National Nurses United

National Nurse magazine April-May 2015

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Francisco HIV/AIDS unit there, is a classic example. When she first started her job, she embarked on a three-month long intensive pre- ceptorship, and she was paid a full salary. "They were essentially paying two salaries to get one worker but, at the end, they got really well-trained nurses," said Jones, who remembered that her entire graduating class in 1982 of about 50 students was able to immedi- ately secure full-time employment at acute-care hospitals. "They invested in me, and they got a lifer out of it. Now those programs have been slashed, and they've put the burden on the worker to try and figure out how to get the equivalent of preceptorship." That's the boat that many recent grads are in, not just the Califor- nia Hospital nurses. Emily, who didn't want to use her last name for fear of jeopardizing her job prospects, went to work in a skilled nurs- ing facility after graduating in 2013 from a Bachelor's of Science in Nursing program at Samuel Merritt College in Oakland, Calif. She left that job for an unpaid internship in the hope of getting closer to her goal of becoming a labor and delivery nurse. She said she had mixed feelings about the internship; she was glad to get a highly competitive slot, but wondered why she was interning after earning her license. "Even though you know you should be getting a job with paid training, you feel appreciative," she said. "I had no options. I had been actively looking for nine months. I applied to over 100 jobs." Emily hoped she'd get hired at the hospital. But that didn't happen. Five weeks into the internship, she was terminated without warning. Another new RN who also graduated from Samuel Merritt and did not want to give her full name, Denise S., was likewise unable to complete her paid internship at Kaiser Permanente Medical Center in Walnut Creek, Calif., which was supposed to lead to a preceptor- ship and then a job, when one of the other interns showed poor judgment and posted a picture of a patient to Facebook. All five of the interns were thrown out of the program. Juner Valencia, also a Samuel Merritt graduate, finished not one, but two "residencies" at Highland Hospital in Oakland, Calif., one in teleme- try and the other in the emergency room. Valencia had been volun- teering at the hospital for years, well before he started nursing school, and he was one of the lucky ones who was guaranteed a job and got hired on as an emer- gency department RN in 2010. "The job market was so bad that there were 1,500 applicants for a position, and they hired seven of us," said Valencia, who has tried to help and mentor new RN grads having difficulty finding work. "My school is a big school and they graduate about 250 people every semester. A lot of them got jobs at a clinic or somewhere they didn't picture themselves being. They're vol- unteering and doing 12-hour shifts to keep their skills up to date. I know people who weren't able to find a job, and they're stuck with an $80,000 loan." That desperation to get a foot in the door can lead new RNs to not only work for free, but actually pay for oppor- tunities to practice nursing. Quite a num- ber of people in Karen Burnes' Samuel Merritt class entered into a "transition-to- practice" program with the school and Sutter's California Pacific Medical Center—something very similar to the Rio Hondo and California Hospital program. "You actually have to pay to do that," said Burnes, who finally landed an RN job in Salt Lake City after searching for more than a year. "It's something to put on your résumé to stand out from other new grads to hopefully get a job, but that's not guaranteed at all." The California Hospital group explained that, since the intern- ship was considered a college course, they were required to pay enrollment and tuition fees of almost $200, plus fees for back- ground checks, a health exam and any needed vaccinations, their own malpractice and liability insurance, among other costs. The senior nurses we spoke with said they were troubled by new graduates having to fork over money out of their own pockets for chances to practice nursing on top of their student debts, and on top of the indignity of working for free. Some of the nurses pointed out that, in some cases, RNs need to repay the costs for their programs if they can't complete it. Even more disturbing is the proliferation of private companies, whether for profit or nonprofit, that see a market in establishing and operating these "internship" or "residency" programs. In 2013, McEwen of NNU's nursing practice department appeared before the California Board of Registered Nursing to discuss concerns regarding "transition- to-practice" programs following an informational presentation by the California Institute for Nursing and Health Care, an industry-affiliated policy think tank. One featured program, marketed by Versant, claimed to be "partnering" with about 79 hospitals to "transition" RNs into prac- tice through its "RN Residency" program, according to their website. "These proprietary models like Ver- sant have no public transparency require- ment," said McEwen. "We did a critique of their literature, and there may be prob- lems with reporter and observer bias in their reporting. Some are 'white papers' written by authors who are employees of the corporation they're promoting." She 18 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G A P R I L | M AY 2 0 1 5 Are you aware of RN "internships," "residencies," or "transition-to-practice" programs that exploit new nurses? Please tell us about them! We will continue to report on this evolving issue. Send tips to! Staff RNs circulated a strongly worded petition to management opposing the use of licensed RNs as unpaid "interns."

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