Ask Dr. Job’s chief contributor, Sandra Pesmen, is a member of the Chicago Journalism Hall of Fame and author of “DR. JOB’s Complete Career Guide.”

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Keeping RNs on the Job


WHY IS IT THAT NURSES are so often disillusioned and leave their jobs early in their careers? According to the Department of Professional employees, 18 to 20 percent of registered nurses in the US are not practicing their profession, and those who start in the profession work an average of 6.4 years as RNs.

While many registered nurses cite limited staffing, long working hours, and higher wages as reasons for seeking employment elsewhere, one professor and board-certified family nurse practitioner suggests the problem may stem from a broader source: The classroom! 

In The Nurse's Reality Gap: Overcoming Barriers Between Academic Achievement and Clinical Success, author Leslie Neal-Boylan directly addresses the gap between academe and clinical practice. 

Including firsthand accounts from new graduates, Neal-Boylan offers practical strategies for nurse educators to help their students successfully navigate the transitional period from classroom to bedside in an attempt to better prepare them for the realities of the profession - and, in turn, help retain nurses in the field.

According to Neal-Boylan, there are a number of reasons that RNS who are recent graduates are leaving nursing, especially clinical nursing, at an alarming rate. 

Chief among them is that these nurses are not always prepared for the reality of the actual work of the nurse. Frequently, students have a distorted and uninformed picture of what nurses need to know and what they do. 

A lot of that comes from grossly inaccurate images that the media perpetuates, she says.  

In school, nursing students learn how to take care of patients but are rarely asked to manage more than 2 patients at a time. Upon graduation, they typically must manage 7 to 8 patients at a time if they work in an inpatient facility.

 Many recent graduates report that they do not feel that they were thoroughly prepared to practice clinically upon graduation. Organizations vary with regard to the length of orientation they give new graduates so there is disparity in how much they learn from preceptors once they are on the job. In addition, nursing students don't typically get enough practice interacting with professionals from other healthcare disciplines, especially physicians, so they frequently feel intimidated once they start working. 

Furthermore, nursing requires intellect, expertise, excellent time management skills, and the ability to comfortably interact with people at all levels of society, she adds. Nursing schools have not always been as circumspect as they might be about who they admit and when they admit students who don't have the academic ability or are otherwise less than capable of performing well as nurses, our programs tend to nurture and coddle them beyond what is going to benefit them once they graduate. 

"We don't do anyone any favors if we bring people into nursing who do not have what it takes to be nurses because they flounder once they begin to work in the real world," says this author. 

Another compelling issue is that nurses tend "to eat their young," she says. Part of this is due to the high-pressure environments in which nurses work but part of this is because new graduates aren't always motivated to "do their homework" and look up what they don't know or to learn from their mistakes. It can be argued that this may also stem from being given too much leeway while in school.

Her final observations are: There is no question that nursing schools can do more to better prepare students for the reality of nursing but nursing faculty are already very overstretched with the demands of nursing education. Nursing faculty work very hard to meet strict accreditation standards. The public can be assured that nurses who graduate from accredited programs have what it takes to provide excellent patient care. However, nursing schools can do more to prepare the nurse graduate for what life is really like so that they will want to stay in the profession they love.

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