Baby RN's running ICU?!!

CVeyeseeyou · Jan 1, 2015

Some hospital units are plagued with higher-than-average RN turnover rates. It's a serious problem that sadly, decreases positive outcomes for patients. Sometimes the cause of high turnover is complex, and sometimes it's not. For example, it may be something as simple as "seasoned" RN's who assign derogatory labels like "baby, baby nurse" to new graduate RN's. I suspect the RN's who do that, lack the mentoring and leadership qualities required to retain newly hired RN's. That makes team building very difficult. Just a hunch.

CVeyeseeyou · Jan 1, 2015

HappyParamedicRN said:

In my opinion this is what happens to hospitals who only hire B.S.N. nurses! Most of the experienced nurses are still in process of obtaining that, thus all you get is inexperienced "baby" nurses with little to no experience, because they choose to not take experience into account. If there is no balance in hiring this is what happens!
HPRN

I hadn't ever considered that. You made a very good point.

LREYES2 · Jan 6, 2015

Do the "seasoned" nurses have a complex due to the fact that individuals much younger than them are their superiors? Or are the "baby" nurses really struggling to apply their knowledge to work-environment situations? The newbies probably have a lot of practical knowledge to learn from the veterans, but the veterans should be aware that the face of nursing is changing and becoming more educationally based and degree-oriented.

Ruby Vee, BSN · Jan 6, 2015

LREYES2 said:

Do the "seasoned" nurses have a complex due to the fact that individuals much younger than them are their superiors? Or are the "baby" nurses really struggling to apply their knowledge to work-environment situations? The newbies probably have a lot of practical knowledge to learn from the veterans, but the veterans should be aware that the face of nursing is changing and becoming more educationally based and degree-oriented.

Where did you get the idea that experienced nurses have a complex or that "people much younger than them are their superiors"?

Speaking for myself, I have the Master's. But an experienced ADN is no "inferior" no a younger (or older) nurse with no experience, regardless of the initials after the latter's name.

LREYES2 · Jan 7, 2015

Thanks for your contribution Ruby Vee. My post was meant to further stimulate conversation, and to get more people thinking about the topic. The first two statements were rhetorical questions, meant only to illustrate the polarization between two very extreme viewpoints. I do appreciate your feedback and your expression of opinion.

That One Nurse · Jan 10, 2015

I absolutely see both sides of this. I work in a 30 bed ICU in a mid sized magnet community hospital. I have 1 year experience as an RN, all of it in ICU. In the last 12 months we have hired 40 RNs, most new grads. We are still hiring more.

I have been asked to precept as have 3 of the 4 other new grads hired with me. I know there is so much that I don't know but there just really isn't too much of an option not to. We need our most experienced to be Charge, RRT and we have a dedicated resource RN because of the sheer number of newbies. They all float, check in and will periodically check up on patients. They cover breaks and help get people caught up. I love having this safety net. Our unit would be so much less safe if we didn't all make sure we have a run down of what's in our pod. Especially now that I probably have more seniority than 2/3rds of our staff- I get nosey. I watch the monitors, BPs, SpO2s, etc. I ask what is going on with their patients, gtts and O's. I encourage questions, bounce off mine and if I don't feel confident in my advice I suggest who to call.

That being said- I know there is SO much I don't know. I haven't seen it all. Just last week I road tripped a patient to CT and fumbled getting the ambu bag back on because I was flustered RT was stuck near the vent. I felt like a moron. Seriously. I haven't had my patient code or die unexpectedly. I get told that's a hallmark of my skills being over a year in but seriously feel torn teaching a newbie. I would hate my first code to be theirs as well. I've done compressions, pushed meds, recorded and run the defibrillator during other codes but it's never been my patient. I don't know if that makes sense.

I have been checked off on ICPs and have my TNCC. I occasionally get the attitude giving report to the older, experienced days nurses that I don't know what I'm talking about or they openly question why I have been given such sick patients with so little experience. It's frustrating and hurtful. I'm pretty thick skinned but it KILLS some of the more sensitive staff. The rudeness/disbelief is usually gone the next time I get or give report because I spend so much time making sure the patients have been bathed, draw sheet in a good spot, 3 pillow turned, rooms clean, tubing changed, IV bags full or in the pass thru if low but not low enough to swap, counters clear and room stocked. I over compensate to make their shift start smoothly.

I guess what I'm saying as a newer ICU nurse is that we're scared too when we look around and starting to run the show. But I really do try to make it as safe as I can for my patients.

veggie530 · Jan 10, 2015

With terms like "baby nurse" being thrown around I'm not entirely surprised by a high turnover rate. At face value, it sounds like the unit culture is not conducive to wanting to stick around.

Hopefully I'm wrong, or you'll never have more than toddler nurses.

Purple_roses · Jan 10, 2015

veggie530 said:

With terms like "baby nurse" being thrown around I'm not entirely surprised by a high turnover rate. At face value, it sounds like the unit culture is not conducive to wanting to stick around.
Hopefully I'm wrong, or you'll never have more than toddler nurses.

As someone who will in three years (hopefully) be a "baby" nurse, I don't really find this terminology offensive. And it doesn't sound like the OP meant it negatively either. If I were a new nurse, I would be terrified of working with all new nurses. New nurses usually need someone who can answer questions as they still have a lot to learn and are probably a little nervous to be newly in charge of maintaining patients' lives.

Not_A_Hat_Person, RN · Jan 10, 2015

I equate "baby nurses" with NICU and nursery nurses, not adult ICU nurses.

lidleanjel · Jan 13, 2015

I personally think there is high turn overs because of older nurses eating their young, poor orientation and follow up from the educational departments of the facilities, and lack of communication of who to discuss problems when they arise or actually action to these problems. If small problems are not fixed, bigger problems will come in the future. This also relates to less experienced nurses (aka. new graduates) because many are trying to figure it out and ask questions, but no one is wanting to mentor or answer those questions. How can nurses learn what they need to with this and why would the "newer" nurses stay if they are not getting the support they need to be successful?

This topic can continue for hours...especially with the increased interest in the area of improving healthcare systems, improved patient safety, and actually identifying the reasons for the high turn overs in the are of nursing.

Ruby Vee, BSN · Jan 19, 2015

lidleanjel said:

I personally think there is high turn overs because of older nurses eating their young, poor orientation and follow up from the educational departments of the facilities, and lack of communication of who to discuss problems when they arise or actually action to these problems. If small problems are not fixed, bigger problems will come in the future. This also relates to less experienced nurses (aka. new graduates) because many are trying to figure it out and ask questions, but no one is wanting to mentor or answer those questions. How can nurses learn what they need to with this and why would the "newer" nurses stay if they are not getting the support they need to be successful?
This topic can continue for hours...especially with the increased interest in the area of improving healthcare systems, improved patient safety, and actually identifying the reasons for the high turn overs in the are of nursing.

Despite more focus and better programs surrounding orientation and mentorship, new grads continue to take jobs they know they won't want to stay in, planning to stay the minimum time necessary before moving on to their dream jobs, anesthesia school or whatever. Orientation isn't poor at my hospital -- we put a lot of time and energy into it. And nurses don't eat their young. So that has nothing to do with turnoer, either.

Nonyvole, BSN, RN · Jan 20, 2015

I'm going to throw out another idea about rapid turnover, especially with the new grads. They simply don't know the unit culture and are blindsided by the way things happen. "Street" nursing vs. "book" nursing. Then they don't give themselves time to become fully integrated into the unit before moving on.

Case in point: two new grads. Both hired at the same time. One is still there, the other isn't. The first? Had worked in a similar field and environment prior to being hired, and the latter had never worked before. So the one was used to the fact that there were situations that they would be yelled at and high-stress periods, but also knew that it wasn't personal when somebody raised their voice and demanded things. The second took everything to heart as personal criticism and adapted very poorly. Is it up to the unit to change their culture to make it easier for all new grads that start there? I don't think so.

On a more personal level, the staff that I work with are very critical of the newer nurses. If a new grad or somebody with minimal comes in and says that it's their way or the highway, they're going to be ignored. They aren't the unit manager, they're the lowest on the totem pole. It also raises hackles a bit when people are focused more on learning things for CRNA or NP school than learning things that they need to know to be an effective nurse on the unit. We don't eat our young; we just expect them to rise to the occasion and pull their own weight, especially on units where it's kept at minimal staffing. Lose one nurse, you're pretty much sunk so close down for the rest of the shift sort of staffing.