Inept New Grads?

Specialties Emergency

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Specializes in ED/trauma.

My director hired some NGs some 6-or-so months ago. They seem not to be catching on. First of all, they're just slow, in general. They can't keep up with the pace of ED (discharged, admitting, charting). Second, they seem not to get bigger ED concepts. I don't want to be too specific, but I discussed this with a co-worker (who started their as a NG), and she's noticed it also - along with several others.

I know being a NG is difficult, esp in a specialty, but things seem to be worse than I'd expect from average NGs. We're wondering what it could be:

- the nursing school from where they came (different from the 2-3 yr old crop of NGs)

- orientation not long enough (3 months)

- orientation not thorough enough (then the blame lies with the preceptors?)

- our director just lets it slide when we confront him

- they're just not cut out for ED

- a little of each

I didn't start in ED as a NG (did 1.5 yrs on 3 different med/surg-type units), so I realize this gives me a very different perspective & advantage as well. I worked days for a large part of my 1st year in ED. There's another nurse who's new to ED like me, did some time in med/surg first (6 months?), but he's slow like the NGs also.

I know I'm not super nurse, but this has become very frustrating for me - and other nurses! I'm thankful I don't have to work with them much anymore because I often find myself picking up their slack, since that seems to be what's accepted & expected. My director seems unreceptive to my concerns (and those of others), so I've just given up on that altogether. :grn:

I'm curious if anyone else is experiencing this? Any suggestions?

TYIA

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

It's probably a combination of the above. Most of all I think 3 months is not good enough orientation for a speciality like ER. Three months is what we get on med-surg. There's just too much to learn to get it all in three months.

If the preceptors didn't hold them accountable and weren't thorough enough, then that's a problem too.

Many people are going to chime in that the ER is not the place for new grads. Our ER hates getting new grads and they usually give them a hard time, or at least the cold shoulder. If that's happening that's not a good culture for the new grad.

If a specialty area is going to hire new grads, then they need to be committed to having a thorough orientation with good preceptors that will gently and positively weed out those that can't cut it.

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3 months on their own is not very long. They need 3 months of orientation just to get minimally competent as a floor Nurse, another 3 months to gain their RN feet and maybe another 3 months to gain their ED specialty feet.

Give them time, teach them, guide them, help them develop their skills. First competence, then speed.

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Specializes in CT stepdown, hospice, psych, ortho.

ED is a cruel department for a new grad. Seems like they would have to have a massive amount of support to be succcessful and safe in practice.

I'm a seasoned nurse and I wouldn't touch it. You don't know what is going to come through the door. I'm going to be honest, my nephew broke his arm last week and I didn't really know what to do. I stablized it and sat with him in the back of the car with the obvious deformity covered in a towel so he wouldn't see it and get distressed while my husband drove us to the ER. I thought about grabbing some ice but not until after we left the house, it was happening so fast. To me, a fresh community emergency is much different than a code or an emergency on the unit. Maybe that's weird to some people but the "clinical" sites and smells in a hospital comfort me and IMHO I'm probably one of the top performers in unit emergencies. But please DO NOT expose me to raw injuries and broken bones. (Probably not a good thing since I have 3 boys, hah)

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Specializes in Developmental Disabilites,.

3 months is not enough orientation at all. I got 3 months for med/ surg and I am on a very supportive unit where the others nurses do pick up my slack when I get overwhelmed. And when I apoligize to them about being so slow they are amazing telling me that is what teamwork is all about and that they know I am trying hard and not slacking off. The ER sounds like a horror show to be in as a new grad and I am getting the impression that it is not a very supportive enviroment for them. People learn best when they are supported, these new grad nurses probably know that they are slow and being talked about, which would cause stress and lead to mistakes which take time and it will also slow their learning process. It is not the new grad nurses fault that they are not up to speed, somewhere along the line the system has failed.

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Specializes in pediatric.

I know I'm not super nurse, but this has become very frustrating for me - and other nurses! I'm thankful I don't have to work with them much anymore because I often find myself picking up their slack, since that seems to be what's accepted & expected.

Being a new grad myself, it is very concerning that you would automatically place these RN's in such a negative light. I am sure they must be trying their very best seeing that 3 months orientation is DEFINATELY not enough time, let alone in an ER, but c'mon, I am sure when you started off as a new grad, even in med/surg you were scared, nervous and slow! Instead of picking up their slack, can't you be a mentor to them and tell them what they are doing wrong, or how they can utilize their time better since you seem to know the ways of the unit?

I am not saying be their best friend, but just remember when YOU were a new grad how nice it was to have an experienced nurse to depend on.

I hope their experience in your ER gets better.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

As someone who went to the ED as a new grad, I have to say that the ED (like Tweety mentioned) has to be 100% committed to the success of the new grad. I had about 14 weeks of orientation, plus an ED nursing fellowship (classroom/online training), plus five years as a medic and nearly four years as an ED tech in the same ED. I also had fabulous preceptors. And you know what? It still wasn't easy! I told my clin spec I wouldn't want to be a totally green new grad in an ED; it was hard enough with the experience I did have. Three months isn't enough for an inexperienced new grad. They just aren't going to have the skills in terms of big picture/prioritization/critical thinking.

These nurses need some mentors, methinks.

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Specializes in CAPA RN, ED RN.

It takes a well thought out and directed program for orientation of new grads in the ED. Otherwise you need to plan on a couple of years before they are functioning well or at par in the department. Also, a few new grads will do well in the ED with good selection. Some never will.

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Specializes in Gerontology, nursing education.
As someone who went to the ED as a new grad, I have to say that the ED (like Tweety mentioned) has to be 100% committed to the success of the new grad. I had about 14 weeks of orientation, plus an ED nursing fellowship (classroom/online training), plus five years as a medic and nearly four years as an ED tech in the same ED. I also had fabulous preceptors. And you know what? It still wasn't easy! I told my clin spec I wouldn't want to be a totally green new grad in an ED; it was hard enough with the experience I did have. Three months isn't enough for an inexperienced new grad. They just aren't going to have the skills in terms of big picture/prioritization/critical thinking.

These nurses need some mentors, methinks.

I agree. This seems like an endless negative feedback loop in which new grads are not given an adequate orientation or sufficient mentoring, the nursing staff becomes resentful of the new grads, the new grads either suck it up or leave and when they leave they get replaced with.....new grads.

I can't blame the OP for feeling frustrated with the new grads but the problem is not with the new grads per se, it's with a system that is setting them up for failure by not providing an adequate orientation to help them develop the skills they need to succeed. Either this facility is going to have to change its policies so that new graduates have to get a year of experience in med-surg before they can transfer into ED or they're going to have to learn to invest in the new grads they place in the ED to improve their levels of competence and satisfaction, decrease the resentment of experienced staff, and, most importantly, ensure patient safety.

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This is maybe why new grads should not start out in the ED. This is a problem not specific to your specialty, its happening everywhere. Why is working 1 year on the floor so repulsive to people?!? sheesh! It helps to hone your nursing skills so that you wont be sooo slow when you pick your specialty. No one is asking you to spend your entire career in med-surg, but a little time (even a couple months) will go a long way in preparing you in your nursing career. New grads are just so disgusted with the thought of spending any time on the floor! News flash: if you can survive a year on the floor, you can survive any specialty!

:) I love my floor nurses!

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I agree. This seems like an endless negative feedback loop in which new grads are not given an adequate orientation or sufficient mentoring, the nursing staff becomes resentful of the new grads, the new grads either suck it up or leave and when they leave they get replaced with.....new grads.

I can't blame the OP for feeling frustrated with the new grads but the problem is not with the new grads per se, it's with a system that is setting them up for failure by not providing an adequate orientation to help them develop the skills they need to succeed.

I agree with what Moogie has said. As a (hopefully) soon to be new grad, I certainly hope that I am able to work with nurses who are willing to give me the tools and training that I need to be successful, rather than the "thank god I don't have to work with new grads and pick up their slack" nurses. You have to remember that nursing jobs are difficult to come by these days, even more-so for new grads. These grads probably knew that ER was not an ideal place for a new grad to start in, but a job is a job, am I right? Instead of slamming them for being slow and not 'getting it', be a mentor and help them develop into the type of nurses you want working in the ER. Being licensed as an RN means that they have at least the minimum level of knowledge necessary to work as an RN. That's a lot different than being proficient and independent in an area like ER where a lot of knowledge is required. I guess what I'm saying is don't be so hard on the new grads... you were a new grad once apon a time too, and maybe somebody at that time though you were slow or not 'getting it'.

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Specializes in ER, Trauma.

Think back to when you got your driver's license. Were you ready to go strait to the Indy 500? Now think about when you got your nursing license and compare how your skills are now. It IS possible to go right from school to the ER, but that's the exception. I feel your manager did these nurses a terrible injustice by hiring new grads to the ER. Now you must totally support them as they come up to speed, or risk devastating them by telling them to go work another floor until they're ready for the ER. I firmly believe in a year on MedSurg before going to the ER. It's time well invested.

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