Inexperienced Nurses Placed in Unsafe Roles Due to Staffing Shortages

By Stacey Kusterbeck

Because of staff shortages, inexperienced nurses are placed in roles that may be unsafe for patients — and for the nurses themselves. “New graduates do not have a firm grasp on nursing skills to be able to effectively work in a fast-paced, critical area such as the ED,” warns Taralynn R. Mackay, RN, JD, an attorney at McDonald, Mackay, Porter & Weitz.

New graduates are perfecting assessment skills, time management, and incorporation of textbook learning into actual practice. “Hospitals have even started reporting new graduates to the board of nursing for practice violations, even when those violations are the result of a lack of training/orientation,” Mackay reports.

Mackay has seen cases where a preceptor is working with a new graduate and allows the inexperienced nurse to make an error. The preceptor then writes up the graduate for the error.

“Precepting a new nurse used to mean working with the new graduate or the nurse new to the unit so that they understood what was required. Making errors was part of the process,” Mackay explains.

Mackay has seen new ED nurses reported to the board of nursing for administering a medication incorrectly, not following ED policies, not meeting time requirements, and discharging patients without appropriate instructions. Some ED leaders even place new graduates in charge and triage nurse roles, or assign them high-acuity patients. “New graduates do not have the experience to handle these high-risk areas,” Mackay cautions.

It is a patient safety concern and a liability concern. “If new graduates are going to persist in taking these positions, they should make sure they have malpractice insurance,” Mackay advises.

Budget cuts are an underlying reason for these practices. “Unfortunately, some hospitals are terminating experienced ER nurses for minor or even unsubstantiated reasons so they can fill the spot with a less expensive nurse, which frequently is a new graduate,” Mackay says.

For some administrators, nursing salaries are viewed as a line item in the budget. Factors such as years of experience, area of practice, working the night shift, and certifications all can increase nurses’ hourly salary. “The hospitals do not realize the experienced nurse saves the hospital money due to their experience,” Mackay says. “Plus, who is there to adequately train the new nurses if the experienced nurses are driven off?”