Determining Actual Working Conditions Of Nurses

Commenter Jennifer (welcome!) wrote:

One thing that scares me about going in to nursing is stories about the bad conditions. How do you find the conditions where you work?

What a good question!

I don’t know how to guarantee that with anything near 100% accuracy, but I can help anyone considering a new nursing position how to find out the “real” from the advertised and help close the credibility gap.

First off, know a couple of things:  nurse recruiters, who may or may not be nurses themselves, are working to fill slots.  They are almost always working to meet quotas, and they are not YOUR agents.  They work for the employer.  So take anything and everything they say with healthy amounts of skepticism.  In other words, “trust AND verify.”  Ask them to verify in writing, any claims they make about staffing, patient case load assignments, time off scheduling policies, education support, assignment to your desired setting/shift/work schedule/patient population, etc., etc.

Let’s start with orientation:

Things to ask the recruiter/tour guide/interviewer:

What method of orientation is used - mentorship, classroom, laboratory, guided practice, formal education, self-directed instruction, web-based, etc.

How long is orientation?

What is the work schedule during orientation?

Who are the teachers?  What are their credentials?

What is the curriculum?  (Ask to see it.  If it’s not in writing anywhere, warning flags should be flying.)

Things to ask yourself:

Is this the style of teaching I do well with?

Is this long/short enough or do I need something else?

Is it guaranteed out of staffing orientation (translation:  if you are counted in staffing, you will be expected to pull a partial or full patient assignment, regardless of your “orientation” status.  Beware.)

Are the instructors qualified to teach the content and are they clinically expert in my field?  (translation:  are the instructors experienced, competent and familiar with your specific nursing specialty.  Critical care nurses teaching critical care nursing, perioperative nurses teaching perioperative nursing, orthopedic medical and surgical nurses teaching orthopedic and rehabilitation nursing, etc.)

Do you have free and open access to a healthcare research-based library?  Can you access it online from your nursing workplace?

Does the curriculum progress from novice to competent independence in nursing in your field?  Is it based on current practice and evidence, and is it specific enough to serve your individual needs? (These will vary based on your entry-into-practice nursing program, whether this is a first professional nursing position, whether this is a new position but in your field of clinical expertise, or whether this is a new clinical field, but in the same employment setting, etc.)

You’ve decided that the orientation generally meets your needs, and you’re still interested, so the next thing is to determine whether you will be satisfied in your work setting.

Take a tour with a nurse who works on the unit or in the department you are considering during the hours you most likely will be working.  In other words, if you are going to be a night owl, take a midnight tour. And meet and greet all of the staff you come into contact with on that unit. It may be that the person who “sets the tone” is the unit coordinator or a nursing assistant, or an environmental service worker.  See who speaks to whom, and get a feel for the overall tenor of the unit.  Is it formal?  Stuffy?  Boisterous?  Chilly (and the thermostat is just fine)? Openly hostile?  Competitive?  Cutesy? Friendly? Something else?

And most important, does it feel comfortable to you?

Chat up the other nurses.  Do they generally have enough time to take care of patients to their preferences?  Do they have any immediate safety concerns for themselves or their patients?  How’s security?  Have nurses been assaulted, bullied?  If so, by whom?  What was done?

Do they get away from the unit for meals and for breaks?  How’s the cafeteria or local eateries?  Is there a potluck culture (celebration by food)?  Do any of the nurses socialize outside of work?

Is anyone attending school?  Does the employer support them in doing that?  How about childcare issues and taking sick time?  What’s that like?  Are nurses able to schedule vacations and time away without undue hassle?

Do you see enough clean linen, sterile supplies, IV poles, IV pumps, PCA machines, pulse oximeters, pillows, etc.?  Do the nurses feel that supplies and equipment are in good working order and are available when they need them?  If not, get the specifics of when, where, how often, why, and what is done or not done to remedy the root cause of the shortage. Are you familiar with the equipment used?  if not, how will you learn to use it?

What do the patient meals look like?  How are they delivered?  Do the patients like the food?  Is it hot/cold enough?  Is it visibly and aromatically appealing? How do nurses obtain meals for patients admitted during closed cafeteria times? What is the quality of that food?  Special diet accommodation?

What are the patients like?  How are physician relations and communication?  Are there any problematic physicians?  If so, find out what the nature of the problem is and how the nurses deal with it/how the employer supports the nurses.

What is the general communication style of the nurse you will be accountable to for your evaluation and direction?  Does your style mesh well?  What are her expectations of you as a new nurse?  Six months after starting?  Will you be assigned charge responsibilities?  If so, when and how will you be oriented to that role?  Does that make you exempt from collective bargaining?  Overtime?

How is nursing practiced on the unit or in the department?  Are you familiar with that method of delivering care?  If not, how will you be oriented to it?

How long have the nurses who will most likely be working with you practiced in that setting?  If there is a lot of turnover, why?  Are nurses generally satisfied working there?  If so, why?  If not, why not? (warning flags again - ask, ask, ask)

Finally, if you can, ask to shadow a nurse for at least a half a shift.  You can learn a lot by watching, listening, smelling (does the unit smell clean?), and in meeting some of the cast of characters.  You will get a better feel for the patient population, too, and the culture of the immediate work setting as well as for the overall organization. Listen to how nurses give and receive reports: are they polite, collegial, cordial, friendly, hostile, remote, abrupt, suspicious, accusatory, etc.?  That often gives a strong clue as to the overall nursing culture in an organization.

The American Association of Colleges of Nursing has a helpful white paper on What Every Nursing School Graduate Should Consider When Seeking Employment. The guide is helpful for all nurses investigating a new position. The objectives include:

Maintain clinical advancement programs
based on education, certification, and
advanced preparation.

Create collaborative relationships among
members of the health care team.

Utilize technological advances in
clinical care and information systems.

Other statistics and information to
request from a potential employer:

RN vacancy rate and RN turnover rate
· Patient satisfaction scores (preferably
percentile ranking)
· Employee satisfaction scores
· Average tenure of nursing staff
· Education mix of nursing staff
· Percentage of registry/travelers used
· Key human resource policies, i.e. reduction
in workforce (tenure vs. performance
criteria)
· Copy of the most recent JCAHO report and
the number of contingencies cited
· Are nurses unionized?
· Copy of a contractManifest a philosophy of clinical care
emphasizing quality, safety, interdisciplinary
collaboration, continuity of care,
and professional accountability.

Recognize the value of nurses’
expertise on clinical care quality and
patient outcomes.

Promote executive level
nursing leadership.

Empower nurses’ participation in
clinical decision-making and
organization of clinical care systems.

Demonstrate professional
development support for nurses.

Refer to the guide for the specific questions and data to obtain.  In general they are on point and are critical for you to know. I find the AACN website of great use for its white papers and research into the nursing shortage, key nursing education issues and nursing career development.

Finally, I’d ask how many  nurses are active in nursing organizations related to their practice.  Which organizations are represented?  Do nurses participate in nursing research, journal clubs, group presentations, on-unit educations presentations, nursing grand rounds, etc.?  Are nursing students on the unit?  If so, from which programs?  What is the role of the clinical nurses with the students? Is the instructor on site?  Do staff interact with the instructor?  If so, how?

That’s where I would start in my investigation into the working and practice conditions.  I would be able to get a sense of the informal culture, of the usual work demands, and of the caliber and commitment of the nurses.

This is only a starter list.  Your mileage will vary.