The quality of some recent nursing school graduates hired by D.C. General Hospital has been so poor that many of them have not possessed basic nursing skills and were unable to calculate dosages of common medications, according to hospital memorandums.
The vast majority of these graduate nurses - persons who have completed nursing school but have not yet passed the national examination to be certified as registered nurses - are graduates of Federal City College and the Washington Technical Institute, according to Robert Johnson, administrator of D.C. General, the city's only hospital.
Fourteen of the 20 D.C. General graduate nurses who took their national licensing exam in Washington in March failed to pass, according to documents filed in U.S. District Court here in connection with a suit involving the quality of care at the hospital.
Twenty other nurses who took the examination in other states had not received the results at the time the documents were filed.
During 1976, 54 graduate nurses at the hospital took the licensing examination, which is administered ny the National League for Nursing, and 35 per cent failed.
In contrast, a spokeswoman for Georgetown University Hospital said that only an average of about 1 to 3 per cent of the graduate nurses at her hospital fail the examinations the first time they take it. Those who do fail, she said are either demoted or fired.
Only 46 per cent of all persons who took the examination in Washington in 1976 passed it.
The examinations are given twice a year, and under D.C. and federal civil service regulations, a nurse has six months in which to be certified. During those six months, even if she has alreadu failed the examination once, she is entitled to function as a registered nurse and care for patients and administer medications!
The orientation of new graduate nurses at D.C. General was discussed at a Nov. 11 meeting of clinical specialists, high level nursing supervisors, according to the minutes of that meeting that were filed in U.S. District Court. The clinical specialists said in that meeting they felt:
"There are many deficiencies in both basic knowledge and skills (of graduate nurses), yet, passing of medications is posing the greatest problem. Many are unable to calculate dosages and to not know normal doses, contraindications, etc. . . .
"The whole group feels that many of the new graduates that have been hired have so many deficiencies that the hospital is having to provide them with knowledge and skills they should have obtained in nursing school."
"It was suggested that the basic skills, particularly the ability to give med(ications) accurately and safely be assessed before they are hired. Anyone lacking in these skills should not be hired."
Asked about the comments, Johnson, D.C. General's administrator, said "We're trying to cut down on our requirement for hiring graduate nurses. We're trying to hire nurses who are already certified. More and more, as we have an option, we are opting to hire nurses who are already certified."
As of February of this year D.C. General had 331 positions for registered nurses, 266 of which were filled by RNs. 16 of which were held by graduate nurses. There were 49 unfilled positions. When graduate nurses fail to gain certifications within the prescribed six month period they are either demoted or fired. Those who may have been trying to upgrade themselves from licensed practical nurse (LPN) positions are returned to LPN status. Those who were recent graduates are demoted to ward clerk or nursing assistant if those positions are open, or they are terminated.
The failure of the graduate nurses further compounds D.C. Genral's problems in keeping nursing positions filled.
"Clearly, if we hire nurses who are already licenses and whose training and experience is at a higher level then they are able to move in with less orientation," Johnson said.
Asked how patient care is affected by having someone acting as an RN who is unable to pass the proficiency exam. Johnson said "the impact on quality is not . . . clear. We have had to have a longer orientation program . . . Obviously, the most qualified have additional training or eduction.
"You can draw a conclusion that a person whose skill level allows them to pass at a high level is bettered trained than a person who passes at a low level or doesn't pass," said Johnson, whose hospital lost its national accreditation more than a year ago.
Johnson added that the graduate nurses do undergo review, particularly "in the area of medication and (we) don't place them on a unit until they have demonstrated their ability to" properly determine dosages.
Federal City College, which is one of the two institutions providing D.C. General with most of its student nurses, has had a pass rate of only 31 per cent for all its graduates on the national examination.
Georgetown, on the other hand, had a 96 per cent pass rate on the July, 1975, exam.
Ivy Nelson, director of the FCC program, said she was not allowed to discuss her program without clearance from the office of the president of the University of the District of Columbia. A university public relations spokesman then told a reporter he couldn't reach Nelson to give her permission to discuss the high failure rate.
Martha Lewis, director of the nursing program at Washington Technical Institute, the other school providing D.C. General with most of its graduate nurses, said she has not received any complaints from the hospital about the quality of the school's graduates.
In 1974 and 1975 the WTI graduates taking the exam had a 55 per cent pass rate, just below the national average.
In 1976 only 32 per cent of the WTI graduates who took the examination passed.
Lewis attributed the poor results to the fact that that class included graduates who had been admitted to the school as part of a special HEW program for those who would not normally be admitted.
According to Lewis, 60 per cent of the regular students who took that exam passed it. However, only two of the 30 special admission students received certification on their first try. Similarly, only 13 per cent of those in a special program at the school for St. Elizabeths Hospital employees passed the examination on the first attempt.
Lewis said the program was opened to those with a background in "health sciences" - nursing assistants, medics, LPNs - who are socially, economically, or educationally deprived.
Asked if lowering admission standards to admit such students wasn't creating false hope for them, given the high failure rate, she replied:
"This is the way the government seemed to want to spend its money. So we had a program. The program finishes in 1979."