When did you realize that "newbie" wouldn't cut it in the ER?

Specialties Emergency

Published

Just curious to hear some of your stories regarding orienting nurses (either new grads or transfers) to the ER and when/how you know if someone is cut out for the ER or not.

Specializes in Med Surg, ER, OR.

Or, how about when a seasoned nurse who has "many years of experience in this setting" establishes an IV, secures it and gives report to you that its a great working IV, but you find the IV in place with the needle still in the cath and tourniquet on... seriously!

Or, "I have great skills at starting IVs. I know I do, because I have done many butterflies before in my other job, and it must be like that." And after asking how many IVs this nurse has done... "Well, none really. It looks really easy." And when asked about how many times this person has done peripheral blood draws... "Well, I haven't worked in 5 years, but I did a few and did a good job." I did not belittle this individual, but reminded them that IV therapy and peripheral blood draws are nothing of the same.

Or, after 15 weeks of orientation (typically given 4-8), a nurse still looks puzzled when a doctor orders an accucheck on a known diabetic.

Just some things like this, that experienced nurses "should" feel comfortable with is challenging for preceptors. Not that there is room for improvement, because there certainly is, but that episodes like these mentioned above are mentally draining. It takes strong expereienced preceptors to hod on tight for the crazy ride at times without pulling hair out :)

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Specializes in Trauma, Teaching.

If they can't get past the "I need an order in the computer first" before being willing to intervene in an urgent situation. Understandable at first, but not being able to learn to trust your team in the long run is a problem.

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If they can't get past the "I need an order in the computer first" before being willing to intervene in an urgent situation. Understandable at first but not being able to learn to trust your team in the long run is a problem.[/quote']

I can see where on the floor not having an order is an issue (just reading some of these posts where docs won't sign phone orders!) but in an ER with 5 million people who all hear the verbal order....well, you are covered, just give it!

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Specializes in Emergency.
A lot of nurses forget that at one time they too were new...I have a huge problem with nurses who think they're better or smarter than the next! I'm an experienced nurse who has oriented new nurses and student nurses and I enjoy teaching. The ER is a stressful place and although it might not be for everyone nobody should ever be made to feel like they're a burden to other nurses because they're new. That's why nursing is so stressful these days...bad attitudes to others!!!

Heavenlee75, I'm right there with you on this! I've watched several new grads crash and burn after their orientation which consisted of their preceptor and the preceptor's buddies belittle every question or difficulty their preceptees had. I personally believe that the "old eating their young" really applied in this setting. It was really unfortunate considering a lot of these new grads had really solid assessment and critical thinking skills, but chose to move to other units because they were so miserable and intimidated. These "seasoned" nurses were notorious for making their own mistakes, including letting septic pts ivf's run dry, not giving abx's when ordered, and running pressors either at the incorrect rate or incorrect concentration because they were so busy sitting on their lazy **** and making fun of everyone else! But in the end, you reap what you sow; from what I hear, now the ED's so understaffed, and most are looking for new jobs.

While I get that some people aren't cut out for the ED, "newbies" should be given every opportunity to prove that they can pull their own weight with the proper preceptorship and unit resources when they're cut loose. IMO.

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If they can't get past the "I need an order in the computer first" before being willing to intervene in an urgent situation. Understandable at first, but not being able to learn to trust your team in the long run is a problem.

I'm getting better at that. Now for a ACLS or trauma situation, there's no time to put orders in the computer. But it seems many doctors are too damn lazy to put in orders on non-urgent patients, so they give a verbal order. I'm learning which doctors I can trust, and which doctors I can't trust easily.

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Heavenlee75, I'm right there with you on this! I've watched several new grads crash and burn after their orientation which consisted of their preceptor and the preceptor's buddies belittle every question or difficulty their preceptees had. I personally believe that the "old eating their young" really applied in this setting. It was really unfortunate considering a lot of these new grads had really solid assessment and critical thinking skills, but chose to move to other units because they were so miserable and intimidated. These "seasoned" nurses were notorious for making their own mistakes, including letting septic pts ivf's run dry, not giving abx's when ordered, and running pressors either at the incorrect rate or incorrect concentration because they were so busy sitting on their lazy **** and making fun of everyone else! But in the end, you reap what you sow; from what I hear, now the ED's so understaffed, and most are looking for new jobs.

While I get that some people aren't cut out for the ED, "newbies" should be given every opportunity to prove that they can pull their own weight with the proper preceptorship and unit resources when they're cut loose. IMO.

And I agree 100% with what you said...I watched one nurse who was super intimidating to new nurses but couldn't even spell good :-/

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Specializes in Med-Surg.

Lol, am I the only one who noticed the context of that previous post and giggled a bit? 'Couldn't even spell good'? :p

Sorry, no offense meant, just a Monday morning brain fart.

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Specializes in Emergency/Trauma/Critical Care Nursing.
When the noob administered PO benadryl IVP and called the diphenhydramine an abx.

....

I don't know much else.... just something i heard.

Eeek!! Was it liquid or pill/capsule form and did the pt live???

WOW!!!

BeLLaRN

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Be careful about who you "write off" as not being a big bad er nurse like yourself. I've seen some of the most unlikely newbies quickly become our better nurses. Just sayin'. Be nice. You were totally clueless at one point too.

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Specializes in Emergency Room.

The #1 no-no for a newbie is no sense of urgency. I have seen a few of these and it's very hard to teach this. IMO if you don't have it you never will. In one case the person was completely clueless, moved really slow, and had no assessment skills. In the other, the person was smart and kind, but slightly arrogant, and no matter how many times he was redirected, he would just take his sweet old time, sometimes even just sitting around chilling while there was a LOT to be done. I can't figure out what it was about him, but I literally told him he needs to light a fire under his butt and it didn't make a dent of improvement. If you work in an ER, you need to know how to MOVE!!!

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I have worked on a very busy colon rectal urology post surgical unit for almost 5 years and I am going to do a "shadow shift" in the ED next week and hopefully transferring.. I love my unit and coworkers and am leaving a very secure position but have always wanted to do "emergency" I know some of my skills are going to need to be brushed up on (ie: iv's- we have an IV team) but I feel I'm taking some good skills too (ngt insertion, difficult foley insertions, ostomy mngmt, some wound care,etc) hearing what you have to say about newbies is both encouraging and discouraging.. But I believe I can do it in time! Any advice for things to look out for or absolute do's and don'ts would be greatly appreciated! Be honest I can handle the truth!! Sorry if I should have started a new "topic" but I'm new to the site and felt this had probably been covered but I didn't go back through all the old topics... Does that mean I'm not gonna cut it?? Jk

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I was an LPN prior to RN. I've worked in various settings, many high pressure/stress in their own right, of course not ER. I don't work in a trauma center. Just a small community hospital, 23 beds or so with a fast track. I've been at this job just over 3 months. I'm sure I've said/done/reacted oddly to situations.

Being the 'newbie' is very frustrating. We are well aware that it's a bother to be precepted and oriented. It's very uncomfortable most times.

With that being said, and I know this isn't the point of this thread.. Try to cut some newbies a little slack.

This was an issue at my job this week. With flu issue on top of the regular high volume of non-emergent visits.. It can be frustrating to even the most seasoned nurse.

I found myself wearing down yesterday, no pee, no snacks, no break or food for 12 hours. Verbal abuse and demanding non-ill patients and family members, I was worn out. I made a snide remark at work and I was looked at like I just shot someone's kitten.. The response was like "you're new, what the hell do you know about anything and you're not gonna survive here if that's how you feel" like I'm too new to be frustrated.

I have noticed that being the happy and bubbly one does not always work so well in the ER. I get looks all the time for being enthusiastic and optimistic--i wouldnt be this way if i didnt love my job. I am sorry for having a heart and actually feeling sorry for certain people. Every time i take even 1 extra minute to listen to a pt vent to me and confide, the nurses with 5 years experience will roll their eyes and comment to me saying "thats not gonna last too long". And god forbid i give people a piece of my mind instead of being the smiley, bubbly girl that i am, everyone's eyebrows raise and eyes pop out. Its okay for them to comment whatever way they choose, but if the newbie does, its the end of the world. i choose to want to work in the emergency dept but that doesnt mean that i am gonna change my positive personality and turn into a heartless b just to fit in with the rest of the crowd.

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