Baby RN's running ICU?!!

Trauma Columnist · Dec 5, 2014

Wow! Is there a unit educator? A mentoring program? Both of those would be helpful. How many experienced RNs are in the unit? Anyway to pair up with a new grad?

kmarieCCRN · Dec 5, 2014

We do have a new grad residency, but at the rate they're coming out of the gate... They out number the seasoned staff. There's 25 beds in our MICU and 6 in our NICU, but I've been on shift where I was the only seasoned RN on the floor. We also get new residents every month, so I'm worried that's it's the perfect storm brewing :/

Pangea Reunited, ASN, RN · Dec 5, 2014

That does sound very scary!

Editorial Team / Admin · Dec 5, 2014

Just curious about the staff's experience on day shift- is it all experienced nurses? Is there a way to provide an incentive for experienced nurses to work the more "undesirable" shifts? Skill mix is important to patient safety, and I can only see adverse safety events if an entire shift is made up of new nurses (I personally do not like the term "baby nurses" as it can seem derogatory- in fact, I at first thought this was about an ICU whose new manager had only mother/baby experience).

RainMom · Dec 5, 2014

We have a similar situation on our med/surg unit. All new grads except for 2 nurses & one of those is a traveler who leaves by the first of the yr. Floating to that floor is worse than usual. Last time I worked there, everything went fine. However, had to show the "charge" how to hang blood (her first time), & troubleshoot a few minor issues for them because they simply DO NOT KNOW. Thankfully they have seasoned aides who recognize when things are going downhill & when to call for help.

This is 11p -7a shift only, though 3-11 is pretty short on experience as well.

RainMom · Dec 5, 2014

Situations like these are not fair to the nurses who are lacking the mentorship & training experience & not fair to the pts who deserve better.

icuRNmaggie, BSN, RN · Dec 5, 2014

I really dislike the labels baby nurse and seasoned nurse.

Calling someone a baby nurse is derogatory.

"Seasoned" makes me feel like a piece of chicken.

These labels devalue the novice nurse's achievement and the expert nurse's hard won abilities.

This chart, based on Benner's theory of Novice to Expert, is the framework we should be using for staff development.

Dr. Bennner's theory has been adopted internationally and yet we still use slang to describe our colleagues here in the U.S.

I consider myself to be highly experienced and proficient, if only from many years of sheer repetition.

I would take the chart to someone in administration and let them know that the situation is not safe.

Each novice RN must be mentored by an advanced beginner or a competent nurse.

Preceptor-NovicetoExpertchar-1.pdf

Here.I.Stand, BSN, RN · Dec 6, 2014

What are they doing hiring so many novices, even if the turnover rate is high?? That sounds really scary. Where I work, new grads are required to work rotating shifts, to avoid having all novices overnight when resources are fewer. At least that's what my manager said when I was hired; I'd applied for straight nights and she allowed it since I had previous ICU experience. We have a fair amount of experienced RNs on straight nights by choice; nobody works straight days until they have a lot of seniority; and a bunch of all levels who rotate.

beckyboo1, BSN, RN · Dec 6, 2014

Just curious, has your hospital looked into what is causing such a high turnover in order to try to improve retention rates in the future?

LadyFree28, BSN, LPN, RN · Dec 6, 2014

Situations like these are not fair to the nurses who are lacking the mentorship & training experience & not fair to the pts who deserve better.

This.

I am in a similar situation as well; though I work in a post-acute setting; albeit it is like a mini hospital.

With the influx of novice nurses and beginner nurses, exempt from the supervisors, I am the ONLY nurse with experience. PERIOD...and it has been challenging to down right frustrating hearing about sentinel events-infections and complications occurring when there was an otherwise 100% compliance; but that was when there was more experienced nurses on staff; but there was a turnover that happened a few months ago, and an influx of newbies.

I had to increase my part time hours to almost full-time hours because management and their wonky hiring practices, transition program and lead ship (who is a novice MSN with virtually no experience working in this capacity) needs help; evening shift is 80% novice with 20% beginner, while night shift was 90% novice, with 10% beginner, and that coworker has NO experience in this specialty so technically they are almost a novice as well, until I increase my hours.

There is still a novice-heavy shift with a trial by fire mentality. I get nervous that there may eventually a sentinel event (larger than one event that happened) that causes legal

action. :nailbiting:

The most I do is council and have complied suggestions to help the newbies have some idea to organize and guide their nursing practice; some form of guidance is needed, and they are not getting it from management, unfortunately.

Ruby Vee, BSN · Dec 6, 2014

Wow! Is there a unit educator? A mentoring program? Both of those would be helpful. How many experienced RNs are in the unit? Anyway to pair up with a new grad?

Neither a mentoring program nor a unit educator is going to help much. New grads seem to start a position with the intention of NOT staying. Turnover is everywhere. Currently, we have more new grads in orientation on any given shift than there are seasoned nurses to precept them. It is scary!