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

[symondsbl]

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?

[Rmooney]

On 12/6/2022 at 3:27 PM, londonflo said:

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. 

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. 

I also make every effort to do med pass with each if my students. However, I can have up to 8 students on the floor at a time and I make two of them team leads. My students get at least 2 patients, sometimes 3 because this is their last clinical before their preceptorship and then they graduate. I can’t pass meds on 12+ patients. I pick one patient for each of my students to complete their med pass with and ask them to communicate with their nurses which patients they will pass meds with me and which they would need to do with them if the nurse is available. I never expect the nurses to do this and there are times when they have to pass the meds without the student and that is just fine. But then I pass meds with the students for 6 of the patients on the floor, which is still a lot. Some days  I’m able to do more than that depending on how many medications each patient has. It isn’t ideal, but l I’m only one person and can only be in one place at a time.  I’ve had nurses comment that they appreciate how hands on I am with my students. They have seen instructors just sit at the computer the entire shift while they pair their students with a nurse on the floor. I definitely don’t agree with that practice. I think instructors should be hands on and with their students the entire shift. But with 8 students on the floor, there are times the instructors may appreciate the RNs being willing to give the students additional learning opportunities.