As an RN in a community hospital ED that sees 48,000 patients annually, I constantly face challenges posed by the lack of orientation of new nurses, as Courtney Craig so poignantly described ("Surviving Orientation," Diary of a New Nurse, September).

Before the NCLEX exam became computerized and it would take months to receive notification of a passing grade, hospitals hired unlicensed new graduates to work under the supervision of a mentor and learn clinical and time management skills. But now scores are sent within a few weeks and hospitals hire newly licensed RNs and expect more without offering much support.

Nursing programs must prepare new nurses better. Diploma programs with their intense clinical training are becoming extinct. Although nurses with a baccalaureate or master's degree can become excellent clinicians, diploma nurses' clinical skills are developed while the nurses are still in school. Maybe nursing curricula should be modeled after the medical residency program and include a combination of theory and clinical training models.

Aside from the new nurses' frustration, we must recognize the effect that ill-prepared nurses have on experienced staff, who feel they have no backup and are too burnt-out or fatigued to orient new nurses.

Patricia Gooch, BSN, RN

Coral Springs, FL