Things that make you go hmmmmmmm....

cannoli · Dec 31, 2004

How many years do you have to work for them?

purplemania, BSN, RN · Dec 31, 2004

I have never heard of a facility requiring a contract in exchange for mentorship. I understand contract for bonus pay or tuition pay. As for the difference between MD and RN, the RN's are on the payroll during the mentorship. The MD's are not. THey are paying for the privilege of having a hospital to learn in.

PamRNC · Dec 31, 2004

New grad contract? What, did they pay for your education?

Bye the way congrats on being a new grad! :balloons:

good luck on the NCLEX!

Tweety, BSN, RN · Dec 31, 2004

I never heard of such a thing. Here new grads only have to committ if they've recieved tuition assistance.

Good luck.

USAFRN 13 · Dec 31, 2004

As for the difference between MD and RN, the RN's are on the payroll during the mentorship. The MD's are not. THey are paying for the privilege of having a hospital to learn in.

That is not accurate. Medical students doing clinicals are "paying for the privilege." Once they graduate and begin internships then residencies, they do get paid.

Are you sure you are being required to work for "years" (how many?) in exchange for only 3 months of mentorship? How is mentorship defined, by the way? Did the hospital pay for some of your schooling, or repay some loans? If that's the case then you're pretty much obligated to them for whatever you signed for.

If you have not taken ANY MONEY from them (i.e., if you signed the contract but have not started working there yet, assuming that you did not accept tuition assist or a signing bonus) and are having second thoughts about the terms of the contract, contact a lawyer. If the contract is that bad, he/she can probably get you out of it. The hospital will probably release you to avoid the litigation.

USAFRN 13 · Dec 31, 2004

Sorry, I just re-read your post. If you have been working there 6 months already, it is probably too late to get out of the contract based only on the poor terms. Most likely a case of "you signed it, you live with it" at this point.

CritterLover, BSN, RN · Jan 1, 2005

i have seen this, especially in "specialty" areas, such as or, icu or for new grads. i don't necessarily agree with it, but it costs a huge amount of money to train a new nurse. think about it: when you are in orientation, you are not a productive staff member. all the money they are paying you is not accounted for by a "return" (for lack of a better word), other than your education. the facility does not get any patient care from your efforts. yes, you may be taking care of patients, but that care is being "charged" by the salary they are paying your preceptor. who, by the way, is probably being less productive than they would be should they be working on their own. (this is, of course, in an "ideal" preceptorship arrangement where each preceptor has only one orientee and no other duties). and then there are the classes they have to send you to.....plus, some hospitals pay preceptors more. it all adds up, quickly. in the hospital system that i work in now, it costs between $30,000-$50,000 to train a new hire, depending on the level of experience.

when you look at it from a financial standpoint, it becomes easier to see why a facility would want a commitment before agreeing to hire someone new. especially in units that have a high turnover rate, or places where new grads go to "get experience," and then move on to something else. i think some icus have implemented this kind of contract due to nurses coming in to get their experience for anesthesia school and then moving on. when i was in school, the floor i worked on (basic med-surg) was requiring a contract of 1 year for any new-grad hire. there wasn't a nursing shortage at the time in that area, though, and they could afford to make such a demand. i don't think i've ever seen an or that would hire someone without a contract.

as far as residents go, the hospital gets a pretty big return from their services. the hospital is able to charge for the services they provide. i'm not sure of how all of the billing works out, but i'm sure the hospital gets a cut somehow. they also do much of the grunt work that the attending physicians don't want to do (for basically a fraction of an attending's salary), which keeps the attendings happy. (the hospital i worked in when a nursing student was a very small hospital, no residents. we had one surgeon who always wrote on his post-op orders to "page ho for temp >101.5....etc. every time i took that order off i laughed to my self thinking "you are the ho in this hospital" :) ).

group_theory · Jan 1, 2005

Residents provide the hospital with cheap labor (compared to the cost of hiring attendings/PAs/NPs to do the same stuff)

But also, funding for graduate medical education comes from the federal government through the medicare program. Funding does not come from the medicare trust fund, but from the federal government's allocation to GME, which is being administered through medicare.

Funding per resident is guided by a formula, but it's around $100,000 per resident per year (rough estimation). Given that the average resident gross pay is $40k, the hospital pockets the difference. The argument given by hospitals for the funding-pay difference is that residents are less efficient and will order more tests/studies than necessary, eating away valuable hospital resources.

In 2003, the cost of Direct GME (residency salary, benefits, attending physician compensation) was 2.59 billion dollar. The cost of indirect medical education payment (cost of ordering more tests, sicker patient population, greater technology needs, etc) was 5.30 billion dollar.

I hope this explains the difference in why residents aren't required to stay on after residency while new nursing grads have to sign binding contracts.

Nurse2be_08 · Jan 1, 2005

Thank you for the post, I would have never thought about that. It's certainly something for recent grads to think about!

bluesky, BSN, RN · Jan 1, 2005

I have never heard of a facility requiring a contract in exchange for mentorship. I understand contract for bonus pay or tuition pay. As for the difference between MD and RN, the RN's are on the payroll during the mentorship. The MD's are not. THey are paying for the privilege of having a hospital to learn in.

All the facilities in my area offer new grads fellowships that last approximately 3 months in exchange for a 1 1/2 to 2 yr contract.

All the residents I know of are paid. Are you referiring to the medical students?