When did you realize that "newbie" wouldn't cut it in the ER? - page 4

by lvnlrn

16,136 Views | 44 Comments

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. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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?
  8. 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.
  9. 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.
  10. 3
    I really don't think the orientation period is the best time to judge whether a new nurse will make it or not. I've seen some nurse who do really well while on orientation, then fall on their faces when left alone. Also, I think you need to give newbies at least 6 months to a year to really acclimate to the ED. It's a whole different way of thinking in the ED. I know someone won't make it when I see that they never learn time management and they become too task oriented. Also, the ones that never seem to be able to look at whole picture and think critically. One thing I tell the new nurses that come from the floor is, this is not floor nursing. On the floor you hae a diagnoses and set plan of action. In the ED, everything new that comes in is a mystery to be solved. When you get that patient with abdominal pain, you need to think of everything it can be, start with the worse case scenario and work down from there. The nurses who can't grasp that are the ones that will never make it in the ED. Still, I believe in giving most nurses at least a year to learn this.
    jrsRN07, JHU2016, and turnforthenurseRN like this.


Top