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.
1. Clinical is way too far removed from the real deal. At most we had 3 patients and that was only once. Our clinical instructors had too many students to monitor so in the end we only got an average of 2 patients.
2. Our curriculum was heavily focused on the NCLEX. So teaching to the test so the school can boast their 95% pass rate.
3. Nursing is a lot about paperwork and legal nonsense. I got more education at my work about paperwork than actual clinical stuff during the first week.
4. Horrendously short orientation periods. I'm a new grad I still need to learn stuff, three weeks isn't going to cut it. Hell, some of my classmates said they only had 2-3 days orientation.
5. Patients have higher acuties these days. My coworkers tell me that their LTC floor used to be for slightly confused patients. Now we get people with BKA's, addicts, homeless people that happen to have some illness, people that their family dump on us, and people that aren't worthy for a psych hospital by cost-cutting standards. Along with the higher acuties, the patients are about 10x nastier where I'm at.
To be honest I'm looking at paperwork more than I'm actually seeing patients.
thanks everyone! I have to agree with the lack of clinical instruction. Many times our instructor was nowhere to be found and we had to rely completely on the RN we followed. Some were not comfortable with giving us patients and tasks. I can't blame them. Also, the nurses are overloaded and stressed and then expected to teach.
As a new nurse, I was assigned 2 students during my first week off orientation which was only 5 weeks anyway. It was stressful but I loved working with them and tried to give them an actual "day in the life" experience. Made a point to show them real stuff like organizing pts, taking report on 6 or 8 pts, assessments, talking to docs, etc. Things I wished I had seen in clinicals.
Nursing schools are being less selective with their students. They increase their class sizes and a lot of the people that join sometimes don't even want to be nurses.
Some of them will be like: "For 2-4 year degree I can make so much money! Nursing is gonna be easy!"
There are are so many things I could focus on but I shall limit myself to two.
The diploma schools that have now all but dissapeared were truly excellent places to learn nursing due to the shear amount of clinical time AND time working as student nurse alongside of an elder experienced nurse. I can't tell you much about the lectures, but I still remember certain patients that I took care of in school and I can still tell you what I learned from them. If you want to talk critical reasoning,we learned it on the job. Kids come out of school these days with a lot of rhetoric about "critical reasoning", but I find that they don't have it because they have not applied it to enough real life nursing situations. Many confuse critical reasoning with memorization...something completely different. I understand that the old diploma schools are no longer practical, but I think that nursing education could include more clinical time and require all students to spend one full year as an intern nurse....adding one full year to the required training of course means more money and time spent in school, so nurses should be compensated as such.
We also need to consider the role of women in the workplace that has changed much over the past fifty years. In my day, many very intelligent women who were interested in medicine or science became nurses because it was one of the careers (elementary school teacher, nurse, telephone operator,secretary) that were available to women. It's a good thing that women have the same options as men do (or at least options are getting better), but I think we need to do a better job of attracting more quality people into nursing, instead of having to settle for some of the students who would have not made the cut years ago. The rise of for profit schools who care less about your qualifications and more about your money make me question what kind of student they are trying to attract into the profession. I am speaking in general of course, because there are still bright young women AND young men (and middle aged and even older folks) who are becoming nurses, but you simply do not see as much natural talent as you used to as many talented young women interested in medicine are now free to choose other careers.
Ha! You know what I took care of a nurse today who has 37 years of nursing experience, so she's only 34 years ahead of me, ;P
Anyway, here is kinda what we came up with:
I thought being a nurse today was so bad because of a high patient load, but my patient tells me that on a medsurg unit 37 years ago she would have 16 patients to care for with the assistance of two aids.
Then I asked what she thought about the acuity of the average med-surg patient today compaired to when she first started. However, she said that she felt her patients were just as sick 37 years ago, they just didn't leave so quickly.
The one thing we did agree on is that newer nurses get a poor education. The book learning is important, but we've swung to far towards it. When she started nursing school she spent every day of the week in the hospital. When I was in nursing school I spent every day at school and 4 hours twice a week in the hospital. Yes, my last semester I had 185 hours of bedside, along with classes, but that still wasn't enough time.
I think that nurses 30 years ago learned some invaluable team work ability and precision that newer nurses today do not understand because we just were never exposed to it.
When I got out of school with my few hundered hours of clinical under my belt, I was then precepted by a nurse who had only been a nurse a year herself. So if nursing school only teaches us how to think and gives us minimal experience, then we get out of school and gain experience from those who have minimal experience, what do you get?? A bunch of fairly new nurses that are over whelmed and not confident in their skills. They end up believeing that this career wasn't for them because they couldn't keep up and they leave. Not to mention the fact that since these nurses show a lack of confidence they had doubting doctors and NPs treating them poorly to further decrease their faith in themselves.
Nursing today is vicious and a down right awful expereince for a new grad (on average). A experience I would not wish on someone I cared about. I truly do not believe this is how things were 30 years ago, because there is no way the public at large would have the respect they seem to in our profession if it was this way 30 years ago.
Specializes in Urgent Care NP, Emergency Nursing, Camp Nursing.
A few thoughts regarding issues raised in this thread:
Computer Charting
All through nursing school I encountered computerized charting, and didn't find it all that onerous. Then again, I've grown up with computers since Elementary school and as such I already think the way most modern charting systems operate. Then again, I did run across an outpatient system in my community clinical which was truly horrendous.
The ED I did my role-transition internship in had scanning for meds, and that wasn't an issue. The types of complaints about this make me wonder if those doing the complaining don't have computers-on-wheels in their department. If you don't have COWs, how on earth are you supposed to scan meds in real-time?
Modern Nursing School Clinicals
In nursing school, my academic advisor was also the clinical coordinator for our program, so I got to hear about some of the clinical issues going on. One of the problems that he kept running into was that the local hospital systems were becoming increasingly restrictive on what they would let nursing students do - and would then get on their high horses about how poorly exposed recent new grads were to clinical skills. While there are also other causes, it is definitely a problem of the hospitals' creation.
New Grads treating Med-Surg as a stepping-stone
Some have complained about new grads viewing med-surg as a place to move on from as quickly as possible. Do you really blame us? By the time we graduated, we all knew that med-surg is the armpit of the modern hospital, with insanely high acuity for the level of staffing and support given to it. Why would any of us want to stay there longer than we have to? Make working med-surg not suck and maybe more of us would stay.
New Grads going to "specialty" units instead of Med-Surg
The complaint I'm responding to referred to new grads "thinking that they can walk into an ICU, get a limited orientation, and know everything there is to know". This is far from the truth, at least in my experience as a new grad. New grads can and do succeed on floors other than med-surg, but we also expect that we get orientation training in proportion to the complexity of the specialty, which is the responsibility of the institution in general and the unit in specific. If a unit hires a new grad and then barely orients them, the unit is setting the new grad up for failure, and that's the unit's fault.
Further, there are units (such as Emergency) for which a med-surg background does not do much, if at all, to prepare a nurse for the pace and time management skills necessary for that position. The department I work for prefers to hire new grads as we don't have all that med-surg baggage.
As I've read some of the other posts now I'd like to address a few other things.
LPNs/LVNs--- I don't know about the rest of you but I don't even know how to work with an LPN/LVN. In school and in real life we were taught how to work with aids or CNAs, thus I understand their scope of practice. I know what I can ask them to do and what they can't. And it doesn't change to much from state to state. I have no clue what the scope of practice of an LPN is. When I traveled to a hospital that still uses LPNs I often felt disorganized and unaware of my patients because the LPN was doing so much of what I felt was my responsibility. I didn't know how to implement her in my daily organization and I found it frustrating.
Please do not take that as I don't see value in LPNs or don't think of them as real nurses. I just honestly have no clue what they are qualified to do. I know they can't do EVERYTHING an RN can because at the hosptial I was at there were medications the LPN couldn't pass and I had to. I think almost all new grads have this issue, because schools just don't teach us about them.
I do agree that those with direct care of the patient get paid far less than they deserve. My first RN job I worked nights with a CNA who had been there 22 years. She knew how to do my job better than I did, and basically for the first year I was there I just did what ever she told me and bought her a lot of dinners.
I would also like to add that nursing does itself a disfavor by telling others to not be concerned about the pay recieved for what we do. I think that is one of the worst things we do to ourselves. No, when I'm doing my work I should only care about my patients needs and give them my attiention, compassion, and support. However, nursing is a career. It is one that we deserved to be compensated for, and we deserved much better compensation than we currently recieve. Have you ever heard the saying, "People don't appriciate free." ? Well they don't. BSN new grads are paying far more than this job pays to get a degree...they are egged on by instructors and media that tell them this job will pay them more than adequatly. Then they get the reality of their meger pay and decide to go to specialties or get more education to get the pay they thought they were going to get as a nurse. I don't blame nurses for wanting to be better compensated and I get sooooooooooooo freaking tired of hearing others say, "You shouldn't go into nursing for the pay."
Why not? Just because I expect to get fairly compensated in my profession does not mean I don't care about my patients. It means I also care about myself and nurses need to do a WHOLE lot more of that.
It doesn't sound like you've worked med-surg. Tele and Med-Surg are EXCELLENT places to get a background for emergency. I know because I worked ER before med-surg and tele and am now going back to the ER. Your hospital likes new grads so the department doesn't have to pay as much for staffing and they can 'mold' you into doing whatever they can manipulate you into doing.
As I've read some of the other posts now I'd like to address a few other things.
LPNs/LVNs--- I don't know about the rest of you but I don't even know how to work with an LPN/LVN. In school and in real life we were taught how to work with aids or CNAs, thus I understand their scope of practice. I know what I can ask them to do and what they can't. And it doesn't change to much from state to state. I have no clue what the scope of practice of an LPN is. When I traveled to a hospital that still uses LPNs I often felt disorganized and unaware of my patients because the LPN was doing so much of what I felt was my responsibility. I didn't know how to implement her in my daily organization and I found it frustrating.
Please do not take that as I don't see value in LPNs or don't think of them as real nurses. I just honestly have no clue what they are qualified to do. I know they can't do EVERYTHING an RN can because at the hosptial I was at there were medications the LPN couldn't pass and I had to. I think almost all new grads have this issue, because schools just don't teach us about them.
I do agree that those with direct care of the patient get paid far less than they deserve. My first RN job I worked nights with a CNA who had been there 22 years. She knew how to do my job better than I did, and basically for the first year I was there I just did what ever she told me and bought her a lot of dinners.
I have a echo this sentiment as a new nurse. I moved out of my state, even region, for my first nursing job. Where I am from, LPNs are completely phased out of the hospitals. The only time I ever experienced an LPN was doing EMS at the nursing homes. I am having a hard time trying to incorporate LPNs into my practice. I didn't even have a glimmer of understanding of their scope until my interview! One floor at my hospital utilizes the LPN as their med tech. Mine is more with the LPN having your 5th patient.
But.. I struggle. I don't want to come off condescending or untrusting of the LPNs, but I don't really know their role, especially as I'm adjusting in my own new position. It is difficult to pass off an assessment (ongoing, not initial) to a LPN yet still be responsible for so much of the patient.
While I was in school, the most I learned was from the other LPNS in my program who were shocked that they weren't breezing through the material and the instructors saying it is isn't important to know since we don't seem them in our region anymore (acute setting).
By the time we graduated, we all knew that med-surg is the armpit of the modern hospital, with insanely high acuity for the level of staffing and support given to it. Why would any of us want to stay there longer than we have to? Make working med-surg not suck and maybe more of us would stay.
You obviously haven't worked med-surg. School clinicals do not provide you with knowledge about what it is really like to work on these floors. Med-surg nurses have some of the best time management skills you will find in the hospital. They have a ton to balance every shift, all shift long. The skills you learn there are great for any other area of the hospital. You may not learn how to be a critical care nurse, but you learn everything they do except the specialized procedures, which probably only make up 30% of their time at work. If it isn't the type of work that you want to do that's fine, but don't bash floor nursing just because YOU don't think you'd like it. I find it appalling the terrible things ED and ICU nurses say about floor nurses when they have never been one and really do not know what they are talking about.
It definitely is easier for a unit to train a new grad into their way of doing things instead of have to take the time to retrain a nurse from a different specialty, but in the end, the nurse with the wider background will be the better nurse, assuming all other things are equal.
Your facility should have a matrix of what LPNs are allowed to do. Sometimes the facility places more restrictions than the state on what we can do (which frustrates me to no end!), so to be safe go by facility P&P when in doubt.
As far as the team nursing concept where responsibility for the same pts are shared...I have no idea. At my hospital I run with my own team, the buck stops with me. I would probably suck at the whole team thing...I'd want to run the team myself b/c there are very few people I would trust enough to share a team with. On the other hand, I would totally understand if the RN felt the same way. Too many toes would get stomped on!
I am not from USA, but these problems exist in Australia. I remember my grad year well even though it was 1990. I learnt so much in that year but we had alot more clinical practice as students than they do now. The clinical instructir was on the ward with the students from the universities...i rarely see that these days. Senior nurses are expected to teach students and gards and look after a patient load. I think that the university training is a poor system even though they say they teach critical thinking...yet I have not come across many lateral and critical thinkers.
I also think the lack of clinical time leaves new nurses scared of patients and they seem so much more task orientated. Yes, they can do the observations but they do not seem to have the ability to compare these to the last few sets done. hence you get patients getting really sick when the problem could have been picked up ealier. It's not that the work isn't done, but it's not analysed and no big picture forms.
I think specialisation has contributed to limited knowledge in an area. These also leads to the inability to trouble shot. Many nurses seem to want to speacilaise within a few years of finsihing their degree. I think that limits peoples ability to think outside the square. Patients can have multiple system problems yet one will be poorly delt with it's not their speciality.
I too am in my forties and feel much like the original poster. I like bedside nursing but it seems because I have so much expoereince I am being pushed into areas like case management, teaching, being in charge and other roles I am not interested in. Whats so wrong with wanting to just look after patients? Is that not want nursing is about?
I certainly dont like the way nursing training and practice has changed. Whilst there have been some postivites, I see more negatives.
Catch22Personified
260 Posts
As a new grad I'll give my input.
1. Clinical is way too far removed from the real deal. At most we had 3 patients and that was only once. Our clinical instructors had too many students to monitor so in the end we only got an average of 2 patients.
2. Our curriculum was heavily focused on the NCLEX. So teaching to the test so the school can boast their 95% pass rate.
3. Nursing is a lot about paperwork and legal nonsense. I got more education at my work about paperwork than actual clinical stuff during the first week.
4. Horrendously short orientation periods. I'm a new grad I still need to learn stuff, three weeks isn't going to cut it. Hell, some of my classmates said they only had 2-3 days orientation.
5. Patients have higher acuties these days. My coworkers tell me that their LTC floor used to be for slightly confused patients. Now we get people with BKA's, addicts, homeless people that happen to have some illness, people that their family dump on us, and people that aren't worthy for a psych hospital by cost-cutting standards. Along with the higher acuties, the patients are about 10x nastier where I'm at.
To be honest I'm looking at paperwork more than I'm actually seeing patients.