We have been struggling with how to acclimate and prepare our new hires and what used to take a month now takes more than 4. (Home Health).
Do you see the same thing in other areas of nursing?
I certainly didn't have the degree of difficulty orienting to acute care that I read about now, where patients stayed long enough to ask their families to bring their favorite nighties and cosmetics. And I was a 22 yr old sheltered kid. In the 1980's my female patients were applying make up at the sink during their hospital stay. It was definitely both a slower and less acute pace.
Does this speak to the need for additional preparation at the pre licensing level for job expectations and acuities in today's faster paced healthcare environment?
Resistance to costs aside, would an additional year of clinical training be reasonable? Would it make a difference?
I have seen a definite shift in both nursing education and employers over 30 years. Back in shangri la, nurses had lots of clinical experience, especially diploma nurses, and employers valued employees and a majority of those employees stayed for a few years. Fast forward to now and we have BSN programs almost exclusively that limit clinical experience to a small fraction of "lesser degrees" with the attitude that the employers can teach them the "hows", universities focus on the "whys". This has made U.S. nurses the best educated in the world which no one would argue is a negative. The problem is employers were presented two challenges to the traditional orientation process, NCLEX and employee mobility.
NCLEX changed the 4 to 6 month licensure process to a few weeks, eliminating the Graduate Nurse position. Pre computerized NCLEX, GNs were working with a preceptor full time for at least 4 months after graduation before holding a licence in their hand. These nurses came off orientation with a vast amount of supervised situational experience. This gave employers ownership of successes of the RN, but more importantly, it gave employers ownership of the employee's shortcomings. Employers were slower to implement a disciplinary track to correct errors and took an educational approach. This created a more desirable workplace that encouraged employees to stay. The current system has employers hiring RNs, with no real differences from experienced RNs as they have their license in hand. Employers are no longer forced to wait for licensure, therefore they minimize investment in education and accelerate the orientation process. This desire to expedite the process has led to a disciplinary track towards correcting behavior which has left the majority of nurses to "fake it until they make it", leaving them dissatisfied with their employer. Nurses on our unit average less than two years, making the employer view the return on investment to be poor.
New nurses are being short changed by both parts of the system. The lack of clinical expertise has put that burden on employers. Employers have put that burden back on the nurse, expecting them to already have this experience. I feel sadness for new nurses as they are being short changed. My orientation back in the '80's was almost 7 months, and exclusive day shift for 1 year after that, a stark contrast to the current 6 weeks and working full time nights. I wish both educators and employers in the nursing field would look at the ultimate end user, the patients, and make an investment for them.
In the program that I'm hoping to get into, you start clinicals the first semester and your last semester is almost entirely clinicals. I guess that's not the norm? And most hospitals around here have either an internship or residency that new grads are in for a year.
End the BSN entry level requirement across the board where that exists (make it optional again)
Reinstitute the 2-3 year hospital based diploma programs. Hospitals get more help and the students get hard core intensive training. Won't ever happen, I know, because of the loss of power the "doctor nurses" would undergo, but we can dream...
Specializes in OR, Nursing Professional Development.
I honestly don't see any value in extending nursing programs. They already grant degrees; extending it will only lead to more degree inflation. Either the programs need to be restructured so that students are getting the experiences they need (unlikely simply due to the vast nature of healthcare when compared to those days when new grads were up and running right away) or the residency needs to become a more widespread phenomenon.
End the BSN entry level requirement across the board where that exists (make it optional again)
There is no such thing as a BSN entry level requirement. State BONs will license those who meet the criteria, which includes diploma, ADN, BSN, entry level MSN programs. What employers do is up to them, but there's no statewide/nationwide BSN requirement. It's a job market issue where there are far too many grads being pumped out of schools two or three times a year with fewer and fewer available positions allowing employers to be more and more choosy about minimum criteria for applicants.
There is no such thing as a BSN entry level requirement. State BONs will license those who meet the criteria, which includes diploma, ADN, BSN, entry level MSN programs. What employers do is up to them, but there's no statewide/nationwide BSN requirement. It's a job market issue where there are far too many grads being pumped out of schools two or three times a year with fewer and fewer available positions allowing employers to be more and more choosy about minimum criteria for applicants.
Who said anything about nation wide BSN requirements? There is most certainly BSN entry requirement at hospitals around the country,and like I said, they should be done away with where they exist. Where I am, nursing schools are ridiculously competitive (BSN or ADN) and the output compared to the demand is a trickle.
Specializes in OR, Nursing Professional Development.
Who said anything about nation wide BSN requirements? There is most certainly BSN entry requirement at hospitals around the country,and like I said, they should be done away with where they exist. Where I am, nursing schools are ridiculously competitive (BSN or ADN) and the output compared to the demand is a trickle.
But that is the facility's choice and they have the right to make that requirement. What would you do to eliminate it? Pass a law? Make a CMS regulation about it? Good luck with that.
Specializes in orthopedic/trauma, Informatics, diabetes.
I was fortunate to have a 6 month residency in a specialty area. Unfortunately, it was not cost effective to keep it and the pendulum has swung quite far the opposite way with new nurses getting 8-12 weeks. That is not enough time for a specialty floor. And we are reaping the rewards (especially when it is July and we have new residents too)-not. Most of the new nurses are fine, but they struggle and it is hard to help them when you have your own full load.
Seems to me there should be some sort of middle ground.
MrNurse(x2), ADN
2,558 Posts
I have seen a definite shift in both nursing education and employers over 30 years. Back in shangri la, nurses had lots of clinical experience, especially diploma nurses, and employers valued employees and a majority of those employees stayed for a few years. Fast forward to now and we have BSN programs almost exclusively that limit clinical experience to a small fraction of "lesser degrees" with the attitude that the employers can teach them the "hows", universities focus on the "whys". This has made U.S. nurses the best educated in the world which no one would argue is a negative. The problem is employers were presented two challenges to the traditional orientation process, NCLEX and employee mobility.
NCLEX changed the 4 to 6 month licensure process to a few weeks, eliminating the Graduate Nurse position. Pre computerized NCLEX, GNs were working with a preceptor full time for at least 4 months after graduation before holding a licence in their hand. These nurses came off orientation with a vast amount of supervised situational experience. This gave employers ownership of successes of the RN, but more importantly, it gave employers ownership of the employee's shortcomings. Employers were slower to implement a disciplinary track to correct errors and took an educational approach. This created a more desirable workplace that encouraged employees to stay. The current system has employers hiring RNs, with no real differences from experienced RNs as they have their license in hand. Employers are no longer forced to wait for licensure, therefore they minimize investment in education and accelerate the orientation process. This desire to expedite the process has led to a disciplinary track towards correcting behavior which has left the majority of nurses to "fake it until they make it", leaving them dissatisfied with their employer. Nurses on our unit average less than two years, making the employer view the return on investment to be poor.
New nurses are being short changed by both parts of the system. The lack of clinical expertise has put that burden on employers. Employers have put that burden back on the nurse, expecting them to already have this experience. I feel sadness for new nurses as they are being short changed. My orientation back in the '80's was almost 7 months, and exclusive day shift for 1 year after that, a stark contrast to the current 6 weeks and working full time nights. I wish both educators and employers in the nursing field would look at the ultimate end user, the patients, and make an investment for them.