About a month ago, I wrote about the University HealthSystem Consortium (UHC) AACN Nurse Residency Program,TM which dramatically decreased turnover rates for nurses in their first year on the job. The blog post prompted Daniel McCarthy, a retired airline pilot and flight instructor, as well as an aircraft mechanic, to write a comment. At 53, McCarthy went to nursing school and later became a nurse. Despite his experience in the tough field of aviation, which is often compared to healthcare as being a complex, safety-oriented field, McCarthy said that “nothing prepared me for the intensity and stress of nursing during my first job.” Granted, McCarthy picked a tough job: he spent two years in the dialysis unit and six in a psych/detox as a non-union nurse in a locked unit. Still, he equates being thrown into the first job to the following hypothetical scenario:
“The best way to put it would be to take a brand new commercial pilot and say, ‘Here is your Boeing 747, full of passengers. You have enough fuel to get to Bejing nonstop. Good luck.’
‘But,’ you say, ‘I’ve never been a captain on a 747, and I have never landed in Bejing.’
‘Don’t worry,’ responds your boss. ‘You have a GPS to find the place and you have all the licenses that cover the laws. Oh, stay away from unfriendly countries, they’ll shoot you down. Good luck.’”
Not very encouraging. Curious, I had to know more. I asked McCarthy some questions and here are some snippets:
Q. Why do you think new nurses quit in the first year or shortly thereafter?
A. Lack of one-to-one mentoring until the new nurse is feeling comfortable on the floor.
Q. What are some of the problems you encountered?
A. Short staffing, floating to another unit, no respect from the CEO down-especially none from a CEO monitoring the bottom line. … Nurse managers who ‘go along to get along,’ nursing directors who will not rock the boat. Violence from patients is also rampant. I’m 6′2″ and 200 lbs, and I’ve gone down from a left hook … The patient ran into her room, I dusted myself off and wrote a note. End of story … [Where I worked] nurses are afraid for their lives and quit quickly.
Q. What would convince you to go back?
A. It wouldn’t be for the money … More respect for the years of education at the university level and less company perks of crappy ‘employee of the month’ [gift cards].
Q. Healthcare systems are often compared to aviation; many experts say that while aviation has implemented evidence-based practice and checklists, healthcare has not. Would you agree? In what ways could you treat frontline healthcare like aviation?
A. Aviation is, in many ways, similar to the medical profession. A mistake can kill a patient; a mistake [in aviation] can kill the entire load of passengers . … Aviation has one item that I would, as an RN, like to see implemented and that is the National Aeronautics & Space Administration (NASA) Aviation Safety Reporting System form, which was implemented as a referee between aviation personnel and mighty government. [Editor's note: NASA's Aviation Safety Reporting System is a system for pilots to report mistakes they or others have made without fear of large monetary fines or losing their jobs.]
Now, with this protection, pilots are eager to tell their mistakes so other will learn from those that have been there and done that. If a nurse makes a minor or major mistake, there will be consequences.
McCarthy says these consequences can include forfeiting an increase in pay, having the mistake permanently documented, and losing your job.
“Is it any wonder nurses leave the profession?” asks McCarthy.
Do my other readers feel this way? I’m sure many experience differ from one another. I’d be interested in hearing what your first year or two was like, and what would help. Share your story below:
April 30th, 2010 at 8:27 pm
I am so relieved to hear that this is a common issue and not one that I felt I was the only one dealing with. I have a BS of Marketing and Management and worked in professional sales for several years; I stayed home to raise my children and decided to enter the nursing profession. After completing my first year I feel that I not only don’t have the respect of a professional but was also thrown to the wolves so to speak. If you are quick to learn that is sometimes a disadvantage in the fact that you are expected to take on more responsibilities quicker. I feel there needs to be a manual for new nurses that has all the unwritten protocols and issues to be aware of being a new nurse. I plan to prepare a small manual for the floor I work on with protocols, common labs, drugs, doctor preferences etc so that someone else will not have to figure it all out by trial and error.
Thank you
May 3rd, 2010 at 8:37 am
I have a BS in Psych that I got years before I went back to school and got my RN degree. I had worked in the psych field with other like minded people, sociologist, psychiatrist, etc. From nursing school I went to the MICU and found that not only was I thrown in with critical patients, even though I did have a preceptor, I was expected to know how to treat these patients and was verbally and emotionally demeaned if I did not know what to do. To say the least, it was not the nurturing environment I had come from. Dealing with this was stressful enough but one of the worst things to deal with was the constant power struggles that went on between the nurses. For me, I just wanted to learn and do my job well, not develop rank among the troops. It seems so inane, petty and very much distracting from the important aspect, which was of course keeping my patients alive. The sad part was this culture was accepted and encouraged by the management staff. It definitely developed the assertive aspect of my personality. Like they say, nursing is the only profession where they “eat their young” and boy did I get gnawed on….
June 17th, 2010 at 4:02 am
Christina, that is very nice of you to do (prepare the manual), but don’t EVER expect to be thanked for it, and don’t be surprised to be criticized.
I also have a BA in psych. Since I really wasn’t ready for grad school, I decided to enter a hospital-based diploma program. I must say that I did well in school and I got a fantastic education compared to the BSN grads I have seen over the years. They get better but it takes time. My first nursing job was in a level one trauma center. It was like swimming with sharks. One night my “mentor” sat and wrote personal letters while I pushed epi after epi after epi on a poisoning patient, who did respiratory arrest as we moved her to the ICU bed. The staff made no bones about the fact that I was not liked, while another classmate of mine was like their long-lost friend. Many years later I learned that they were all abusing stimulants. She was accepted because she did too.
I have a lot of stories I could tell. I have to say that I wish I had known what I was getting into, because I would have had a drastically different life. Right now I am out of work — got fired over one mistake that wasn’t really a mistake. It was a matter of a co-worker with a history of meddling. She got rid of me after I had 8 years at this particular job as well as another nurse who had 10 years in. She’s been there 3. I am praying to find work that has nothing to do with medicine. Enough is enough. No more nurses, no more doctors, no more urine, vomit, stool. No more working to exhaustion for lousy pay that doesn’t even come close to compensating me for my knowledge and abilities.
July 6th, 2010 at 9:03 am
It is sad that our profession has such a bad reputation for setting our new nurses up for failure! I have my own stories of being a new grad! While doing clinicals in nursing school one of my class mates quit because we were treated so badly by the staff nurses. At that time I vowed to never treat a student or new nurse like that! We have to start a new pattern of mentoring new nurses and new staff.
I am the Nurse Educator of Surgical Services at my hospital. Changing the way we orient new employees has made a big difference in turn overs. Pairing people with good teachers and mentors makes a HUGE difference. Getting orientee feedback on a daily basis and giving them time to ask questions and being available to them has also helped. Designated preceptors go though a training class to emphasize the importance of precepting the right way.
If we all strive to be better precptors and not “eat our young” we can make a difference!
August 2nd, 2011 at 7:59 pm
I recently retired from nursing June 30th, this year. I had been looking forward to this for the past two years. I had all ways worked full time for 31 years, and worked in general medical surgical for 9 mos., emergency nursing for 25 years, and finally 6 years in GI nursing. My love was emergency nursing, but because of a manager that was dictatorial, not compromising, I decided to leave. I could see the writing on the wall for me. But, since I have retired, I feel part of me was left behind. I have some projects and goals I want to work on, but right now I feel lost. After all this time, it seems crazy I would feel this way. Because you see, I was one of those nurses, that did anything I could to help with the departments I worked in, to the point of sometimes ignoring my family. If I had to do it again, I can’t honestly say I would. I am thinking about writing letters to nursing schools, to go and speak to these new people, but again, I don’t know if I would help or hurt. When one has given so much, the expectation for the younger troops is to do the same, and I haven’t seen it. Also, I wonder how much the organizations (hospitals) have contributed to this. The saying is you reap what you sow. I am thinking about writing a book about this profession. Because, what this profession needs is individuals that choose it really need to know what they are in for before a life long commitment, where most of your forefillment comes from within. Anyways, for all the new troops, stay focused, strive to be one of the best, and be true to yourself.
December 14th, 2011 at 7:15 pm
Hallelujah….well said….and they wonder why there aren’t enuff nurses…who wants to do this kind of shit for 30+ years and really…not even hear a “Thank You” from the boss…only what you forgot to do as far as your job goes….
I made it thru 30 years of swing shifts, double shifts, raising my 2 kids by myself, no sleep hardly at all, and working on very intense skilled care units….AND MAN IS IT GETTING UGLY OUT THERE….
I am only 49 right now…but guess what? Nursing and all that it entails can KISS MY BUTT…
I am a professional custom and commercial painter now AND I LOVE WATCHING THE PAINT DRY…..and I absolutely LOVE WHAT I AM DOING….
Thanks for reading the post and keep the faith.