Unsafe Orientation for NG in ER

[gemmi999]

So...I feel I got really, really lucky when I was hired by my hospital. I was hired under an interim manager before most of the ER staff ended up leaving the hospital. I was given 10 weeks of preceptorship WITH THE SAME PRECEPTOR on Days in ER, and another month in ICU when I said I didn't feel comfortable with ICU patients. I've been on my own for about 6 or 7 weeks now, and I know I have a lot to learn, but I am not scared of asking for help when it's needed from other's RNs or even asking the ER doc what I should be on the look out for when it's an unusual patient condition (such as WPW with rhabdomyolysis, which I had last shift).

I'm writing this because when I was in ICU for a month precepting, our ER got a new manager and now new grad's get 6 weeks of orientation and maybe 1 week in ICU (but for the most part not) before they're set on their own. Most of the newer new grads (my hospital works on a rotating hiring basis) have said to me that they don't feel ready to be on their own.

I'm on nights with VERY little consistent staffing, we are ALWAYS short staffed, and typically have travel nurses and new grads together with maybe one experienced nurse who is used to the hospital. When it's just my patient's I'm worried about, it's fine. I can handle my load typically and I know that asking for help is okay. It's the other new grad's I'm worried about.

Example: last week it was end of shift and I was just charting, maybe 45 minutes left before change of shift. I overheard the charge RN and a tech talking about a small possible STEMI that was coming in and they put the patient in another nurses' room, so I figured it was okay. I overheard the doctor asking that bed's nurse to start an IV, get blood and to go from there. The charge heard this too. The nurse is a new grad who was sitting next to me and she kept charting. Didn't even look up. I waited like two or three minutes to see if she would do anything and she didn't, so I offered to start an IV for her and get the blood because I was caught up.

She didn't even know she had a new patient. So I go to the patient's room, start assessing him and start an IV, get blood. He is basically screaming in pain, I ask if he's had nitro or ASA and he says no. I look out and ask his nurse to ask the doctor for Nitro and ASA and she looks at me like: "whaa?" and I tell her to come here, I explain that her patient is having chest pain and has a history of heart problems, can she ask the ERMD for Nitro and ASA.

She comes back with the Nitro but no ASA; by this time IV is started and blood collected. I go to the ERMD and ask for ASA and morphine, told to give ASA but get urine before morphine. By which time I give ASA and start working with the ERMD to get old EKGs from patient's chart and fax to cardiologist, etc.

When I leave the hospital that day, I realize that the charge RN was no where to be seen in that situation. I felt like I was the one who was teaching the New Grad, and I'm a new grad! I don't mind helping out, that's the mentality of the ER, but I don't know if I feel safe working in an ER with other New Grads who have that short an orientation due to change in hospital policy. I feel like I'm responsible for more patient's then my own, which is nutty feeling!

Any advice would be appreciated.

[HouTx, BSN, MSN, EdD]

You are so fortunate. Sounds like your orientation was ideal & you certainly have what it takes to be a stellar ED nurse. Your next step is to improve your self-advocacy & assertiveness. When you're faced with situations like the one you described, you need to confront all the players rather than holding it all in and hoping for the best like a good little camper. I'm not promoting rudeness. Just point how you were impacted by their actions and let them know how you want things to be handled if a similar situation arises in the future.

As time goes on, you'll learn that there is a very fine line between 'helping' and 'enabling'. It's wonderful to step up and help a colleague who simply doesn't yet know what needs to be done. .... maybe even do it a couple of times more. But eventually, you begin to realize that the colleague may NEVER bother to up his game if you're always there to pick up the slack.

You may get some splash back - accusations of not being 'supportive' or 'bullying'. But the only way that slackers can survive in high-pressure environments is by attaching themselves to stronger staff who support them FOREVER. Don't be that nurse.

[annabash_rn]

I have no advice to offer, but just wanted to say I am a new grad and would love to have awesome coworkers/preceptors like you. It sounds like your hospital is quite lucky to have you :)

[sapoland]

Wow!! Sounds like you rocked it. Do you feel ten weeks was enough of a preceptorship for you? I just graduated and will be starting in a busy ER with my preceptorship lasting 4-6 months, and I have had two non-nursing positions in an ER for the last 1.5 years. I can't imagine only getting a few weeks like the newer new grads are getting where you are!!

[Dacatster, ADN]

Sounds like the new grad nurse was scared so ignoring the problem until next shift came in.