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After chatting with a fourth year med student today at clinical, it occurred to me how vastly different the physician career-path is from our own. Fourth year medical students are undergoing the process of being matched to a residency in the specialty of their choosing. They apply to prospective hospitals and hope to be matched to their top choice, awaiting the chance to learn from their experienced superiors. Then, after gaining some experience, they apply for a fellowship or are recruited to a hospital.
Meanwhile, new graduate nurses face roadblock after roadblock to becoming an experienced nurse. As nursing students approach graduation, they frantically begin the job search, only to encounter "__ years experience required" on almost every job posting. If nursing school is not adequate preparation to be recruited to a nursing position, is our education failing us? How are we to become experienced professionals if hospitals are unwilling to let us grow to this capacity?
I believe the answer to this problem is nurse residency programs. Like medical residencies, these programs assume and even require that the applicant be a relatively-inexperienced new graduate. I feel that like medical residencies, nurse residencies should become a traditional and required portion of nursing training. I envision this to be far off in the future, but maybe someday every teaching hospital will have "nurse residents" and every nursing student will go through a residency as part of their training, not just the lucky few who are accepted to these programs today.
You didn't complete a nurse residency? I did. Nurse residency in Critical Care. Nurse residencies already exist. Obviously not wide spread and what some organizations call "residency" can be something pathetic like meeting for 4 hours a week or some brief four month orientation.
Nurse "residency" programs are the exception and not the rule and I have found they are "offered" by the larger academic type facilities almost exclusively.
They don't offer new grads positions because they are too cheap to train them. They staff poorly on purpose and complain about a nursing shortage that doesn't exist.
A simple orientation to new grads isn't an unfair expectation and if they are so afraid to train them and loose them I do think it is reasonable to have them sign a contract that put a time limit on how long they must stay top "pay for" the education.
Meanwhile, new graduate nurses face roadblock after roadblock to becoming an experienced nurse. As nursing students approach graduation, they frantically begin the job search, only to encounter "__ years experience required" on almost every job posting.
One of the main differences is there are federal (?) regulations on how many new docs are made each year, in order to ensure that there are enough residency spots for all of them.
No such regulations exist for new nurses or nursing schools. As a result, you see lots of for-profit and fly-by-night "schools" churning out new grad nurses by the thousands, and not enough new grad programs or residencies to accommodate them all.
I think part of the problem is that medical schools limit the numbers and nursing schools are constantly trying to flood the market with as many nurses as they can.Are new nurses willing to work for dirt cheap wages and be on call for lengthy periods of time and submit to the hierarchical nature of medical residencies? It doesn't seem so.
Or I could have just kept reading and saved a lot of typing.
They are definitely in the minority. Most residents work about 80 hours a week (it used to be more, but laws now prevent that due to patient safety issues) - I believe the national average has the typical resident making about $12-15/hour, when you consider how many hours they work.Not all doctors work their residencies for "dirt cheap wages." The resident doctors at my university teaching hospital are paid more than I make now, plus they only work 4 days per week. They have generous amounts of time off, and they can work in emergency rooms for extra money if they want to.
GREAT post! I totally agree with this, especially.On any given day on this forum you'll find nurses "eating their young" to be a hot topic. The pecking order in a typical 3 or 4 year residency structure would have those people beside themselves. Interns know they have to earn their respect as they plug through the hell of their first year. I don't think nursing has accepted the same, and is more focussed on being treated almost as equal to their elders in the nursing world from day one.
One of the main differences is there are federal (?) regulations on how many new docs are made each year, in order to ensure that there are enough residency spots for all of them.No such regulations exist for new nurses or nursing schools. As a result, you see lots of for-profit and fly-by-night "schools" churning out new grad nurses by the thousands, and not enough new grad programs or residencies to accommodate them all.
There are no fed regulations regarding number of med schools' graduates. There are money Medicare pays for training of the residents. There is only that much of the money, and there are accreditations' rules. If hospital has "X" beds and does "Y" surgeries every year, it can only have certain number of residents. Hospital has to have "X" number of high-risk L&D cases every year in order to train obstetricians, etc. But these rules are pretty flexible and "outside rotations" are not prohibited, so that's usually not a problem.
Actually, Medicare pays for more residency positions then number of all Americn grads every year. That's why so-called "foreign medical graduates" can get into residency training. At the same time, Medicare (and anybody else, as a matter of fact) doesn't care if newly graduated and licensed doctors can find jobs or not. Right now there is a dead glut of pathologists but pathology residencies continue to churn out grads just like before because they got the money to spend on doing just this. As I mentioned, it is not impossible but extremely difficult for a doctor to change specialty after he/she was initially "matched", and specialties in medicine are prone for the same "fashions" and "waves" of popularuity as everything else.
Of course, getting $200000 every year for training of one resident who is paid $50000 over the same time, the hospital sure could hire one more resident for the same money. But, you see, it will decrease what attendings can legally pocket for their indespensible "teaching functions". They suffer so much inconviniences calling those friends of them, aka drug reps, to come and tell their residents about those new miracles from the pharmacy and feed them stale pretzels, or mouthing their old war stories by hours while rounding... it would be unacceptable to deny them some miserable financial gratification!
BTW, doctors as a community vehemently deny the very fact of existence of violence in residency programs.
In nursing, I cannot imagine situation where a preceptor would have absolute power over a new grad nurse, limited only for things like gang rape, and where the new nurse would knowingly forfeit his/her legal rights in order to remain in training and not to kill chances of being a nurse in the future. But that's how it looks like in some residency programs. If you take a textbook for doctors, chances are you'll find a list of "experts" or "referrees" in there, many of whom will be listed as "residents". These people were "honored" to do a job of writing down whole chapters for the author without any pay, any royalties from the money which came from selling the book and such, all that done in their sparce free time. It is so specified in legal paperwork they have to sign to be so "honored". For some of them, the "honor" would be an opportunity (not a guarantee!) to get a reference letter from the author. For some, it would be a single option to just stay where they are. And the opportunity to become such sort of intellectual slave is considered to be a hallmark of a good, benigh residency program. The worse ones can be only compared to a cross between gestapo, ghetto and Moscow in 1937.
Nurse "residency" programs are the exception and not the rule and I have found they are "offered" by the larger academic type facilities almost exclusively.
*** Yes I understand that. However a few health systems use a universal nurse residency program for all new nurses wether the grad working in the big flagship hospital or one of the smaller feeder hospitals in the system.
They don't offer new grads positions because they are too cheap to train them. They staff poorly on purpose and complain about a nursing shortage that doesn't exist.
*** Yes well said and 100% correct. However it is my observation that new grads are graduating from nursing school helpless at the bedside and not having learned simple and basic nursing tasks and skills. Rather than the well trained new nurse concentrating on learning time managment, advanced skills and critical thinking when she is first hired, she must be trained in fundamental nurse tasks and skills by her employer. This dramaticaly increases the cost of training new grads.
A simple orientation to new grads isn't an unfair expectation and if they are so afraid to train them and loose them I do think it is reasonable to have them sign a contract that put a time limit on how long they must stay top "pay for" the education
*** I agree but a simple orientation isn't going to be enough for new grads going into specialiety units. Any new grad should be able to function on a med-surg floor with a few week orientation. They can't though cause nursing schools are letting them down.
Esme12, ASN, BSN, RN
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