Why such high new RN turnover?

MN-Nurse, ASN, RN · Mar 13, 2012

My understanding is that new nurses (recent graduates) are the most likely to leave the field. If true, why is this? Is it because they underestimated the job's demands?

Possibly. However, it also might be that the jobs most available to a new grad RN are the ones everyone else refuses to do.

MN-Nurse, ASN, RN · Mar 13, 2012

The job is harder than most believe. Research over the past 20 years has shown that new grads are likely to move from their first job within 2 years, thinking the grass is greener elsewhere.

Sometimes it is greener elsewhere. LTC is a good example. I have never heard one RN say "Boy I wish I was back at the nursing home!"

My very demanding unit has a fairly high turnover rate. We have recently lost many very strong RNs - ones with 4-6 years experience. These RNs are very skilled and extremely enthusiastic about teaching the oncoming nurses. However, due to the extremely difficult environment and less than impressive support from management, they are leaving fast.

I picked up one night shift and noticed that I was one of the more experienced nurses working that night. This is a bad thing.

As far as "the grass being greener" I run into these former coworkers a lot because I work in a very large facility. They could come back to my unit any time they want, but they sure as heck don't.

I think my unit is a meat grinder "on purpose." Recently the more skilled, experienced, late-20's/early 30's RNs were stuck there as no other units were hiring. Now that hiring has picked up, these strong RNs are leaving skid marks getting away.

I think at first, management likes it because they can easily find new grads who will jump at the chance to take any job. However, our attrition rate doesn't leave very many good teachers around as we are hiring new grads like crazy.

This is going to be a problem pretty soon. I (and my cohorts) are learning, but not so fast and well that we can replace the experience of a dozen highly skilled nurses.

cdsga · Mar 13, 2012

I think as patient safety factors are tabulated over time, the information will speak for itself. The documentation was perfect but the care was far from it. Hospitals will have to pay nurses at some point. Don't you think they could afford to offer higher wages and lengthen the top out years to retain experienced employees and keep from churning out the bucks on the amount of expenses needed for new hires? It seems it would be a good investment. The older you get the less inclined you are to go through the orientation that is painful and you really like to find a home at some point, but it seems harder and harder to do. It takes too much energy, and the also arduous energy of having to prove yourself over and over again. That's why changing jobs can take it's toll. There are many valuable people who have alot to offer and can be utilized for the benefit of the organization but its a money reimbursement game now and we have to play it. We're really excellent at obtaining and compiling data-the results of that data is not always revealed and if it was would it be news to us at the bedside? Are we asked to sit at the table trying to make things better? Usually not in a substantive way.

jabarker11677 · Mar 13, 2012

I'm hoping to become a newbie, myself. Would working at a nursing home as a CNA for a year help get the training I need to survive being a newbie?

I can only speak to my own experience, but I believe yes, it will help. It won't give you everything you need, but it will help. I was a waitress, then went to school for nursing. During nursing school, I became a CNA and the skills I learned as a CNA was invaluable. ( I have been a nurse for 10 years now. ) Plus many nurses that I worked with allowed me to observe procedures, gave me insight to pt. diagnosis and sometimes let me assist with procedures once I tested out on them at school, and gave me a lot of time management skills. It also gave me a "foot" in the door of the hospital I wanted to work for. Some one said that

"Unless of course you see your whole future as an RN as cleaning poop and repositioning patients etc. The roles are completely different and while nurses do a large amount of patient care that is something anyone can do." The roles are different, but do overlap, as it takes great team work and understanding of each other's roles to provide pt care. Part of being an nurse is doing the basic patient care when able and when needed. So I think that absolutely every nurse should work as an aide if they have the opportunity to do so.

All4NursingRN · Mar 13, 2012

LOL yep this is something I've never understood, why don't the pharmacist just call the providers directly after all no one but the PA's, NP, or MD are placing those orders anyway so why they call the nurse I will never know. And to make things more ridiculous because of electronic charting they can see who ordered what, yet they are still calling the RN. Most times I just transfer the call to the docs.

A lot of the hospitals here in Florida are getting rid of the patient care techs....so if you plan on being a nurse, you better make sure you're ok with doing a lot of what a typical CNA would do for the patients. I can understand why turn over is high for new grads....it is crazy out here. I've been a nurse for over 7 years & even I am getting fed up with the shortstaffing, poor pt to nurse ratios, the constant berating of HCAHP scores & how we (the nurses) need to do better.....even though the hospital chooses to keep us running with as few nurses as possible. Our poor new grads are started out on med/surg with 7 patients, no techs and no secretary. If I had started in an environment, I would have turned around & ran the other way.
I don't think it's so much that older nurses are eating their young......rather they are too overwhelmed themselves to help very much. I am not jaded towards nursing.....nursing is a fine career. It is when administration thinks because a nurse "can"...that they "should" do everyone's job. We put in our orders, we are doing respiratory treatments, now they are telling us to make sure we clean the rooms on a daily basis.....as well as emptying the trash & laundry. Cater to not only the patients, but their families also...because 60% of the patient satisfaction surveys are filled out by family members. Remind doctors to do this or that. Call doctors with results of tests....and in turn get yelled at by these doctors for bothering them with results.
Where is the nursing in all that? We are being turned into a jack of all trades & then blamed when something doesn't go right. Lab messes up a time or a order....well, the nurse should have caught the mistake & corrected it....or the nurse should have noticed no one from lab drew the blood at the exact time & the nurse should have made a call to remind lab to draw the blood. The doctor orders the wrong test or doesn't give a reason why a test is ordered....the nurse should figure it out or follow up with the md. MRI is ordered but the dept is taking awhile to get the patient...the nurse should call & find out why they are taking so long. Pharmacy is questioning medications, have the nurse call the MD to clarify & then call the pharmacist to follow thru on clarification. Pharmacist still doesn't agree? The nurse should keep calling until it is resolved. Why can't the doctor & pharmacist talk to one another? No one around to answer the phone, the nurse should drop everything to answer the random unit phone calls. It goes on & on & on. Put the nurse in the middle & then blame the nurse for everything that isn't perfect. That is not nursing!

TheCommuter, BSN, RN · Mar 13, 2012

The new hire now is more self loyal, they don't want to give to an institution.

You can bet top dollar that I'm self-loyal. Businesses and employers have not been loyal to their workers in a very long time, so why should I show loyalty to the organization that views nurses as replaceable?

The lack of loyalty is a two-way street. It's a sign of the times and a strong indication that society has changed. Workers are looked upon as replaceable cogs in a profitable machine.

My employer will keep me around as long as I am meeting their needs. Conversely, I'll remain with my employer as long as they continue to meet my needs. Once anything changes, the employer/employee relationship gets terminated.

cdsga · Mar 13, 2012

Exactly my point-I don't blame anyone for taking care of self. Just a change in times and employers have always banked on the opposite. They are not prepared for people who won't dish out what's given and expected to like it. Hardly much negotiation. Both sides have to give to get.

Dana1969 · Mar 13, 2012

I'm a second career nurse with just two years of med-surg experience, and over twenty in management. And based upon that (modest) experience, I believe that the turnover in new grads is high because of several factors.

First, nursing schools aren't teaching student how to be nurses. They are teaching them how to pass the NCLEX. If a schools fails to meet the minimum NCLEX pass rate for three consecutive years, that school is at risk of their accreditation being revoked. So schools are doing what they need to do to stay in the business of graduating nurses, not edcuating nurses.

Secondly, hospitals aren't teaching nurses how to be nurses. The first sacrifice made during difficult budgetary times is the training budget. Why? Because it will immediately help your bottom line in the short term. And by the time it shows up in the long-term(with reduced patient satisfaction scores, increased nursing burnout, increased incidence of disability leaves, increased litigation costs due to increased patient falls-hospital acquired infections-bedsores), the people who sacrificed the training budget willl have been promoted (based upon those short-term gains) or otherwise moved on to greener pastures. Of the twenty nurses in my new grad class, there are nine of us left after two years. My new grad training consisted of eight days of a burned out former nurse (aka nurse manager) reading powerpoint slides to us. And after each slide, repeating the phrase "you are responsible for this standard of care. If you fail to provide this care, you may be subject to progressive discipline ..." .

This was followed by four weeks of a steadily increasing workload on the floor, paired with a preceptor who would only speak Hindi when the unit manager wasn't present (and I can't speak Hindi).

I TRAINED MYSELF, by purchasing training DVDs and studying them on my off hours. By not taking a coffee or lunch break my first year on the floor and using the time to observe senior nurses performing tasks. By trading instruction from senior nurses (I would do their patient baths, in exchange for a bit of training...). My hospital may have spent buckets of money ON PAPER, for my training. But in reality, they spent almost nothing.

That's why new grad nurses are burning out faster and leaving sooner. They are being sacrificed on the altar of hospital profits and to perpetuate the myth of the "Nursing Shortage" for nursing school profits. I'm just finishing up my first vacation (one whole week in two years) and I'm tearing up at the thought of going back tomorrow.

I came to nursing, hoping to do God's work. But instead, I feel used up, disposable, and stuck in the middle between patients, families, doctors and other staff. I don't know how much longer I can take this. Thank you Hospital, in the SF Bay Area. Edited because I need my job, and they fire people who speak out. I've seen it happen too often.

Multicollinearity, BSN, RN · Mar 13, 2012

It seems to me that many new grads are not prepared for the level of multi-tasking and pace of work. I see this as a problem from their nursing schools not preparing them. It seems many nursing programs focus on NCLEX-passing games and ivory-tower views. It's also a problem endemic to the occupation that nursing has evolved to tolerate such working conditions.

For the employers, it seems to boil down to a shell game of money and liability. And right now many of us nurses feel like we are pawns (without much power) in this game.

I do not see improvement for nursing schools unless there is a shift in focus and change in the mission, structure, and content of nursing education. I don't see much change regarding employers until the job market and economy improves, giving workers more power due to changes in supply v. demand.

Health-care institutions need to shift to institutional thinking, and focus on their missions and responsibility. The shell game of restricting efforts to money and liability lacks humanity and lacks mission. How does this happen? I don't know.

caroladybelle, BSN, RN · Mar 13, 2012

Is it because they underestimated the job's demands?

Yes.

And if I see one more "Hi, I'm an MBA that was not doing well in business and decided to become an RN to CRNA as fast as I can, so I can make Beaucoup bucks and have a guaranteed job", I will run screaming amok.

cdsga · Mar 13, 2012

Seems like a vicious cycle-educate for accreditation/run hospitals for accreditation-get more money-hire more expendables that don't join lock step-have students drop out and get more students-there's a waiting list you know. How is this cycle broken? Is Florence Nightengale a figure head or a point of rally for passionate nurses who want to do what's best for the patient? Leaving Facebook... | Facebook

missladyrn · Mar 13, 2012

The new hire now is more self loyal, they don't want to give to an institution. If the institution does not give them what they want when they want it, they leave. They look for greener pastures. There is no sense of paying dues as a new employee like in the old days when you got the evening or night shift first, the unit that needed the most help, or where you had to work to wait for a slot in a department that you desired. They don't want to work overtime, they don't want to take call, they don't want to work extra UNLESS it benefits them. I don't blame them, but on the other hand, I didn't have a choice when I took my first job. I was glad to get it and always was aware of the resume' killing "job hopping". I knew then and there that would be a red flag to future employers. Sometimes you have to "pay the dues to sing the blues" so to speak.

I am not loyal to my employer because employers are no longer loyal to us. Loyalty is earned, not just something to blindly give to the guy who will cut you in a second to save a buck.