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.
Then on top of all of this, you have the infighting amongst nurses themselves. Example:
"Nurses who work x y or z areas are not REAL nurses." Please. Everyone who works as a nurse is a "real" nurse. People enjoy or thrive in different areas for different reasons.
As long as nurses continue to be divided, the problems exist.
From what I can see, although far from perfect, Canadian nurses are somewhat better off. Universal health care for all, less focus on "customer service", and better working conditions and pay across the country. Why? Unionization. Yes, we are also facing hard times, but not nearly as bad as the US. For this, I am grateful.
Okay, I'll jump in with something that I didn't see in the previous posts - This is from personal observation...
Some people get into nursing because they think they can make a great deal of money, but are poorly prepared for the work needed to actually 'CARE' for another person... "you mean I have to clean up their 'dirt'?!??!?!!?!" or "I'm going to be an RN so I don't have to wipe butts" I've HEARD this...
Some cultures seem to 'push' their children/relatives into nursing (expecting them to pursue the career) when these children/relatives have little or NO interest in becoming a nurse. They are simply doing it because the 'family' expects it... We had a young man in our nursing class (his 2nd attempt) who admitted that he had NO interest in nursing but that his family expected him to become a nurse... He didn't make it the 2nd time either...
I also am a new 'older' nurse, 2nd career and I thought long and hard before deciding to enter nursing - I took an 18 week course and received my certification as a CNA before even considering nursing because I wanted to make sure I could 'stomach' the job... At my school, the Nurse Assistant class was NOT a requirement for Registered Nurses, but SHOULD have been... I learned A LOT from that class that I didn't get from the quick 6 weeks in first semester on how to take care of a patient - which was taught with all the 'other' pressures of being in nursing school.
From personal experience at my current/first job - I'll jump on the lack of support bandwagon. I work in a small community hospital that serves an 'under-served' population. On my unit, we have 32 available beds that are almost always full with everything from vent/tele tube feeding patients from local nursing homes to drug abusers who have 'skin popped' and ended up with a nasty abscess - craving their next hit and mad that the methadone isn't given on demand..., to the older person with generalized weakness or SOB, or a young person with uncontrolled HTN or ESRD and on dialysis.
I received a total of 12 shifts of orientation with 2 very different nurses - neither of whom wanted to precept, one who admitted she got into nursing because her sister told her she could make a lot of money... My first night was a nightmare that I'll never forget.
Our assigned 1 or 2 nurse assistants (for up to 32 patients, which I've always thought was crazy, but they think nothing of it...) often are used as 'sitters' for confused/combative/psych patients or taken from us to work on a different unit. Which causes the nurses to need to do all the normal work in addition to cleaning patients (often with the vent patients needing 2 people just to manage the tubing or girth of the patient). The patient load is most often 4 - 5 patients (in California, though I've heard nurses here say that they have had to take 6 patients due to short staffing) with discharges and admits along with patient care and paper charting.
So, my opinion, some people that enter nursing don't really consider nor are they really prepared for the WORK that goes into staying in nursing.
I would agree with the previous post. Nursing is work. However, the face of nursing is very different than it was before the economy tanked. Due to severe cutbacks, nurses everywhere are expected to contend with unrealistic workloads, leading to unhappiness, stress, and burnout.
I see a lot of people who get in to nurse for either of 2 reasons -- all the money they'll make (Ha...haha....hahahahaha) or to "help" people. Sometimes you really can help someone, sometime you can really make a difference, but they are so rare, we run right to AN to write about them!. The simple, horrible truth is, most people don't want to be "fixed," they want to be put back into shape to go back to doing what put them in the ER/ICU/OR to begin with. I've yet to have a repeat DKA patient say, "you, know, I really need help getting my sugar under control. Can you help me?" Same with addictions (unless it's followed by a mock pitiful "so you can give me extra pain medicine to get thru it, right?"), CHF, COPD. I've had COPDers with a history of multiple intubations who still smoke 3 PPD -- and will continue to. I think that's one thing nursing school rarely if ever talks about -- the soul draining, resource eating "frequent flyer."
For what you risk -- AIDS, hepatitis C, MRSA, VRE, exposure to toxic chemicals when giving chemo (which we have to do in ICU), physical/mental/emotional assault by families and patients, low census periods where you don't know literally if you're going to work 1 12 hour shift a week or not, we are NOT paid well. If we screw up badly, just one bad night, one bad call, one sick patient you missed a critical sign or lab on because you had someone else that was crashing, you not only lose your job, you can lose your ability to ever have that job again anywhere, and get sued in the process. I'm seeing new RNs racking up 20-40-60,000 dollars in loans for a job that pays 32,000 per year before taxes.
I see people being precepted by nurses that only have a year or two as a nurse. I was lucky and bless by God that my original preceptor in my LPN days had 20 year's experience in multiple settings; she came in the first day, said, "Forget all that crap they taught you in nursing school, today you start learning to be a nurse." She's the one that made me a nurse, not the lala dreamland they teach you in school.
False expectations, hyperinflated sense of self worth (nobody's impressed that I'm a nurse unless a kid barfs at church -- then they're all about me dealing with it because vomit makes them want to be sick, too -- new nurses are being set up to fail. The ones I'm seeing are coming out of school and think they already know everything, are talking about getting their CCRN certification when they've never even been in a code, much less run one. Nursing is hands on learning, folks, and we just can't give a student the 4, 6, 8 or more patient workload so that they learn what it's like to have that many plates in the air at one time. I think we need to go back to the old system where you were taught at a hospital, and you lived/ate/slept that hospital until when you graduated, you'd actually been working and pulling a patient load. That's how they did it during my aunt's time, and they turned out some awesome nurses. I know I would have been better prepared than I was under the college degree system.
I wish more schools offered externships or practicums for students, where they get a feel for real nursing without the stupid care plans. I am currently completing an externship, and by day 2 I was taking care of 3 patients. I may take 4 but my preceptor often has patients with sophomore students, so I can't intrude on those students' learning. No care plans for anyone I've taken care of, which has been liberating. I wish the externship was longer, but oh well. I had to take what the school offered.
Specializes in Critical Care, Emergency Medicine, Flight.
i start nursing school in the fall, and reading a lot of the forums on this website about new grads' horror stories about the first year after licensure and/or inability to find jobs is really scary/discouraging!
im applying for jobs in every state that i think id like to live in/can afford. im not throwin out my cash and sanity to not get hired
I've worked at many different hospitals the past few years as a travel nurse & really observe the new grads & find out what their orientation is. I really feel bad for them most of the time, b/c I had a 12 week orientation as a new grad and was part of a new grad residency program. Most hospitals don't do this. There's just not enough staff, not enough support, not enough education (no clinical educator on the unit, poor management, etc...), experienced nurses are just so busy on their shift how do they have time to be a resource and to educate the new nurses? All around, at many places, I feel management is not supportive of their staff at all, or just do a poor job. It's all about saving money, keeping the minimal amount of nurses required and the bottom line, unfortunetely.
I feel a major issue in nursing is the limiting of L.P.N's. L.P.N's go into school with the dream of being a nurse they work hard and learn everything the R.N knows aside from the associate degree english etc. They also do alot more clinical hours than R.N programs, they come out these information, clinical skill powerhouses to find they will work ltc, office and then mayyyyyyyybe someday be lucky enough to get enough experience to get into homecare and do the nursing they thought they went to school for. I never wanted to become an R.N, I thought it was great I was an L.P.N 7 years ago until everyone treats you like your less of a nurse, and your jobs keep being taken away so you get replaced by a tech or get demoted to a tech. The L.P.N use to work right with the R.N's and it was a better day. All the load was shared patients were better cared for as far as I am concerned, I say this because I came out of school when my area started demoting the L.P.N's I have watched them get shoved into ltc which lets face it takes a speciallllllllll nurse to be the only nurse for 40 patients for meds tx etc etc etc plus supervising the aides. I also was sick of ppl asking me what i do for a living and when I replied nurse I got ooo you are an R.N? My answer would be L.P.N and I then would get oh. I went back to school am just about done and am soooooo mad personally at the lack of respect for L.P.N's when I havent learned a darn thing I didnt already know as an L.P.N. in this R.N program... get mad at me all you want I dont care the R.N is over rated i did it solely fopr the money and to make sure I didnt get shoved intop a corner of nursing I hated... and thats what I believe happens with many new nurses, most nurses eat their young, its a competitive field, some dare not ask questions to learn for fear the others will make them feel stupid after all they are already nurses they should know it all already. Idk all the answers but this is what I have seen a lot of in my area they go in with high hopes and come out with crappy jobs even the R.Ns come out and are treated like **** from the older nurses who are just too burned out to teach them anything, all the good teaching nurses are coming up for retirement, we're in trouble as a profession, all the reforms and mergers are coming and nowwwwww they are putting L.P.N's back to work on the floors, ers, ors, etc, Im glad I went back to school so I didnt have to keep getting tossed around Im also fortunate for the experience I was able to get in the fields of nursing by being an L.P.N that will prepare me as an R.N I just swear I will never understand this big division of im a better nurse than you because I work here or Im an rn bsn etc, Its all a huge mess and the reason for the major shortages are turnover, nurses work and then make a career move, why put up with all of it when you can go make about the same and have alot less responsibility? I left owning a salon for the joy of nursing .... well i fear the day will come when i will put the stethoscope on part time and the scissors on again fulltime. I am ready to have the nice R.N behind my name and go work behind a desk in a homecare agency for $7 more an hour than what I get now and continue to do literally the same job. Its all messed up anymore, there are no easy fixes Its always going to be a profession with major flaws. I just hope for the sake of humanity spme souls are brave enough to keep trying to fix it.
Specializes in ED, Telemetry,Hospice, ICU, Supervisor.
I feel a major issue in nursing is the limiting of L.P.N's. L.P.N's go into school with the dream of being a nurse they work hard and learn everything the R.N knows aside from the associate degree english etc. They also do alot more clinical hours than R.N programs, they come out these information, clinical skill powerhouses to find they will work ltc, office and then mayyyyyyyybe someday be lucky enough to get enough experience to get into homecare and do the nursing they thought they went to school for. I never wanted to become an R.N, I thought it was great I was an L.P.N 7 years ago until everyone treats you like your less of a nurse, and your jobs keep being taken away so you get replaced by a tech or get demoted to a tech. The L.P.N use to work right with the R.N's and it was a better day. All the load was shared patients were better cared for as far as I am concerned, I say this because I came out of school when my area started demoting the L.P.N's I have watched them get shoved into ltc which lets face it takes a speciallllllllll nurse to be the only nurse for 40 patients for meds tx etc etc etc plus supervising the aides. I also was sick of ppl asking me what i do for a living and when I replied nurse I got ooo you are an R.N? My answer would be L.P.N and I then would get oh. I went back to school am just about done and am soooooo mad personally at the lack of respect for L.P.N's when I havent learned a darn thing I didnt already know as an L.P.N. in this R.N program... get mad at me all you want I dont care the R.N is over rated i did it solely fopr the money and to make sure I didnt get shoved intop a corner of nursing I hated... and thats what I believe happens with many new nurses, most nurses eat their young, its a competitive field, some dare not ask questions to learn for fear the others will make them feel stupid after all they are already nurses they should know it all already. Idk all the answers but this is what I have seen a lot of in my area they go in with high hopes and come out with crappy jobs even the R.Ns come out and are treated like **** from the older nurses who are just too burned out to teach them anything, all the good teaching nurses are coming up for retirement, we're in trouble as a profession, all the reforms and mergers are coming and nowwwwww they are putting L.P.N's back to work on the floors, ers, ors, etc, Im glad I went back to school so I didnt have to keep getting tossed around Im also fortunate for the experience I was able to get in the fields of nursing by being an L.P.N that will prepare me as an R.N I just swear I will never understand this big division of im a better nurse than you because I work here or Im an rn bsn etc, Its all a huge mess and the reason for the major shortages are turnover, nurses work and then make a career move, why put up with all of it when you can go make about the same and have alot less responsibility? I left owning a salon for the joy of nursing .... well i fear the day will come when i will put the stethoscope on part time and the scissors on again fulltime. I am ready to have the nice R.N behind my name and go work behind a desk in a homecare agency for $7 more an hour than what I get now and continue to do literally the same job. Its all messed up anymore, there are no easy fixes Its always going to be a profession with major flaws. I just hope for the sake of humanity spme souls are brave enough to keep trying to fix it.
Seriously take a deep breath and calm down first, the RN hate is not cool at all. Some nurses move up and make a career move because of many reasons, some of them like the advanced scope of practice like NP and more autonomy as compared to other nurses like CNA and LVN.
1. I think that nursing schools used to do a better job of weeding people out in clinicals. I can't begin to tell you how many new grads have told me that clinicals were the easy A or B and lecture was where all their time studying and learning was really invested. So yes, there have always been those who don't transition well, but I think we're seeing more of them. Some of that I'm sure is due to the nature of the setting...an answer wrong on a multiple choice test is there in black and white, whereas a more subtle error in clinicals is often a judgement call with no more than a "he said she said" to back it up, if the judgement comes into question. In this economy, with this litigious of a society, I could easily see where clinical instructors might feel some pressure to pass people on that they feel are questionable. I saw a few circumstances of this myself while in nursing school, and can only imagine that it's likely gotten worse.
2. I actually had a long conversation with a new gead about this several months ago...he felt shortchanged that learning to care for pts was sacraficed in exchange for guaranteeing a high pass rate. I think that there could be a better balance. Students at our local BSN programs who do clinicals on our floor get a max of two pts, even in their last rotations. Not too real world there, is it?
3. I've been becrying the lack of adequate precepting on our floor for over a year now. The most experienced staff on days, with the exception of one nurse, are lousy and have issues with pt care and time management themselves. The other option is to have them with nurses with less than two years experience themselves. No matter how much the not-so-new newbies can rock it, there's still going to be plenty of things that they haven't come across, and they are still in the learning process themselves. It has caused no end of issues on our floor. Another frustrating situation is that per my facility's P&P, LPNs cannot precept. So we have a nurse on days who has been doing this for so long that we joke they built the hospital around her, who is awesome at her job, who can't precept. On nights, the RNs who precept tell their orientees to come to me and the other LPN for any questions, since we've BTDT for so long. It's not unusual for our charge nurses to come to us with questions, or for a second opinion on how to handle a situation. But we still can't orient newbies. It's a waste of resources IMO.
4. The pts are definitely more acute, and the economy has made staffing into a game of "how few bodies can we have on the floor before we get sued?". It's a brewing perfect storm, and the pts are the ones who suffer the most.
As far as computerized charting goes...love it and hate it. Love it when compared to the old way...hate it in that it's so limited compared to what it should be capable of. I grew up with computers, married a computer geek (some of our first excursions when we moved in together were not for furniture, but for parts to build the ultimate computer)...so I know what we should be able to get out of a good system. But our charges still have to do time-consuming audits by hand, data regarding "never events" is always a quarter out-of-date, and some of the built-in safety features are so ridiculous as to render them useless. I want a system that allows for a meta-analysis of all pts in the system based on a set of variables I describe, if I so choose...and while that should theoretically be possible, there's no way it could handle it. If we could have near real-time feedback on what's going on with our pts on a large scale, it would increase pt safety and outcomes. That's apparently still for the future though. (Sorry, I know it's a bit OT, but it's a real frustration I have.)
And the "paperwork"...Holy of holies, when will it stop? Not the charting per se, that's a necessary evil, but the core measures and the fall risk and the braden and...it goes on and on. And to an extent, back to the above. There is no reason at all why the computer shouldn't be able to generate most of that info automatically, and save me the time of doing it. We have to regularly answer questions like if pt received any benzos or seizure meds in the last 24 hours for our fall risk...hmmmm...isn't that right on the eMAR? Why doesn't that just blow right in? Same for core measures...the computer knows if the BNP is elevated and if the pt has hx of CHF, as well as if an echo has been done, if pt is on ACE or ARB, so why do I have to answer those questions on a piece of paper after hunting through the chart? Again, it comes down to an under-utilization of resources. We have the technology, so why on Earth can't these things be done?
5. Yep, I think the average nursing student has changed...at least, the average new grad has changed. When I was a newbie, only just over a decade ago, it was understood that you did your time in med-surg before you applied to specialty positions. Now we get new grads who don't know jack thinking that they can walk into an ICU, get a limited orientation, and know everything there is to know. Yes, there are new grads who are highly successful and excellent nurses without that med-surg time put in, but it seems to me like they are few and far between. I'm on tele, and the number of new grads who can hack even that are at about 25% based on personal experience...and that's the percentage who turn out decent after a good two years of it...if you want to talk about minimally competent to come onto our floor after orientation (of three months), I'd put it at about 10%.
There is also an attitude that teamwork means "stop what you're doing and help me NOW" from a good 50% of the new grads. They seem to think that even though they aren't in nursing school anymore, we exist only to ensure that they do well. I have no problem jumping in and helping, but when the people I help leave on time every night while I'm staying an extra 30 minutes to get my charting done, it ticks me off. And when after months of this I finally start saying "no", only to have them get po'ed at me, it makes me even more angry. Additionally, we're seeing a lot of issues crop up in regards to how techs are treated, which coincides with when we started hiring almost exclusively new grads. We've got more older nurses on noghts, and try to nip that behavior, but on days it's rampant and is causing all kinds of problems.
I also can't tell you how many complaints I've heard about how hard "real" nursing is. I feel like saying "Honey, sometimes you have to make what could be life-or-death decisions...if you wanted easy, go find a sugar daddy." Yes, it's hard, but it's good honest work in a field where you can make a difference. You get out of it what you put into it, and if all you put into it is negativity and the minimum, that's what you'll get back.
Yeah, life's too short to waste and all that. But it's also too short for me to be all about me...who knows how much time I have on this Earth to help make things better for other people? So why not focus on that now, and save the selfish time for later? For some people, it's teaching, for others, volunteering, etc. For me it's nursing that gives me that "I've done something good" high, even when it sucks. It can be all about me when I'm living off my kids' income...they want to work for NASA, be a Ferrari engineer, be a MLB player, and be a forensic investigator. Between all that, I should be set. :)
Specializes in Professional Development Specialist.
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.
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 totally agree, but as a newbie it's hard. no one tells you that it gets better. the nurses i work with who have experience seem just as stressed out and frustrated. they tell stories about how nursing used to be and have a litany of things wrong with it these days. it's hard to see any silver lining in that environment.
from my own personal experience i can say that the clinical experience is declining rapidly. my first and second semester we were encouraged to be fully responsible. by third i found i was restricted in my scope. i could no longer even check someone's blood sugar. i could no longer do anything without the preceptor, and when the preceptor had 6 students you couldn't learn how to manage time. you could only wait around and hope that your preceptor would be available soon so you could pass your meds. we weren't allowed to take any actually sick patients, so we were never allowed more than 1 patient a shift. as hospitals needed new grads less and less, they limited the exposure of patients to students more and more. my final semester practicum was spent sitting or standing behind my preceptor and watching her take off orders. i learned nothing.
and yes, the clinical experience is sacrificed at the alter of the nclex pass rate. i wouldn't say our clinical instructors were reluctant to fail us, but it was difficult to spot a bad student amount the good when 4 of 6 are failing the semester at halfway point and you have 6 students on 3 different floors. if you have to pass meds with each one over the course of 6 clinical days the bad students are hard to identify. plus most of the preceptors seemed to think this was an easy day off the floor for them. i had a few shining examples of amazing teachers, but out of 8 only two seemed to actually want to challenge the students in any way. the school would rather fail a student with fantastic clinical skills, common sense and instincts but who can't take nclex style questions well. schools are not about teaching anymore as much as they are about recruiting new students, and a high nclex pass rate is a big part of that recruiting.
as for training i can't speak. i don't work in a hospital so as a new grad i got a day and a half training and was turned loose to sink or swim. hopefully it made me a strong nurse, if nothing else.
i say bring back the diploma program! graduate nurses who know what nursing is like and are ready to hit the floor running.
From my own personal experience I can say that the clinical experience is declining rapidly. My first and second semester we were encouraged to be fully responsible. By third I found I was restricted in my scope. I could no longer even check someone's blood sugar. I could no longer do anything without the preceptor, and when the preceptor had 6 students you couldn't learn how to manage time. You could only wait around and hope that your preceptor would be available soon so you could pass your meds. We weren't allowed to take any actually sick patients, so we were never allowed more than 1 patient a shift. As hospitals needed new grads less and less, they limited the exposure of patients to students more and more. My final semester practicum was spent sitting or standing behind my preceptor and watching her take off orders. I learned nothing.
You bring up an excellent point and I think it's due to the shortage of clinical instructors. It's ridiculous what they get paid, for all that responsibility. Add to that, you need at least a Masters to do a job that only pays about $40-45,000 a year and it gets even worse. I love teaching and would probably make a good clinical instructor someday- no way in hell I'd do it though, because the pay is a joke.
We also had to wait until the instructor was free so she could pass meds with us..ditto for any procedure. The CI had 8 of us in a group. You do the math.
I also think some of the younger grads were raised in a very coddled environment- everyone is special, everyone gets a trophy etc. So, they get to NS and while the environment is tougher, even some of the schools these days do some coddling. Every lecture after a test, it sucked, because we had to hear Susie contest every wrong answer. :rolleyes:Then, they graduate and all of a sudden, no one cares that your dream has always been to be a nurse. It's put up or shut up time.
And also, the first year of nursing is tough on everyone. You need great coping skills. Not everyone has these.
joanna73, BSN, RN
4,767 Posts
Then on top of all of this, you have the infighting amongst nurses themselves. Example:
"Nurses who work x y or z areas are not REAL nurses." Please. Everyone who works as a nurse is a "real" nurse. People enjoy or thrive in different areas for different reasons.
As long as nurses continue to be divided, the problems exist.
From what I can see, although far from perfect, Canadian nurses are somewhat better off. Universal health care for all, less focus on "customer service", and better working conditions and pay across the country. Why? Unionization. Yes, we are also facing hard times, but not nearly as bad as the US. For this, I am grateful.