To The Young Nurses…

…us ‘old school’ nurses don’t really hate you! At least this one doesn’t!  I miss being around students and new grads.  We’ve all been new, but things are different, and nursing school is VERY different than it used to be.  Back in the day, we didn’t graduate if we didn’t do all of the skills on the basic checklist. We either repeated the class, or got kicked out. Anything else we could do to get experience while we were still in school we volunteered for, whether it was our patient or not. Our instructors were the ones that followed us when we did anything for the first time (the hospital nurse had very little interaction with us – we weren’t her problem), and if it wasn’t up to her standards, she’d follow us until it was. Period.  When I’ve been in the hospital, I’ve had student nurses following my nurse. I was stunned by how little they were allowed to do, and the obvious absence of any instructor. I was willing to be a guinea pig! These hospitals get students from at least 5 nursing schools…and it was all the same, whether ADN or BSN.  The floor nurse not only got a patient assignment, she ended up with students to look after…not really fair. She didn’t sign up to be the substitute instructor.

That being said, I personally liked new nurses (still do, but I’m disabled, so no longer work with y’all).  Correction. I liked new nurses who remembered that they were new. Nursing school teaches you how not to kill someone on purpose- the rest comes with experience.  And that takes time, no matter how many books you read.  ‘Critical thinking’ isn’t something that is taught- it is something that is acquired. The basic skills are what get the job done.  It’s frustrating when schools expect the newbie’s employer to pick up the slack they left by not getting those skills taught.  I understand that not all schools are like that, but a LOT of them are. Much more than even 10 years ago.

I feel for nursing students and new grads. The hospitals have caught on. They don’t want to finish your education that you paid the school you went to to provide. They don’t want to fork over the money to have another nurse at your side for 3-6 months (orientation in 1985 was one week. Period. Can’t cut it? Hit the road).  I hear so many say ‘well, we have so much more technology now’.  Exactly !  We didn’t have machines, and still had to get the job done- so the excuses get old.  If you don’t know, you’ll get a lot more respect if you just say so, and don’t try and pass blame on to someone or something else.  But, in the meantime, you guys don’t get the hospital job you thought you were going to get.  Add in this economy, and you got a raw deal. The school still wants payment, and you get stuck making sandwiches at Subway to pay the rent and student loans.  (Nothing against Subway, but they don’t need nurses).

The whole nursing shortage thing is another problem. In some parts of the country, there is a bona fide shortage. In other parts, it’s more that people are overwhelmed by inadequate preparation, and can’t get the job done with the number of staff that fit into the budget (trust me, there are formulas for figuring out how many nurses the facility can afford and still stay open).  The nurse:patient ratio on an acute neuro floor in a community hospital in Austin, TX  (1986) was 1:14.  That’s right….fourteen fresh neuro patients (strokes, seizures, back surgeries, brain surgeries- after a short time in Neuro ICU, progressive neuromuscular disorders, meningitis, slow viruses, etc…mostly totally dependent patients with a multitude of tubes- PLUS any pediatric patient with a neuro problem since we didn’t have many dedicated pedi floors then) for one nurse on the night shift, and no CNA or ward clerk.  That is being short staffed- but we did it.  It wasn’t uncommon to have ET tubes in place without a vent, or nasotracheal tubes, trachs, feeding tubes, Foleys, IVs, and sometimes rectal tubes on most of the patients. Two or three of the fourteen might be ‘walkie-talkies’… So don’t tell us we had it so much easier, and don’t know how hard you have it when we’ve been working next to you (teaching you the ropes) – and were probably doing the same job before you started kindergarten. We didn’t know lower ratios.  One night it was me (out of school for about a year) and a CNA for 14 patients.  THAT was a bad night. The CNA was a nursing student, and extremely helpful. But she couldn’t chart, give meds, assess changes, or call docs. She was very good at letting me know what the next disaster was, so I could deal with it.  And that was appreciated. Everybody survived, but I was a wreck.

There weren’t IV pumps on anyone with fluids running (or antibiotics) unless they were at enormous risk for fluid overload- we counted drops while looking at the second hand of our watches.  We charted by hand. There weren’t any computers for a long time.  We checked blood sugars with urine dipsticks, and when blood sugar monitors arrived, we shared them with the entire 3rd floor- that included OB/Postpartum and Neuro.  I’m not sure why today’s younger nurses think that patients didn’t get as sick until the last few years. They did 🙂  Sometimes they were in ICU, but if they were still total care with stable vitals, we got them on the floor. Every. Damn. Day.  Total care is hardly a new concept.  Complaining about it has gotten much worse.

But I do sympathize that a lot of newbies haven’t been prepared for what is realistic.  Or how to manage time. Or do basic skills.  That isn’t your fault.  You got ripped off with your $20K/year education (should never pay that much- nobody cares what school you went to…. get an ADN, get a job, and get your employer to help with further tuition- it’s a general benefit in the vast majority of jobs I’ve had- especially if they demand a 4 year degree; not everybody does).  It’s not fair for you guys to get out of school and not have the skills you need.  Maybe that’s what happens when people go to nursing school just to be an instructor, and never really get real experience under their own belts before trying to teach others.  Check out the experience of the instructors you have. IF they haven’t spent at least 10 years doing what they teach, move on.  There is no end of learning once you’re out of school.  But not to have put in the time to really get a good representation of what’s out there cheats everyone.  Especially the patients their students will eventually care for.

Maybe this sounds harsh. Maybe it is. But I see/hear the same thing over and over.  Nursing isn’t a new profession.  Getting into it purely for the money is fairly new.  Yeah, it’s a pretty decent way to keep employed (especially if you’re willing to relocate to areas with real nursing shortages).  The pay isn’t bad.  The hours can be flexible (but newsflash: if you’re new, you get the crap hours).  I liked weekend nights so I always knew my days off, and the brass was at home 😀   With an ADN, I worked the floor, charge, supervisory positions, and administrative jobs for 20 years.  The whole ‘mandatory BSN’ thing was going on when I was in school in 1983.  It’s getting to be more of an issue in some parts of the country, and less so in others.  Where I spent the vast majority of my working years, I was able to work neuro, head injury rehab, med-surg, pediatrics, alcohol and drug rehab, adolescent psych, nursing homes (don’t knock it til you try it- it was my least fav thing in school, but I really enjoyed the old folks!), and MDS/Care Plans in nursing homes.  It was great to be able to move around when I got tired of something- but I never got tired of the interaction with patients.  If you don’t like being a waitress, babysitter, target for bodily fluids, getting beaten up with no recourse, family feud referee, or scapegoat for doctors, switch to something else.  You’re not that special to get out of ‘normal’ nursing tasks.  And, you’ll either survive and get good- or you’ll bail. But taking care of the majority of really neat people is worth it, IF you can deal with the lousy parts.

Nursing is something I really miss. I hate being on the patient end of things, and miss working with students and newbies.  I liked the fresh eyes and ideas.  But those with a superiority thing going on were just annoying.  I’ve had nurses with all of 3 years of experience go after me in a situation where my 15 years of doing the job came in really handy. One question: ‘have you ever felt like this before?’ gave me a lot more information than running around looking for heart monitors when they lady just needed to fart.  She had gas- not angina.  But the new nurse (3 years is still pretty new- it’s not uncommon to feel like a total dunce for 3-5 years- it’s a lot to get figured out) was sure that the woman was going to croak from a heart attack in a matter of seconds.  Uh huh. I told her she was welcome to call the doc herself (I was in charge, so made all MD calls, and assessments before those calls).  She declined. The lady was fine. I did put her on a monitor for a little while, and had it read by ICU nurses, and it was normal sinus.  I recognized that I hadn’t seen every cardiac event in the world- so was assessing her cardiac situation. All t-waves were going the right way. But ego and inexperience could have cost the patient stress, extra tests, and a lot of money.  IF the lady said she had felt that way in the past, just before she had open heart surgery, it would have been a totally different story. Alert the militia and sound the alarms !  But THINK!! Get the information! Do your own assessment. 🙂  And ask for help if you have questions.

When any supervisor would ask me how a new nurse was doing after they started, I had one huge criteria as to how much I trusted the newbie to be OK:  did he/she ask questions?  The quiet ones gave me the creeps, and I followed them like flies on roadkill.  I could deal with someone who asked 30 questions every night. I LIKED them ! I knew how they were thinking, and where their focus was!  I liked when a new nurse asked for help with something- even if they just wanted me to be there because they’d only done something once or twice before.  I was really OK with that.  They knew what they didn’t know, and that’s knowing a lot!  Time management and picking up the bigger picture come along with just doing it.

So if it seems like older nurses don’t like new grads, a lot of times it’s not really true. They don’t like how things have gone downhill with how nurses are educated and turned loose. Getting 75 questions right on boards isn’t impressive (our minimum was 600 out of 1000, over 2 days using a #2 pencil… a typical NCLEX question could involve a 15 year old pregnant girl in renal failure, with a hot appendix).  Yes, many of us need to listen more to what you’re all saying behind the actual comments and questions (i.e.-“I’m scared to death, help!”). We need to be more approachable (that is one of the best things any of my coworker LVNs ever said to me- I never made her feel stupid, so she felt she could ask me anything- we’re still friends).  But please remember, we’ve made it for decades!  We’ve had to go with the flow with all of the changes.  Many of us want to be useful to new nurses.  The whole thing about nurses eating their young is SO old… don’t even go there. It’s because you’re new, and SOME of you don’t know what you don’t know, and have gotten a shoddy education (no matter how expensive it was). You’re more work.  But be open. If you show respect, you’ll get it much more quickly.  🙂

I hope you will love nursing as much as I have. I miss working so much, and still keep my license active. I worked hard for it, and learned a lot by having it.  It gets better !

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2 thoughts on “To The Young Nurses…

  1. I’m going to be getting practical experience (doing who knows what) in an assisted care facility next semester. It’s helpful to know that I should be not afraid to ask a billion questions because I am one of those quiet ones- I am afraid to admit I don’t know or that I need help. Thanks for the insight!

    • Never be afraid to ask !! The experience in the assisted care facility will be a HUGE help ! I worked as a CNA during school, and it was the best thing I could have done 🙂 There are no stupid questions when it comes to someone’s health ❤

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