What makes you nervous about or irritated with a new grad or orientee? - page 7
I've noticed alot of threads lately from new nurses who seemed quite stressed out, which I can totally understand, I've been there for sure. So I thought I'd start a thread from the other POV. This... Read More
Jan 10, '07Normally I just lurk, and somebody may have already covered this, but I just have to get my 2 cents in.
Recapping a needle using the scoop method: Not a problem. The issue with the needle no longer being sterile isn't an issue for me. I don't think you should use the same needle to draw up a med as you use to inject. I usually use an 18 to draw from the vials then change the needle to a new sterile one. Some medications can cause damage to tissue or pain if they are IM and are drug through the subcut/subdermal layers on the exterior of the needle.
As far as new nurses - I expect questions - lots. I try to always stay patient with them. And just FYI they tend to gravitate to me. I do let them do it wrong if it won't hurt the patient - and then tell them "Well, this might work better, this is how I do it." Little junk like air in the line that kicks the pumps off a hundred times cause they spiked a bag of fluids upside down... etc. Little stuff - let 'em learn by trial and error. Big stuff - you better ask questions. If a patient is endangered by a nurse on my floor (I'm usually the charge nurse) I lose it. That's when I "eat my young." I can say, being open for questions and nonjudgemental with them has made the times when I thought a patient was endangered very infrequent.
Jan 10, '07I am a new grad, just out of orientation in November. I was top of my class, but that meant NOTHING once I started my new job. I was SO BLESSED to have an amazing preceptor that treated me like we were on the same level intellectually...and she wasn't afraid to say, "I don't know...let's find out!" It made all the difference in the world to have someone that answered my questions like a co-worker/friend instead of a boss. I quickly learned which nurses were NOT approachable...the ones that answered my questions with that "duh" look on their faces...or those who talked down to me and made me feel that I was in nursing school clinicals all over again! Lol. So I guess I just want to say thanks to all of those approachable nurses out there that make it so easy for us newbies to ask questions!! For those experienced nurses that are bothered by the questions...just try to remember back to your days as a new nurse...it can be scary! You're not just helping us out with your knowledge/experience, but you're helping the patients, too!! :spin:
Jan 10, '07I'm still a student. I think its funny in the first half hour or so I follow around a nurse, I get "Don't you have any questions? What else can I show you? You're so quiet!" The thing is, I won't ask questions until I get the lay of the land, so to speak. I have to observe for a bit before I know the right questions to ask, I have to get my bearings first. Then, you'll wish I wouldn't ask so many, because no one that knows me for more than an hour thinks I am quiet, once I get going I never shut up!
Moral of the story: maybe they aren't quiet because they think they know it all, maybe they aren't asking questions because they don't know enough to know what to ask!
Ok in a student, kinda scary in a grad.
Jan 10, '07A nurse once told me while I was still in school, "when you graduate you will find out how much you don't know". He was so right. Don't be afraid to ask questions. The know-it-alls are the most scarey! I especially see this in the ER with students. They don't need to start another IV because they started one yesterday. Guess what!!! Each start is different and you learn every day. When you think you know it all look out!!!
Jan 11, '07"Little junk like air in the line that kicks the pumps off a hundred times cause they spiked a bag of fluids upside down... etc. "
I know you like to lurk, but Friday is IV day for me. Is there a certain way to spike the bag to reduce potential problems? Should I turn the bag so I spike into fluid or reverse the bag so I spike into air?
// Wail of confused newbie!!! // I 'thought' that I knew what I was doing!!!!!
peace, JediWitch :smiley_ab
Jan 11, '07In my experience as a student nurse, most nurses I worked with didn't want me around let alone to teach me. There are many different types of personalities that are a factor with graduate nurses and preceptors. You could have a young or mature student nurse who may be confident or not. It's a hard thing going into a new environment which you don't belong in and don't really know. As a new graduate nurse on a Haematology, Oncology and Nephrology ward, the small amount of confidence I had was not welcomed by staff and so was smashed to peices. I nearly didn't make it as I was too scared to do anything and nearly quit all together. Fortunately I have moved to a new ward (Neurosurgery) where I am treated with respect despite being a new nurse, though still guided in my practice. I don't have to worry about people judging me when I as a question, and people DO JUDGE.
Appearences aren't always what they seem and a new nurse who seems too big for their boots may just be covering up feelings of inadequacy. We're well aware of the strain we bring to wards as we are not skilled-up and senior staff have to keep an eye. This isn't easy to know.
I hope that funding in the future will allow staff numbers to reduce this strain on senior nursing staff.
Jan 11, '07I really become quite nervous around new grads who will NOT ask for help until a situation escalates into an emergency. I spend a lot of time watching certain grads because they have way too much confidence in themselves and not enough knowledge to back up their actions. I also have no patience with tears and tantrums. One of our new grads got 2 weeks off because she was stressed out. She pitched a fit at the DON and got that time off because " we don't want the grads to leave because they are stressed"...well alrighty then. Does that apply to any of the more seasoned nurses who have become stressed because the grads told them " you had better watch yourself, I was told I could write you up if I don't like your attitude "...my days of precepting are over...I have always tried to teach the new nurses what they need,with patience, kindness and understanding that we are not born with the knowledge or skills necessary to be a nurse. This latest crowd has cremated whatever iota of excitement to teach them I ever had. Patence and a sincere desire to help them learn is not enough anymore...I will not pucker to anyone's behind. I shall continue to be helpful to anyone but I WILL NOT PUCKER UP TO THE NEW RUMPS IN TOWN !!!
Jan 11, '07I think most new grads know they are clueless, anyway, the ones I know think that way. I am distressed over the negativity toward new people in nursing in general, and in this thread.
Jan 11, '07Sometimes it's hard to keep asking questions if your preceptor keeps saying "I don't know what that is". .
Jan 11, '07From another perspective (that of nursing clinical instructor) it has been my experience that nurses have unrealistic expectations of students at times. The program I teach with is always struggling to find enough clinical spots and what has happened is the students are often getting only 1 12 hour day a week for their clinical rotations rather than 2 6 hour ones. We all know that that greatly cuts down on the stuff they are exposed to. In acute medicine our students only get a total of 10 shifts. Some of them have to do 5 of these in a pediatric setting. Could you imagine having a 5 shift exposure to adult internal medicine and then ONE YEAR LATER (after going through palliative and psych rotations) you show up to start your senior practicum? Of course they will be weak.
I think the reason they often have what we call "grad-itis" and that know-it-all attitude is they are on the defensive and they often have more current knowledge and have just reviewed procedures manuals while nurses are doing things by memory from years gone by and may actually be doing something that is not technically correct. It is very tempting when you have always felt like you know nothing to jump all over another person's error to make yourself feel bigger. I give a speech to all my groups about this type of behaviour. Team player..If you are not part of the solution you are part of the problem..yada yada yada. I discourage this attitude but have seen other instructors encourage it by also criticizing the practice of nurses on various units as substandard, etc. So if you have a student that came out of this climate I would not be surprised by a continued critical attitude toward senior staff.
We all have to take personal responsibility for the way we act. Student, instructor and nurse alike.
Jan 11, '07I myself am a fairly new nurse (grad last May). I could not imagine acting as if I knew what I was doing. I sometimes feel bad at how many questions I ask or I feel like I am annoying some of the other nurses as I know we are all busy. But at the same time, I would rather ask and possibly "annoy" someone, then make a mistake or overlook something I am unsure of. I sometimes feel like I am not cut out for the hospital because I feel like I will never be sure of myself. But I have had more experienced nurses say the same as most of you, they would be much more worried if you didn't ask questions. Quite frankly I wish I could get more constructive criticism, but when you are off orientation, it is hard for anyone to be watching me to tell me if there are things I could improve on. Nursing is for sure like no other job I have ever had!
Jan 11, '07I would agree that a new nurse who asks a question and then argues with you would become hard to take. When someone does this to me when I'm teaching them something about riding a horse, I shut down and let the wheels fall off, until they come back with some humility, unfortunately that can't always happen with nurses because it will cause harm or risk the patient somehow.
That being said, I think sometimes a preceptor needs to recognize the reason why a student/preceptee might not ask questions is that they are so overwhelmed that they don't know what to ask. Or, perhaps that isn't their learning style, maybe they learn by observation and repetitive doing of whatever task it is that you are trying to teach them. Not everyone is an auditory learner, and not everyone learns by reading a book/looking it up. Some of us just have to learn by repetitive practical application of the knowledge and/or skill. I think that preceptors need to learn to teach, as some who take it on really shouldn't, due to their own lack of confidence, nervousness and self esteem issues. If the student isn't "up to snuff" they somehow think it reflects on them.
I had a preceptor in the OR who screamed at me (literally) because she felt that I hadn't prepared enough for a TAH (hysterectomy). I was so overwhelmed during the procedure it was all I could do to focus on the surgeon, meanwhile she was whispering to me what to do differently and that was just breaking my focus. The surgeon told her to be quiet, and after the procedure was over chastised her for putting me in that position and not taking over when things proved to be more difficult than anticipated. She started crying, and then after our 1400 lunch break, she took me aside and stripped me down telling me it was my fault for not preparing (I had). She started crying again and then stated "how do you think it made me feel being yelled at by the surgeon, when I was clinician for 10 years in gyney?", which tells me the whole thing had WAY too much to do with her ego and very little to do with my education.
I tried to explain my learning style, kinesthetic, and tried to help her by telling her what I needed in order to learn better. She was just a nut bar, and never did try to see things from my angle.
I've also worked with a few nurses who were calm, confident and kind who gave me time to understand and practice and made sure I had ample opportunity to repeat a task over and over until I got it. They were few and far between however. Most were either teachers who got out of active care for the same reason that I am considering it, or nurses who didn't join the status quo and hate all newbies.
Jan 11, '07Quote from KellNYI can identify with your comment. I had such a bad experience as a new RN three years ago, that I left hospital nursing permanently. I would never treat anyone as badly as I was treated, I was literally harassed and the only solution that I was given by the CEO was to transfer to another floor or return to the harassment. Nothing was done to the manager(s) and the group creating the problem. And this was at a magnet hospital. Thank goodness there is a variety in nursing fields.I'd just like to add that as a relatively new nurse, I def. think that there are nurses who eat their young. Why, I'm not sure, but I've never confused them with a nurse who genuinely wanted to teach me.