Experienced nurses: Has there been a decline in the quality of nurses coming out of school?

I don’t know if there is a decline per se. I think the bigger issue is that there aren’t enough veteran nurses to help the newbies learn things on the floor. Sure, just like everything, you learn stuff in school. But it’s a bit different when you’re on your own, doing things on the floor. But since there is apparently a mass of experienced nurses leaving bedside and nursing in general. It’s kind of like the blind leading the blind. 

Also, as someone that enjoys teaching. I’ll admit, I have no problem with people asking questions. Even if it’s as you say, stuff that’s been mentioned a number of times. I want to know why someone is not getting what I’m saying, and find a way for the info to stick.

I was really dumb as a new nurse.

The change I have seen is that newer grads have not been prepared well for the realities of working in healthcare.

They have less clinical time during school, and they are very much shielded from a lot of the skills required - for example, IVs and other competencies are not expected of them during school.

Instead they are taught about models of care and collaboration to solve international health disparities.

I think this is extremely unfair to students - it is not their fault, but many of them are wildly unprepared for what their first nursing job will demand of them. This leads to the extremely high attrition we see, and I believe it is unethical of the schools not to prepare students for the reality of the work.

Students have worked hard to get where they are, and then it turns out that school did not prepare them for the real world. Another issue is that it has become so competitive to get in that students who would make great nurses can't get in, and are beaten out by academic high achievers who either want to get into medicine, or don't really want a blue collar job.

Personally I haven’t noticed, all the new grads I work work are awesome. However, I have noticed a decline in etiquette of nursing students themselves. So many nursing students would rather sit on their phone than learn or ask HCA’s to do their “dirty work”. I feel like preceptorship weeds them out though.

I think we all had peers in nursing school we had serious doubts about.

I feel like the attitudes coming out are different.

I don't blame the students, I blame the programs, and COVID.

I think a new grad just needs to be inquisitive and ask a lot of questions. Nothing is scarier than a new grad who thinks they know everything because they still have information fresh in their head. I’d rather a new grad ask a million questions than just be overly confident and harm a patient.

Nursing school does not teach you how to be a nurse. It teaches you how to pass NCLEX and very basic things about how not to fuck up. (Like not giving too much fluids to a patient with cardiac issues or to check compatibility before giving certain meds.) But nursing school is not real nursing.

I would say… as someone who also graduated older. I would check yourself. I find the people who judge others tend to struggle the most when the shoe is on the other foot. Focus on yourself. Worry about yourself. Find areas where you can grow. Sometimes the people who do the worst in school make the best nurses.

It’s important to focus on yourself and your development and not on everyone around you.

When you put down everyone in your cohort it’s really just thinly veiled narcissism.

If you’re looking down on your classmates now, you’ll look down on your coworkers eventually too.

Be the best nurse you can be, don’t worry about anyone else’s performance. Stay humble.

When did nursing school produce quality nurses? The 80s or 90s? Nursing training has been crap for the 15 years I've been in the business

Tail end of Gen X here & if I had to generalize broadly (always a bad idea) I'd say the world today offers fewer chances to learn troubleshooting/critical thinking skills. When I was 20, I could change the oil in my car and there was no computer chip to reset. It was just about figuring out where to put my wrench and the oil pan, and yeah I did get oil all over my hands. With my modern car, I don't have a clue!

The technology of the world today is not stuff that you can just look at and figure out, so they don't always have practice with this before they come into nursing. Add to this the fact that many people live with their parents into their early 20s, so their parents shoulder some of the "real life" headaches we all have to cope with (transportation issues, inconveniences, etc) and they have less experience with that stuff too. One of my new grads in her 20s her dad keeps track of her paychecks etc for her and I would never have done this. But I moved away to college at 17, so we obviously had different paths.

I'm also seeing a lot of perfectionism in new grads, like they don't want to try something unless they are sure they will get it right. Which, on the one hand, is admirable when we're talking about life-saving skills, but on the other hand can be very paralyzing. The tension between "just try something" and "if you don't chart a colace your license is in danger" is very challenging.

Ultimately, be your own nurse. It's very rare that I've met a nurse who wasn't better than I am at something whether it was dementia-whispering or starting IVs or vibing with a young patient or using the stupid iPad we have in the rooms. And yeah, I'm better than they are at some stuff too. Help where you can, without drowning yourself, and ask for help when you need it.

They’re definitely more aware of how shitty nursing is and less willing to eat a spoonful of shit with a smile on their face. But that means they don’t stay and the short staffing doesn’t get better. It sucks all around. I tell new nurses that nursing sucks a lot and to find a unit they can stomach where they like their coworkers. For a few it’s been a real wake up call about what having a real job or a career is like. Many went straight from high school to nursing school with no or minimal job experience. They don’t understand that to some degree it’s like this in all professions and work is work. You’re not going to always like it. It probably won’t fulfill you. Get a paycheck and cash out and go home.

There's always been nurses where you ask yourself "how did this person make it through nursing school". I think it's that with the advent of social media, it's more frequently getting discussed, making it seem like there's a recent influx of bad nurses.  That said, now that nursing schools are switching to for profit styles (esp grad school), the standards are lowering. 

Asking a ton of questions, isn’t a reflection of one’s intelligence. Just because something seems like common sense or basic to you doesn’t mean it’s the same for everyone else. I’ve taught classes and it always upset me when others would sneer or loudly sigh when a student who was trying to learn and asking a ton of questions, even if it’s the same question rephrased. School is a place to learn and we should foster a learning environment. Can it be frustrating? Absolutely! But just try not to it get to you and don’t judge the student asking a billion questions. 

I mean, I have a PhD in statistics and other advanced degrees, and I was the one who usually asked the most questions in my clinical groups while in nursing school. I just had zero healthcare experience and hadn’t had an interactive job in many years, so everything was a lot was completely new to me. 

Back when I first started nursing the nursing students used to be on the floor the entire time they were at the facility. They did everything from basic care to passing medication. Now when students come they’re on the floor maybe an hour, do vitals, sit at the nursing station looking at charts (on their phones), and then sit in the conference room for hours doing ATI’s. When I train new nurses on my unit, it’s clear that there’s less hand on experience in comparison to what there used to be. There’s so much focus now on computer based learning.

I'm an educator and noticed we are getting more of an inverted bell curve of quality over the last 4 years, where we used to have a standard bell curve.

So we used to have a few super high quality students, a lot of average students and few lower performing students.

Now we have a lot of super high performing students, a few average and a lot of lower performing.

Not sure what the cause is, but we think a lot has to do with most pre reques being online and the quality of those classes aren't weeding people out like they used to

There has been a bunch of crappy quality nursing schools popping up in my area. Their students are really bad because they count things like observing kids at the mall as a clinical when they can’t find a real unit for the students.

I think what matters a lot is that new grads get hired to units that are supportive and help them transition. 4 year nurse here and I didn't feel like I was great at nursing until I found a supportive unit. Now my coworkers depend on me and I on them.

Nurses are not supposed to be "fully-fledged" nurses upon graduation. you learn more in the first 6 months to a year than during nursing school. This is actually common in most professions.

I think the bigger issue is the toxic nursing culture that does not want to create a positive, safe, and learning-focused environment. Many seasoned nurses/admin want a punitive environment that pits everyone against one another. New nurses will only be as good as they are trained on the job. I am not saying seasoned nurses are solely to blame, it is probably mainly the admin and healthcare industry in the US because it focuses on profit over care. Also, the staffing in the US is a JOKE, so most nurses are working or have worked in environments that are literally unsafe and insane. They keep you running around like a chicken with its head cut off, so you are too focused on that than coming together and unionizing for better working conditions.

I noticed bad attitudes and long nails in the new nurses 🤣

Even “teaching hospitals “ are limited to what skills can be done on a patient which makes it difficult to teach even the basics. Critical thinking doesn’t exist bc they don’t understand pathophysiology of even common diagnoses. Paperwork volumes will always hinder development of basic skills, ability to spend time with patient’s which goes a long way into developing insight into patient needs and how to treat them.

I find many new nurses don’t know the realities of working in this field. I personally know 3 nurses who left the field BEFORE they had worked 1 year!! One felt no nurses helped or were supportive(some are just to busy), preceptor only spent 1 week with her, mentally broken with fears of hurting a patient so quit!!!

It’s so sad…..

Nursing school is pretty different than nursing. Also different nursing fields are pretty different than each other. Most of your education is going to happen on the job. School and the NCLEX just help you stay safe enough while you actually learn.

I was happy to never see most of my classmates again. I really thought they were awful. They are probably thriving somewhere. I’ve been able to become a competent and happy nurse on my own path. ED for life.

All the same stuff you mention about classmates describes 50% of my class from 10-12 years ago. Nursing school is stressful, which is why you’re going to get all the complaining, and half the people you’re with are going to be straight out of high school, where they still expect hand-holding.

Free he only difference I’ve noticed now is some of the new grads being overconfident and arrogant in their abilities coming out of school than 5+ years ago, but they’re still a small minority.

It's like learning to drive, you pass the test and then you learn how to do it in real life.

I think whether you go to a 2- year or 4- year program, you're gonna have a lot to learn when you start working. Even the brightest new grads I've worked with needed support/resources. The classroom/clinical setting can only prepare you so much. The real learning/experience/confidence happens with full-time experience.

I’m graduating in December as well and have had similar experiences with several people in my cohort. We did a sim the other day and the pt was sating at like 84 and they didn’t address it (and didn’t know that O2 is a nurse driven intervention) and they didn’t catch that 45 minutes after Tylenol the temp went up to 39.5 and gave the patient another blanket when they said they were cold. I was floored.

But I also work in an emergency room and I’ve been exposed a lot more to situations that have given me real world experience with critical thinking. I’m almost positive the group during that sim didn’t have previous healthcare experience. Between their capstone and new grad orientation they’ll hopefully get more of an opportunity to develop better critical thinking skills. I think it’s a really difficult thing to hone without real-world patient care experience.

I just can't even...because if I start it's gonna turn into an epic rant and I don't have the time or energy for all that today. so I will just say this ..if I help you and you are rude to me one time, I won't do it again. if you can't function as a member of a team you won't last long because we are not about to let your pissy attitude and self importance eff up our team. so I just smile and mark my calendar bc they won't last six months...prob not even three. There won't be any arguing or nonsense... you will choose the door on your own or the boss will show it to you. don't eff with the team.

Absolutely. I taught for nursing program and was a bedside nurse for 10+ years. The quality was decreasing substantially. Big decline after Covid. The quantity of student is down and the amount of clinical requirements has decreased so students are less prepared.

No. There's been a decline in the quality of training.

I’ve gotten my BSN and taking the NCLEX soon, I’m 29, and many others among my cohort hated my program. Inefficient professors and one of the clinical days, my instructor left my whole group to go do his mom’s laundry 45 minutes away. A lot of nursing school programs ain’t going well but it’s just for the NCLEX. I know first RN job will be nothing as expected. A whole new start.

I’ve only been a nurse for 18 months, but I’ll add my two cents. Yes, there has been a decline. I remember one of my clinical instructors telling us that when she was in nursing school back in the early 80’s that nursing school was like a full time job. By the time she was done with the program they were expected to be able to take charge of a med surg unit. And they were capable of doing so, because they were essentially working full time unpaid on the unit throughout school, as well as taking classes.

Compare that with my experience: clinical one day a week, supposed to be 9 hours each week but often got sent home early because “there was nothing to do” according to the instructor. The first semester we didn’t even really have clinical at all. We were supposed to be in a nursing home, but didn’t get to go due to Covid. So instead of that we had a sim lab once a week. Even when clinical was “busy”, we weren’t given a nurse to shadow. Instead, our clinical instructor would assign us each two patients. We would have to do a head to toe on each, and then review their chart and create a care plan. We would pass meds with our clinical instructor breathing down our neck, making what could be a 5 minute process become 30 minutes. That was honestly about it. I might have gotten to take out a couple IVs. That’s about where it ended.

Did I feel ready to take patients on my own after graduating? Hell no. But it was a means to an end. I was able to pass the NCLEX and get a license. The real learning was done on the job.

More very ill prepared vs a decline in quality.

Nursing school needs a massive curriculum overhaul. It’s almost a complete joke. I was a flight medic before getting my RN and I basically studied zero. I can imagine it being slightly more difficult if you have no real previous medical knowledge.

I have noticed it’s all about Nursing Theory. Very little bedside sense. They are all very nice. Their nursing skills are lacking. I might catch heck for this, but they are also lazy. Call lights are going off and they just sit and chat about T Swift. It doesn’t even occur to them to stop talking and answer the light. That is just one example.

I don’t think there is a decline. I think nursing schools are run strangely. Like how do you have no IV training in school except on those worn out fake arms? And the bullshit they emphasize in labs is awful.

I had an instructor talk badly about her students’ care plans and notes. I gave her such a look. Look, nurses click through care plans now in a few minutes. We write very brief annotations. And my teachers were often petty and played favorites.

There have been and always will be people who make it through programs who suck but to me it hasn’t changed over the years.

Looking at comments on this post and others I feel like it needs to be pointed out that either pointing out or questions a decline in quality does not make you a bully. There are terrible nurses just like there are terrible teachers and cops and doctors and every other job/profession. I feel like the second there is any kind of topic that questions nurses the people on this subreddit instantly withdraw and claim bullying and nurses eating their young. It's ok to question quality. Poor quality care and nursing and doctors and every other whatever should be called out. Professionally of course but how else can you start to improve on deficits if you aren't willing to acknowledge them?

I wondered this 8 yrs ago when I got thru school. I went to a kind of shitty school. I've seen people who graduated the past 2 or 3 years doing just fine. I think any perceived decline is probably more gradual than people think.

I dunno. 🤷🏻‍♀️ decades ago when I graduated we still had a student that tried to push potassium in his final semester (preceptor stopped him - not because he asked questions but because she didn’t trust him to not do something stupid, so she caught when he tried to “help”).

Yeah. I don’t know what it is but most new grads I’ve met over the last couple of years have been fucking awesome.

I blame COVID, which left few experienced preceptors. I was oriented to ICU exclusively by 10 year+ veterans. It's not like that anymore. After COVID, 9 month nurses were suddenly charge nurses and preceptors. I do, however, blame the nursing programs for inventing the term 'oxygen stats'.

I think there’s a lack of quality instructors. During one of my clinical rotations, our instructor had us feed patients their lunch. That was it. The other ten hours we were there, we sat in the conference room and she would tell us how about “real” nursing. I would say of all my clinical rotations, I had one, maybe two, where my instructor actually forced us to learn and do things. So many instructors are there because they see it as an easy paycheck.

Also, you sound like you think you’re better than your classmates. Everyone there wants to learn, and they have a right to complain especially if they feel like they have to teach themselves everything. I had a number of instructors who just assumed we knew how to do things…but if you’ve never been shown something or done something before, how can you be expected to do it right?

My sister has been the longest employed nurse at one NY hospital (~40 years). She says she loves the new grads because she's learned from them how to speak up for herself and stop taking shit, lol.

This new gen of nurses coming out in my experience are not as coach able and “know it all”. I always say the day you think you know it all is the day you are going to kill someone, especially in the ER.

When I first started it was the older experienced nurses eating their young and I hated it. It makes people afraid to ask questions and then that’s when they may hurt a patient. It made me love to precept and always be a safe person for any new grad to ask me a question or for help and I won’t belittle them.

Now it seems to be the nurses with less than 3 years experience who are perpetuating the mean girl culture and making some units toxic. I definitely have seen a shift.

No. Like with any bell curve, you and your classmates will mostly be basic-a$$ nurses. Some will be great, some will suck. Most of you will fall in the middle (Hell, odds are I'm a basic-a$$ nurse too... and I'm ok with it).

Not to knock my profession but, the bar of entry to be considered a nurse is not too high. Getting an associates and even our prerequisites are often simpler than STEMI fields. I recall classmates getting been out of shape for the math involved or microbiology/chem classes. Not realizing that it's not difficult stuff we need to know to get into the nursing program.

My BSN was a joke (can't say all of them are like that though... so, comment if you think otherwise).

You're gonna find, antivaxxers, antiflouride, antimask, antibirth control; and pro: water infusion, abstinence only, or any wonky woowoo medicine. Docs aren't immune but, as you go higher in education, they get filtered out. I've had one travel RN who literally believed in Lizard people and half the things I've mentioned... this woman was making more than any nurse in the department.

I'm nothing special but, when I started as an LPN, I realized that I was a better nurse than some of these RNs I was working with. That's when I decided that I need to move up because I can't be getting paid than less these fools. Most were good though. Just that "10%."

Complaining is common everywhere you go. You just don't see it. I have worked with department heads and there's dumb bullshit even with nursing supervisors with decades of experience.

If anything, I see better nursing with the younger generations (granted, that's after a few years of experience). Older nurses are more likely to be lazy, and know enough to "CYA" staying out of trouble. Less likely to teach and more likely to look down on others.

Younger nurses are more likely to work as a team, and aren't jaded about the profession.

Also, asking questions isn't a bad thing. I'd rather a person ask me a million questions so I know where they stand... versus nodding that they understand something but, ultimately mess it up. Critical thinking is important but, clarification (like closed loop) communication is vital in this field.

Lastly, the older generation will always assume the younger generation is worse or less intelligent. Ignoring the fact that IQ is constantly improving with every generation (IQ isn't the best metric but, it's all we have). These nurses are looking down on students despite the fact they have moved forward in the nursing field and are likely biased. Plus, the phrase "those that can't do, teach" is partially true for some of your instructors...

Save this post. Finish your last semester. Pass that NCLEX. Work at least a could of years and then look back on this and laugh how little you actually knew...

Definitely a decline in the ability to critically think. Not just nurses… everyone

Only been in 4 years but the issue is the better you are at something the easier it is to see the inadequacies in someone else performing that task or role and mistake what you are used to as being “easy”

I’d argue shit like pharm and critical thinking skills are prioritized in schools but its still a challenge to translate class/clinical to being on your own

I mean think about it

As a new nurse and even as a vet I often don’t think about the overall patient condition and whats going on with them

I confirm orders and make sure shit is safe but I’m not really digging insanely deep on them or noticing issues when I’m new as opposed to when I had more time in the role

You’re inundated with tasks, communication, delegation, taking criticism, prioritization, learning the EMR, learning how to talk to specific people like Doc Asshole or RT Lazypants so things get done and you feel less stupid…

… all while feeling stupid, often being belittled by higher ups, consistently getting feedback (often bad) about your work,

AND

on top of all that hearing that new nurses ain’t shit and that they don’t have what it takes anymore from posts on reddit.

Like guys.

schools not any easier if anything its worse off and harder

Our frame of reference is different though as people who fucked around during COVID or the pre covid years

but people are sicker, everyone’s meaner, and us vets are jaded as shit.

The new nurses have what it takes and I hate to say it

But if they don’t the job ought to change around them

not the other way around

Because I don’t see people lining up to wipe asses as demographic changes slowly degrades our profession.

Hello! ICU nurse, with approx 10 years experience. I would say the thing I noticed is maybe overconfidence? People trying to achieve everything quickly (in terms of patient acuity). I have worked with some excellent new nurses though! I left bedside recently and have also seen very junior people in leadership roles (because senior staff are leaving too I suppose). I think the overall quality is suffering because of lack of seniority.

Im an LPN, been for 14 years and one of my BEST learning experiences people now would rant about. As a brand new nurse on the job, I was in training (NY) my DON came to me on day 3 and said there was an emergency and she had to pull my preceptor. She asked if I could do it but her face was telling me you can do it, sink or swim. She and other nurses were there if I had questions or was struggling but for the most part I was on my own. Obviously I swam because I'm still here and I'm thankful to her always because I didn't receive hand holding.

Some of my classmates are very entitled, we’ll see how the workforce treats them. I had people upset because they weren’t allowed to leave early from clinical (no reason, they just didn’t want to be there).

As someone whom trains a lot of our RNs, it made me appreciate the little clinical time in hospitals students get, because the ones who got zero in person clinicals were not prepared for what they were walking into. Since those restrictions have been lifted, our newest students have been great again.

No. But due to nurses having a greater number of patients at much higher acuities than before, and add on decreasing ancillary services and you’re bound to see a decrease in quality.
But that is not the nurses fault.

Low cost schools like the community college I went to ($9K for the whole program) have like 400 applicants each semester for 44 seats, so it’s really competitive and only the best get in.

Really expensive private schools (a popular one here is $80K for the program) takes anyone who can pay.

When they come to do their rotations, the students from the cheaper schools are streets ahead of the ones from the expensive schools. Also some teachers are just better at teaching and who knows what school they’ll end up teaching at.

Tbh I honestly feel like the same! I'm a recent graduate and my cohort was highly praised by our professors, but idk my friend is in the cohort before mine (in her last semester) and something about her cohort and the cohorts before them are just... bad . For some reason, everyone is just excelling in exams but are absolutely failing clinicals and the professors don't know why. They are giving the exact same clinical experience and training as the older classes, but for some reason, they are just forgetting basic things like how to hang up IV meds and administer them on the pump, which are basic things we've been taught since semester 1.

Nursing is a blue collar job. My local community college in Canada expanded their two year program to a BSN. They teach you some theory, but most of what you do is hands on. The local uni has now changed their BSN program, as they got complaints that their nursing grads couldn't compete with the college nursing grads. The issue was the uni taught a lot of theory, which is fine, but the classes didn't prepare nurses for the reality of the job.

Before 1990, all of the nursing programs in my city were done through a school attached to the hospital. It was a two year diploma. In 1990, everything flipped to a four year BSN. Older nurses were grandfathered in, but new grads had to go through a 4 year BSN.

“Every generation imagines itself to be more intelligent than the one that went before it, and wiser than the one that comes after it.”

George Orwell

Imho yes. Partly experience at the bedside during their schooling was insufficient, another measure of critical thinking lacking. Had one give IV protonix through a PEG recently lol. That said, I’ve also had a 25 year experienced RN give an entire heparin syringe of insulin. So it cuts both ways. You don’t know what you don’t know. You’ll learn. If you’re asking this question, I’m not worried about you.

Working in the NICU, I have to say yes. I've been blaming it on covid school. No critical thinking, time management, or ability to take criticism, to just name a few.

-lack of experience is HUGE inpatient right now. For perspective when I started 7 years ago you had to have 5-10 years of nursing to be considered for charge. We all know what’s occurring now. -new nurses have better boundaries and it shocks those who have taken on more than they should. -THERE IS NOT ENOUGH FLOOR STAFF TO DO THE PATIENT FACING WORK.

I think there's less experience out there, so much institutional knowledge walked out the door during the pandemic. New grads seem to be about the same when they're fresh out of school, but in my opinion, orientation is poorer and overall support is poorer. I feel like nurses at the one year mark are not as far along as one year nurses a decade ago.

It’s always odd to me how it’s just accepted that “ nursing school dies t teach you how to be nurse, just pass the nclex “ is.

Nursing school used to teach you how to be a nurse. In our last semester at one of the old style hospital based programs when we arrived in the floor the scheduled staff would LEAVE the floor. It was just us, instructors, and charge. We did everything start to finish. Surgical prep and receiving. Admits. Discharges. All meds and IV and other tube/line management. Procedures. Everything.

Nursing schools could do that again.

Covid baby.

“Learned” how to do a catheter on a plastic bottle in my living room in my zoom med-surg lab.

I had a nurse call me today and ask if I prescribed oxycodone for pain or another reason. She’s been a nurse for 2 years so I don’t really have an explanation for that one 😭

I think that 2020-2023 we weren’t turning out the best new grads…but I also have to consider what their nursing school experience was at the time. At the same time, a lot of experienced nurses left and didn’t return to the bedside, so they didn’t receive the best training once they hit the floors. Those nurses who weren’t set up for success are now training new nurses.

Less bad quality coming out of school, more too many babies teaching babies at the bedside.

To want to work with great nurses, we have to help create them!!

Everyone is dumb when they're a new grad. You'll be surprised at how humbling it'll feel when you're in a situation on your own for the first time and have no idea what to do even though the situation has already been "explained" to you previously. If you can, help answer their questions/lead in whatever ways you can in a positive way. Being on a unit with nurses who have big ego's can foster a pretty judgmental and toxic environment. Be nice.

No. But there is definitely a quality in how new nurses are trained. The quality has gone downhill, significantly. Most of the very experienced nurses (10+ years of experience) have left. And what’s left is nurses who want to leave the field. All very unfortunate

I'm going to say no because school is about passing the NCLEX which is basically a safety exam. Not that nursing school isn't hard or that studying isn't necessary, but the end goal is NCLEX pass rate; that's what the schools are aiming for.

What is lacking? Hospitals educating new nurses. We had actual classes on cardiac procedures, cardiac meds, cardiac pathologies, basic vent management, CRRT, hemodynamics, etc. (I work in CCU), Now it's all online modules and it's just a bullshit education. Hospitals will use "COVID made us broke" for the rest of eternity as an excuse to not spend a dime on nursing.

Most learning as a nurse happens after you graduate so it’s pretty hard to tell if new grads are better or worse. I’ll take someone who wants to learn and has the ability to adapt to change over someone who just did well on exams. The specific knowledge will come along a bit later, when you get enough experience to apply the concepts and techniques you learned in school with real world nursing.

I’ve always worked in psych, so for us a big part of whether a new grad will do well or not has to do with a lot of things that can’t be taught in nursing school and can’t be learned in some cases. You have to have the personality, social IQ, and so many more intangibles to be successful. Knowing what to say, how to react, etc in novel situations is critical. If you can’t put your ego aside you’ll never make it, regardless of your fund of knowledge. I could go on but this isn’t the place for it.

There have always been and will always be bad nursing schools who will graduate anyone and teach students to barely scrape by on the NCLEX

I guess I wonder what your schools NCLEX pass rate is? And how your program is designed? When I went to nursing school we lost about half the cohort the first semester. And our cohort continued to slowly decline as we progressed. This schools NCLEX pass rate has been 98 - 100% percent for the last 10 years. I know students who went to rear loaded programs or programs that were just not so good. And students failed at the end of the program or could never pass the NCLEX. So if I noticed poor quality nursing students I would worry about the quality of my program and what my ability to pass the NCLEX is.

The next question would be do you have prior healthcare experience. This has a lot to do with familiarity and confidence. Textbook critical thinking is not the same as practice critical thinking. The textbook is a perfect magical world where everything you need appears. In the textbook you don’t have to worry about where anything is? How you’ll get it? How long it will take? Who your resources are? You also don’t have to think about being judged or graded. This all plays a role (its like to the too many minds scene in the last samurai). If you have experience you are more confident and your “mind is quieter”.

I slightly agree on the literacy issue. But my overall observation being in nursing with first year attendings and other professionals is that. People closer to my age (29) and younger are more non formal in conversation. But my perception may be altered because I’ve been doing this for a while with the same people. I work with people with heavy foreign accents and limited understanding of English but they understand enough to get the job done well and I can depend on them! I’ve also precepted many nurses and I’ve only ever met 1 nurse who I was concerned about. She was born and raised Caucasian American in her mid 20s who spoke perfect English. She was eventually let go.

I’m not sure if it’s an issue of the individual that is the problem entirely. What I have noticed over the years is that the way nursing education is conducted has changed. This allows for many excuses to be made and things to be allowed that shouldn’t be. Even several years ago when I was an educator in the hospital, there were so many things that had to be “trained“ out of people because of the stupid stuff they learned in college. For example, people with BSN’s don’t ever have to clean butts. That was a common statement, fed to us by new nurses that were told by their school they didn’t have to do that anymore. And then there was the assumption that they were so special that they could get any holiday and length of vacation they wanted in their first year and subsequent years. They just expected this to be the case, and therefore anybody who had been working there long enough to actually earn more of those privileges didn’t count because they were special. Stuff like that. Or when their lunch period came up no matter what, that was the priority for them. Not the patient who had been in agonizing pain and needed pain medication and they decided that this person could wait until after their lunch.

Back in the day, when nursing instructors were really tough on people, I think we found that the quality of nursing students being turned out from the schools stronger. Because I think there’s a lot of people out there who choose nursing because it pays well in a lot of areas of the country , and the schools are not honest about what it actually means to be a nurse. Then these folks come out of school and they are ill prepared to take on the challenges of the clinical environment. Or, worse yet, they wanna spend a total of two months clinically and then go straight into a masters to be an NP. In my experience, these are the worst types of NP’s. They are entitled, selfish, clueless about how things really are in this profession. And because they lack the context and experience as a nurse, they aren’t even nearly as effective as those who have paid their dues clinically before going and getting a masters and moving onto that role, IMO.

I think this is in large part a fault of the current educational environment preparing new nurses for the work they eventually will do. For a long time we’ve had a shortage and I think schools have lowered the bar quite a bit over the years because they are trying to keep Admissions high enough and they’re passing NCLEX scores high enough to be competitive. However, individuals are also at fault to degree because nursing isn’t for sissies. It isn’t for entitled people, and if you make it through an entire nursing program and still remain that kind of person then you should have been weeded out of that program long beforehand, in my opinion.

Patients don’t need to be dealing with people who are so self-centered that they can’t effectively do their jobs under very difficult conditions to meet the needs of the patients they are there to take care of.

And I’m thinking specifically of situations like that new nurse who decided to go to lunch before medicating this patient who had been asking for pain medication for nearly an hour already. By the time I just happened to answer the call light and went to look at her and see what she needed, that lady was definitely and overtly being affected by the degree of pain she was in. The new nurse said she was going to get her pain meds and never did, it’s that kind of thinking that really angers me. When I went and found her, her reasoning was that she was told to go to lunch right then with her preceptor and was going to get the pain upon return. We had a difficult conversation about critical thinking and empathy.

As an educator, that’s a situation that taught me something as well. People coming out of school these days seem to lack a degree of empathy that is needed in the battle. And I say battle because we all know what the clinical world is like these days. After this experience, I was trying to figure out how I could demonstrate or encourage empathy with regard to pain medication. So I designed an exercise that we would do during orientation in the critical care course. I filled some basins up with ice water. And I would put them on the table and after discussing what people thought was a reasonable timeframe and working to relieve someone’s pain and having that discussion with them, I would have them put their hands into the ice water and hold it there as long as they could tolerate it. As expected, they couldn’t tolerate it for more than a few seconds. Except for that one guy who served in the Air Force in Antarctica he had it in there for like a minute and a half (there’s always someone!). So when I asked them what their pain rating was at the time they took the hand out of the water. They all invariably rated it closer to 10. Then I asked how long do you think if you were in that degree of pain you would want to wait for pain medication to relieve it knowing that it’s gonna take some time for it to even take effect. They all got the point. Everyone had to do this unless they had a valid medical reason not to. And I even managed to use the Antarctica guy as an example of how we all experience pain differently and shouldn’t assume there is uniformity across the board. Assess exchange patient as individuals.

I don’t mention this to toot my own horn, but I do think this was effective and maybe it could be for others.

But without schools also driving these points home in their curriculum I’m not sure if the nursing profession that I went into will resemble what it was intended to be in even the next few years:

I have been a nurse almost 30 years, LPN first, then RN. About 14 years ago I noticed that some schools were graduating nurses who had not learned things I would not have been allowed to graduate not knowing (my first encounter with this was a new grad RN who had never given an IM injection). I don’t think this is the fault of the student though…I begin to wonder if the schools are changing their curriculum so fundamentally that these things just aren’t coming up as frequently in clinical or clinical sites aren’t allowing students to do some of these technical tasks. I was an LPN for 18 years, went back and got my ADN and then BSN…I had more clinical hours in my 11 month LPN program than in my 13 month ADN program (my LPN-RN transition program only eliminated the first semester for me).

When it boils down, I don’t think there has been a decline in the quality of new nurses and many new nurses know technology and techniques that I never had the opportunity to learn. If we all take the time to learn from and teach each other, we all become better.

That said, I have one major frustration with what nursing school doesn’t currently seem to be teaching well. I don’t care why someone is in the hospital, elimination status is always important. I don’t know when that fell by the wayside, but it was drilled into my brain as a nursing student. I am not a hospital nurse, I work in community residential care, specializing in people with disabilities. I can’t tell you how often I get a call for discharge report that goes something like this:

Hospital nurse: I am calling report, patient is ready for discharge after 6 days inpatient for pneumonia with sepsis. IV antibiotics are done, transitioned to oral antibiotics 24 hours ago and tolerating well, O2 sats are in the 90s, they are medically stable and ready to go home.

Me: It would be great to bring them home. Are there any skin issues we should be aware of? When was their last BM?

Hospital nurse: oh, their skin looks great, we do have a dressing on their coccyx but that is just for protection. BM, ahh, let me look that up… well, I’m not really sure, but I don’t see anything in the system, hold on (puts me on hold for a minute or two), okay, I double checked, they haven’t had a BM while they are here.

Me: Have they been eating and drinking?

Hospital nurse: oh, yes, almost 100% at every meal.

Me: I am sorry but I am not willing to accept this discharge without documented evidence of a recent BM. They were on day 2 when we brought them to the ED. That would make them day 8 now. I cannot accept a patient who has not had a BM for 8 days. I will happily accept the discharge once they have a documented BM. Hospital nurse: Ummm, let me go talk to my charge nurse…

Our local hospital nurses are amazing at caring for skin and monitoring the condition that led to admission I don’t know why bowel status gets forgotten so often, so I can only guess it has to be that the school didn’t emphasize the importance.

So if you are ever giving report and the receiving nurse declines to accept based on bowel status, you might be giving report to me.

PS This usually gets fixed with an enema and we proceed with discharge but it is hugely unfair to the patient to be subjected to an enema because nurses weren’t monitoring elimination status.

Okay, off my soap box now. If you are a nursing student, please tuck monitoring elimination into your (already very full) brain.

I'm an educator and noticed we are getting more of an inverted bell curve of quality over the last 4 years, where we used to have a standard bell curve.

So we used to have a few super high quality students, a lot of average students and few lower performing students.

Now we have a lot of super high performing students, a few average and a lot of lower performing.

Not sure what the cause is,

In every nursing program you're going to have those students who you wonder how they got into the program and how they're every going to make it as a nurse. And if you think you don't have any of those people in your program..... then its you.

The main issue IMO is every student I see (PACU) behaves like they are “better than” bedside nursing before they have even graduated. Everyone seems like they have plans to go to CRNA or NP school (which is great!) but they don’t have an interest in learning what is presented to them in their clinical. No matter what type of nursing, learning is continued but feel like these students have a one track mind and don’t realize that they need a strong foundation in order to progress and be successful

There's been a decline in experienced nurses at the bedside to orient and mentor the nurses coming out of school. It'll get better

I'm in the UK and have been seriously impressed with some of the current students and recently qualified. Tbh a couple of students recently have inspired me to hit the books and up my game a bit.

Idk I feel like a lot of these schools are challenging, especially my school. We started with 44, only 18 of us graduated. Can’t say they’re just letting everyone through. Now the kind of nurse that comes out, depends on the hands on training she or he will get out there and also the kind of person one is. Burnout can also affect outcome and work efforts.

There’s always good and bad. I think there are a lot of great nurses coming out as well as many that won’t make it long. Nursing schools used to weed out the bad ones a bit better is what I think. Now they are passing everyone. So now it’s up to the floors to weed them out. We also have a lot less ‘experienced’ nurses, so new nurses are training newer nurses.

It seems that graduates who completed virtual clinicals due to COVID-19 needed more time to adapt, but once things returned to normal, all new graduates caught up and progressed at the same rate as before.

Im a relatively new rpn grad (graduated in 2022), and am back in school now for my RN. However, i do feel like ive noticed a difference in the students that are completing placements on surgical units (my old unit that i occasionally pick up on). Not consolidating students, but lower level students in a group placement. All they do is stand around and talk loudly by the nurses station and are on their phones.. I also had a student give my patient what appeared to be a love letter? Like wtf..

After reading a few genuinely honest questions from new grads, asking about VERY basic nursing skills, I am convinced that nursing priorities have really changed. It’s eye opening, for sure.

Ime it depends what schools they come out of. I went to a CC for my ADN and you had to be a CNA to get in (meaning, take the 6 week course, not that you are forced to have worked as one but it Def made your application better) and we had great clinical locations.

As an experienced nurse I remember working med surg and rehab and a local $100k/year for profit school just had their students standing around. These guys were getting a bsn and had no skills and had to be coaxed into helping and no one had instructors around to do procedures like IVs or catheters so they would watch (if they wanted) and wtf kind of training is that?!

The local state university has amazing clinical spots for their students and produced very clinically competent nurses. Same for the CCs. For profit colleges aren't giving good educations, imo.

I think in general the work ethic is strong for young nurses; the only two new nurses in the past few years I’ve felt had bad work ethic actually used to be techs, which is super weird. And like others have said, you learn how to be a nurse on the job, so a knowledge gap is sort of whatever.

The only thing I feel is an actual difference is communication. I have no idea why (I’m sure there are a lot of sociologists who’d love to weigh in) but the newer nurses do not seem to be able to communicate with others. I cannot even count how many times as charge I’ve had nurses come to me about the doctors asking ridiculous things of them or having some friction with them via text, so I ask them to add me to the chat…and I have to rewind and rewrite the whole conversation. Not even just SBAR (which takes time to become comfortable with) but basic human-to-human conversation. Like, acknowledging what the doctor said and answering the question, spelling out what it is they want, etc. I also have a hard time when some of the new nurses ask me for help, I’ve had to say so many times: “yes I understand that XYZ is going on, what do you need from me?”

Most of our students and new grads have been fantastic. There's always the occassional one that isn't strong enough to start in the ER though.

Looking back, I don't think I was all that great as a new grad - perspective is kinda everything. School really doesn't teach you how to function as a whole nurse.. and critical thinking skills come with time and experience, not school.

Yes, there's going to be some students that won't make it. But I don't think students, new grads or new staff should be put down for asking questions - I'm honestly scared of the ones that don't ask questions.

The cocky new grad that thinks they're all that right out of school are the ones that are likely to drop the ball in a critical situation.

You might feel you are way ahead of your peers right now, but I'm willing to bet that you will be humbled at some point too when you're on your own.

There has been a pretty hard decline recently but I don’t think it’s entirely the fault of the new grads. Many of them didn’t get nearly enough clinical hands on rotations due to COVID. And honestly I think the heavy emphasis of online learning is hurting students. Online learning is not sufficient in my opinion. It’s all busy work and it does not engage most students.

I was an idiot as a new nurse. I learn so much on the job, still learn every day after over 15 years. So I won't say there's a decline in the QUALITY of nurses. But I do think there's a decline in the WILLINGNESS TO LEARN on newer nurses, if that makes sense. It seems to get worse as time goes by. Please don't think I'm judging all new nurses. We have gotten some amazing younger nurses. I'm generalizing here, which isn't really fair to all young nurses. It's just what I have observed. 🤷🏼

7 years in. It’s been said but I think people forget how green they were in the beginning. Especially if you hadn’t worked in healthcare at all.

School gives you the fundamentals, being on the job is where you actually learn how to nurse.

Unless you've been a tech or something similar before being a nurse, you're gonna struggle and feel dumb for a bit before you learn your flow. Even if you've been a tech or something there's all kinds of new stuff you don't know how to do and have to learn.

Almost 40 years as a nurse and still learning. Just like all of those years, I see great nurses and those that shouldn’t be nurses. Best of luck in your career:)

There’s a huge decline in the basic skill level of nurses graduating; accelerated programs especially seem problematic.

The students who have been on my floor this past week did not know how to put on sterile gloves or empty foleys. They want to practice skills but apparently it’s on me, the bedside ICU nurse, to teach them super basic stuff. They’re graduating in a few weeks which is pretty scary IMO. Our intensivist was disturbed when he heard that their program was ONLY one year. This is super basic stuff and I can’t image how much they have paid to not even know the most basic of bedside nursing skills.

One of them wanted to hang IV meds on a fresh open heart pt and I told them no. I’m usually super happy to let people practice skills and teach but critically ill patients are also not guinea pigs.

Y’ll are nice.

Anecdotally here in Canada. Yes. Very much yes.

Not a nurse, start nursing school this fall.

But as a tech, I wasn’t a great tech at first, I feel you stick to the essentials at first, and as you get more comfortable with everything, you improve everything aswell. Everyone starts from nothing, what matters is dedication to improving, and actually doing it.

even critical thinking, you get so in your head about remembering everything important, you sometimes don’t think at all, even when you’re fully capable of it should you be more comfortable/experienced

I find that while I’m way better at everything now, I still have no free time because now I just do more as I’ve gotten more comfortable. “Shortcuts” you had to take in order to function at first I don’t have to take anymore(how I was taught but realized I don’t need to).

And im certain this directly applies to nurses aswell. As long as they don’t directly put patients in danger, struggling at first is normal as everything is new and you’re trying your best to not mess up something critical, and the less critical (the things that make you a good nurse on the surface) get passed up. But as you get more experienced you improve everything.

So I’d say your classmates, so long as they have a desire to improve and actually DO improve over time (they have even if it’s hard to see), they will learn. Critical thinking IS a skill, and common sense CAN be learned (mostly)

I’m planning on going to nursing school and I’m concerned about this, too. I used to be a PhD student (literally wrote 75% of a dissertation before imploding) so am academically inclined but need a job that is both physical and makes me think on my feet. I took a job in a pharmacy to get a jump on pharmacology.

I still fully expect to be dumb as a new nurse. I suspect what matters is that you have a basic knowledge base, are trainable, and can problem solve.

I’m not sure about the ones I’ve gotten proper clinical experience since the pandemic but a few that I have worked with that went to school during the pandemic or less skilled. I’m used to LPNs coming out of nursing school, knowing how to do foley catheters and follow basic wound care instructions. my hospice hired three that had graduated during the pandemic and they could barely follow instructions on how to do. Wound care. None of them had done a Foley before either, which was shocking to me until I remembered that they didn’t get the experience during school.

Having said that, I don’t believe anyone should feel comfortable being a nurse until they have at least two years experience experience and a given field. The ones that feel comfortable at work from the jump, worry me. I feel like there so sure and arrogant that they are bound to make serious mistakes because , they’re not second-guessing themselves.

So no, you shouldn’t feel like you know everything you need to know straight out of school. nursing school is the foundation so you can get on the job training in the field.

Yes x 1000000000. They were not granted the experience in clinical the rest of us were due to Covid. It shows.

I'm a new nurse: I feel dumb every day.

Teachers always complain, and when people have been nursing for a while, you always see the attitude pop up of us vs them, instead of “hey they’re new and this is a tough fucking job and school doesn’t teach them anything important except outdated lab values.”

A nurse that is asking question so they can understand themselves is okay in my book. I’d rather they ask questions than be dangerous and fake it until they make it.

I have no doubt that covid caused a decline because students were doing online clinicals instead of touching a patient 😭 not to mention most the units they couldn't go to at all; and lots of hospitals declined students altogether. The only place I k own they were allowed was medsurg and medsurg ONLY. Those students suffered.((and it wasn't their fault of course)) I felt really bad for them .

Other than that ,I can't attest to.

That’s every new nurse cohort. They either sink or swim. You’ll find the same types of nurses new and old in every place you work. Best bet is to keep focusing on yourself and get your skills and common sense honed in to whatever specialty you’re in and know you’ll be prepared if shit hits the fan no matter who you’re working with. Unfortunately even the scariest nurses sometimes manage to continue to squeak through and healthcare isn’t being too choosy so buckle up