Seasoned Nurses VS Newbie Nurses - page 3

As I've stated in multiple other posts, I am a new grad in the ER. As a new grad, I do not possess the EXPERIENCE that a seasoned nurse has; however, I have noticed that many seasoned nurses are not... Read More

  1. by   BrandonLPN
    Well, admittedly, the responses here suggest that we seasoned nurses are a bit touchy when it's implied our practice is outdated. But the responses you got also suggest that you didn't choose your words very carefully. Trust me.... ten years from now, reading a post like your OP from a new-ish nurse will make you bristle, too.

    In any event, I think you're overthinking it. No two nurses have the exact same practice. It's not even necessarily a matter of some nurses being more "up to date" than others. Even new nurses who graduated the same year as you may have learned very different techniques if they attended a different nursing program. Sure, some of the practices you learned in school may be better than what you see the COBs (Crusty Old Bats)doing on your floor. But some of the practices of the COBs may be better than your school's. Really, most of them won't be "better" or "worse", just "different". Common sense and your own preferences will generally tell you whether to do it like your old instructor, or do it like the nurse currently precepting you.
    Last edit by BrandonLPN on Feb 23
  2. by   Alex Egan
    I was an EMT before I was a nurse. The learning curb from EMT class to the practice is severe, and I tripped on it very hard. I pissed a lot of people off, and made myself look bad a lot. It was all because I didn't know what I didn't know. I knew a lot from class but I didn't know I had a lot to learn. I had a good preceptor, and a few hard partners and when I got to nursing school I vowed not to do that again. I oriented with a few different people, I took with worked, left what didn't. I picked up same bad habbets and learnt that shortcuts aren't always good for me. In the end my transition to nursing was easier because I followed the motto "I will learn your ways, take the best, leave the rest, and make my practice mine, as soon as I know which way is up"

    It wording in your original post is a little standoffish. Because as with nursing you don't know that we have this topic every year, every year someone comes and tells us how bad all their preceptors are. It's easy for the crusty amongt is to be easily offended by sick posts, but we all did it to to some extent or another.
  3. by   Crush
    Quote from BrandonLPN
    some of the practices you learned in school may be better than what you see the COBs (Crusty Old Bats)doing on your floor. But some of the practices of the COBs may be better than your school's. Really, most of them won't be "better" or "worse", just "different".
    There is always something we can learn from each other, regardless of the length of time we have been a nurse. Just remember that different styles are not necessarily "bad", just different.

    I recall thinking the same thing right out of nursing school. I think making observations and incorporating what you learned through nursing school plus adding in some helpful tips and such from the more experienced nurses will be very helpful in the long run.
    Last edit by Crush on Feb 23
  4. by   SpankedInPittsburgh
    My advice is don't critique your preceptor. He/she has been in the ER long enough to be respected and trusted to precept you. Nurses in the ER have exceptionally long memories and this will be thought of as disrespectful at the very least. Unless they are going to make a mistake that will have an adverse patient event suck it up. You can add your nuisances to your practice when you are on your own.
  5. by   maxthecat
    This is why school emphasizes learning how to critically think. Evaluate each way of doing something and decide if one way is better or if it really comes down to personal preference and act accordingly.
  6. by   TriciaJ
    Quote from SpankedInPittsburgh
    My advice is don't critique your preceptor. He/she has been in the ER long enough to be respected and trusted to precept you. Nurses in the ER have exceptionally long memories and this will be thought of as disrespectful at the very least. Unless they are going to make a mistake that will have an adverse patient event suck it up. You can add your nuisances to your practice when you are on your own.
    You probably mean nuances. Administration likes to add the nuisances.
  7. by   Neats
    We are each individuals. Any new updated Nursing skills I am sure will be made soon enough. Unless it is a matter of life and death I would not place so much focus on it. Renewal of CPR/advanced CPR will be made, Clinical competencies will be relearned. and I think you will find a variety of different ways one can accomplish the goal, again is it really such a life and death need to say something. If it is then by all means speak up, if not just observe and learn.
    When I first took A&P there was only one paragraph related to HIV in the book, it was unknown. I learned more about it in the work environment and of course when I took A&P over again.

    New is not always better it is just different. I would cooperate and graduate your preceptor time and then begin your nursing practice within your scope of responsibility. There is no need to compare/question/and assume your way is better because it is new and current. Unless it is mandated to perform a specific task in a specific way why worry about it? Think about this... 5 years from now when you are a preceptor and a new nurse is following you around they will be saying the same thing about you.
  8. by   MotherOfBoys
    I am a new grad RN and have experienced the same thing when I was going through orientation. My preceptor has been an LPN for many years and had only been an RN for about a year. Yes a lot of the things she had done were not the same as I was taught in school. Most of the time I would just accept the opportunity to learn how to do something a different way. If I was questionable about something I would do my own research before even thinking about mentioning it. The only time I did say something was when we were putting in a foley and she kept missing the right spot and would pull it out and put it right back in with stuff all over it. Totally not sterile technique. Now that I have been off of orientation I do things mostly how I was taught in nursing school as I found they are more efficient than what my preceptor taught me. But once your on your own you kind of figure out your own way of doing things. I still ask questions all the time to more seasoned nurses.
  9. by   Here.I.Stand
    You do realize that all nurses have to renew our ACLS/BLS q 2 yrs, right? Which specific protocol was the "seasoned" nurse not "up to date" on?

    One thought I have on this is, not every RN actually needs ACLS. Was this experienced RN taking the class after many years in med-surg or subacute? If that's the case, it isn't an issue of not keeping up-to-date -- of COURSE she wouldn't be up-to-date on ACLS protocols.

    And as several page 1 replies state (as of now, I have only read the 1st page) -- real life nursing can look different than nursing school textbooks. A couple of examples:

    1) verifying NG/OG placement: where I work we never verify placement with an x-ray. If we aspirate gastric contents, we're good to go. We almost never feed through an NG/OG -- we feed through an NJ; THAT is always x-rayed to verify it's post-pyloric. But not the NG/OG which is only used to keep stomach empty of gastric secretions.

    2) AHA rec's for SBE prophylaxis. My older son has a bicuspid aortic valve/AV regurg. Several years ago, the AHA stopped recommending prophylactic antibiotics for oral or GU procedures, except for complex CHD. HIS cardiologist however, has anecdotally seen more cases of SBE in the defect my son has. SHE (a med school professor of peds cardiology, I'll add) opts to err on the side of caution, and continues his Rx for prn amoxicillin.

    3) metoprolol parameters. In school it was drilled into us "hold for SBP <110 or HR <60." Well in some cases, the provider feels that the benefit of the beta blocker outweighs the risk of a lowish BP. I have seen providers who want it given unless the SBP is <90 or even <80.

    4) tPA given to young stroke pts, even if outside the window, or even if stroke isn't proven (unless a bleed IS proven, of course.) The neurologists have felt that their risk of a hemorrhagic conversion is low in the under-40 set, and the benefit outweighs the risk.

    5) Q 2 hr turns: yes we understood that pts are at risk for skin breakdown if not repositioned... but some people are too unstable to tolerate repositioning. That will become obvious as you gain more experience with critical pts.

    None of those deviations reflect outdated standards; they reflect the reality of PATIENTS whose bodies haven't read the textbook.

    If you are concerned about any overlooked "best practices," I would encourage you to reach out to the hospital's nurse educator. ASK why the said practice is used -- don't assume you truly know better. One of two things will happen: either the experienced RN will be educated, or you will.
  10. by   Isabelm1122
    I don't usually post here, but I had to speak up after reading some of these comments.

    The nasty attitudes on this post are the reason I'm starting to feel disappointed in the nursing profession. I'm about to be a new grad RN in a brand new job, and instead of being passionate and excited to learn, all I can think about is trying to find a job where the nurses aren't nasty to each other.

    Alex is bringing up something that is pounded to our head in nursing school- using evidence based practice. An amazing example of seasoned nurses transforming seamlessly into newer, safer practices: our nursing school instructors! They're adapting to the latest research in order to teach us the most current evidence based nursing practices.

    I can see, from my clinical experience, how this concept is quickly forgotten in the real world. I can also see that seasoned nurses have an incredible amount of real world experience that, hey, if it's worked for 20 years with good patient outcomes... keep doing it!!!! My mother is a very seasoned critical care nurse, and I trust her judgement in a profound way... she is sage in the world of nursing - and I am sure to ask her advice as often as I can. However, if a newer, safer practice exists, it's worth bringing awareness to!

    New or seasoned, patient safety will always remain paramount, and I think that is what Alex was trying to get at in this discussion post. I wish that nurses, as a community, could spend more time lifting each other up and helping one another learn (new practice, and seasoned, very valuable practice!) instead of throwing egos around the halls of our facilities and creating ugly environments for us new nurses to try to learn in.

    Xo
    Isabel
  11. by   LPNewbie
    Ooooh what a post!

    Newbie here, well kind of. I've been doing this for only 2 years and faced a lot of challenges. But I 100% believe that I am a better nurse now than I was when I first graduated with all the material "fresh in my mind". Experience trumps education ALWAYS.

    In a perfect world, during my med pass, I would like to have to do my 3 checks. I would love to have time to do a full through assessment. But in nursing school, you don't have the hustle and bustle of 10+ patients, angry doctors, concerned family members, etc. Nursing school is set in Hospital Utopia where all of the situations are ideal.

    Your methods may be new but experience nurses know what works and what doesn't. Sometimes old is gold! But no matter if you're a newbie or a seasoned nurse, you're always learning so really no one should be using obsolete methods.
  12. by   ProperlySeasoned
    You pose an excellent question. I have been a RN for 17 years, and I recognize that much has changed. On a med-surg floor, I would have much to refresh on. But, in my speciality (very small and unorthodox, will not mention it as it will be too easy to identify me), I am an certified "expert" and aware of almost every change and update to practice. I am very confident that I am using current knowledge (they don't even teach my speciality in school). So, to answer your question, I bridge the gap between knownledge and experience by narrowing my focus, and devoting my proffesional life to it. I am sure new grads could run circles around me when it comes to say, fetal monitoring, but within my little world, I have both academic knowledge and the wisdom that comes from caring for the same population for a decade.
  13. by   Alexx_xox
    Quote from Isabelm1122
    I don't usually post here, but I had to speak up after reading some of these comments.

    The nasty attitudes on this post are the reason I'm starting to feel disappointed in the nursing profession. I'm about to be a new grad RN in a brand new job, and instead of being passionate and excited to learn, all I can think about is trying to find a job where the nurses aren't nasty to each other.

    Alex is bringing up something that is pounded to our head in nursing school- using evidence based practice. An amazing example of seasoned nurses transforming seamlessly into newer, safer practices: our nursing school instructors! They're adapting to the latest research in order to teach us the most current evidence based nursing practices.

    I can see, from my clinical experience, how this concept is quickly forgotten in the real world. I can also see that seasoned nurses have an incredible amount of real world experience that, hey, if it's worked for 20 years with good patient outcomes... keep doing it!!!! My mother is a very seasoned critical care nurse, and I trust her judgement in a profound way... she is sage in the world of nursing - and I am sure to ask her advice as often as I can. However, if a newer, safer practice exists, it's worth bringing awareness to!

    New or seasoned, patient safety will always remain paramount, and I think that is what Alex was trying to get at in this discussion post. I wish that nurses, as a community, could spend more time lifting each other up and helping one another learn (new practice, and seasoned, very valuable practice!) instead of throwing egos around the halls of our facilities and creating ugly environments for us new nurses to try to learn in.

    Xo
    Isabel
    Honestly, this is EXACTLY my thoughts. Talk about nurses eating their young here. WOW, just trying to get some advice and input I'm not say one is better than the other by ANY MEANS. In fact, I stated that their knowledge is invaluable and they're soooo very lucky to have it. It is quite sad to see how other nurses treat their colleagues.

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