Not all that long ago I was a fresh-faced new grad, eager to explore the great wide world of nursing. School was done, externship was over and I had passed the dreaded NCLEX on the first try. I was ready.
My first year was brutal. Trial by fire, eating of the young, stress migraines and an overwhelming urge to run screaming as fast as possible away from my job and go work at McDonalds, that encompassed the first 6-8 months. Then as if by magic, I realized I wasn’t struggling, I wasn’t hating work, I didn’t get sick on the way to work and people were asking ME for answers instead of the other way around. I couldn’t tell you when it happened, just that it did. Having been through it I know that it made me a better nurse. That hell I went through toughened me up, made me become organized as a survival technique, taught me how to juggle the needs of my patients with the duties I needed to perform whilst maintaining a sembalnce of sanity. And it worked. It was kind of like boot camp: break you down to build you up.
Since then I’ve precepted new grads, been a mentor of sorts to them and tried to make their first year a little less harrowing, but still instilling the fire they need to survive. I don’t practice eating of the young, it’s counter-productive and will drive promising new nurses right out of nursing, or at least off of your unit leaving you back where you started: short handed. But I do believe a little bit of “tough love” is needed. Our job is not easy and the sooner you accept that it isn’t all candy and rainbows the sooner we can build you into a competent nurse. Not saying that you’re crying on the way home everyday, but not shielding from the rough days either.
Our system just bought into the Versant Residency Solution, which is a systematic residency program intended to rapidly prepare new nurses. “After only 18 weeks, trained observers report that Versant RN Residency graduates achieve Nursing Skills Competency ratings that are slightly above new graduate comparison groups who have been in professional practice for nearly a year and a half (17.1 months).” Sounds awesome. Wish we had something like that when I was starting out. That would have made my first year a little bit better. Or is it just delaying the inevitable?
Our RN Resident is with us for 18 weeks. 18 weeks of being precepted before they are on their own. 2 days a week in classes, 2 days a week on the floor. It’s a tough schedule, worse for those that drew a night shift slot. But in our over-saturated market many new grads were willing to sign over their first and second born to get a nursing job. For 50 something slots, over 500 newly graduated nurses applied. It’s that desperate here. Truly these are the cream of the crop. But for 18 weeks they are coddled into nursing on the floor. I had 12 shifts with a preceptor, and was told straight out that by shift 9 or so I would be taking a full load with the preceptor merely supplying help when needed. Our poor resident is struggling still to take 2-3 patients a night and they are already past day 12 and those running the program have told the preceptors that the residents aren’t expected to take a full load until the final weeks of the residency, if even then. For 18 weeks we expect less, are allowed to expect less and not to push as hard as we might have before. We’re coddling.
Do I expect new nurses to go through the same shit I did? It sounds like it. But I truly believe that there comes a point where you can no longer hold their hands, no longer allow them to sit idly by, skimming along with help from their preceptor: it’s time to fly! The 18 weeks is doing a dis-service as it is not making them fly on their own. What made me a competent and efficient nurse? Stress. Pain. Being kicked out of the nest and having no choice but to fly. Did it suck? Yeah, but I know that I’m stronger for it. This coddling aspect is so ingrained in our culture, from the “everyone wins” school of thought in sports, to getting a 4.3 GPA on a 4.0 scale, to overprotective parents, that we can’t just let people go and see how they function on their own.
Since I started on my floor, it has changed drastically. The old battle axe nurses have moved on, now you’re more likely to get help when you ask rather than a dirty look or eye roll and generally it’s a better place. Being let fly here is far less daunting than it was when I started, there is support whereas previously you really were on your own. But, due to the rules of the program we can’t let our residents fly on their own.
I know that people will ask, “So, are you doing anything to help the resident?” Yes, the preceptors (there are three of them) and a couple of the charge nurses have talked about ways to help them. We don’t want them to fail, but we don’t want the end of the 18 weeks to be a huge issue either, where all of a sudden you’re flying free and haven’t developed the skills to keep aloft. Who knows, maybe this idea is great and it will produce incredible results – that’s at least what the program developers say. But I have one lingering question: how can you be as good as a 18 month nurse at 18 weeks when you’re only spent 12 of those weeks actually caring for patients? Book learning is great, but it means nothing until you get to use it. It is the actual act of caring for the patients that brings the book knowledge into focus as Ricky Gervais said, “Without application, knowledge is pointless.” We’ll see how it end in about 3 months.