Baby RN's running ICU?!!

Ruby Vee, BSN · Dec 6, 2014

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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.

I see no problem with either label, "baby nurse" or "seasoned nurse." Neither is derogatory. Now "nasty old biter nurses" is derogatory.

Ruby Vee, BSN · 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?

It's common in large teaching hospitals. New grads start with no intention of staying. They just want to get "the name" on their resume before moving on to "bigger and better things."

SubSippi · Dec 6, 2014

It's common in large teaching hospitals. New grads start with no intention of staying. They just want to get "the name" on their resume before moving on to "bigger and better things."

Don't you work in a CVICU, Ruby? What in the world is bigger and better than cardiac surgical nursing at a big, well known teaching hospital?!? Hemodynamics, bedside resternotomies, a dozen drips at once!!!

Oh...you must be talking about grad school.

Pediatric Critical Care Columnist · Dec 6, 2014

This all sounds too familiar. Rapid turnover, the replacement of experienced and highly-skilled nurses with newly graduated ones and the subsequent watering-down of expertise along with the burgeoning fear of sentinel events - it's a growing concern everywhere. I've worked on my unit a little more than a decade now and there are days when I look around me and don't see anyone who has been there as long as I have. I feel responsible for every patient on the unit as well as the livelihood of every nurse on those days. My last day shift I was surrounded by very junior staff, only one of whom had any significant experience on our unit but in a casual position and three who had just come off orientation. Fortunately our acuity was lower than usual, but I spent the day putting out fires all over the unit. Nights is another story. We seem to have a preponderance of senior staff who work permanent nights. I wish there was a way to balance out the hiring so that more experienced nurses are mixed in with the new grads so that there's some balance, but how would that work?

Ruas61, BSN, RN · Dec 7, 2014

I see no problem with either label, "baby nurse" or "seasoned nurse." Neither is derogatory. Now "nasty old biter nurses" is derogatory.

I find the term 'baby nurse' used in a professional setting as derogatory.

If you're at the bar or coffee house maybe not so much.

I think other adjectives can be found.

SoaringOwl · Dec 7, 2014

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!

In my opinion, that's because it's so hard to get your first job. We newbies grab whatever job we get first, then we can move on to what we really want, or where we really want to be. I don't plan on staying with my first job past two years, max.

wanderlust99 · Dec 7, 2014

When I was a newer nurse I worked in a unit with a lot of new grads/new nurses on night shift. Days were always staffed with more experienced RNs. But we definitely had about 5 nurses with experience who would be in charge. It was kinda fun in that we would all work together as a team. If we had a really sick patient or something going on we would bounce ideas off of one another. I would always ask fellow nurses what do you think? It was a great learning environment.

We had residents though and an intensivist on at night, so of course they were a big resource should a patient crash.

Here.I.Stand, BSN, RN · Dec 7, 2014

Don't you work in a CVICU, Ruby? What in the world is bigger and better than cardiac surgical nursing at a big, well known teaching hospital?!? Hemodynamics, bedside resternotomies, a dozen drips at once!!!
Oh...you must be talking about grad school.

Probably planning on their one year min. to qualify for anesthesia school. :snurse:

calivianya, BSN, RN · Dec 7, 2014

When I was a newer nurse I worked in a unit with a lot of new grads/new nurses on night shift. Days were always staffed with more experienced RNs. But we definitely had about 5 nurses with experience who would be in charge. It was kinda fun in that we would all work together as a team. If we had a really sick patient or something going on we would bounce ideas off of one another. I would always ask fellow nurses what do you think? It was a great learning environment.
We had residents though and an intensivist on at night, so of course they were a big resource should a patient crash.

My first job was like that. That job had more beginner and novice nurses than my current one, but I actually thought it was safer. Expert nurses are useless to the unit if they keep their heads down and refuse to help others. Cliques and isolationism are bigger problems than overall unit experience levels, IMO, especially in critical care where a nurse may not even be able to do basic care like turns alone. At my current job everyone keeps to themselves... it is very scary. I have tried to engage coworkers in conversations about the patients on the unit but they just shut me down. It is very much an every man for himself mentality. Give me a unit full of newbies who like teamwork any day over this. I feel like if you get ten new grads talking, at least one will remember something helpful from nursing school, and that's better than one beginner nurse in a room alone with five nearby experienced coworkers wrapped up in the novels they are reading at the desk...

wanderlust99 · Dec 8, 2014

Calivianya - that is how my current job is too. Nurses stay in their rooms mostly and it is not uncommon for no one to even assist me with placing a new admit on the monitor. And what is sad is there are nurses who come from the floors to train in the ICU and they are being taught this way. ICUs are much better as a team, you are suppose to help your neighbor! We even have a charge RN and a resource RN(who relieves us for breaks) that I don't see ALL DAY long!! There is no team work. But plenty of seasoned nurses with 10 plus years of experience on the unit!

agcaruso · Dec 9, 2014

I agree that novice and experience are better adjectives. Working around many novice RN's I've found that they often have qualities that experienced RN often loose. They often have a strong desire to learn and have a more current grasp on the literature. They haven't experienced cargiver fatigue and are often more caring. The term baby nurse makes it sound like they just cry, smile and poop and have to be taken care of all the time.

DeeAngel · Dec 9, 2014

From my recent experiences this is not at all unusual. Night shift has more experienced nurses with probably a normal rate of turnover so there is always someone in charge that has several years of experience. Day shift, they come right out of school, stay their 1 year and POOF they're gone onto something better. It is almost always someone right out of school that's charge if the clinical coordinator is off, so that's 4 days a week out of 7 at least. Very frequently there is no one working day shift with more than 1 year of experience. It's is scary and this is on a 48 bed BUSY MedSurg unit.