When did you realize that "newbie" wouldn't cut it in the ER? - page 3

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.... Read More

  1. Visit  HikingNinja profile page
    1
    I agree with a previous poster about no sense of urgency being the kiss of death (sometimes quite literally for the pt) with a new grad or RN new to the ED. When you see the new person chatting with the pharmacist tech about the latest movie she saw while the rest of the team is coding HER pt its a very bad sign. What's awful is that now she's only on an extended orientation not moved back to her own no critical unit where she belongs. I'm just waiting for her to kill someone. Her preceptor is developing an ulcer from the whole affair. I love our union, really I do but fighting for someone like this to stay in critical care is insanity.
    canoehead likes this.
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  3. Visit  oscar0183 profile page
    1
    Quote from ADNRNTX
    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

    I hope you enjoy the ER as much as I do! My best advice is to always ask questions when you aren't sure of something and be eager to learn. In my ER a know it all or bad attitude gets outcasted real fast. The skills will come as you do them more and more. I would say brush up on your assessment skills: focused and head to toe. Depending on the situation you need both in the ER. Again, hope you enjoy it and find a home in the ER!
    Armygirl7 likes this.
  4. Visit  sandyfeet profile page
    0
    There is one newbie I think won't make it where I work. At my hospital the first 6 months of your employment, you are on probation. She got put back on probation (i.e. at 6 months was not performing) after making multiple mistakes. Whenever I work with her, she is always drowning and if you ask her if she needs anything, she always says no. Once she took report from a nurse and later asked "Do you know who has that room?". This is a nurse who came to the ER with experience. Very bizarre!
  5. Visit  KeeperMom profile page
    1
    The nurse that thinks she knows everything and/or is overconfident, won't ask for help, doesn't ever bother to help others but is often sitting on her arse, and even tries to tell others how it was done at her last hospital all the time won't make it.

    We have one new orientee right now and 2 weeks into it I'm betting she won't cut it. She's a brand new grad and never even had a "real" job before. Her coach is not on the trauma team so they never see the traumas to begin with. She was allowed to observe a Level 1 the other day and she was told to stand in the corner (away from the action) but yet she walks in and grabs some trauma lead and gown and MY orientee asked her what she was doing. This 4 week out of school grad thought she was just going to dress out and run that trauma. The fact that someone had to tell her she couldn't come to play was pretty scary.
    Lawgirl14 likes this.
  6. Visit  krazievi3t6url profile page
    1
    Quote from KeeperMom
    The nurse that thinks she knows everything and/or is overconfident, won't ask for help, doesn't ever bother to help others but is often sitting on her arse, and even tries to tell others how it was done at her last hospital all the time won't make it.

    We have one new orientee right now and 2 weeks into it I'm betting she won't cut it. She's a brand new grad and never even had a "real" job before. Her coach is not on the trauma team so they never see the traumas to begin with. She was allowed to observe a Level 1 the other day and she was told to stand in the corner (away from the action) but yet she walks in and grabs some trauma lead and gown and MY orientee asked her what she was doing. This 4 week out of school grad thought she was just going to dress out and run that trauma. The fact that someone had to tell her she couldn't come to play was pretty scary.
    Wait, I'm confused. I don't see why she couldn't just jump right in? Maybe not run the trauma but at least participate.
    sallyrnrrt likes this.
  7. Visit  itsnowornever profile page
    1
    Quote from krazievi3t6url

    Wait, I'm confused. I don't see why she couldn't just jump right in? Maybe not run the trauma but at least participate.
    I think it was more that she was told to stand in the corner and didn't follow directions.

    Posting from my phone, ease forgive my fat thumbs!
    canoehead likes this.
  8. Visit  cHaNkStA profile page
    1
    As a new-ish grad. I had the mentality of I'm entering "YOUR" territory. You've been here longer than me and so you know more than me. I took my precepting days as a day of learning. Everyone had a different charting style, or whatever. You just need to learn to accumulate all the information you took, and just do what you feel works best for you. But again, my mentality was me entering their territory. I came in enthusiastic and eager to learn. I got along with everyone, and everyone seems to like me (at least, I'd like to say they do).

    In terms of showing compassion, you just have to let the "newb" learn themselves. I was very sympathetic in the beginning with a lot of the "regulars" and to others, it seemed like a waste of time. But overtime I'd realize how much some people abuse the system and would literally come in 3x a week for the same complaint hoping to get something different from a different doctor. I'm still new, but I can typically spot a regular.
    jrsRN07 likes this.
  9. Visit  Armygirl7 profile page
    2
    My top tips (and although I am a couple years into being an ER RN I still think of myself as a newbie!)

    1. Follow directions.
    2. Move fast, but don't panic.
    3. Be humble, and appreciative.
    4. Create alliances with the smart experienced RNs that you respect, and always be willing to help someone else when you have 2 minutes of calm in your own area!

    So if I was told to stand in the corner and observe a trauma - I would stand in the corner and observe the trauma.

    When I first started, my preceptor used to kid me about how panicked I looked just bringing someone a pillow! EVERYTHING was an emergency to me at first. It took me at least a year to learn to manage my time. I now kind of continually triage my area. My preceptors taught me that when I feel overwhelmed to take a breath, take 60 seconds with my cheat sheet, re-group and plan my next few moves.

    Even if a senior nurse was trying deliberately to bully me or unsettle me or just show her superiority I tried to remain humble - I don't need to argue with idiots - because then who is the idiot?? If there was even a sliver or grain of truth to the advice or the comment I would just try to be grateful for the direction and MOVE ON! Keep your friends close and your enemies closer. I KNOW who my enemies are. But I will never give them the satisfaction of knowing they can unnerve me.

    I don't think I ever let the words "I know" come from my lips. Sometimes in debriefing an especially heavy day or incident or mistake (YES YOU WILL MAKE MISTAKES!) with my preceptor I would question why I did this or that when I know better or should have recognized something earlier. I never ever want to assume I know everything - because even if you technically did know everything you still have to transfer your knowledge to action on a second by second basis in the ER - "doing" is different than "knowing."

    The best moment is when you reach a place where you have enough confidence to admit what you don't know because you realize in learning from your preceptor and senior nurses around you that THEY don't know everything, that no nurse CAN know everything - but with common sense you can always do the right thing - even if the right thing is calling time out and verifying that your next move is correct.

    Written with gratitude to all my preceptors and co-workers!
    zakry and jrsRN07 like this.
  10. Visit  SionainnRN profile page
    1
    I have a feeling a nurse just off orientation isn't going to make it. Called to tell them I was bringing back a chest pain, they tell me they're going to take a non-monitored pt up to med-surg. I tell them the tech can do that, they insist in taking the pt up. Now this is a night when we were slammed, short nurses, and this nurse just didn't get it. The other pt could have easily waited, and the chest pain needed to be seen.
    jrsRN07 likes this.
  11. Visit  canoehead profile page
    1
    If yu haven't assessed the patient going to the floor you can't be certain that there isn't something else going on. It seems unfair to judge whether someone can hack the ER based on one incident. If the receiving nurse is unreasonable, bring it to your charge, it's her job to deal with that sort of thing.
    jrsRN07 likes this.
  12. Visit  SionainnRN profile page
    0
    Quote from canoehead
    If yu haven't assessed the patient going to the floor you can't be certain that there isn't something else going on. It seems unfair to judge whether someone can hack the ER based on one incident. If the receiving nurse is unreasonable, bring it to your charge, it's her job to deal with that sort of thing.
    Was this directed at me?
  13. Visit  ChristineN profile page
    1
    Quote from canoehead
    If yu haven't assessed the patient going to the floor you can't be certain that there isn't something else going on. It seems unfair to judge whether someone can hack the ER based on one incident. If the receiving nurse is unreasonable, bring it to your charge, it's her job to deal with that sort of thing.
    True there may be more going on, but chest pain generally trumps a lot of other stuff. Especially since my ER wants an EKG within 15 min I would be high tailing it in there if one had not been done in triage.

    Sometimes new grads can be task orientated and aren't looking at the big picture, so they don't even think about the chest pain pt being the priority
    jrsRN07 likes this.
  14. Visit  SionainnRN profile page
    1
    Quote from ChristineN

    True there may be more going on, but chest pain generally trumps a lot of other stuff. Especially since my ER wants an EKG within 15 min I would be high tailing it in there if one had not been done in triage.

    Sometimes new grads can be task orientated and aren't looking at the big picture, so they don't even think about the chest pain pt being the priority
    Exactly. The pt being transferred could have waited a half hour. We weren't short on beds we were short nurses and that pt didn't need to be moved at that moment. What they needed to do is come see their chest pain pt, assess, get labs going an EKG. The sad part is they aren't a new grad, just new to ER.
    jrsRN07 likes this.


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