oh so now we PAY to do residency to get a job?!?! seriously?

heron, ASN, RN · Dec 3, 2009

$4500 doesn't come anywhere near what it costs to train you.

Back in the late 90's, the Mass Nurses' Association figured out that it costs over $60,000 - that's right, three zeros - to hire and train a nurse in critical care and something around $45,000 for a med-surg nurse.

Why should they spend that kind of money on you just to have you leave for greener pastures as soon as you get marketable?

AnnieRN2B · Dec 3, 2009

Blame the spoiled rich Ivy Leaguers whose rich parents "buy" Muffy and Bif an internship to give them a "leg up" from the unwashed "hoi polloi." http://www.thebigmoney.com/articles/judgments/2009/06/10/intern-nation

Ridiculous!

HeartsOpenWide, RN · Dec 3, 2009

It cost money to train some one.

In total, the average cost per new hire was estimated to be approximately $22,000 (standard deviation [sD] $18,795). The largest proportion was decreased productivity per new hire (mean $10,804, SD $4,124), followed by orientation and training per new hire (mean $5,838, SD $3,589).

http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102275308.html

All told, the Nursing Executive Center estimates that out-of-pocket costs of turnover account for only 21 percent
of total costs, with 79 percent being hidden costs. In dollar amounts, the typical accounting of turnover estimates
$10,800 in turnover costs for each medical/surgical nurse and $11,520 for each specialty nurse. The American
Organization of Nurse Executives estimates that visible costs represent 24 percent of total costs for
medical/surgical nurses and only 18 percent for specialty nurses. Thus, the true total costs of turnover are
$42,000 per medical/surgical RN and $64,000 per specialty nurse.

http://www.americanhs.com/Resources/articles/pdf/Nursing-The%20Cost%20of%20Failure%201.pdf

heron, ASN, RN · Dec 3, 2009

It cost money to train some one.
http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102275308.html
http://www.americanhs.com/Resources/articles/pdf/Nursing-The%20Cost%20of%20Failure%201.pdf

Thanks for chasing down those numbers :flowersfo

I'm as disgusted by the bean-counter mentality as the next nurse, but these days we seem to change jobs more often than we change the oil in our cars.

Is it really reasonable to expect them to pay for training and your salary when chances are good that they'll never get the benefit of the training they paid for?

ukstudent · Dec 3, 2009

i'am with you bymysoultosqueezern. it is one thing to offer a job with a promise to stay x number of months/years, and if you don't then you need to pay back some money. but to ask new nurses to pay for some experence with no job offer is just not right.

llg, PhD, RN · Dec 3, 2009

Such residency programs are not really "jobs," they are "training programs" to compensate for the fact that many new grads come out of school not ready to actually practice nursing in the real world.

I have mixed feelings about them. As other people have pointed out, hospitals have to spend lots of money to further educate a new grad to the point that they can actually do the job of being a staff nurse. And many of the new grads feel no sense of committment to stay in that first job long enough to "pay back" that investment made by the hospital in their role transition/orientation.

Also consider that there are an increasing number of "accelerated" programs and ones that are streamlined in such a way that their graduates are even less prepared to practice in the real world than average.

Something's got to give. Hospitals cannot afford to continue to pour money into special new grad orientations, internships, residencies, etc. and not see an adequate return on their investment. If society expects the hospitals to provide that education -- rather than increase the requirements for it to be provided by the schools -- then those hospitals need to find some way to pay for those educational programs.

At least those hospitals providing the residencies are being honest up-front about what they are providing. They are providing additional education to help people who went to schools that did not adequately prepare them for real jobs. People who want to purchase that additional education are free to do so. People who don't want to purchase that additional education are not forced to.

What I think is a shame is that our educational system is doing such a disservice to its students that such programs are required. Students should graduate with adequate preparation to not need such an intensive and extensive role transition program. Entering students should be taught about realistic expectations about what it takes to become a competent RN -- and that most people can't do that in a 15-month "quickie" program -- regardless of your previous academic background.

What we are seeing with these residency programs that you have to pay for is the natural result of an educational system that is not doing its job -- and the hospitals "fighting back" saying essentially "If you don't teach the students how to be nurses and expect us to do it, then we will charge tuition just like the schools do." It's not a pretty state of affairs, but it is an understandable reaction.

nanagose · Dec 3, 2009

What I think is a shame is that our educational system is doing such a disservice to its students that such programs are required. Students should graduate with adequate preparation to not need such an intensive and extensive role transition program.

Whether it's during school or after, that preparation you are talking about has to take place in a hospital, at the bedside. The hospitals that are fighting back about having to provide additional preparation to graduate nurses might want to take a hard look at how they treat the nursing *students* that come to their hospitals for clinical rotations. It's hard to get the needed amount of experience when hospitals are antsy about allowing nursing students to do real nursing work. At one hospital, we weren't even allowed to chart. What are the nursing schools supposed to do to provide all of this additional, comprehensive training if there's no place to do it?

Why should a hospital pay to train a new grad that they might not reap the benefits of? Because they're reaping the benefits of some other hospital's new grad when they hire any experienced nurse! There are so many posts on this board where people say, "This is an awful work environment, but I need to stay to get that year or two of experience." If hospitals want to retain their new graduates, they should either have them sign a contract (as some do) or provide a healthy and supportive work environment.

llg, PhD, RN · Dec 3, 2009

If hospitals want to retain their new graduates, they should either have them sign a contract (as some do) or provide a healthy and supportive work environment.

Even the ones with reasonable work environments have trouble retaining new grads. Just look at the discussions from students here on allnurses. Many, many students say they have no intention of working as a bedside nurse for more than a year or so. That's their career plan -- work for about a year to "finish their training," then move on to something else. Maybe it's to be a traveler, maybe it's to grad school, maybe it's to home health, or whatever. But they have no intention of staying at the bedside regardless of how well they are treated.

Also ... a lot of the new nurses who get burned out and overwhelmed during that first 6 months say they were/are mistreated, when in fact ... if they had been well-prepared for the job in the first place, they would have been able to handle it and would NOT feel abused. Some of those feelings of having been abused are due to a lack of preparation.

Of course there ARE bad hospitals and bad working environments. I'm not saying that there are no bad work environments.. Yes, some of what nanagose says is valid. But it is not that simple. The hospitals are not totally to blame for this situation.

Schools who do not/can not provide the appropriate preparation for their students to succeed in the local job market need to address those problems. That might mean cutting their enrollments and providing a higher faculty/student ratio. It might require them to hire faculty that are clinically competent. etc. Such things would promote a better relationship between the hospitals and the schools that would allow for students to get a better clinical experience. Some hospitals are over-run with student clinical groups "supervised" by faculty who have never set foot in that hospital before and are totally ignorant of its policies, procedures, etc. -- and nowhere near competent to practice nursing there. No hospital can allow such clinical groups to do much of anything with their patients. If the schools provided expert faculty that were known and trusted by the hospital, then students would be allowed to do more in their clinical rotations.

Use your critical thinking skills. The hospitals cannot allow the care it provides to be compromised by incompetent (and stretched-too-thin) faculty members. Schools need to invest in its faculty and work WITH the hospitals to provide good clinical experiences. As long as the schools are simply trying to take the students' money and get them to pass the NCLEX and not really focusing on clinical education, then hospitals will have to protect their patients by limiting the students' activities. Those schools who maintain high standards in its clinical education will graduate students who don't need to pay for a residency to get hired. Only the graduates of schools who don't provide good clinical education will need such programs.

Of course, there will be exceptions -- particularly when the job markets get off-kilter as they are now. With most new grads struggling to find jobs, there will be people willing to pay extra for some extra training that might help them be more competitive. And there will always be people/institutions that are willing to provide that training in order to make a buck. That's just "free enterprise" at work.

I think that what we have now is that ALL of those trends are coming together to give hospitals the motivation to create these "residency for a fee" programs. As I said before, it's not pretty, but it is understandable. Everyone needs to decide for himself/herself whether or not they want to spend the money for the additional education.

Jershar · Dec 6, 2009

It's a sad shift for the profession of nursing, new grads, and health care. :crying2: It's funny how there are so many predictions about nursing shortages in the near future. Yet, we continue to prolong hiring new nurses and even outsource nurses from other countries. :angryfire

elkpark · Dec 7, 2009

Blame the spoiled rich Ivy Leaguers whose rich parents "buy" Muffy and Bif an internship to give them a "leg up" from the unwashed "hoi polloi." http://www.thebigmoney.com/articles/judgments/2009/06/10/intern-nation
Ridiculous!

??

I didn't see anything in the Slate article that sounded like this -- it was just about how everyone nowadays, even Ivy League grads, is having trouble finding jobs and having to settle for unpaid internships.

ITA (as usual) with llg's excellent analysis. The real problem leading to this situation in nursing is (IMHO) the inadequacy of the current model of nursing education.

lindarn · Dec 7, 2009

It cost money to train some one.
http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102275308.html
http://www.americanhs.com/Resources/articles/pdf/Nursing-The%20Cost%20of%20Failure%201.pdf

You have to wionder when it will finally accur to them, to actually encourage retention of nurses, rather than encouraging the revolving door that has become nursing employment. JMHO and my NY $0.02.

Lindarn, BSN, CCRN

Spokane, Washington