New Grads Today v. New Grads From Years Ago

[sj73201]

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

[ddv106]

Hello,

What you are feeling is just normal. When I graduated 35 years ago, our instructors told us to go out and take a private duty case on the 11 Pm to 7 am shift. Then they said contact one of them in the morning. Well I did. I had a major headache from severe fright. I just felt so scared. The case I had must have had 20 IV piggy Backs in 8 hours. It was a teaching hospital in NYC. The interns and residents all wrote orders and I look back now and know they did not read what the other one wrote. When I called one instructor in the morning, I told her that I really questioned if I would make it. I actually told her I stunk at being a nurse. She laughed so hard on the phone. I asked her what was so funny. She said don't worry, as long as you are aware of what you don't know and will seek out the answer, you will be fine. At that time, I wasn't sure what she meant, but as time went on, I questioned everyone from the housekeeper up to the supervisors. I wanted to know all the ways everyone did everything. I have beed told that I am great at what I do. Patients, families, co-workers and yes, even Doctors, compliment and praise my work.

The complexity of the illnesses these days make it harder coming out of school with just the basic knowledge. It is not easy. Too many people don't have access to health care for many reasons. They are coming into the hospital sicker than ever. Nurses have to use everything they can to do a good job. THEY DO!!!!

In my teaching days, I always advised my new Nurses to go and work on Med-surg first. Get a solid ground under your feet. Everyday of my Nursing life, which is approximately 12775 days or about 120,000 hours, I learn something every day. And if you haven't seen by now, I try to be funny and laugh with counting the days and hours. I love funny movies, comedy central to have a deep laugh from the gut. And while talking about gut, I have said over all these years listen to your guts, they will start talking to you. If a thought crosses your mind, don't ignore it. Follow it up. Sometimes it is giving you an answer to something you weren't sure of.

Go into specialty areas after you have some solid nursing skills under your belt. That includes Long Term Care. I think someone mentioned that in one of the responses. Geriatrics in Long Term Care has become very specialized as the population ages into the 90's or more and we see different conditions and diseases that are new to them.

You will have more stress if you don't have enough skills and are ill prepared to do the task at hand. Find someone who is willing to work with you and teach you. There are good and bad out there as far as sharing knowledge. The nurses who are the most confident will be the one who will be less threatened by your questions. So feel them out before you approach them with a question. I always pose it this way: I see you doing such a good job, and I don't have your knowledge yet. Would you mind showing me how you do it? I also use this when I question doctors on orders. I say, Doctor, this is something new to me, would you mind sharing the procedure or reason so I can learn for the next time. This way no one feel threatened. Then doctors might also change their mind because of what they were telling me. That was the real reason I asked them to tell me because my guts might have been saying something.

I wish you well and I hope you enjoy nursing as much as I do. Look at the positive, associate yourself around positive people and laugh.

[LUNETUNES]

Hi,

I am practicing almost 30 year. It is very often and common to feel completely overwhelmed with ALL the new tasks & responsibilities as a new nurse, IF you are serious about caring and doing your job to your greatest ability. There is great stress, and expectations on many levels to do our best, the safest, fastest, most courteous and efficient manner, and it doesn't always work out, no matter how hard we try. So many circumstances can distract us. Families, doctor's orders, calls, patient status changes, procedures, etc.

Many of the patients today, are much higher acuity than of years past. There is so much done outpatient, and before people can afford to or take the time to go to the doc, or for the doc to admit to a hospital for a covered need. There used to be a balance of what we called, "walkie/talkies". Patients who were admitted for tests, self care, and less physically demanding, that balanced our much sicker and needier patients. Now, most are of the latter standard, by the time they are admitted.

And with so many discharged, often too soon, they are repeat offenders, and weaker than if they stayed longer the first trip, to be really ready to go for good.

We share a profession with people, that allows us to touch patients, families and coworkers in deeper ways than most ever share in their daily lives. We see people at their most vulnerable times, patients and families, and we need to stay professional and strong and supportive and focused to deliver the greatest care.

There is less support than ever in our units, or in most cases of management....and that adds to the stressors....AND, not enough seasoned nurse preceptors are willing or desiring to teach our new nurses, nor do most new nurses, make themselves available to be taught by the seasoned nurses ,we welcome in to the field of caring....it is a beautiful thing, when you are comfortable in your own skin, and know the valuable effects you can have as a NURSE, on many people!

[beavetron]

I am a new grad who has been on the floor for a little over 4 months, I work on a high acuity telemetry stepdown unit. By no means is it easy every single day and when one peer is having a bad day it tends to rub off, but I find that as long as you do what you need to do without having to be asked it gets you through the day without a glitch. Just remember to always use your critical thinking, have confidence in yourself and when you don't know something, ask someone reliable and approachable. And if you're feeling constantly swamped and behind, talk to someone higher up and let them know whats going on.

[kbrn2002, ADN, RN]

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.

Boy I can agree with that! The prep for clinicals sometimes took longer than the actual clinical day. I really think the main reason survived and thrived is I was fortunate enough to work as a nurse tech through school, started right after my first semester. I can honestly say I learned way more practical knowledge working than I did in the school setting. Combined with the extensive "book learning" I got both sides of the education coin at the same time.

[cjsbaskets]

It certainly is much harder today than years ago. When I started in 1965 I was the only night RN on a 40 bed unit. But there were patients there for their pre-op work up, the 5 day post hernia, and of course those patients who came in to get tuned up! Of course none of those patients are even admitted today. Now you must care for patients with multiple complex problems that will have minimal hospital time. But the bottom line is good team work. Everyone working together for the best interest of the patient. I believe that there is a special place in hell for nurses who "eat their young" as well as a special place in heaven for those who help, teach and support the new nurse.

[ddv106]

To all,

Something I heard thought all of you would enjoy. When Nurses get to heaven they are welcomed by St Peter and pass right through gate. So there is a spot there for all of us for all that we do. We do many things without any thanks or acknowledgement. We do it with love, caring, and smiles (most of the time). This is our life and for most of us our love to help people.

We have also been voted most trusted and respected profession for many years.

Try to remember each day to tell a fellow nurse and aide, you are great.

To all of you out there, YOU ARE GREAT!!!!!!!!! Hugs from me:>)

[livelaughlove09]

This is such a painful subject, for everyone involved. The older nurse think the newbies are dumb, the new grads think the older nurse eat thier young...etc.

Here is my take.

Hospital pt.s are sicker than ever before, what is now delineated to be MS was an ICU pt. 2 years ago.

New nurses are woefully undertrained. I have seen AS seniors walk onto a unit prepared to do nothing except "shadow" a nurse with a "really interesting renal pt." Why? The student has no clue, except that it's what her instructor said.

What happened to before the shift assignments, students doing research, reading and coming fully prepared to take care of a pt., including knowing his dx, meds, scheduled tx's and labs, as well as having a clue as to WHY they were ordered?

If you don't have practice RN scenarios, how well can you function in the real world?

THIS is why new grads are resented, and THIS is why new grads think older nurses eat their young.

We have certain expectations of you, newbies, and YOU think we are "mean" when we look at you crossseyed when you tell us, "Oh yeah, that wound has been bleeding all day, but I just reinforced the dressing 4 times."

Are you serious? Don't all schools do this? I have to do all of this research you mentioned, care planning, concept mapping, lab analysis, memorization of the meds, plus any hospital policy and procedure that goes along with anything the patient has (chest tube, picc line, G tube, trach, etc). We also have to know diet, why they're on that diet, what foods to include or exclude, explain the steps of any procedure they have (even if it's not a nursing function, such as write out the procedure for picc line placement, or what goes on in a total knee replacement surgery) and all the pre and post nursing care and any complications that may arise. We also have to explain the steps of all the diagnostic tests. I can't tell you how much I loathe repeatedly writing the explanation and pre and post nursing care of an x-ray, although some of the more complicated things I've never seen before I do enjoy reading and writing about. But seriously, how many times do you have to explain what an x ray is? Then you better be prepared to answer any and all questions the instructors have on your patient and what you're going to do and why you're going to do it, because if you don't know, you better find out really quick like...or go home.

[livelaughlove09]

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'm so glad to see someone giving props to diploma nursing schools. I attend a very reputable diploma school of nursing that has been around for 100+ years. It's discouraging when people ask me what kind of degree I'll graduate with and I tell them a diploma and they ask questions like "oh so you'll be a nursing assistant" (or medical assistant, or fill in the blank here). Some people ask me what kind of nurse that will make me. An RN...is what that will make me. From what I hear from the nursing managers in the hospitals that I do clinicals in, a well prepared new graduate nurse. We always hear people saying that they love our grads because they take less time and effort to orient and precept. I have no delusions of grandeur about graduating and knowing all there is to know about nursing, I know that it takes years of experience to become well rounded in the clinical area, and I'll be scared to death as a new grad, but I also think I'll be more at ease having spent so much time in the clinical setting. This semester my clinical hours are more than twice the classroom instruction hours. I don't begrudge the BSN students, or the ADN students, but I really don't see much difference between the curriculum I am taking vs. the ADN student, so it's especially insulting when ADN students or even nurses with their ADN turn their nose up. I am planning on pursuing my RN-BSN starting in January of next year, but I almost feel like the reason behind it is mostly pressure from the stigma.

[OCNRN63, RN]

I'm so glad to see someone giving props to diploma nursing schools. I attend a very reputable diploma school of nursing that has been around for 100+ years. It's discouraging when people ask me what kind of degree I'll graduate with and I tell them a diploma and they ask questions like "oh so you'll be a nursing assistant" (or medical assistant, or fill in the blank here). Some people ask me what kind of nurse that will make me. An RN...is what that will make me. From what I hear from the nursing managers in the hospitals that I do clinicals in, a well prepared new graduate nurse. We always hear people saying that they love our grads because they take less time and effort to orient and precept. I have no delusions of grandeur about graduating and knowing all there is to know about nursing, I know that it takes years of experience to become well rounded in the clinical area, and I'll be scared to death as a new grad, but I also think I'll be more at ease having spent so much time in the clinical setting. This semester my clinical hours are more than twice the classroom instruction hours. I don't begrudge the BSN students, or the ADN students, but I really don't see much difference between the curriculum I am taking vs. the ADN student, so it's especially insulting when ADN students or even nurses with their ADN turn their nose up. I am planning on pursuing my RN-BSN starting in January of next year, but I almost feel like the reason behind it is mostly pressure from the stigma.

Don't let anyone make you feel inferior because you're in a diploma program; they have an excellent reputation of graduating well-educated nurses. I graduated from a highly regarded diploma program many years ago. It was a shame to see it close.

Make the most of your education, and never mind the opinions of naysayers.

[ddv106]

When they act like snobs because you went to a diploma school, ask them a question. Do we all take the same boards to become nurse? When you pass it you are a nurse. There are BSN nurses who take the boards many times and can't pass. I know the pass rate for Diploma schools have always been high.

It is the person that makes the nurse not the school. Not everyone can go to an expensive Ivy League school but there are many people who went to cheaper unknown schools who are extremely proficient and successful.

I know many great nurses who went to diploma schools. Just be the best you can be and ignore the ignorance.

[nursel56]

I know this will probably sound weird to a lot of people, but if all else was equal I would have wanted to go to a diploma school. I started out at Children's Hospital with a nurse who had gone to Los Angeles County Hospital School of Nursing that died long ago, I was soooooo envious! She had already learned so much and done so much that none of us other new grads had, either RN or LVN.

Even as far back as the 1970s our Diploma Nurse instructors were starting to sound somewhat defensive and almost apologetic about it, and I never understood why. Who was making them feel not good enough? Was it the academic nurses of the day? Were they sending subtle messages even that long ago that the Diploma programs just weren't good enough? It's a given that every nurse, no matter what his or her degrees are at graduation is going to need to be a lifelong learner or they won't survive in the field. From my own personal experience with diploma nurses, they have nothing to explain away or apologize for, and I always had the feeling they understood people so much better, and what made them tick.

Eriksoln, I really can't agree that the healthcare system had a "nose in the air" attitude, I felt it was more a "matter of fact" attitude, which was directly related to the fact that they had gone to school to learn the facts that the patient didn't, as a matter of fact. If I take my car in to a mechanic because it's making an awful noise, I am not going to say the mechanic has his nose in the air when he tells me I need new brakes, or that I should get more frequent tune-ups. If he bakes me some cookies and serves me a steaming hot cup o' Joe I'd be alright with that, though.

[twinkletoes53]

I graduated from college 35 years ago, with a BSN degree. Our curriculum was heavy on Clinicals and actual floor work, so when I graduated I didn't have any difficulty at all starting a new grad. position. The staff nurses were very happy to see the students nurses arrive on the floor, because we would change our patients' linens, bathe them, give them their meds. help them with feeding, etc. If there were procedures to be performed, the staff knew to ask our Instructors if she wanted one of us to do it. So before graduating, I had catheterized at least one male and one female patient, inserted a feeding tube, did post-partum care, etc. We had Journals that we kept as student nurses, where required skills were listed before we could be checked off on a particular area. For example: I had to assist at 10 minor and 10 major surgeries as a scrub nurse and as a circulating nurse; assist with 10 deliveries and 10 C-Sections; administer oral and I'm meds. on my own with only an Instructor supervising, etc. We rotated to a pediatric, maternity, and psychiatric hospital for 6 weeks each.

We went to college 5 1/2 days a week. Starting in the third semester, we either had class in the morning and worked at the hospital for 4 hours in the afternoon, or we would be in the hospital by 0700-1200, and have classes from 1400-1600.

And BTW, I trained in a third world country, (the Philippines) at a top college, using U.S. textbooks. Our BSN degree was a 5 year program until 1975----the year I graduated. Then it went to a 4 year program.