Looking through the posts I see so many new nurses wanting to leave nursing. Now, one might chalk it up to "kids these days" or the instant gratification generation, BUT I am not of this young population. I am in my forties, held different professional positions, chaired organizations, dealt with life and death- not a spring chicken. Many of the posts from new nurses are career changers as well. So it is likely not a generational problem.
Believe me, I have reflected on my situation over and over, trying to identify the issues. Was it me? Did I have unrealistic expectations? Did I like some aspects of nursing and gloss over the others thinking I'd get used to it? Or was it the job- short staffing, too many patients, lack of training, lack of support?
So,
My questions are:
1. Is this a new problem, or has there always been a group that just doesn't "fit" or has trouble transitioning? Maybe it's just the connectedness of the internet that makes it more apparent.
2. Has the shift in education toward NCLEX changed how prepared students are for actual work? You always hear "you learn how to learn" or "you learn critical thinking in school" and the other stuff you learn on the job. BUT
3. Is it the lack of training through preceptors, residencies, etc.? Many new grads are going into regular positions with very little orientation time and no support system. SO they aren't being "taught" but thrown in to learn on their own.
4. Have the conditions on the floor changed for the new grad> more patients, low staff, high acuity, etc.? How does it compare to conditions 5, 10, 15 years ago?
5. Has the average nursing student changed? Is the motivation to go into nursing different than before? I was not motivated by "a dream" but by the interest in science, psychology and working with people. Does this affect our ability to "stick with it"?
6. Has there been a shift of mentality? "life is too short" kind of thing. Are we more likely to change when things don't go as expected or don't meet our needs? This could be good or bad.
There are probably many more things to ask. Any input is appreciated. Just interested, not writing a thesis. Although, it would be a good project topic.
awesome question. i have to agree with some of the other posters about the computerized nursing. it takes longer to learn to use computerized charting and something is always being rolled out, updated, changed, or "off line." scanning and charting are time consuming. meeting the needs of the computers "entry system" eat your time and in the end, the flow sheets and electronic record take more time and essentially say less. i would hate to have to read the electronic chart years down the road in a lawsuit and know what it was i had done. nurses are told "document everything" and "if it isn't charted it wasn't done" but no one really teaches new nurses how to chart.
sadly though, except for the computer nightmare and the general public having a sense of entitlement and treating nurses with less respect,(which is why i finally really burned out at the bedside) the issues i see and read on here are exactly the same ones i wrestled with in the 1980's when i started. the nurse:patient ratios were horrendous, the patient acuities have steadily declined, patients really are sicker, and medicare has gone crazy micromanaging and driving the kind of care you can give verse what they will pay for. core measures is just another way to stream line care like an assembly line and pay as little as possible. some of cms's goals are so unrealistic! infection rates at zero would be great if physically possible, but as long as there are germs and human beings there are going to be infections. medicare is just going overboard.
horizontal violence, gossiping, and the struggles between cna vs lpn vs rn vs bsn in 1985 look exactly the same. i wish i could say things have changed. i am not sure there are any solid answers. it's as if the more things change the more things stay the same.
1. is this a new problem, or has there always been a group that just doesn't "fit" or has trouble transitioning? maybe it's just the connectedness of the internet that makes it more apparent.
imo, the constant connectedness of social media has indeed changed our daily interactions -- in many cases we know we will hear about friends' and acquaintenances' every up & down throughout their day.
2. has the shift in education toward nclex changed how prepared students are for actual work? you always hear "you learn how to learn" or "you learn critical thinking in school" and the other stuff you learn on the job. but
the lack of clinical time is quite distressing. you can teach critical thinking until the cows come home but until you get some experience dealing with actual patients it is extremely difficult to connect the dots and understand the why and how of what you're doing. also ... the lack of clinical experience during pre-licensure education often means that a lot of time is eaten up learning hands-on skills. if it takes an hour to insert a foley or get some iv antibiotics going ... that's an hour that is not spent with your entire team of patients and is certainly not spent "getting the big picture."
3. is it the lack of training through preceptors, residencies, etc.? many new grads are going into regular positions with very little orientation time and no support system. so they aren't being "taught" but thrown in to learn on their own.
i was fortunate to have been precepted in my first nursing job by a nurse with > 10 years experience. many others are not so lucky. she was also a natural at teaching, but her experience was what made my transition so successful -- she had the solid foundation to assure me that, together, we would make it through the day. the sheer anxiety felt by so many newer nurses means that there can't ever be this kind of mental safe zone when they precept nurses who are even newer. i was also fortunate to have been in a unit where the mindset was, "it will take you a year to figure out what you're doing, 2-3 to feel comfortable, and 3-5 to really feel like you can handle anything that comes in the door."
4. have the conditions on the floor changed for the new grad> more patients, low staff, high acuity, etc.? how does it compare to conditions 5, 10, 15 years ago?
when i speak with other nurses my age, many of whom have 10-15 years more experience than i do, they report that patient acuity has been on a steep uphill climb, and lengths of stay are shorter. regulatory requirements are greatly increased, as is the documentation required to demonstrate that those regulatory requirements are being met. i've talked with a number of med-surg nurses who report that they used to write 1-2 notes on a patient per shift, unless they had some acute change.
5. has the average nursing student changed? is the motivation to go into nursing different than before? i was not motivated by "a dream" but by the interest in science, psychology and working with people. does this affect our ability to "stick with it"?
i think that the recent push toward advanced practice nursing has greatly increased the numbers of nursing students who consider bedside nursing as a temporary stepping stone to something else. like it or not -- this does affect care.
6. has there been a shift of mentality? "life is too short" kind of thing. are we more likely to change when things don't go as expected or don't meet our needs? this could be good or bad.
many more people in all fields, all across the population, now pursue more than one career during their working lives than did a generation or two ago.
there are probably many more things to ask. any input is appreciated. just interested, not writing a thesis. although, it would be a good project topic.
what are the implications of all this? a mixed bag, at best.
I think in addition to many of the points above, we are expecting already over-taxed nurses with little interest in it to orientate new staff. And lets face it, despite the fact that students/new grads are great at taking obs and "doing" tasks, they take time to teach. Add that into an already overwhelming workload and orientation is going to be inadequate at best.
And then, that inadequate orientation leads to new staffers who are overwhelmed and under-supported. It all becomes too hard, especially when you add in the issues of "customer satisfaction".
Perhaps a more apt thought would be ... why do so many nurses STAY in nursing given these constraints.
Oh sure. I think that a lot of what you are referring to is the 'instant gratification' that our society demands these days. There are some that think nursing is too difficult at first...because IT IS...and don't weather the storm long enough to experience the nice calm seas that come afterward. Have you ever been completely frustrated when you first started to learn something-to the point of crying almost-and then after you have mastered the task, you wonder what in the hell you were so bent out of shape about? Same mentality. It takes a while to get the gist of nursing. It is SO worth it if you stick to it.
I can't add to the discussion (I start my first shift as a nurse in about 50 hours), but I just had to comment on the brilliance of this statement. Nursing is a second career for me. I spent 10 years working professionally as a potter in a small shop. When I first started out, I hated it. My boss was hard on me, I felt incompetant compared to the others around me. I just knew I was meant to be a potter. After a year or so, I had my "aha" moment where everything seemed to click. I ended up running the shop and (if I can toot my own horn), I am a very talented artist.
I fully expect my new career to be the same way. There will be days I hate my job, when I go home crying b/c I feel like a moron. But I know if I stick with it, things will click for me and I'll be a great nurse.
More people need to read what you've said; life isn't easy, but if we stick with things, we can be more than we ever expected.
Specializes in Trauma Surgery, Nursing Management.
Wow. You guys are amazing. Such great responses. Thanks for taking the time to write honest and thought provoking answers. I love to see different and insightful perspectives to good questions.
Y'all continue to educate me by sharing your experiences, and for that I thank you. This is a great thread, OP. I appreciate your inquisitive mind.
As still a relatively new nurse, I have to agree with some of the problem being a continual increase in expectations from management without any additional resources. In my 1.5 years I've seen additional expectations placed on us at least once a month, with no additional resources to get the work done. I really don't mind the medication scanning, but having to have another nurse go to the room with you to co-sign takes so much extra time when you're on a large unit. I agree it is safer, but feel they need to staff a resource nurse that can cover the extra work being created.
I did complete a residency program and while it helped greatly with the transition from student to nurse, it doesn't change the fact that nurses feel overworked and under supported. And at least at my facility it isn't that you're crazy busy the whole shift (at least not on a regular basis), but it's that there is no available help for when you need it. I guess my hospital is looking at staffing a resource nurse form 1000-2200, which I think is a great idea. Charge is too busy to help and the other nurses are too busy, so to have someone who can be there during the busiest times and just help where needed would be a huge help. I think it would alleviate a lot of the complaints that our nurses have about feeling overworked.
In addition to the excellent points made, nursing (and every other profession) is taxed to the limit because of harsh economic times. Mass unemployment, sicker patients, and lack of resources make it harder and harder to get the work done. We have very little time to actually TALK to our patients. It's like an assembly line...get in and get out, because you have a hundred other things to do. Very unfair to the patients and their nurses. Furthermore, people who are employed are often working jobs they don't really want, just to work as a nurse.
While I enjoy nursing, I have toyed with the idea of leaving the profession, at 8 months in....for the reasons listed. I won't, but at some point, I plan to either find a clinic job or return to the OR. I don't mind where I am right now, but I am certain that I will never work many hospital positions in my career, for the simple fact that they are never staffed properly. I'm a second career nurse, intent on taking care of myself first, and the burnout just is not worth it.
In order to get through my shifts, and enjoy them, I constantly remind myself to try my best, learn what I can, and not worry about the rest. If you go in with a healthy perspective, nursing can be great. The other thing to remember is this : the staffing shortages are NOT your problem. It's theirs (administration). Do what you can...and don't make nursing your whole life.
Specializes in Trauma Surgery, Nursing Management.
You know, guys-we are all identifying the same problems here. The bottom line is that we are not well supported with staffing. Why is it that our hospital administrators can't rectify this situation? Don't they see that nurses are burning out more quickly, and new staff are being hired (at great expense to train them) at a fast rate? Don't get me wrong: I welcome new staff and want them to come on board. But at the same time, I don't see why it is so difficult to retain the experienced nurses that we already have. It doesn't take much to make us happy. Give us adequate staffing, equipment that WORKS, managers who have our backs, educators that are available, and a charting system that is user friendly. We can handle the rest.
I will be the first to admit that I am a Gold Card Carrying Member of the Airhead Club. What I fail to understand is why our administration doesn't go the extra mile to retain staff. I am not talking about the malarky of Nurses Week or the whole dog and pony show for 'celebrating our staff'. Very few of us can attend these functions designed to make us feel appreciated. Hell, we can't even take a five minute break most of the time.
I think the best approach would be to save the resources and expense of rolling the red carpet out for Nurses Week, Magnet Status Celebrations, Employee Appreciation Week, etc. and put that money into a pot to hire resource nurses like Annaiya's unit is instituting. THAT would make me feel appreciated and celebrated.
Sorry for hijacking your thread for a minute, OP! Can y'all tell that I feel strongly about this?!?!
I agree. I feel all that nurses week and magnet stuff is rather insulting. It's not needed, and an embarrassment. I want to work with professionals with a company that is ready for prime time, that is all. Reward me with a raise in pay and benefits.
We could pass NCLEX first go around at 75 questions, but could we take a patient load of 6-7? I did not feel confident that's for sure. I was told by a nurse once that you're not a real nurse until you hit the 5yr mark. I took great offense at that for the longest time as I thought NCLEX and a job made me a real nurse and then after that first year, that would make it official. But the amount of time needed to get that experience...it can be about 5yrs. Some can get "there" sooner, some might be later. They don't tell you in school you need much more experience in order to feel more confident and settled. They let you think videotaping yourself doing skills is enough. NOTHING replaces hands-on experience, real life experience. Amen sister- I am 40 years old with a BS in Science Education and wanted to go into nursing for 12 years. Finally graduated in December of 2010 with only 1 B- passed the NCLEX with 75 questions and landed a job in Critical Care 3 months later. I crashed and burned. In my clinical experience we had 1-2 patients of this caliber, but I wasn't prepared for 3-4. I know this sounds like a small ratio, but our patient's were on vents, PEG tubes, wounds, critically ill with multiple co-morbidities, huge amount of meds, paper charting, admits, discharges, procedures (we had to go with patients), non-ambulatory (constant turning), brittle diabetics, kidney failure, etc. We had a code in our 75 bed hospital at least weekly with patient's dying at least every other week. I started making errors and getting overwhelmed. Finally at 3 months they told me it wasn't right for me, but felt like I would do really well in a less-acute environment. They are trying to help me find another position within the system. For me this is like entering college again and trying to figure out what major is right for me. I never saw myself working in a Dr.'s office, but knowing how much I enjoy teaching (difficult to do with pts AO x1) and spending time with pts, plus stress level it may end up being right for me.
Specializes in Certified Med/Surg tele, and other stuff.
I think a lot of it has to do with the charting requirements. I have been a nurse a long time and have seen many trends come and go, but the electronic charting is a disaster. If I have a critical patient, I have to decide if I am going to treat the patient or treat the chart. Of course I treat the patient, but things go uncharted, so it looks like things were not done. Our particular system Cerner/First Net is tedious.
In addition, we now use a PPID system for generating labels for labs. It too, is tedious, often doesn't work and is time consuming. We are soon going to a similar system to give meds. I think this will make us all work as if we are in quicksand.
I work in a very busy trauma center ED, with over 100 beds. We have not implemented it yet, so I'm not sure of the logistics but I have taken the online course info on it. We have to log in, scan the meds individually (but first an order must be in the chart, and we often need to give meds before we enter the order), scan the patient....if a med doesn't scan (and the packaging is getting flimsier and more cumbersome), we have to send it back to pharmacy with a note saying it won't scan, the administer the med, then chart it.
I'm not looking forward to this. I think this kind of stuff continually slows us down in the name of patient safety, but how safe is it if you are bogged down scanning meds when you have patients requiring immediate attention and there is no back up??
Oh well, just my thoughts on the new trends in nursing that are certainly not in anyone's best interest!
I think once you learn to use this system you will like it. We had a few bumps in the road with meds not scanning at first, but now it goes pretty quick. If there is a code we give meds and scan when done.
Scarlette Wings
358 Posts
awesome question. i have to agree with some of the other posters about the computerized nursing. it takes longer to learn to use computerized charting and something is always being rolled out, updated, changed, or "off line." scanning and charting are time consuming. meeting the needs of the computers "entry system" eat your time and in the end, the flow sheets and electronic record take more time and essentially say less. i would hate to have to read the electronic chart years down the road in a lawsuit and know what it was i had done. nurses are told "document everything" and "if it isn't charted it wasn't done" but no one really teaches new nurses how to chart.
sadly though, except for the computer nightmare and the general public having a sense of entitlement and treating nurses with less respect,(which is why i finally really burned out at the bedside) the issues i see and read on here are exactly the same ones i wrestled with in the 1980's when i started. the nurse:patient ratios were horrendous, the patient acuities have steadily declined, patients really are sicker, and medicare has gone crazy micromanaging and driving the kind of care you can give verse what they will pay for. core measures is just another way to stream line care like an assembly line and pay as little as possible. some of cms's goals are so unrealistic! infection rates at zero would be great if physically possible, but as long as there are germs and human beings there are going to be infections. medicare is just going overboard.
horizontal violence, gossiping, and the struggles between cna vs lpn vs rn vs bsn in 1985 look exactly the same. i wish i could say things have changed. i am not sure there are any solid answers. it's as if the more things change the more things stay the same.