precepting new grads in ER

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    I have precepted many new nurses coming to the ED, but this is my first brand new grad. Not only is she a new grad but NO clinical experience except school clinicals. I am having a hard time being patient with her. I Started my career in ED but was a tech and worked in the ED for 10yrs before graduating. Any suggestions on how to turn her into a competent ED nurse in 20 wks?
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  3. 5 Comments so far...

  4. 2
    Lol first, lower your standards.

    Wouldn't you be really upset with yourself if you found out they found out they didn't want to do it and quit?

    Remember, even the most basic things they are not aware of. I'd suggest being a vocal teacher. Verbalize everything you're doing. Explain. Make sure they are doing things, like IV sticks ect.

    Review your protocols and ask questions. For example. This pt is coming in with abdominal pain. What do we do for abdominal pain? Seizures, ect.

    Suggest she read up on things like commonly used drugs ect.
    bebbercorn and hiddencatRN like this.
  5. 2
    Quote from Sassy5d
    Remember, even the most basic things they are not aware of. I'd suggest being a vocal teacher. Verbalize everything you're doing. Explain. Make sure they are doing things, like IV sticks ect.

    Review your protocols and ask questions. For example. This pt is coming in with abdominal pain. What do we do for abdominal pain? Seizures, ect.

    Suggest she read up on things like commonly used drugs ect.
    Agree with the post above. I'm pleased to see that your orientation is 20 weeks, and I feel that's enough time, even for a new grad.

    I also suggest you take some time weekly for your new grad to review/decompress/gripe/reflect. If you have the ability to review charts within your facility's policies, do it. But definitely make time to talk out what's gone well and what hasn't gone so well, as well as give the new grad the opportunity to verbalize, if needed, all the mental and emotional adjustments and reality checks that come with being a new grad in the ED.
  6. 4
    I myself am a recent new grad who started in the ED straight out of nursing school with relatively no clinical experience (EMT-Basic for 6 months, ED-preceptorship for 1 month in nursing school). I am in my early 30's, so I wasn't exactly a doe-eyed new grad starting my first job ever though. From the start, it was quite the transition. I needed help for everything, IV-start success rate of maybe 50%, more than half the time had difficulty pulling labs from an existing line, couldn't read "physician-scratch", had to ask about various meds I had never given before and maybe a few times after that, couldn't anticipate labs, uncomfortable with vented patients, drips, etc. Just learning hospital protocol, the charting system, the multitude of forms and when to use them was a daunting task. However, I was a quick learner. Within a few short months, things finally clicked and I was no longer just tasking, having a greater sense of what was going on and enabling me to anticipate and prioritize more effectively. In time, I learned many tricks of the trade for our everyday tasks and gained confidence as an ED nurse. I became more competent and independent as time progressed, allowing my preceptor to do their own thing and me not having to ask for assistance every 10 minutes. I've been on my own for a few months now and that in itself was another huge transition, as I encountered many scenarios I had no experience with, yet worked through these with the help of a supportive staff.

    My advice is to be patient. The biggest thing is patient safety; perhaps the new grad may be slow and require assistance, but as long as they know the difference of what can and can not harm the patient, and know when to ask for help, working in the ED should all click at some point, transitioning your newly precepted nurse from a bright-eyed new grad into a competent and proud ED nurse. I am thankful for my experience that I worked with wonderfully patient preceptors who worked with me and took the time to answer my multitude of questions without judgement and help me in the transition from school to practice. Best of luck with your new grad.
    bebbercorn, bokerglory, Altra, and 1 other like this.
  7. 1
    From my experience as a new grad starting in the ER I have to agree with the previous posters. I like the suggestion about focusing on patient safety--with time she will get faster, her skills will get better, and she will act more professionally. But she needs to be able to recognize immediately when she is over her head, when she needs help, when she needs to get the doctor to the bed NOW, etc.

    My preceptor was great at recognizing my strengths and capitalizing on those, while pushing me to develop other strengths. For example, I was great at establishing rapport with patients during my assessment. But I needed encouragement to learn to ask assessment questions and eyeball a patient while setting up my IV kit to start a line. She helped me find a way to do this while continuing to maintain a good rapport with patients. Sounds basic to me now, but initially that was a challenge.

    Have other new grads been precepted in your ER? It could help you to talk to other preceptors, to see what adjustments need to be made in your precepting for a new grad. Good luck!
    Altra likes this.
  8. 0
    remember you had "background" in the ED before becoming super ED nurse...sounds like you do not have what it takes to train someone new. that doesn't make you a bad person, just not the right person. i would see about have her train with someone else.


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