Inexperienced RNs... too much.. too soon

JLN · May 1, 1999

I graduated from nursing school 2 years ago, and I just transferred to the maternity floor in my hospital. I have to say that it certainly is difficult to be new, and that some of the more experienced RNs seem to go out of their way to be downright hostile to new people. It is quite difficult to try to learn what is expected in a new position when one is constantly looking over one's shoulder and receiving cryptic notes and email messages about minor mistakes and overhearing the other people discuss one in a very derogatory manner. It has been my experience that a lot of senior people scrutinize the work of newer nurses just looking for things to run to the manager and complain about instead of trying to help the newer nurse learn to do her job better or make suggestions for improvement. I certainly didn't go into nursing to kill anybody or do a lousy job, and I do try to learn what is expected and I just can't understand why some more experienced people(not all of them) get so much enjoyment out of being mean and sarcastic. I have to work third shift tonight and I have had heartburn all day thinking about it.

nickola · Nov 6, 2005

I find this interesting & sad, but not surprising. Inexperienced RNs in charge of a floor is not new-- as a GN in the 70's I was thrown in charge (night shift) of a 56 bed surgical floor at a large teaching hospital!! I was totally green, cried after every shift, and quit after 3 mos-- I remember going to the DON just before my 3 mos probation was up & begging to not be in charge-- she said "you're an RN-- you have to be in charge no matter where I put you-- that's what you went to school for." One wk later I turned in my resignation- she called me into her office and tried to get me to stay-- so I made up a bogus story about needing some kind of female surgery & going home (out of state) to have it. I was 22 yrs old. After that, I took 8 mos off & then I went to another hospital, smaller-- less than 300 beds, and loved it-- I still had to do charge- this time on 3-11, but I had a very experienced RN working w/me part-time, as well as an LPN who mentored me & to whom I am eternally grateful. Today it seems a lifetime away- but unfortunately it appears that not much has changed.

Pediatric Critical Care Columnist · Nov 6, 2005

Our unit has hired a substantial number of brand new grads over the last two years. After sixteen weeks they're expected to function independently in a very fast-paced high-acuity PICU where on any given shift, there are zero patients that would make an appropriate assignment for half the staff on that shift. The standard of care has been watered down to adjust for this, and the new staff members have no real understanding of what they should be doing at this stage in their careers, and have no idea what exactly they know and don't know. We've had several serious incidents lately where a new nurse has had an assignment that looked reasonable on the surface, but wasn't, and the patient has experienced a setback or worse because of knowledge deficits on the part of the nurse (captopril via central line, to mention one). Management tends to sweep these incidents under the rug, unless they're pushed to actually address the issue by threats to take the problem to the licensing board. Senior staff members are starting to get very vocal about being expected to babysit these nurses all the time, in addition to having their own assignments. But most people are too intimidated by management to constructively complain so most things are ignored. Earlier this year as a part of our accreditation process, we were "invited" to take part in a survey on how well our unit functions. The management team was astounded to learn that morale is at an all-time low, staff are feeling that they aren't listened to, problems with staff are not dealt with swiftly or effectively and that management doesn't care about the people they are managing. Duh. Now those same managers are asking for input about how to make our unit a better place to work and to keep our outcomes near the top. They should be prepared for some hard truths coming their way.

sasparilla · Nov 6, 2005

I'm a first year nursing student and the other day I ran into an LVN that I worked with as a unit secretary in the SICU before I started school. He's a good nurse, has had probably 15 years of experience. He told me that recently when at work, he got handed the code pager one night shift by the charge nurse. He looked around to see why since all the other nurses there that night had more advanced degrees than he has. That's when he realized that no one there had more than a few years of nursing experience of any kind, not even the charge nurse! He then understood why no one else felt comfortable with it.

JentheRN05, RN · Nov 6, 2005

I had this happen to me as well. I made it through my 90 days and quit. Where I started it was a small hospital. I had worked there 10 years previously as a CNA and was anxious to start again at the same hospital. I was going to live my dream, to be an OB nurse! Got the job, and was told on day 1 that I was going to 'skip' orientation and go straight to the floor. Well....okay I guess, I said. I spent the first month in OB trying to pick things up as I went along. Postpardum and Nursery wasn't a problem (nursery would be if the baby wasn't doing well). Then they started floating me to med/surg. The first day I was to follow someone because I didn't know the floor at all. I followed for a little while and got bored. Took on one patient. Well...the next few weeks was filled with OB/Medsurg. I tried to pick things up in L&D but we had so few of them it was hard to do. In Med/surg I only knew who my preceptor was 2x. The first day and my last day. In between I was given between 3-4 patients and had no idea who to ask questions of, so I asked whoever I came accross. So after all the stress I developed an ulcer. The last day of my job, after only participating in 1 delivery I was thrown into 2nd person. I was clueless, the 1st person kept having to do my job as well because I wasn't sure what to do.

I still want to be an OB nurse someday. But for now I will continue to be an ortho/neuro nurse and get further education to better myself until that opportunity arises. I can't wait.

Keysnurse2008 · Dec 10, 2005

Amen! What a great thread...when are hospitals going to start looking at patient safety outcomes? I mean....for gods sake...these are people we are talking about.Not equipment....when events happen...families lives can be forever changed. When inexperienced nurses are left to care for patients Mand M rates soar. It isnt their fault that they dont have the experience that builds sharper assessment skills. It is the managers fault for not retaining enough experienced Rns to mentor those new grads. The new grads cant help that they are new grads....but administration can help the fact that they do not actively try to retain enough experienced nurses on those units to mentor them.And until HC facilities start getting hit in the bank they wont "see the light"

Sheri257 · Dec 11, 2005

i'm still trying to locate the suit so i can read it myself...

Please let us know if you can find it. I also wonder if this case happened before the ratio law was enacted. As a student, I've heard these stories from RN's but, they also say that the ratios, which have been in effect for two years now, have really helped bring experienced nurses back to the bedside.

Amen! What a great thread...when are hospitals going to start looking at patient safety outcomes? I mean....for gods sake...these are people we are talking about. Not equipment....when events happen...families lives can be forever changed. When inexperienced nurses are left to care for patients Mand M rates soar. It isnt their fault that they dont have the experience that builds sharper assessment skills. It is the managers fault for not retaining enough experienced Rns to mentor those new grads. The new grads cant help that they are new grads....but administration can help the fact that they do not actively try to retain enough experienced nurses on those units to mentor them.And until HC facilities start getting hit in the bank they wont "see the light"

That's it: the bank. New grads are cheaper than veteran nurses. The cost savings are probably greater than the occassional lawsuit expenses. Unfortunately, that's how it works.

:eek:

Keysnurse2008 · Feb 5, 2006

i recently attended a seminar where the following lawsuit was discussed in regards to hospitals using unsafe staffing..
in california, a hospital was sued because a mother's unborn child was deprived of much needed oxygen for 10-15 minutes before it was picked up by the rns. as a result, the child was born with all the anoxic complications you would assume would be there.. ie cerebral palsy etc.. (i'm not a l&d rn so forgive me if i get some of this incorrect )
the plantiffs sued the hospital based on their hiring process.. the evening this horrible event occurred there were 4 rns on the floor... the total number of years of experience of these 4 rns was six.. six years between all 4 rns... the lawyers were able to show conclusively that the hospital created a hostile environment for the more experienced, highly paid rns to work and as attrition occured they replaced them with much less experienced rns at a much lower wage.. mmmmmmm.. to compound the already unsafe situation, they did not have adequate initial orientation nor did they have adequate ongoing education.. which the lawyers proved was exactly why they were unable to pick up the life threatening situation before irreversable damage was done..
how sad... and yet i see the same thing in my icu.. as experienced staff quits due to burnout.. frustration.. etc.. they are replaced with brand new nurses... not there is not a place for new nurses.. there is .. but what we see historically is that during times of a rn glut new nurses are not hired to some areas.. but when a shortage rolls back around they're everywhere... manager must keep the overall picture in mind... there needs to be a good mix of the most experienced down to the least experienced.. so that as the more experienced nurses move on there will be nurses already in place to fill their leadership roles..
i have only been an icu nurse for 15 months.. yet i already do charge.. and there have been many 3-11 shifts when i could add up the years of experience of 6 nurses and not come up with a number greater than 8 years!!! again, we lucked out.. but how long can the luck be sustained???
share your experiences with an inappropriate staff mix and how it affected your patient care...
by the way, the nurses were charged as liable in this lawsuit from what i understand.. i'm still trying to locate the suit so i can read it myself...

this is horrible......but more and more we are seeing this occur.you dont have enough experience on the unit to be able to reconize the early warning signs before a patient goes down the tubes.i hate that you got placed in this position....but charge after less than 2 years is wrong child!it isnt fair to you...bc .....what wouldve happened to you...if ...if a sentinel event had occurred? if that hcf could have hung you out to dry to save its hide in a sentinel event they would have.this is a sad trend that is a loose-loose situation for everyone ....you and the patients both. :eek:

MrsWampthang, BSN, RN · Feb 5, 2006

It doesn't surprise me that so many new grads are getting thrust into situations that can be dangerous. I recently went in and talked to a nurse recruiter at one of the larger hospitals in our area. She told me that, for now, this hospital had done away with sign on bonuses, and the wage they offered was over 6 dollars an hour less than I am making at the much smaller hospital that I am employed with. Needless to say, I didn't fill out the online application for that hospital. As I drove away, I thought to myself that they must be crazy to think that any experienced nurses are going to want to come to work for them, and they are going to end up with a lot of new nurses with no experience. It's really sad to think that too. It's not fair to the patients, or to the new grads. Being thrust into situations that are too stressful is what will make a lot of new nurses get out of the business. As I said, how sad. On a side note, please don't think that I am trying to slam new nurses, I'm not. I just think that new nurses deserve the chance to develop their skills and love of the job without the stress being thrown in the deep end of the pool with no lifeguard on duty, if that makes sense.

Pam