one pocket and the red tip in the other and about every 2 weeks a memo would go out for ppl to please return the thermometers because it never failed you always went home with some.
Part 2
I always tell new nurses....." There isn't enough money in the world to make me be a new grad again!" I believe your 1st year as a nurse will be the hardest thing you do in your career, harder then even school was. Yes, you have all this book knowledge, but now you have to apply it to your patients and that can be very hard to do. The one thing you can never be taught and probably the one skill you will need the most is experience. I never felt more stupid, more incompetent, i never cried more or doubted myself more then I did that 1st year. And yes some of us more experienced nurses can be a major PITA to new nurses. But it doesn't help when you get a new grad who comes in tooting their own horn because they graduated in the top 5 or 10 in their class, or being told " We never were shown that!" I hear that one alot and its on basic nursing skills like giving a supp. There has been a time or two when we thought we should call the college and give them some feedback on how well we think they are preparing the students. Or have them come off of 6 wks daytime orientation and be unwilling to give report untill the've seen you do it. I mean come on, report is report no matter what shift it is. I'm not saying that new nurses should let us walk all over them, but don't sit there like a bump on a log either. This is an age old debate that will most likely never be resolved untill they day comes when all of us realize that we need each other.
Sorry if i rambled and i hope i made as much sense in writing as i do in my head LOL
I have been in long term care for 15 years+ and I love it, but.....in the last five years the level of acuity has increased amazingly. I have especially noticed this in the last year or so. My new admits are no longer little old ladies [or gents] with dementia or general failure to thrive. The vast majority, at least 90%, are very fresh surgical pts or even worse extremely demented with psych diagnoses on top of the dementia. My case load is no less, but my work load is a lot more! Not to mention the ever expanding charting and other paperwork requirements. I spend a lot more time on the computer than I used to, and this combined with the higher acuity level of patients makes for a sometimes challenging shift. It use to be that long term care was considered a great place for new grads to gain experience, not so much anymore. In the past year only 2 of the 10 or so new RN grads we hired lasted more than 90 days, and those 2 had long term care experience as either CNA's or LPN's prior to working as an RN, the others all found the level of responsibility overwhelming. Not to mention orientation for new staff leaves much to be desired, hospital orientation is much more thorough...new grads in a hospital are not "thrown to the wolves" nearly as fast as they will be in a LTC facility.
In order to begin to influence nursing care, a restructuring of formal nursing curricula is necessary. The difficulty of trying to develop a clinical curriculum based on academic theory that must be successfully combined with clinical skills training and practical know-how is huge with so many mitigating factors.
You make it sound like this is some impossible dream that no one has (or is likely to) figure out. My diploma school did this v. successfully, and turned out well-educated grads well-prepared to enter practice, for over a hundred years (until it closed several years ago). So did plenty of other diploma schools. IMO, we have "thrown the baby out with the bathwater" in many ways in nursing education. We had a good system, but, instead of capitalizing on the strengths of the old model and working together to improve and update its weaknesses, TPTB in nursing were bound and determined to move nursing education into colleges and universities and marginalize and dismiss diploma programs. I've continued my education beyond my original diploma program (BSN and MSN) and have taught in both ADN and BSN programs over the years, and my own observation is that, in general, my classmates and I got a much better nursing education than most ADN and BSN students are. Don't get me wrong -- I'm a strong advocate of higher education in nursing; I just have a problem with how most nursing curricula are put together these days.
i would love to have the opportunity to get the information and do the research the night before. my school does not allow this. they want us to show up and assign patients right then and we're expected to just run with it. we usually can't even look at our textbooks before doing the initial assessment and charting it because of the timetable that they want us to follow.
wow!! i find that amazingly awful! how do you poor students get the chance to actually learn anything when you are flying blind from jump? when i was in school [not quite the dark ages though it feels that way sometimes] preparing for clinical s was required. if we weren't 100% prepared to face our patients with a plan of care in mind we were not allowed on the floor. this was enforced by extensive questioning by our clinical instructor prior to the start of our shift, and you better be able to rattle off the correct answer or convince her you would find the right answer by the end of your shift. if you didn't report back with a correct answer by then you were off the floor for your next clinical. since there are only so many clinical days you could miss, this was pretty stressful to say the least!
wow!! i find that amazingly awful! how do you poor students get the chance to actually learn anything when you are flying blind from jump? when i was in school [not quite the dark ages though it feels that way sometimes] preparing for clinical s was required. if we weren't 100% prepared to face our patients with a plan of care in mind we were not allowed on the floor. this was enforced by extensive questioning by our clinical instructor prior to the start of our shift, and you better be able to rattle off the correct answer or convince her you would find the right answer by the end of your shift. if you didn't report back with a correct answer by then you were off the floor for your next clinical. since there are only so many clinical days you could miss, this was pretty stressful to say the least!
WOW!! I find that amazingly awful! How do you poor students get the chance to actually learn anything when you are flying blind from jump? When I was in school [not quite the dark ages though it feels that way sometimes] preparing for clinical s was required. If we weren't 100% prepared to face our patients with a plan of care in mind we were not allowed on the floor. This was enforced by extensive questioning by our clinical instructor prior to the start of our shift, and you better be able to rattle off the correct answer or convince her you would find the right answer by the end of your shift. If you didn't report back with a correct answer by then you were off the floor for your next clinical. Since there are only so many clinical days you could miss, this was pretty stressful to say the least!
We went in to clinicals with no prior assignment/prep our last semester of my diploma program. At that point, we were assumed to have gained enough knowledge about a variety of diagnoses to start the day fresh, like a "real nurse". However, up until that point, we did the traditional night before prep work.
And yet... being 100% prepared before taking a patient can also contribute to education-practice gap, no? Nurses *do* have to able to provide safe care without knowing every last thing about a patient and their condition backwards and forwards from initial symptom onset, to all of the latest possible treatment modalities.
New grads feel like they are being irresponsible and just plain *bad* nurses if they accept care of their full workload when they don't know just about everything about each patient from the first hour of care! New grads/students may also bring this attitude towards the experienced nurses whose competence as a nurse may seem brought into question when the precepting nurse can't or won't explain everything backwards and forward about each patient/condition/treatment to the student/new grad.
I can definitely agree that in depth prep the night before is very good place to start and helps set a foundation for students. But students also need to prepared for the fact that they will have to deal with situations in real time when they don't have all information right at hand.
From my first semester, we went in cold. You arrived 30 min prior to shift change, got your patient assignment, went directly to chart review, then MAR and morning meds review. This was to be done prior to shift change. When your on-coming nurse arrived, you intro'd yourself and went to report with her, also taking report. Then you met your instructor in the med room and were drilled on all of your a.m. medpass. You had to know all about the drugs and why the patient took that drug without notes. Then your instructor watched you do your med pass. Other care was done with the RN - you watched/helped till most care was completed. You got another look at the chart if you were quick for more labs/tests etc. and that night you needed to produce a very large careplan usually all diagnosis, then top 4 flushed out with 5 or so interventions and rationale, etc. also pathophys write up.
Other semesters, you hit the floor with your assignment and found your nurse and then you were on your own just as a "real" nurse pretty much. You had been assigned a EPIC or whatever login and you documented everything (eg. full assessment, rounds, scanned meds, IVs etc.) If you had questions, you found your RN, or maybe instructor. I remember some places keeping access limited for narcs (you needed an RN to pull/waste and watch admin). Also as a student you could not enter new orders or take an order for any action from an MD of course (tho they'd try to give them to you). Your RN or instructor was required to electronically sign after you on your documentation. Time was an issue, your instructor would be somewhere else monitoring your electronic charting, and could see if you were late... then you had better have a reason why... all this went for medsurg, but if you were in a specialty like LD or ICU - you stuck with your RN, but did do just about everything possible for you to do without being dangerous to the patient.
The hospital I work at now offers a 12 week preceptor program. But what I see is that nurses here are forced to fixate on customer services areas - offering, blankets, pillows, coffee, tea, catering to visitors and chit chat instead of focusing on excellent, knowledgeable medical care. If customer service surveys aren't perfect they get repremanded. Hey its a hospital where exceptional medical care should be practiced not a 5 star hotel with smiling, yes sir puppets work. These nurses are frustrated because they want to do a good job attending to their patients medical needs instead of their social needs. I am not saying I am against answering questions, calming anxious or scared patients and families, but that is not the case here.
The biggest difference I see for new grads at present is the lack of experience they recieve in school. Of course I am a "dinosaur" and graduated from a diploma program in 1979. How can you go from working short 4 hour shifts a couple of days a week for a couple of months to a full time nurse working 12hr days? These poor kids really have no idea what is expected of them!
I agree with the statement that patients are sicker. More knowledge and diagnostic tools are expected of nurses today compared to 30 years ago. I see a certain lack of work ethic in many new young nurses. They don't expect to have to work hard and don't volunteer to help. They certainly will help if asked, but have to be asked.
Nursing is very, very different today than it was when I first started in 1979! At that time we all wore our caps, our uniforms were white dresses and we wore stockings. When the doctors came into the nurse's station you stood and gave him your chair, you followed him on rounds and carried the charts for them....and I said him because a female physician was rare. After graduation I quickly left floor nursing and started a long career in out patient hemodialysis. After 12 years of being a stay at home mom I returned to dialysis. I switched jobs 4 years ago and returned to the bedside in ICU. At 48 years old I was doing inpatient care for the first time in 28 years. Kinda like a new graduate with a lot of experience. I was helped by having "life" experience and knowing how to deal with people. My co-workers were great to me and my orientation was 6 weeks long. The last 4 years have been some of my best experiences in nursing.
I am not one of those nurses who "eat their young"! I want new nurses to succeed. I just want them to work as hard at it as I did and continue to do! :)
Specializes in Emergency, Internal Medicine, Sports Med.
I am a relatively new grad- got my BSN in May 2010.
I work in an ED. I don't find it to be all that difficult or overwhelming, although I taught CPR and other lifesaving courses before entering nursing so I somewhat already had the "A-B-C" ingrained into me. I find in terms of team support it's different where you go, and although I think *certain* older nurses eat their young, I also think a lot of younger nurses have a really bad attitude towards others.
I am 29, for reference sake. Nursing is my 2nd career. Before nursing, I was had a fast paced job which involved not just multitasking behind a desk- but physically being at 10 places at once. I became very good at this- prioritizing. I discovered that certain life skills are applicable across the board, not just nursing. So if you have any other experience, not necessarily in health-care related jobs but with similar skill sets, it helps a lot.
My biggest eye-opener has been not the nursing job itself, but the politics behind it all. There was no class that could of ever prepared me for THAT. The job I can do, but sometimes it's not all that simple/matter-of-fact.
I will however say this: I got my BSN in Canada, and have since moved to WA state. I live close enough that I continue to work in Canada as I landed basically my ideal job straight away, full time. The job market in WA is not the greatest. Be prepared to travel for a good offer, if you get one.
I will also say that the entire dynamic of health care in Canada is different. There is much less of this "cater to the family" that I read about here. Don't get me wrong, I do consider family and etc...but in terms of treating it like a hotel or whatnot, I am fortunate enough that I don't deal with that. I also do not have any fear of being reported. We have a strong union but moreso a strong team in the emerg and I know the manager would support any of us before repremanding actions (it helps to have an older nurse x 25 years as the manager).
I think new grads nowadays may be older then new grads of 30 yrs ago. They may have kids, a spouse, etc- whereas a lot of older diploma programs would be virtually impossible to complete for this demographic. Having these experiences and being older gives different life skills though. I am finding certain older nurses approach my direct entry to the emerg as "not having paid my dues" and having bypassed learning time management skills. These skills come in many shapes and forms...in life.
To me, the thing that got me through my first two years of nursing was always thinking "You could be landscaping". lol
Sad but true.
Yes, patients have changed. They see the cost of hospitalization and want a fair return for their investment. Its not there most of the time. Why? Thats a whole other thread. I think patients have been upset for a long time now, but only recently has the power to voice said frustration been handed to them.
Hospitals and the medical field as a whole had its nose in the air, felt it was "recession proof" and "you can live without the sports car and cable, but if you are sick, you don't have a choice but to get help and go to the hospital" attitude.
During this past recession, we found out we were wrong. The general public said "BAH" to overpriced medical care and stayed home. Now we are scrambling to become "service oriented". As we have our finger on the panic button and seek the same thing other businesses have understood for decades, some patients take advantage.
DF-LPN
72 Posts
Part 1
I've been a nurse for over 20yrs in LTC and I agree with all the other "experienced" (ummm euphemism for old?) patients are sicker, they're stay in the hosp is shorter also. When I started as an NA in "86" about 90% of our admits were ltc placements. We didn't do CPR. I don't think we even had advance directives back then. Now, that 90% has dropped down to, (this is just a guess) maybe 20%. Acuity of care is much higher, requiring more skilled nursing. I've taken care of res with eviscerated chest wounds from by-pass surgery, a 3rd day post-op triple A repair, even a 2nd day post-op breast augmentation
Nursing itself has changed. When I first started as a nurse, we didn't have pulse ox machines, ppl got O2 if they were SOB or kinda blue around the lips. Hell we didn't even have O2 concentrators, we were useing the big H tanks. Heres something that will blow you new nurses minds.....when I started as a nursing assistant ( you did need to be certified back then) we didn't have gloves!!! The only place you needed gloves was in the dirty utility room to rinse out soiled linens. What we had were finger cots( think condom downsized to fit a finger 
) we had glass thermometers, you put the blue tip ones in one pocket and the red tip in the other and about every 2 weeks a memo would go out for ppl to please return the thermometers because it never failed you always went home with some.
Part 2
I always tell new nurses....." There isn't enough money in the world to make me be a new grad again!" I believe your 1st year as a nurse will be the hardest thing you do in your career, harder then even school was. Yes, you have all this book knowledge, but now you have to apply it to your patients and that can be very hard to do. The one thing you can never be taught and probably the one skill you will need the most is experience. I never felt more stupid, more incompetent, i never cried more or doubted myself more then I did that 1st year. And yes some of us more experienced nurses can be a major PITA to new nurses. But it doesn't help when you get a new grad who comes in tooting their own horn because they graduated in the top 5 or 10 in their class, or being told " We never were shown that!" I hear that one alot and its on basic nursing skills like giving a supp. There has been a time or two when we thought we should call the college and give them some feedback on how well we think they are preparing the students. Or have them come off of 6 wks daytime orientation and be unwilling to give report untill the've seen you do it. I mean come on, report is report no matter what shift it is. I'm not saying that new nurses should let us walk all over them, but don't sit there like a bump on a log either. This is an age old debate that will most likely never be resolved untill they day comes when all of us realize that we need each other.
Sorry if i rambled and i hope i made as much sense in writing as i do in my head LOL
Dee