Educating new nurses

3 I didn't know exactly where to put this, so I put this in the general nursing section.

I just finished my first session of the RN to BSN program I am in. As part of my Dimensions of Professional Nursing class, I had to write a paper focusing on something in Professional nursing, Leadership, Education, Research, or Service. I decided to focus on Education, specifically education of new or inexperienced nurses as it relates to nurse residency programs. I am convinced those programs are good for nurses and nursing in general and should be expanded, especially those like the UHC/ACCN residency program. There is a lot to the transition from classroom to practice that imho general orientation programs just do not address. I also think there should be a part that focuses on the special problems LPN's might have transitioning into practice as an RN. Programs like this might make all the difference in a new nurse leaving at the end of his/her first year and actually sticking with it. Now, that's not to say that work environment, staffing, corporate policies, etc don't have a huge part in it. But imho having a structured transition program and only having preceptors who actually want to teach would make a HUGE difference.

This paper is the beginning of what will most likely become part of my capstone for this nursing program. My idea is this: Nurse Residency programs should be subsidized like Physician Residencies so more organizations will implement them, and preceptors should be recruited from those who want to actually do it and who love to teach...not the first warm body. Also preceptors should get some recognition for what they do. I know that this would only work at organizations who value nurses as assets, not liabilities but I think it's important for our future. If hospitals realize that a nominal investment in their nurses will help their bottom line, they might actually be more inclined to implement more of these programs. From my research the turnover rate for new RN's is 30% in the first year and upwards of 50% in the second year, versus a retention rate of 95.6% for those that complete the program. That's tangible dollar signs if you want to put it into that perspective.

I don't think I got across exactly everything I wanted to in that paper, but I got the main points.

Am I on the right track with this?
Nurses will need to take 10 cents on the dollar while in residency like Doctors do. But no-one wants to get paid 2.50 an hour.

I think you make some good points, and I would hope hospitals that are seeking Magnus status by pushing all nurses to become BSN's would take a page from your essay.

I applaud your efforts. You are thinking, looking for solutions and that is wonderful. I am not sure the a residency program similar to physicians is needed however a well structured orientation program certainly is. As part of my work, I developed a 16 week orientation program. As educator, I met with the preceptor and orientee every 2 wks to review progress and set goals. These feedback and goals were written and required input from each. It was time consuming but very productive.As you continue your research, you will see that reasons for high turnover of RNs in the first year are many. Proper orientation is just one. Unrealistic expectations is another. Lateral violence, how receptive and helpful are the existing staff? Of course the setting is key. Having been a travel nurse for many years, I have seen huge differences in the ambience, the culture, of a facility and units. BTW, I have worked at Magnet hospitals and they have been hands down the best places to work. Thus the reason the term magnet is used, it attracts nurses and historically have very little turnover. Studying this model would be very helpful to your project. Thank you for caring and best wishes

Oh and follow through after orientation is done is important. Maybe a quarterly meeting, "How are things going?, What can we do better?" type thing. We bring them in and love on them for such a short while and then we just push them off the edge?This is an area that I have strong feelings about.

Actually, there is a "subsidy" already available for nurse training programs - by way of Medicare cost reports. Organizations can "pass through" their costs on their annual Medicare Cost Reports. The programs have to meet very specific criteria: * Be approved for CE -- this means they cannot be a repetition of basic nursing education* Be graded - measurable outcomes based on a logical grading scaleThe organization has to establish a very careful financial tracking process to ensure that all reported costs are clean. It's almost certain that these claims will be audited because they are so rarely included on cost reports. If you want to research this, it is in the CMS rule # [FONT=NewCenturySchlbk-Bold][FONT=NewCenturySchlbk-Bold]413.85 Cost of approved nursing and allied health education activities. This is the way most hospital-based diploma programs stay(ed) afloat for so many years. Unfortunately, it seems that the financial wizards who manage hospital financial systems are clueless in this area, so hardly anyone is taking advantage of this funding opportunity.

THANKS, HouTx. Good info.As for the original post, I realize there is a gap between nursing school and nursing practice, but it is sad to me that someone who is deemed competent to have a license does not know how to do their job. We have to spend lots of time and money RETRAINING new grads. Rather than residency programs I am more in favor of BSN as entry level to nursing in a hospital. We have better results with BSN students because they have "become" a nurse in that longer period of time.

While that's all well and good, I don't feel you are getting to the big elephant in the room. WHY are new grads so poorly educated that they need prolonged preceptorships. I believe nursing programs overall need to be re-evaluated. When they did away with the Diploma programs they shot themselves in the foot. Those new grad nurses could do the job with minimum orientation (30 days), why because they had a hospital based program with tons of clinical hours that were REAL clinical hours, they were trained to do the jobs they were hired for when they graduated, if you didn't cut it - you flunked out period. My LPN program was based on the Diploma school model and we had tons of clinical hours,we worked full shifts and were expected to do the work and class after and before the shifts - if not we were gone. When I graduated from nursing school, my first job was a med/surg floor, I had a few weeks orientation and off I went. In my area when the ADN programs were started, their requirments were you HAD to have been an LPN, nurse aid or medic for so many years, they didn't take just "someone off the street" with no medical training or background, the experience was to suppliment the lack of clinical hours offered in those programs.Preceptorships are a "nice idea" but I think you really need to look at why they are needed in the first place, new grads should be able to hit the ground running with basic orientation. It's not the hospital's job to train a new grad for months on end, they are supposed to be functional but they no longer are.I think the whole nursing education model needs to be revamped and return to more hands on and less fluff.

I agree with most of what is being said in the responses to this thread. While the OP is doing fine with her beginner-level thinking on these issues, most of us who have been "in the trenches" for a while know that things are a lot more complicated than they may appear to a newbie.I too believe that hospitals should not be expected to bear such enormous costs for the "re-training" of new grads. New grads should not be licensed or expect a professional salary unless they are prepared to function as a professional in the RN role. That means that we need to either:1. Upgrade nursing education and eliminate those programs that don't prepare their students to function. (And yes, it can be done in a standard 4-year BSN program. We regularly hire from a few high quality schools that do a great job. Their graduates don't NEED fancy residencies/internships unless they are hired into special care units.) It means eliminating many "accelerated programs" and ones designed to "fit the student's lifestyle" -- at the expense of preparing students for the real world of professional practice.or2. New grads need to accept a dramatically reduced "training wage" similar to that of physician residents. If the employer is going to be expected to provide new grads with what is essentially an "apprenticeship," then the new grad need to accept the fact that they are, indeed, "apprentices" and not yet professional nurses. Alternatives could be the signing of work contracts in which the new grad would pay for the training if they didn't stay on the job for a specified length of time, etc. But my point is clear. Hospitals can't afford to pay the tens of thousands of dollars that such programs cost with no promise of getting anything back in return.Personally, I think both approaches should be taken simultaneously -- ASAP.

In our area, residency programs are common. Graduate nurses make around $13/hour until licensed and undergo extensive training that continues into their practice after they are licensed. Once licensed, they make their full rate. A typical program consists of two 12 hour shifts shadowing and two eight hour shifts of classroom work. This program continues for around 3 months (typically 1 month or more before licensed and 2 months after licensing). It has been very successful. Training programs are expensive but you only have to prevent one CLABSI, fall, or pressure sore to pay for several nurses to go through them.The residency classes do repeat some of nursing school. Most of it, however, is facility specific training and enhancement of clinical thinking skills and skills not commonly taught in nursing schools (glucostabilizer, advanced dysrhythmia recognition, alsius, ACLS, PALS, NRP, etc...).

Quote from classicdameTHANKS, HouTx. Good info.As for the original post, I realize there is a gap between nursing school and nursing practice, but it is sad to me that someone who is deemed competent to have a license does not know how to do their job. We have to spend lots of time and money RETRAINING new grads. Rather than residency programs I am more in favor of BSN as entry level to nursing in a hospital. We have better results with BSN students because they have "become" a nurse in that longer period of time.

Quote from llgI agree with most of what is being said in the responses to this thread. While the OP is doing fine with her beginner-level thinking on these issues, most of us who have been "in the trenches" for a while know that things are a lot more complicated than they may appear to a newbie.I too believe that hospitals should not be expected to bear such enormous costs for the "re-training" of new grads. New grads should not be licensed or expect a professional salary unless they are prepared to function as a professional in the RN role. That means that we need to either:1. Upgrade nursing education and eliminate those programs that don't prepare their students to function. (And yes, it can be done in a standard 4-year BSN program. We regularly hire from a few high quality schools that do a great job. Their graduates don't NEED fancy residencies/internships unless they are hired into special care units.) It means eliminating many "accelerated programs" and ones designed to "fit the student's lifestyle" -- at the expense of preparing students for the real world of professional practice.or2. New grads need to accept a dramatically reduced "training wage" similar to that of physician residents. If the employer is going to be expected to provide new grads with what is essentially an "apprenticeship," then the new grad need to accept the fact that they are, indeed, "apprentices" and not yet professional nurses. Alternatives could be the signing of work contracts in which the new grad would pay for the training if they didn't stay on the job for a specified length of time, etc. But my point is clear. Hospitals can't afford to pay the tens of thousands of dollars that such programs cost with no promise of getting anything back in return.Personally, I think both approaches should be taken simultaneously -- ASAP.

Quote from HouTxActually, there is a "subsidy" already available for nurse training programs - by way of Medicare cost reports. Organizations can "pass through" their costs on their annual Medicare Cost Reports. The programs have to meet very specific criteria: * Be approved for CE -- this means they cannot be a repetition of basic nursing education* Be graded - measurable outcomes based on a logical grading scaleThe organization has to establish a very careful financial tracking process to ensure that all reported costs are clean. It's almost certain that these claims will be audited because they are so rarely included on cost reports. If you want to research this, it is in the CMS rule # [FONT=NewCenturySchlbk-Bold][FONT=NewCenturySchlbk-Bold]413.85 Cost of approved nursing and allied health education activities.[FONT=NewCenturySchlbk-Bold]This is the way most hospital-based diploma programs stay(ed) afloat for so many years. Unfortunately, it seems that the financial wizards who manage hospital financial systems are clueless in this area, so hardly anyone is taking advantage of this funding opportunity.