Nursing Education and the Recession - Tough Economic Times

[VickyRN]

The recession has definitely left its mark on universities and community colleges. Funding is being slashed, educators' salaries are frozen, faculty workloads are increasing, supplies are in short demand, and fear and uncertainty abound.

The State Constitution of North Carolina requires a balanced budget each year (unlike our federal government). There is an estimated $3 billion shortfall this fiscal year. State employees are currently being required to "give back" to the state 0.5% of their salaries, to help make up for this fiduciary crisis. This is in exchange for a "furlough" of 10 hours, which most educators will never see.

The latest projected cuts to education in North Carolina (for the year 2010-2011) are most disconcerting - a projected decrease in funding for 2010-11 by $59.2 million. This translates to:

• 16.1% cut from the state university system
  
• 14.2% cut from the state community college system
  
• 14.2% cut from the state public school system

Some sources of financial aid to students have dried up, but others remain available (such as Stafford Loans).

In my college of nursing, we are restricted on photocopying, travel, and use of supplies. We are rationing paper and ink cartridges. Workloads have increased. Nursing classes have been doubled in size. Students are packed in classrooms like sardines. People are very worried that actual job cuts (to faculty and staff) are next.

I consider myself most fortunate to still have a job that I love in the midst of this terrible recession.

Our graduates are having difficulty finding employment. Only 40% of the latest group of graduates (May) have found nursing jobs. Many have placed applications at multiple facilities, including longterm care, with little success.

How is your school of nursing faring in these tough financial times?

[jpeters84]

Mommyonamission-

There are nursing jobs available but new grads with no jobs because hospitals are unwilling to hire new grads. In other words there are plenty of jobs for nurses out there with at least one year of experience but if you're a new grad you are SOL. According to hospitals "it takes a lot of money to train new grads." I am personally incredibly frustrated by hospitals that will not hire new grads or hospitals that allow their new grad programs to diasappear during economic downturns.

First off, new grads need good preceptors which are already hired nurses on the floor with a lot of experience and some patience. Why this should cost a hospital so much more money I don't know. Again, how do these hospitals think that the quality nurses that they currently employ ever became quality nurses if someone didn't give them the opportunity and the experience right out of nursing school. How do these hospitals expect these newly graduated students to ever become nurses that they want and will need to hire in the future without being given the chance their first year out?

Many of these hospitals expect nursing students to fend for themselves and expect other hospitals to shoulder the burden of training new nurses. I am taking a stance and have vowed to never work for a hospital that does not hire new grads. If you're not willing to give me an opportunity to prove myself in the beginning then I don't think you should benefit from my experience later on.

Wherever I do finally get employed when I graduate I will be forever loyal and grateful and I feel that every hospital should open their doors to both nursing students in allowing for more room for clinical spots and in hiring new grads. This benefits everyone in the long-run. If the hospitals need to put a little more capital in the beginning in order to get better trained new nurses then so be it. If hospitals want to start drawing up contracts with new grads saying that they will train the new grads if they promise to work for the hospital for X amount of years I don't have a problem with that. But the flat-out not hiring of new grads is absolutely unacceptable. The short-sightedness of hospitals in a down-turn mirrors the ridiculous mentality of state bureacracies making poorly thought out budget cuts. I believe both are in the wrong and I am constantly astounded by the lack of fore-thought that goes into the decisions made all in the name of economics.

[jpeters84]

I wanted to add a bit about how litigious our society has become and how negatively it has affected nursing education. I am going into my third semester of nursing school and have yet to insert a foley catheter. I have not inserted IVs, been trained to do blood transfusions, inserted an NG, seen a surgery, nor have I really had much hands on experience. I know hospitals are really afraid of being sued and as such the hospitals and nursing schools have limited what nursing students can do in the clinical setting but I feel like that is an incredibly dangerous stance to take.

I think that hospitals should be given greater protection against litigation when it involves training both physicians and nurses. If nurses are expected to learn the majority of their skills their first year out of school when they are licensed, on their own, and no one guiding them through their first time doing a major skill and have double the patient load then they have ever had before I think that is a dangerous and placing an unnecessary burden and huge learning curve onto new nurses.

I think we should ask the public, do you want a nurse trying a new skill on you when she is in nursing school and has studied the procedure thoroughly, has gone over what she is going to do with her professor, and has her professor right there to provide guidance, support, and if necessary intervene or do you want her to attempt a new skill on you when she is newly licensed, no one is looking over her shoulder, and she is trying to manage a large patient load while attempting skills she doesn't have much experience on?

Going back to school and becoming a nursing student has really openned my eyes to some situations within nursing education that I am really dismayed by. I love nursing but the process of getting a nursing education I am finding is frustrating for students, educators, nursing schools, and hospitals. I think we should come together and find ways to advocate for a better process then the one we have now. Better funding, more new nurse programs that hospitals not only are obligated to have but find value in, and litigation protection within reason for hospitals providing proper training to medical students, nursing students, etc.

I've been ranting so much on this post but now that I am off from classes this summer I have really had a chance to reflect on how the current climate has affected my nursing education and I feel like the time has come for us to stand up to some of these issues that must be addressed.

[traumaRUs, MSN, APRN]

Totally agree Vicky. I'm heading back to school to pick up a peds/family CNS this fall and the budget is driving what courses I take and when.

I live in central IL and our state doesn't have a budget at this time.

[mommyonamission]

I wanted to add a bit about how litigious our society has become and how negatively it has affected nursing education. I am going into my third semester of nursing school and have yet to insert a foley catheter. I have not inserted IVs, been trained to do blood transfusions, inserted an NG, seen a surgery, nor have I really had much hands on experience. I know hospitals are really afraid of being sued and as such the hospitals and nursing schools have limited what nursing students can do in the clinical setting but I feel like that is an incredibly dangerous stance to take.

I think that hospitals should be given greater protection against litigation when it involves training both physicians and nurses. If nurses are expected to learn the majority of their skills their first year out of school when they are licensed, on their own, and no one guiding them through their first time doing a major skill and have double the patient load then they have ever had before I think that is a dangerous and placing an unnecessary burden and huge learning curve onto new nurses.

I think we should ask the public, do you want a nurse trying a new skill on you when she is in nursing school and has studied the procedure thoroughly, has gone over what she is going to do with her professor, and has her professor right there to provide guidance, support, and if necessary intervene or do you want her to attempt a new skill on you when she is newly licensed, no one is looking over her shoulder, and she is trying to manage a large patient load while attempting skills she doesn't have much experience on?

Going back to school and becoming a nursing student has really openned my eyes to some situations within nursing education that I am really dismayed by. I love nursing but the process of getting a nursing education I am finding is frustrating for students, educators, nursing schools, and hospitals. I think we should come together and find ways to advocate for a better process then the one we have now. Better funding, more new nurse programs that hospitals not only are obligated to have but find value in, and litigation protection within reason for hospitals providing proper training to medical students, nursing students, etc.

I've been ranting so much on this post but now that I am off from classes this summer I have really had a chance to reflect on how the current climate has affected my nursing education and I feel like the time has come for us to stand up to some of these issues that must be addressed.

Jpeters, I have to say that both of your posts on this topic give a remarkable perspective and interpretation of the problem. I like your stance to not work for a hospital that does not welcome new nurses. For me, I would want to work for a hospital system that supports its employees with continuing education and complete and quality training. For any hospital that truly embodies this it would make sense that they should also have a new nurse training program. Every profession in this country benefits from the mentorship provided by newbies into the field and nursing should be no different.

[Moogie]

Mommyonamission-

There are nursing jobs available but new grads with no jobs because hospitals are unwilling to hire new grads. In other words there are plenty of jobs for nurses out there with at least one year of experience but if you're a new grad you are SOL. According to hospitals "it takes a lot of money to train new grads." I am personally incredibly frustrated by hospitals that will not hire new grads or hospitals that allow their new grad programs to diasappear during economic downturns.

First off, new grads need good preceptors which are already hired nurses on the floor with a lot of experience and some patience. Why this should cost a hospital so much more money I don't know. Again, how do these hospitals think that the quality nurses that they currently employ ever became quality nurses if someone didn't give them the opportunity and the experience right out of nursing school. How do these hospitals expect these newly graduated students to ever become nurses that they want and will need to hire in the future without being given the chance their first year out?

Many of these hospitals expect nursing students to fend for themselves and expect other hospitals to shoulder the burden of training new nurses. I am taking a stance and have vowed to never work for a hospital that does not hire new grads. If you're not willing to give me an opportunity to prove myself in the beginning then I don't think you should benefit from my experience later on.

Wherever I do finally get employed when I graduate I will be forever loyal and grateful and I feel that every hospital should open their doors to both nursing students in allowing for more room for clinical spots and in hiring new grads. This benefits everyone in the long-run. If the hospitals need to put a little more capital in the beginning in order to get better trained new nurses then so be it. If hospitals want to start drawing up contracts with new grads saying that they will train the new grads if they promise to work for the hospital for X amount of years I don't have a problem with that. But the flat-out not hiring of new grads is absolutely unacceptable. The short-sightedness of hospitals in a down-turn mirrors the ridiculous mentality of state bureacracies making poorly thought out budget cuts. I believe both are in the wrong and I am constantly astounded by the lack of fore-thought that goes into the decisions made all in the name of economics.

You are absolutely right that it makes no sense that hospitals don't want to hire new grads. Oddly enough, the opposite is also true. Nurses who haven't worked acute care for some time are having difficulty finding jobs that require recent acute care experience---they're also told that it's too expensive to hire them. This, too, demonstrates a lack of forward thinking. When the economy improves---and it will---and current nurses decide to cut back, retire, or go on hiatus for a few years, the hospitals will have to hire---guess who? New grads with "no" experience. Recent grads who weren't able to find nursing jobs for a year or more after they finished school. Seasoned nurses who don't have "recent" acute care experience and were working LTC, home health or other positions because they couldn't get hospital jobs.

BTW, JPeters, you appear to be an insightful, intelligent individual. Any facility will be fortunate to have you on its staff!

[Solaera]

I have been reading the blog here and I am really concerned. I have been a practicing RN for 17 years and I am working on my BSN to MSN in order to teach nursing. Primarily because I see students graduating without the necessary skills that are needed to do the job.

First, the need of the nurses has not changed. Now I haven't seen any posts from people from Florida, where I am, but I could be mistaken. We have several needs in nursing down here. I was told that the area colleges have waiting lists for students to get in. But where are they going??? They are not applying to hospitals, nursing homes , or clinics! In fact, we are finding that most students that actually graduate are not even working as nurses at this time. And it isn't because they can't find jobs, it's because they had higher expectations of what their job would be like.

I am a cardiac floor nurse, I take care of patients that are fresh from cardiac caths, and step down for post open hearts. It is very hard, hands on work. Most of the students we see who come to the hospital as students are very lacking in the fundamentals of nursing. What happened to the care and compassion that so many of us had, and still most of us have, in taking care of another human being. Most of the students I see now are more concerned with how much money they will be making and not really caring about the patient that they are taking care of! Much less, care about how to place a foley catheter! These people are not allowed "hands on" training at all! When I was in school we started IV's on each other, just short of placing foley's and NG tubes in each other, we did it all. On the floor during our rotations, we gave meds with our intructors, we learned various nursing diagnoses as well as what those nurses were doing with their patients. I am appalled to see that these things are not even being allowed in schools today! It's no wonder we aren't seeing new nurses applying for these available jobs. Most of the students, if any, that come and apply are more worried about the income they will receive than the patients they are going to take care of. For example, look up how many go directly to ICU's. They are completely unprepared to float to a regular floor where the patient load ratio is significantly higher than 1:2.

It seems like people hear that there is money in nursing so they jump on it and find out that it is actually work. As a matter of fact, almost all of our LPN's are going back to get their RN degrees because they are essentially doing what an RN does, except pushing some meds. Most of the nurses I work with fortunately are idealists like me. When we went into nursing, we wanted to help people. It wasn't about the paycheck. I started out in Kansas, trust me it wasn't about the paycheck!

Now, all I hear about from students are the same thing, how much money will I make? How much work do you have to do?

The sad part is the most needed positions are our helpers...now in my day...lol you became a nurse tech while going through school, or if you were thinking about it. I'm not seeing that anymore. We are in a crisis at this time. It isn't just nurses, it is nurse techs, LPN's, and pharmacists. We do have an increase in doctors. Maybe we can cross train!

Sorry for the rant, but when I saw that people on here were not seeing a nurse shortage I had to say something. There is indeed a nurse shortage going on. And it is going to get worse! Our teachers, instructors, and fellow nurses that were in large numbers are about to RETIRE! The baby boomers from WW2 are about to leave their legacy to us. And I fear we are completely unprepared to handle the onslaught of patients without the help of adequately trained, caring and compassionate new nurses.

[mommyonamission]

I have been reading the blog here and I am really concerned. I have been a practicing RN for 17 years and I am working on my BSN to MSN in order to teach nursing. Primarily because I see students graduating without the necessary skills that are needed to do the job.

First, the need of the nurses has not changed. Now I haven't seen any posts from people from Florida, where I am, but I could be mistaken. We have several needs in nursing down here. I was told that the area colleges have waiting lists for students to get in. But where are they going??? They are not applying to hospitals, nursing homes , or clinics! In fact, we are finding that most students that actually graduate are not even working as nurses at this time. And it isn't because they can't find jobs, it's because they had higher expectations of what their job would be like.

I am a cardiac floor nurse, I take care of patients that are fresh from cardiac caths, and step down for post open hearts. It is very hard, hands on work. Most of the students we see who come to the hospital as students are very lacking in the fundamentals of nursing. What happened to the care and compassion that so many of us had, and still most of us have, in taking care of another human being. Most of the students I see now are more concerned with how much money they will be making and not really caring about the patient that they are taking care of! Much less, care about how to place a foley catheter! These people are not allowed "hands on" training at all! When I was in school we started IV's on each other, just short of placing foley's and NG tubes in each other, we did it all. On the floor during our rotations, we gave meds with our intructors, we learned various nursing diagnoses as well as what those nurses were doing with their patients. I am appalled to see that these things are not even being allowed in schools today! It's no wonder we aren't seeing new nurses applying for these available jobs. Most of the students, if any, that come and apply are more worried about the income they will receive than the patients they are going to take care of. For example, look up how many go directly to ICU's. They are completely unprepared to float to a regular floor where the patient load ratio is significantly higher than 1:2.

It seems like people hear that there is money in nursing so they jump on it and find out that it is actually work. As a matter of fact, almost all of our LPN's are going back to get their RN degrees because they are essentially doing what an RN does, except pushing some meds. Most of the nurses I work with fortunately are idealists like me. When we went into nursing, we wanted to help people. It wasn't about the paycheck. I started out in Kansas, trust me it wasn't about the paycheck!

Now, all I hear about from students are the same thing, how much money will I make? How much work do you have to do?

The sad part is the most needed positions are our helpers...now in my day...lol you became a nurse tech while going through school, or if you were thinking about it. I'm not seeing that anymore. We are in a crisis at this time. It isn't just nurses, it is nurse techs, LPN's, and pharmacists. We do have an increase in doctors. Maybe we can cross train!

Sorry for the rant, but when I saw that people on here were not seeing a nurse shortage I had to say something. There is indeed a nurse shortage going on. And it is going to get worse! Our teachers, instructors, and fellow nurses that were in large numbers are about to RETIRE! The baby boomers from WW2 are about to leave their legacy to us. And I fear we are completely unprepared to handle the onslaught of patients without the help of adequately trained, caring and compassionate new nurses.

I find your post to be VERY interesting because for years I've been told there's a nursing shortage and the amount of nursing jobs is really some proof in the pudding. As someone who's considering going to nursing school for the first time I am not going into it blindly and DEFINITELY not just thinking of the money I'm going to make. As a matter of fact, based on what I want to do I will likely make LESS money if I go into nursing than I have. I think the level of maturity of a person speaks volumes too here and I'm not saying that every teenager and young 20's person is not thinking things through or approaching the nursing route with realistic and compassionate expectations, but are definitely those out there who are not!

I think with your experience and insight you can absolutely impact new nursing students as a teacher and instructor. I have a friend who's getting her PhD in nursing for the very same reasons you mentioned about going the MSN route. I wish you both well because we need nurse educators greatly! We can't fill the nursing shortage voids without the education infrastructure in place and ready to go!

[VickyRN, MSN, DNP, RN]

VickyRN, points well taken!

What I don't understand is how hospitals have numerous nurse openings (at least according to their websites) yet so many nursing grads that you know are unemployed. Of course, this is my observation without breaking down the data in detail but how would you explain this?

I think there's a misperception by some considering the nursing field as a profession that the job supply is excellent. However, apparently, that does not appear to be the case; especially from some of the geographical differences I've seen folks cite in other forums.

Excellent question, mommyonamission.

In many parts of the country there is no longer a nursing shortage. Some areas are Pennsylvania, New Jersey, parts of New England, and parts of California (such as San Diego and San Francisco). It happened so suddenly, that the media is just now beginning to pick up on it. In fact, in these areas of the country, there is a glut of nurses, especially new nursing grads. Many older nurses have delayed retirement due to spouses losing their jobs, evaporation of retirement funds, and the dramatic increase in the cost of living. Many part-time nurses have become fulltime for the same reasons. The deep recession has affected us all. Nursing isn't as "recession-proof" a profession as many had believed.

This situation is only temporary. After some of the more severe economic problems are resolved, the nursing shortage will return with a vengeance. The next shortage, which will be demographic in nature, will occur suddenly and ferociously. It will happen as the aging nurses leave the workforce in droves and the aging Boomers simultaneously need more healthcare services. It will be an enduring shortage with no end in sight.

Most hospitals/ healthcare facilities are presently experiencing a tight money crunch. In fact, the downturn in finances and reimbursements has been so severe that some facilities have closed their doors entirely. Many people have lost their jobs. Because they are unemployed, they are also without insurance. Therefore, they are delaying elective procedures and only go to the hospital when they are acutely ill. The hospitals receive less reimbursements from the reduced census and money flow. At the same time, insurance companies and Medicare have become extra vigilant with the purse strings. Claims are being denied or delayed. Medicare, the major reimburser, is tightening up, as it is due to become "insolvent" (aka bankrupt) in the year 2017.

Less reminbursements = less money to pay employees = less nursing staff.

Many healthcare facilities just don't have the extra capital to invest in new nurse grads right now. It is my understanding that it costs hospitals ~ $40,000 just to orient/ train a new nurse. Additionally, many hospitals have hiring freezes in place, and aren't hiring any nurses at all. Some are actually requiring their employees to "pay back" some of their wages in order to avoid layoffs (in exchange for a "furlough" of a few hours from each paycheck). Others have cut nurses and other staff.

We are definitely living in turbulent times for healthcare.

[mommyonamission]

Excellent question, mommyonamission.

In many parts of the country, there is no longer a nursing shortage. Some of these areas include Pennsylvania, New Jersey, parts of New England, and parts of California (such as San Diego and San Francisco). It happened so suddenly, that the media is just now beginning to pick up on it. In fact, in these areas of the country, there is a glut of nurses, especially new nursing grads. Many older nurses have delayed retirement due to spouses losing their jobs, evaporation of retirement funds, and the dramatic increase in the cost of living. Many part-time nurses have become fulltime for the same reasons. The deep recession has affected us all. Nursing isn't as "recession-proof" a profession as many had believed.

This situation is only temporary. After some of the more severe economic problems are resolved, the nursing shortage will return with a vengeance. The next shortage, which will be demographic in nature, will occur suddenly and ferociously. It will happen as the aging nurses leave the workforce in droves and the aging Boomers simultaneously need more healthcare services. It will be an enduring shortage with no end in sight.

Most hospitals/ healthcare facilities are presently experiencing a tight money crunch. In fact, the downturn in finances and reimbursements has been so severe that some facilities have closed their doors entirely. Many people have lost their jobs. Because they are unemployed, they are also without insurance. Therefore, they are delaying elective procedures and only go to the hospital when they are acutely ill. The hospitals receive less reimbursements from the reduced census and money flow. At the same time, insurance companies and Medicare have become extra vigilant with the purse strings. Claims are being denied or delayed. Medicare, the major reimburser, is tightening up, as it is due to become "insolvent" (aka bankrupt) in the year 2017.

Less reminbursements = less money to pay employees = less nursing staff.

Many healthcare facilities just don't have the extra capital to invest in new nurse grads right now. It is my understanding that it costs hospitals ~ $40,000 just to orient/ train a new nurse. Additionally, many hospitals have hiring freezes in place, and aren't hiring any nurses at all. Some are actually requiring their employees to "pay back" some of their wages in order to avoid layoffs (in exchange for a "furlough" of a few hours from each paycheck). Others have cut nurses and other staff.

We are definitely living in turbulent times for healthcare.

Thanks so much VickyRN for your thorough response. I had no idea that certain areas of the country aren't feeling the nursing shortage as much and it has really opened my eyes. It gives me a much more thorough understanding of what's going on.

As aging nurses leave the workforce during the moment you described (when it comes) that will be a time of great hardship for many facilities and the patient population as a whole, so it seems. It also makes me feel like it's my duty to enter this profession and to help promote nursing as a career.

I'm going to continue to read your blog and appreciate your feedback!

[jpeters84]

SunFlowerStars-

You talk about how a lot of students these days are only concerned with how much money they are going to make. And while it's true there are a few nursing students that are going into it for all the wrong reasons (I really would like to believe that most of these eventually get weeded out) I thought I would provide you with a reason for why money is so important to us. You see most of us are graduating with an exorbitant amount of student debt because of how much getting an education costs these days. This is my second degree having graduated the first time in 2002 and I can't even believe the esculation of prices in all things related to getting your degree just in the last few years. I'll be happy if I graduate with $60,000 in debt. I had the choice between sitting in the lottery for the local community college RN program where there was no guarantee I would ever get in where I could potential go many more years without earning an income or jumping right in and going to the private nursing school in my state and getting a BSN. I chose to get the BSN. If I were to graduate with no debt I really wouldn't care how much I was paid. In all honesty I would be a neonatal nurse for free. But I have to be concerned with how much money I am going to make for at least the first 5-10 years after I graduate if I have any hope of paying off my debt. It's a heavy burden that weighs on me and is causing me to be much more concerned with salary then I would ever care to be.

As far as your contention that nursing students are graduating without getting the experience they need to go on to be competent nurses right off the bat, I couldn't agree with you more. But please don't blame the students. I am dying to do Foleys, NGs, be involved in a code, start an IV, etc. I just haven't been allowed to. So I really encourage you to teach and to lobby the nursing school administration to work on allowing nursing professors and nursing students a broader range of experiences within the clinical setting.

And I must say if it costs a hospital $40,000 to train a new nurse, then why don't hospitals allow nursing students more clinical hours and more clinical experiences so that when they do graduate maybe hospitals won't have to pay so much to train them. I would think the hospitals would love 1) the free labor of nursing students 2) to put the burden back on the schools to better train nurses to be better new nurses 3) the easier transition between student nurse to new nurse 4) result in cheaper training 5) this would probably result in better nursing care from new nurses and therefore better outocomes for patient and hospitals. I don't know about anywhere else in the country but I live in Hawaii and I know that there are only so many hospitals on this island and apparently they get "burned out" by too many nursing students. But I think this is a BS reason to not allow for more clinical hours. My OB clinical next semester is for only 4 weeks and my professor told me that we don't even touch the patients we just "observe." How frustrating! I'm paying $12,000 a semester to basically learn how to pass the NCLEX. At least that's what it feels like. All of my professors tell me 'don't worry you'll figure this (skill) out when you're out practicing in the real world." I've heard that for just about everything. I am so frightened for my first year I can't even tell you. What a huge injustice.

[VickyRN, MSN, DNP, RN]

And I must say if it costs a hospital $40,000 to train a new nurse, then why don't hospitals allow nursing students more clinical hours and more clinical experiences so that when they do graduate maybe hospitals won't have to pay so much to train them. I would think the hospitals would love 1) the free labor of nursing students 2) to put the burden back on the schools to better train nurses to be better new nurses 3) the easier transition between student nurse to new nurse 4) result in cheaper training 5) this would probably result in better nursing care from new nurses and therefore better outocomes for patient and hospitals. I don't know about anywhere else in the country but I live in Hawaii and I know that there are only so many hospitals on this island and apparently they get "burned out" by too many nursing students. But I think this is a BS reason to not allow for more clinical hours. My OB clinical next semester is for only 4 weeks and my professor told me that we don't even touch the patients we just "observe." How frustrating! I'm paying $12,000 a semester to basically learn how to pass the NCLEX. At least that's what it feels like. All of my professors tell me 'don't worry you'll figure this (skill) out when you're out practicing in the real world." I've heard that for just about everything. I am so frightened for my first year I can't even tell you. What a huge injustice.

Clinical hours are determined by each state's BON and not by clinical facilities. There are a few options however, for a determined student. If your school of nursing offers a nurse extern program (usually offered over the summer) or an internship (usually offered during the last semester), I would strongly encourage you to take advantage of it. These extern programs offer nursing students the chance to be precepted one-on-one by a practicing nurse and the student is given the opportunity to perform most skills that practicing nurses perform on the floor. Another idea is to become a certified nursing assistant. At least in my state (NC), CNA IIs are allowed to insert foley catheters, prepare and give enteral feedings, and many other tasks.

[bert0206]

I just wanted to reply to several of these posts. First of all I am a North Carolinian living in Michigan. I have been hearing from my sister who is a public school art teacher about how dire things are in my home state. Since we have been in recession here in Michigan for about 7 years as opposed to the two years for the rest of the country, I have a great deal of empathy for what all of you are going through. Our unemployment is up to 15% as of May(highest in the nation) but I know southern states are not far behind us. I work as nursing faculty for a small private college here in Michigan and the interesting thing is our overall collge enrollment is up. Mainly because many people are receiving $$ through No Worker Left Behind programs and other state and federally funded "back to work" initiatives. This has had a great impact on our college in that we are financially stronger than we have ever been. In fact we are moving into a brand new health science building in the fall since we are rapidly outgrowing our old facility.

Our applicant pool for our nursing program has doubled which is a good thing because in recent years we have had just enough applicants to fill our 60 seats. This means that all applicants have gotten in not just the best. This has impacted our attrition rates since more students are finding it difficult to complete the program. and failing out. We had our highest number of failures this year that we have ever had.

However, our graduates are finding it much harder to obtain their first job. So far we have been able to place everyone this year. Many are going into LTC rather than the hospitals. The hospitals up here have been hurting for awhile since the auto industry downturn started several years ago and people up here have not had insurance for quite a while. Our hospitals are trying to maintain theri nurse extern and nur residency programs but teh numbers of students and grads who are being taken into these programs has been severely reduced. I agree with the writer who suggested that nursing students complete a CNA course, that is a great way to get experience with alll types of procedures. Fortunately the program I work in is an ADN school so our students get tons of hands on practice--our clinicals are all 5-9 weeks long, two 6-9 hour days each week, with direct patient care in each one. But I do see a distinct difference between our ADN program and the BSN program at our local university. Lots of observing there much less patient care.

As for students going into the profession for the money, that is also true for us. With an added reason, this is one area that they can still get a job of some type. Maybe not the job of their dreams but at least a job. That is precious to everyone up here. The point about needing to make money to pay for student loans is also true. While the back to work programs help with some college costs, students still come out with huge loans and need a way to repay them.

Finally a comment on nursing faculty. Our workload is horrendous(60-70 hours/week). Our pay is horrible($50,000/year tops). We recently did a market study of our own to try to convince our college to increase pay and got laughed at. But I cannot think of another place I would rather work. I have a great team of colleagues to work with(I consider myself fortunate) and an eager group of students to guide. I also work as a perdiem nurse educator for a small local hospital and the difference is night and day.

I believe we have to be patient in these times, try to instill as much professionalism as we can in our students, provide them with as many opportunities for learning as we can and hope for the best.

Robbi in Michigan