Seasoned Nurses VS Newbie Nurses - page 4
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
Feb 23Sometimes facility policy will deviate from what you learned in school. As long as it's not unsafe or blatant bad nursing, follow the FACILITY policy. To put an even finer point on it, sometimes policies differ from ED/floor/stepdown/ICU.
Feb 23I think most of us understand what you were trying to say. Perhaps the heading got some fired up. Seasoned Nurses VS Newbie Nurses makes it sound like a heavyweight title boxing match
Feb 23Well sonny, when you've been a nurse as long as those "other" old people, you realize ACLS guidelines change and even though the flavor of this revision says to use or not use a certain drug these old dogs have been through 10-12 revisions with those same drugs either on or off the list, and have seen them work in real codes, not in class. Don't get me wrong, I agree nursing is changing so fast, and so often, it is hard to keep current, but maybe next time ask why ....
Feb 23My suggestion is learn as much as you can from everyone you can. There is something to learn from every person from the environmental services folks through management. Take what you learned in school and intermix what you learn on the job. Create your way of providing safe, efficient, and timely care. Most importantly, make friends with the CNAs and ER techs. They can make or break a shift. Always ask questions when you aren't sure.
Feb 23Quote from Isabelm1122I don't think anyone was "trying to throw an ego around." All the seasoned nurses here are saying is that real nursing practice is often nothing like what you're going to read about in a textbook, and that having a new nurse fresh out of school (or still in school) telling them that their practices are incorrect and outdated is... aggravating. This is especially true when the seasoned nurse has years of positive patient outcomes, and does not have the time to go "by the book."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.
As far as evidence-based practice goes, yay EBP! The only thing about EBP is that, even after the research has been done, it takes a while to disseminate the findings, and even longer to put them into practice. If the OP is truly concerned with EBP and better patient outcomes, she should find a specific focus, do some research, then present this to the unit manager/director, or ask to present it at the next unit meeting. However, until the change is implemented, I would caution the OP about practicing with EBP if it does not follow current hospital policy and protocol. Even with more recent EBP, if there happened to be poor patient while following the EBP, the OP would not be covered, and could be fired, sued, or worse.
Feb 23Quote from NeatsAnd accusing you of snark and NETY when it rubs you the wrong way.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.
Feb 23Quote from Alexx_xoxDisagreeing with you is in no way eating you, it is not treating you badly and FTR it is not bullying you.Honestly, this is EXACTLY my thoughts. Talk about nurses eating their young here.
Your title was inflammatory and you made a gross generalization of seasoned nurses based on your experiences and yours alone. Not only that but you cannot be sure that just because you learned it in school it is the latest and greatest. You wouldn't believe the nonsense I've had to correct in my years as a preceptor and yes I keep up with EBP.
As for ACLS. It is upated every two years. It changes every year. Sometimes it changes back to the way it was done in a previous iteration. Usually it rolls out in a somewhat confusing way. Until you've had your ACLS for more than one cycle that may be difficult for you to understand. Sometimes you run into someone who is at the end of their cycle and will be updated at their next re-cert. When you learn a rote skill and a major change is made, for example, you've had "ABC" not "CAB" beaten into your head for over three decades it can be difficult to remember that change in the heat of the moment. Cut your colleagues some slack just like I'm sure they are doing for you.
Feb 23Quote from brandy1017Thank you for your insight about documentation and protocols! This gave me a new perspective, and it's very helpful!You'll find older nurses chart less, the young ones usually over chart because that is what they are taught and they are worried about making a mistake or being sued!
... This brings to mind the micromanagement another ER nurse mentioned in the article here Knaves, fools, and the pitfalls of micromanagement and how new nurses were documenting to a T, but in the process patient's safety and real life needs were being put on the back burner...
Sadly while the protocols are meant for best practice and some spurred on by medicare demands and reimbursement, they are not always realistic due to the time constraints, number of patients and the need to keep everyone safe. All you can do is do your best to follow the protocols while keeping patients safe.Last edit by thoughtful21 on Feb 23 : Reason: clarification
Feb 23As someone who has seen both sides of the coin, here's my little bit of advice:
Follow the golden rule before anything else: Keep them breathing, keep them safe. If your preceptor does something that puts either of these into question, then you have the right to speak up and speak up quickly.
For the rest of the time, pay attention to your preceptors assessments. Most seasoned nurses (especially ER nurses) have the ability to quickly whittle away useless information/physical findings and hone in on what is pertinent. This will be difficult at first for you but will be a huge time saver as you develop this ability.
I would also encourage you to pay attention to their procedural skills and get all of the education/tips and tricks related to these procedures that they will give you. We can all read the procedure of how to place an NG tube, but what separates the experienced nurse and you is experience from having done these procedures over and over again. They will have knowledge that the book simply can't provide.
Another thing that I encourage new grads to do is ask why. Some people find this annoying, but there are so many things that experienced nurses do that are like second nature, that they don't even think about or realize they are doing. However, asking them why will give them the opportunity to explain to you, which will help you understand why they are doing what they are doing, which will in turn help you to understand your job better.
Go with the flow and follow what your preceptor teaches you and like previous posters have said, unless it is going to cause harm to the patient or directly goes against your hospitals policy and procedure, just pay attention and change your practice as you see fit when you are on your own.
Good luck with your new nursing job!
Feb 23As a full time bedside nurse for 21 years and preceptor for 18 years, I can say that I made sure to keep an open mind when working with my preceptees. As much experience as I have, and as much pride as I take in my personal touches to patient care, I take my role as preceptor seriously and realize that educating someone is never a one way street. I pose questions and situations to my preceptees and I expect them to do the same to me. I also encourage them to branch out and speak to doctors, the charge nurse, and other staff nurses to build camaraderie, bring them out of their shell, and realize that we are not alone in caring for our unit and our patients. Our patients are people from all different walks of life that require different types of care. Not one person and not one algorithm can teach us everything we need to know in caring for our patients. Guidelines from the AHA are to be followed for obvious reasons. But the bigger picture here is the experienced nurse following her own internal guidance instead of following well studied protocol, and a new nurse wanting to assist the experienced nurse in understanding the implicit danger of not following said protocol. Yes, there is a tactful way of doing this, and I applaud the new nurse for having the gumption to observe and question dangerous practices. Conversely, new nurses need to understand that real life is not and will not be text book perfect. Observe the experienced nurse in her practice and the end result of patient care. You want positive outcomes for the patients. This occurs by bridging your new found knowledge with that of the well seasoned nurse and yes, following life-saving protocol.
Feb 23I've experienced this when I was a new grad. Sometimes other new grads were taught differently as well and some were very stubborn to try and listen to reason. I'd say make sure what you're practicing is within protocol and meets the standards of nursing care. Also, confirm with your superior as they should be up to date on everything as well. I'm sure they explained that once you get out into the real nursing world not everything is done exactly textbook and being in the ER it's a high stress environment but maintaining efficiency under pressure is essential. Make sure everyone is on the same team and maybe come to an understanding if you want to question something. Sometimes egos get bruised but the end goal is all the same, deliver the best care to each patient. Working as a team is very important especially in critical situations.
Feb 23Nursing school is to nursing as law school is to the practice of law and the police academy is to policing. School gives you the basic knowledge, the outline if you will with some parts written in stone but it is only a starting point. Every facility in this country has protocols and often those protocols are very different, in fact in my city the protocols between the two major hospitals are quite different. Every ER runs differently with the desired results being the same stabilizing patients or in some cases saving their lives then moving the patient on to the floor/unit for further treatment.
My first day working the Nursing supervisor told all the new grads - school is the ideal but you are in the real world now and now you learn. My first day in the ER my preceptor was also the day charge nurse and he told me with each patient he sent me to care for - go take care of this and if you get in trouble call me. So many things that day were the basics from school, ng's, foley's, dressings and so forth. Unbeknownst to me he had other nurses watching from a distance and my second day he handed me a burn patient to work with one of the most difficult ER physicians we had. After the Doc complained how I was doing a dressing I turned to him and told him he had given me two different sets of instructions and I was following the one the burn protocol listed. He left the room to calculate the drip rate which I set while he was gone and surprise we had the same rate and that Doc often requested me to assist him. Now to make a longer story short, yeah too late, I took school, hospital protocols and my own extended learning and created my style that got me sent (the only nurse sent) to more advanced teaching such as WMD training, Burn training and Chest Pain Center training.
I never openly corrected any of the "seasoned nurses" but they would ask why I did certain things. Example why I pushed methylene blue on an overdose patient. My Nurse manager had to pass on compliments from the physicians and I was often asked to come in to take care of certain kinds of patients. Fire medics wanted me to teach them to start an emergency IV on burn patients in less than normal places. I never corrected, inferred or suggested that the more "seasoned nurses" were not "up to date" as what is "up to date" today may be out of favor next week but what I did do was watch them, listen to them and discuss the nights patients. It should never be "seasoned" vs "new grad" in a place like the ER it should be about all working together exchanging information. discussing the new, comparing with the "old", helping write new updated protocols for the unit and designing tracks to help with keeping the flow through the ER running as smoothly as possible.