New Graduate Nurses Require Support and Honesty, No More "Eating The Young"

thesocialanomaly, BSN, RN · Dec 2, 2022

You are Indeed correct. We are told in school bullying is unacceptable, so why would/should it be tolerated in the workplace? The new ones coming in are “literally” part of the staff you say there is a need for, but you need to usher us in on what the flow of the unit is and skills to practice. My perceptors in my nurse externship in SICU I have been doing since before I graduated, they literally talk me everything and others would even call me if they thought it was something I should do or see.

JKL33 · Dec 3, 2022

On 11/29/2022 at 10:38 PM, symondsbl said:

Eating your young breeds for a toxic environment that leads to worsening staffing issues and lack of safety for our patients. What do you all think?

I think that the "eat their young" idea is really not helpful, or at the very least there are numerous interwoven factors at play besides the idea that nurses are mean and set out to eat their young.

I will tell you who is responsible for not eating--but chewing up and spitting out--nurses, and that is employers. Peel things back yet another layer and you'll find that nursing schools aren't generally doing anyone any favors either. Nurses come out of school in a state that is known to be completely inadequate for managing even a modest assignment. How is that?

Well, these things matter. I think focusing on the people who show up to work on any given day and end up being tasked with completing the training of new nurses despite having their own full patient load is a VERY small and unfortunate view of things.

There are kind people everywhere, including in nursing, and there are people who are less kind or flat out unkind. Everywhere; including in nursing.

I did personally have an excellent orientation and I do think it mattered that my preceptors were pleasant enough people who treated me well. They also happened to be very, very experienced. There is a reason that people like that were available to train me--it's because they themselves were being treated well and because the unit believed in putting some resources into training new hires. When those factors aren't present you end up with inexperienced preceptors, preceptors who are are tired/worn out, people who do not have the personality/skills/desire to try to manage a patient load and train others at the same time.

It's fine to say NETY needs to end, but then you are left with the problem of deciding how you are going to force over-stressed and understaffed random nurses to provide a wonderful orientation when many feel they can't even provide decent patient care. It just doesn't work to treat people poorly and then try to demand that they do all of their work and "other tasks as assigned" with a sweet and pleasant demeanor at all times. That is irrational. Frankly I think it's gaslighting.

There are so many issues in nursing where, rather than use re$ource$ to do better, the powers that be would rather have all of us picking AT EACH OTHER and keeping our criticisms limited to ONE ANOTHER. I have never fallen for that, I think it's bullcrap.

$.02

Career Columnist / Author · Dec 5, 2022

On 11/29/2022 at 10:38 PM, symondsbl said:

I was inspired by all of the wonderful nurses I work with to write this and hope for more discussion. For some background, I am coming up on my third year of nursing. I started as a new graduate nurse on the same unit I work on now. It is a neuroscience intensive care unit that also handles trauma-surgery patients at a level 1 trauma center. Starting on my unit was intimidating knowing the high acuity of care it provides, but I was determined to thrive and learn. My determination was met with great support by my preceptor, who very plainly told me day one that the ICU is not for everyone. Her intent was honesty, and she reassured me that my success is her goal. I was never discouraged from asking any and all (read: so many) questions. She also told me something that I think was vital to our success, that she would never be mad at me as long as I did not lie. All mistakes were met with education and reassurance, not a form of hazing.

I have been told awful stories by other new grads about their difficult transitions to their units, and that they were affected by the culture of “eat you young” that nursing has been known for. Letting them drown in an assignment that was not appropriate for their experience level. Not providing guidance, belittling them for not knowing something, yet not being the resource the experienced nurse should be. They struggled during their three twelve hour shifts, having pre-shift anxiety weekly. Having their mental health affected by a job that they worked so hard to get, all while being underpaid.

I never experienced this type of treatment on my unit, and I believe it is why I was able to advance to the place I am at now. I was and continue to be treated with respect. One of the most important things my unit practices is open communication. Feedback is given when reporting back to the nurse after your shift, if need be. Management checks in with new grad nurses weekly. Each new grad has a resource assigned next to them for their first two months of shifts off orientation. The preceptor coordinator also is communicating and checking in with the new grad and preceptor nurse, making sure all needs are being met.

I’m now into my third year of nursing and I am confidently taking care of our sickest patients. I’m becoming a resource for other younger nurses during our shifts. I still look for help when I need it, knowing that my resources are there and ready for me to help. I also serve as charge nurse from time to time. Eating your young breeds for a toxic environment that leads to worsening staffing issues and lack of safety for our patients. What do you all think?

Love this! I have read your letter 2X now, and thank you so much for sharing. I'd like to copy this and give to all new preceptors. But it's more than that, it's a unit culture where new grads and preceptors both can thrive.

This is how it should be.

londonflo · Dec 6, 2022

On 12/3/2022 at 9:46 AM, JKL33 said:

Nurses come out of school in a state that is known to be completely inadequate for managing even a modest assignment. How is that?

I can tell you why. After May 2015, The hospitals we dealt with (as faculty) would only permit us one 12 hour day per week. The reasoning was that so many colleges wanted clinical placement and there were not enough units/floors/ days to allow for clinical placement per college to be 2 days per week. I have always been a firm supporter that 2 days with the same patient(s) allows the student to be more confident, repeat skills, compare assessments and help prepare the patient for discharge. Before 2016 I had always taught evening clinical, where I could get 2 consecutive late afternoon/evenings with planned student assignments to coincide with the same 1-2 patients BOTH days. In 2016 I was told I had to go to the one day per week 12 hour schedule. I quit in May 2016. All learning times were being dictated by the hospital, but then of course we were told "the students were not graduating with the necessary skills", as you have repeated here.

JKL33 · Dec 6, 2022

1 hour ago, londonflo said:

I can tell you why.

I agree that is part of it, I have noticed hospitals becoming less and less cooperative. There is all kinds of silliness with which they obstruct the experience of students, even HIPAA has become an excuse for why students can't do this or that; for example research charts (which is ridiculous).

On the other hand, that can't be the whole story. Hospitals and healthcare corporations need nurses; they're willing to go through them like toilet paper if need be--so schools that are producing said workforce should have some bargaining power. For whatever reason they don't seem to use that for much of anything. And if things are going to be acceptable as they are then they don't really have much incentive to go to bat for their students. Why should they go out of their way as long as the tuition money keeps coming in? Does nursing school cost less if students can only go to clinical one day a week instead of the 3 days we used to go? I don't know the answer (well, I imagine I do).

londonflo · Dec 6, 2022

11 hours ago, JKL33 said:

On the other hand, that can't be the whole story. Hospitals and healthcare corporations need nurses

The hospitals here actively recruit nursing students from as many schools/colleges as they can. We have some colleges that send students from 90 miles away, 2 others 60 miles, as well as 3 local colleges (one a state school that one hospital subsidizes their program). Each college is limited by the Nurse Practice act to 10 students per group. Each college has at least 100 students. We also use Saturday and Sunday. The education coordinator has plainly said that by exposing this many students to their organization they can get a couple from each college to apply and hire.

11 hours ago, JKL33 said:

Does nursing school cost less if students can only go to clinical one day a week instead of the 3 days we used to go? I don't know the answer (well, I imagine I do).

Here is the answer -- schools haven't done 3 days since the days of the diploma nurse. We are limited by how many credits an ADN can have (60) or a BSN (120). 3 hours of clinical equates to 1 credit.

11 hours ago, JKL33 said:

Does nursing school cost less if students can only go to clinical one day a week instead of the 3 days

So we have 2 (6 hour) days equals 1 (12 hour days) ...same cost of faculty salaries. Same cost of tuition.

11 hours ago, JKL33 said:

And if things are going to be acceptable as they are then they don't really have much incentive to go to bat for their students.

The nursing school has no power...you should have come to a scheduling meeting with a representative from each school - All the school reps jockey for the units they need for that particular semester, and there are disagreements galore but one hospital is a magnet one and they want as many BSN students as they can get.. We have to have concurrent clinical with theory.

It just is not as simple as you think.

Rmooney · Dec 6, 2022

I agree, nurses eating your young creates a toxic work environment. It's noticed by student nurses too. And guess what? When those students see this happen on the floor they have clinical on, that is a unit that they will not be applying to work on some day. I teach in an associate degree nurse program in Northern WI and Northern MN. We have seen the negative impacts of the MNA going on strike and the long, drawn out process of negotiating their contracts. Staffing has been terrible, nurses are frustrated and feeling burnt out. This has resulted in nurses not being as accepting to having students on the floor. They've been overheard complaining about students being on the floor and how much longer it takes them to do everything and have even yelled at them and me, the instructor, for allowing them to do a med pass for a patient with a lot of meds. I'm seeing nurses eat their young before they even become RNs. When this happens, my students tell me that they don't feel welcome or comfortable on the floor and would never apply to work on that floor. If nurses want staffing issues to improve, they need to take an active role in being part of the solution. They need to be willing to teach students and be welcoming to them on the floor. Yes, sometimes this means it will take longer to do a med pass, but it's the only way the student nurse is going to learn. And if there's an emergent situation, guess what? It's okay to ask the student to observe and take over the task. It's still a learning opportunity for that student. But if they choose to complain about students and make them feel unwelcome, they will continue to to struggle with safe staffing.

londonflo · Dec 6, 2022

1 hour ago, Rmooney said:

Yes, sometimes this means it will take longer to do a med pass, but it's the only way the student nurse is going to learn.

In my experience as a the faculty member I always did med passes with students. I gotta say the majority of my time is spent teaching the computer charting of meds when passing meds. I had one staff member pull me aside and say "you are the only instructor that works with the students on the Pyxis to pull the meds but we so appreciate it". I have worked Diploma, ADN and BSN programs. My standards and work ethic never changed.

I have read of schools on AN that just require a 'preceptor" to work with students. I have seen that teaching methodology used (by other schools) in the last semester of their nursing program. Heck I say it was endemic in the BSN programs. No matter the length of the program I am totally against this practice.

1 hour ago, Rmooney said:

nurses eating your young creates a toxic work environment. It's noticed by student nurses too.

I have overheard RNs tell students, "it is not too late to find another career. Do you really want to do this?" "Don't get stuck like me"

One hospital I went to required the faculty member be with the student for EVERY skill , even though we had extremely rigorous lab content and testing. For example, a student could not, perform a urinary catheterization with a staff RN, only with their instructor. Students couldn't even get an okay to do any accuchecks. This is the SAME hospital that gave "Carte Blanche" for 'techs' to hang plain fluids and perform urinary caths. The rationale was for 'techs' to see they were moving up in the hospital hierarchy, therefore keeping them to stay.

I am declaring right here and now that our clinical hospital sites (in my experience) pit school against another school, show favoritism in clinical placement for some schools and use any power play they can against schools.

JKL33 · Dec 7, 2022

7 hours ago, londonflo said:

It just is not as simple as you think.

I don't think it's simple at all. I am not trying to argue with you but rather point out that there is plenty of jockeying and shenanigans and deal-making that is way above the level of the student nurse and the floor nurse who gets to finish the new grad's training. Nursing schools do have to put up with a lot (from hospital corporations) but they are not complete victims; they are taking students' money after all, it is incumbent upon them to provide a quality service.

1 hour ago, londonflo said:

I am declaring right here and now that our clinical hospital sites (in my experience) pit school against another school, show favoritism in clinical placement for some schools and use any power play they can against schools.

I have NO problem believing this, at all.

4 hours ago, Rmooney said:

We have seen the negative impacts of the MNA going on strike and the long, drawn out process of negotiating their contracts. Staffing has been terrible, nurses are frustrated and feeling burnt out.

Can you explain more? This reads as if you are saying that staffing is terrible and nurses are frustrated and burnt out because of MNA's activities. Is that what you are saying?

4 hours ago, Rmooney said:

They need to be willing to teach students and be welcoming to them on the floor. Yes, sometimes this means it will take longer to do a med pass, but it's the only way the student nurse is going to learn.

You are really downplaying this. You mention "take longer" as if that is no big deal. I know what you mean by (real) emergencies, obviously, and am glad you acknowledged that they exist, but beyond that haven't you noticed that the staff is under pressure over every single little thing--whether it is a real emergency or not? Have you noticed that?

Healthcare corporations have purposely been wreaking havoc on units all over to make sure that we are as "efficient" as humanly possible and at this point there is painfully little slack in the routine--BY DESIGN. Inpatient nurses already feel that they cannot provide adequate care to patients. So it is no small deal when you nonchalantly drop this idea that "yeah, it's gonna take more time...." There IS no more TIME. If time were really an endless resource then YOU would have time to attend all of your students while they pass meds.

It seems like in your post you have blamed the MNA and working nurses for the fact that staffing is, in your words, "terrible."

I think that is worthy of a sincere "come on now..."

londonflo · Dec 7, 2022

1 hour ago, JKL33 said:

I am not trying to argue with you

Nor I am trying to argue with you.

1 hour ago, JKL33 said:

Nursing schools do have to put up with a lot (from hospital corporations) but they are not complete victims; they are taking students' money after all, it is incumbent upon them to provide a quality service.

So tell me where to find the quality service when there is so much competition for acute care clinical sites. Yes, some schools default to rehab/nursing home settings.

1 hour ago, JKL33 said:

Nursing schools do have to put up with a lot (from hospital corporations) but they are not complete victims; they are taking students' money after all, it is incumbent upon them to provide a quality service

Okay, We can refuse students money and close......Will that make you happy that schools are not providing a quality service (because of no service)?

Please don't pontificate on an area of nursing education you know nothing about. If you have had a significant role in nursing education beyond being an adjunct/staff nurse, please explain. Have you actually been in the trenches? Your posts are always so negative on any hospital or nursing education topics. Yes, I am angry with your comments. I went in every day trying to provide good to great experiences with students and patients. And I succeeded despite the extraneous factors. I get many messages from students who I taught 25 to 45 years ago thanking me for making their clinical time a 'great learning time'.

When I came to my current city, both of the hospitals had 800 beds. Now they have less than 500 each. Patients do not have the same LOS as 40 years ago, ergo less beds are needed. Another hospital we used closed.

We have 4 new BSN programs with students traveling between 60 to 90 miles per day and an 100% increase in students in our ADN program all with a lower bed capacity in each of our local hospitals. Give me solutions, not negativity!

JKL33 · Dec 7, 2022

1 hour ago, londonflo said:

Your posts are always so negative on any hospital or nursing education topics. Yes, I am angry with your comments.

As is your prerogative, but I feel your anger is misplaced. I am not sure if you believe I am talking about nursing instructors or why this need to argue the basic tenets of what I am saying. I didn't think it was too inflammatory to voice that I think institutions taking money from students should find a way to provide the product they are supposedly selling. You asked if I would be happy if schools had to close if they can't provide quality service--I wouldn't cry too many tears; I think the abundance of them is part of the problem that enables nursing employers' bad behavior. ??‍♀️

1 hour ago, londonflo said:

I get many messages from students who I taught 25 to 45 years ago thanking me for making their clinical time a 'great learning time'.

As I have written my thanks to a nursing instructor or two in my time.

1 hour ago, londonflo said:

When I came to my current city, both of the hospitals had 800 beds. Now they have less than 500 each. Patients do not have the same LOS as 40 years ago, ergo less beds are needed.

I don't agree with your ergo. What happened to this aging generation we've been being warned was coming? It was one of the reasons that we needed to crank out lots more nurses. Beds aren't closing because of lengths of stay--they're closing in no small part to optimize the profits of ever-enlarging healthcare behemoths; they know precisely how many they need to have open in order to ensure that every single one of those beds has people stacked up in the ED waiting for it at all times (while being billed for inpatient level care). They've gone all over this country putting their names on things and then consolidating any real services at their flagships leaving everyone else high and dry but ensuring their own private "patient funnel" mechanism across very large regions.

1 hour ago, londonflo said:

We have 4 new BSN programs with students traveling between 60 to 90 miles per day and an 100% increase in students in our ADN program all with a lower bed capacity in each of our local hospitals. Give me solutions, not negativity!

Okay. So someone somewhere feels there is a need for FOUR new programs. Whoever it is believes there is a need, or at least that it's a concept they can make money from. They are "willing" to "answer the call" to accept money from students. Why don't you tell me what you think should happen next?

I have no problem saying that they either need to provide adequate training or else they should've stayed out of it. You wouldn't accept/defend the idea of paying anyone to do work or to provide a service who then comes along with excuses for not providing it after you already paid them. What would you do if you paid a company to put a new roof on your house start to finish and they managed to get most of the underlay tacked down but then let you know that, as it turns out, they have a lot of problems actually getting shingles because the Shingle People are mean to them. But rest assured, they will work diligently to put on some number of shingles as long as you just stay quiet and let them worry about it. What would you say to that?

I say the fact that houses need roofs doesn't justify them taking your money.

I don't have the solution, as frustrating (or entertaining) as that may be to hear. My original point here was that looking at this situation where things are coming apart at every seam and determining that staff nurses working the floors are (once again) responsible for fixing yet another ill that originates WAY above their pay grade and blaming the fallout--of HUGE problems created by HUGE players--on things like NETY is basically just hen-pecking.