Why such high new RN turnover?

Nurses New Nurse

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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?

Specializes in ICU, PACU, OR.

As bad as I hate to admit it-all service related jobs, police, fire, EMT, nurses, doctors, etc. have to staff units 24 hours a day, 365 days a year.

I find it hard to believe, but I too see that mentality, that when deciding to be a nurse that you would be in such denial. Places that don't staff that way are outpatient clinics and doctor's offices, schools,nursing management... and as a beginning nurse you don't get alot of good experience or pay in those areas. I would be hard pressed to hire a new grad to any of those areas. I also find it a little disconcerting that the instructors of the nursing school don't explain that more emphatically.

You have to start somewhere no matter what job you have directly out of school.

I think because it takes a while to get comfortable as a nurse, and orientation programs are sometimes too short. Nursing school doesn't really prepare the new grad for the demands placed on nurses. I think some go in with the expectation that it will be their "dream job" and it will not be that difficult because they made it through clinicals..right? Reality is, it can be overwhelming at first, but if they would just "hang in there", it does get easier. I think too, it depends a lot upon someone's personality. Is that person determined to make it, or will he or she give up when it gets rough? I don't think working as a CNA really helps , because the skills required are worlds apart. I think you have to go in with the mindset that you will give it time, that your expectations might not be reality, and that you will not quit. As a new grad, thirteen years ago, I started out on a busy Hem/Onc floor, and at times I had eight patients of my own, all with serious medical issues, not to mention if we were overstaffed I would get pulled to a different floor where I was totally out of my element. I would have multiple tasks to do, and the physicians weren't always the nicest, and neither were some of the experienced nurses, and it was all one big juggling act. Many times I wanted to quit, but I didn't. I believed it would get better as I gained more experience, and I was right. Even after thriteen years, I still love the nursing profession, and can't imagine doing anything else.

Specializes in Family Medicine.

On my floor, we can't retain the experienced nurses they hire. They hired three experienced nurses last year. One quit during orientation and another quit the day before she was suppose to be on her own, without a preceptor. The third one is now 20 weeks pregnant and told me she is going to quit soon because the floor is too much stress for her pregnancy.

I was one of three new grads hired last year (they hired us in February 2011 and we started in March 2011) and we are all still working on the floor.

I think the experienced nurses don't stay because our floor kind of sucks and they know there are better jobs out there. We, the new grads, on the other hand, don't know any better so we stick around.

I believe there is a lot of 'nurse-bullying' going on that is not being addressed. It is the 'mean girl' syndrome that goes from high school into the work place. This with long hours, meager compensation, along with the way doctors can sometimes 'bully' creates such an unfavorable work environment that it's just not worth it. I just left an area that I had worked in for 10 years. the bullying/harrassment that occured from my superiors was unbelievable and the idea that the corporation ALLOWED it was even more bewildering. I spoke with an attorney who said unless someone harrassed me sexually, I had no case. Yet I had numerous derogatory remarks made to and about me, had subordinates sending me harrassing email to my PERSONAL email address, and was spoke to in such a demeaning manner on many occasions that my self-esteem just couldn't handle such a hostile and negative environment. I am moving into a different field of nursing which I hope proves to be of a different environment, but we will see. The facct that students leave so early and that seasoned nurses such as myself are sick of it needs to be addressed or the healthcare community could see an exodus of nurses leaving the field...

Specializes in ICU, PACU, OR.

Solidifies my theory that we never get out of high school!

Specializes in Oncology.
Personally, I never worked a day as a CNA and do not see it as particularly beneficial. 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. Now a days many places like to hire RNs who were a CNA in the facility first but that is because they know you and your work ethic etc. Networking is always important for newbies. All of this said anyone who has read these boards even a bit knows why there is such turnover. These are things like: lack of respect, high demands, staffing issues, expectations of doing more with less, heavy patient loads, and of course the all encompassing patient satisfaction scores that are all so important now a days. The expectations are enormous and becoming harder to reach by the day. My pay hasn't increased for all of this extra effort and stress though. The hospital has now become the Burger King Drive through where patients "get it their way" and now. Do not be late with that pain medicine and by all means make that ice a little colder. I digress as surely you get the picture:twocents:

Really Good Observation Mom to 4!

Specializes in Oncology.
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.

You would think at some point they would wise up and reason that they should pay the seasoned nurses more to make them stay and raise morale a little but that would be smart and they're just not all about smart. Money is the bottom line and it's the ONLY THING that matters to them! I am sure though, eventually they will have to do something in this line because there are so-o many nurses in my age bracket (50's) that will be retiring in the next 10-15 years. Since they can't keep new nurses and they aren't staying long enough to become seasoned nurses, when the seasoned nurses do start leaving they're going to have a mess on their hands. And when I leave in about 8 years, I'm not looking back at the nightmare that nursing is, no part time, stand by or anything for me for any amount of money! So they should be figuring out what the hell they're gonna do now, but I know they're not, they're just living for today and thinking tomorrow is never gonna come!

Specializes in Oncology.
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.

My heart so goes out to you. I know exactly how you feel (used up, disposable and stuck in the middle between patients, families, doctors and other staff). I wonder is administration really so oblivious to what's really going on behind the scenes or do they just choose to be on purpose because then they don't have to deal with anything? I wonder, wonder, wonder???

Specializes in Oncology.
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.

You are so-o right!

It is impossible to get a Hospital as a new grad in AZ, hence I went into home visits and LOVE IT! The staff are so nice, the clients love to see you and are so grateful and nice, you get a lot of skills, critical thinking, calling doctors, social services, actually making a difference in peoples lives, I get vents, trachs, foleys, wound care, you name it. No IVs though as a vendor in town has that contract. No overworked floor nurses to fight with. The home visit companies are really supportive and some offer paid training.

Specializes in ER, Open heart, Long Term Care,Camp.
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?
I think there are a few reasons why new grads leave nursing. First, they can get overwhelmed by the enormity of their jobs; the responsibility can be daunting especially if they are not mentored as they are hired. Secondly, many new grads accept positions that they are not ready to do. Thirdly, many who come out of BSN programs are coddled so much by schools that they do not get the experience needed to prepare them for the onslaught of what they will be doing as a RN. Another reason is choosing a field of expertise that you are not adequately trained in; this goes hand in hand with not getting enough experience in all fields while still a student. Two weeks of ER observation does not an ER nurse make!! I graduated from a diploma program many years ago; we frequently worked in all areas of nursing as CNA's to get an idea of what we wanted from our jobs. This gave us experience as well as confidence. I did go back to school to get my BSN and fortunately the students I worked with did get a lot of clinical time; the instructors made sure to expose the students to as much as possible. For me, as a new grad, I chose to go into the military where I was responsible for a large orthopedic ward. My interest was ortho or neurology but after handling a medical emergency well, I found myself sent to work in the ER. I was lucky in that I had two very good doctors that mentored me daily. My responsibilities were huge but I always had corpsmen and my mentors to assist me. I worked for three years as an ER nurse with the USNavy and as a result found it was my calling. I stayed in ER's for over 25 years and I thank my Navy experience for helping me find my niche. I would encourage new grads to consider such a step...it doesn't have to be a lifetime job either, but it sure can help one gain confidence and perspective on a future job.
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?

Personally, I am a newly graduated RN from May 2011. I feel that this subject is near and dear to me. I came into nursing school with a very realistic idea of what nurses do and had a fairly extensive list of experiences in the medical field, SNF's, doctors offices, and hospitals alike, so I don't feel that underestimating the job demands is the reason nursing is tarnished for me. I graduated from a top rated school and took all of the advice and reccomendations that my professors offered but even with all of this I was still unable to find an RN position within a hospital that didn't want at least one year experience. How can you get experience if no one is willing to give it to you? Alas I was offered a job as a rehab nurse in a LTC facility. I felt at this time this was going to be the only offer that I would receive so I accepted. This is making me question my decision to become a nurse. In rehab the accuity of patients is higher than that of a LTC facility, but they can get away with higher nurse to patient ratios in my rehab dept because they are part of LTC, so most days I find myself caring for upwards of 18-20 pts. I'm talking patients wtih TPN, IV ABT, Trachs needing frequent monitoring, peg tubes, and to top it all off admits! Oh and I forgot to mention I only had 3 days of on the floor training and was thrown to the wolves. I also feel like the phrase "nurse eat their young" is very much the truth. I know that I am knowledgable in my field but everyone has limits. I feel that this acuity with this number of patients is alot for anyone and I fear that I may miss something one day and it can have consequences whether they be small or large. Its not that I underestimated the demands of being an RN I just never knew that a situation like this could exist! I also don't understand why it is so difficult to get into a hospital! Any suggestions would be greatly appreciated. Thanks!

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