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?
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!
I totally agree. I have heard many students say they never want to work in med-surg. I think it is the best place to get your feet wet in nursing - there is so much to learn in that department. Then, after your time, go off into the specialties. Or stay in med-surg :) I could not fathom starting out in the Emergency Department as a new grad. Too fast paced IMO.
I feel badly for these new grads. They most likely know they are slow and struggling. Three months is definitely not enough time for orientation. I received 3 weeks of orientation as a new grad on a medsurge floor and I left in tears everyday. The only thing that got me to the year mark was a supportive group of nurses around me.
These new grads need support right now and not negativity. It is not their fault that the hospital did not support them with a good orientation.
These new nurses are probably already feeling inadequate. A little bit of building them up will buid their skill level and confidence. None of us came out of school with super nurse tatooted on our foreheads
I will direct some of these naysayers to read an excellent New Yorker article by the very esteemed writer/physician Atul Gawande's "The Learning Curve"
New Grads need support and good mentors. Coming from experience, it seems to me that many of experienced nurses seem to be too stressed and busy and stretched to their abilities and thus are getting frustrated with new grads. This comes to there being a problem with the manager of the unit and the hospital themselves. I worked as a Nurse Tech for many years before becoming a new grad and being a new grad was still overwhelming when it came to specialty areas. I caught on to Med/Surg very easily as this is where I was a nurse tech for a majority of my shifts. Specialty areas are different and each area needs to be approached differently and taught differently. I was a new grad who was set up for failure in my first new grad specialty job. I worked in Med/Surg for a little while and then went to a Level III NICU. I have always had a passion for NICU and this was the reason I became a nurse. But, I didn't have any really good preceptors and the manager was no help. My orientation to the NICU was 90 days (no more and no less). Needless to say, I was fired the last week of my orientation. I absolutely loved the job, but my preceptors were never around when I needed them or they couldn't be found. Then, they held up my orientation and basically halted my learning, not going forward with teaching me other things. I was getting it just fine, but they were never around to see that. They focused more on the negative instead of the positive. Since this experience, I have had a hard time getting other jobs.
Experienced nurses need to mentor new grads and shape them into the nurses they want them to become. Not helping them and complaining about them does not make your or their job any easier!
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.
I agree with you. Of course, there are always exceptions; however, most nurses need at least a year before they get into specialty areas so they can successfully make the role transition from student to nurse. I would think that hospitals would be aware of the challenges faced by new graduates, especially in specialty areas, and try to avoid problems by having policies that would discourage the hiring of new grads into specialty areas or provide them with nurse residencies that would give them the skills, the mentoring, and the confidence that could help them succeed in these specialty areas.
I am sure it would be devastating to tell a new grad who is floundering in a specialty area that he/she should work on a med-surg floor for a while---but it might be much kinder and better for the nurse's career if a manager would do that rather than continue to let that nurse drown and either quit or get fired.
I have heard many students say they never want to work in med-surg. I think it is the best place to get your feet wet in nursing - there is so much to learn in that department.
In my case, it wasn't a matter of NOT wanting to work in med-surg ... I have all the respect in the world for my fellow nurses over on that side of the house! :) For me, it was a matter of just wanting to be in the ED, period. It was the best fit for me, and I don't regret it. But everyone is different.
New Grads need support and good mentors. Coming from experience, it seems to me that many of experienced nurses seem to be too stressed and busy and stretched to their abilities and thus are getting frustrated with new grads. This comes to there being a problem with the manager of the unit and the hospital themselves. I worked as a Nurse Tech for many years before becoming a new grad and being a new grad was still overwhelming when it came to specialty areas. I caught on to Med/Surg very easily as this is where I was a nurse tech for a majority of my shifts. Specialty areas are different and each area needs to be approached differently and taught differently. I was a new grad who was set up for failure in my first new grad specialty job. I worked in Med/Surg for a little while and then went to a Level III NICU. I have always had a passion for NICU and this was the reason I became a nurse. But, I didn't have any really good preceptors and the manager was no help. My orientation to the NICU was 90 days (no more and no less). Needless to say, I was fired the last week of my orientation. I absolutely loved the job, but my preceptors were never around when I needed them or they couldn't be found. Then, they held up my orientation and basically halted my learning, not going forward with teaching me other things. I was getting it just fine, but they were never around to see that. They focused more on the negative instead of the positive. Since this experience, I have had a hard time getting other jobs.
Experienced nurses need to mentor new grads and shape them into the nurses they want them to become. Not helping them and complaining about them does not make your or their job any easier!
It would also be nice if hospitals gave some incentive to nurses who served as preceptors. You're right---adding the responsibility of mentoring a new graduate is simply too much for the nurse who is overwhelmed with a heavy patient load. The nurse who has clinical expertise may not have the skills or the temperament to teach others. Even worse, few nurses are taught how to be mentors and are given little support or direction when they're given the responsibility of mentoring someone new. The nurses being mentored often have little recourse against a bad preceptor or even one with whom they may have personality conflicts.
And then we wonder why nurses "eat their young"? It's just a vicious cycle of hazing or being hazed and it's a pitiful excuse for meaningful orientation.
What happened to you is a damned shame. You paid the price for the inability of your preceptors to teach you and your manager to recognize what was happening before it was no longer fixable. 90 days of orientation in the NICU is ridiculous. I am so sorry you went through this and that it has hurt your career. I hope it hasn't destroyed your dreams altogether...
I know this is probably a novel concept but have you tried pulling them aside in a non-threatening manner and asking why they are slow? Do they not know where things are? Are they having a hard time with the computer systems? Do they not know how to get ahold of the right people
(house supervisor, lab, pharmacy, case management) to facilitate a speedy discharge/admission)? Or do they just not have the desire/motivation to catch on? If this is the case, I absolutely empathize with you, our facility has the same problem, but it is in general the experienced nurses who have become accustomed to others picking up the slack they leave behind. If it is anything else, help them, point them in the right way, try to do something before you write them off as inept. Maybe they are trying but feel that they aren't getting enough help or don't know where to turn to. Maybe try coaching them to talk to the educator if they aren't understanding the concepts/procedures, IT for additional computer training, and get them a list of commonly used phone numbers and step by step guides for completing procedures.
I totally agree with everyone and i feel really sorry for the new grads because its thier license on the line now. Also, if all of them are doing bad, then the whole system of and preceptorship is screwed up and needs to be addressed. ER, ICU all those speciality areas precept for a year. 3 months is nothing. those are very critical high acuity areas
As a new grad I am going through some of the hardships that you have all been describing. First I would like to say that I am not one of the new grads who decided that floor nursing was beneath me. I am a second degree nurse who has bills to pay. The market is tough and you have to make it work no matter what specialty/floor you were hired for. It is not easy out there. I was top in my class and came out with a BSN in an area where they will only hire BNS prepared nurses from now on. I was finally able to get a position 10 months after graduation in a busy Level I OR in the inner city that runs up to 26 OR's at a time. I have a six month orientation to not only learn one position, but two. I will have to circulate and scrub once finished my orientation and be able to handle call for any type of case that comes in. I am three months in and I still feel completely lost at times. The sad part is that many of my preceptors are so stressed out and short staffed that they are constantly on the move and really do not have time to mentor. I understand it is my responsibility to seek out learning opportunities, but I have also not been receiving any feedback from the orientation leader. How can someone know that they are not cutting it if no one provides feedback. Constructive criticism is good and I would love some of that right now. Hell, any feedback at this point would be a plus. What I am trying to say is please just don't assume that new grads are "inept" and not able to contribute. I for one know that we are really trying our hardest out there.
As a new grad ED nurse, I have to agree with what most of the other posters said about the new grads needing support. If they are ALL giving shabby performance, then the problem can't be completely placed on their heads. Orientation at my hospital is four months long, and includes days in class and days on the floor. Going through it myself, I have to say some of the problems with my own orientation (and possible with the one in your ED) is that the classes are spent going over the big deal stuff (like RSI, giving TNK or TpA, etc) no time is spent on the simpler but more common events. Its a huge department, and everything isn't always kept in it's place.....if you're new, figuring out where else something could be when its not where u were taught it should be can take up some of your time. Sometimes having different preceptors is good because you can take the best methods from each person and make them your own, but at the same times its bad because there is no one preceptor that can accurately track ur progress, and therefore cannot push you with the things you need to work on. The best nurse on earth isn't necessarily the best teacher too. As a new grad, I can say, we don't want you to "pick up the slack" for us, we really do want to learn how to do things for ourselves.....When one of them asks for help, do just that...help, don't just walk in and take over. If they've never done something before, talk them through it, but don't do it for them. Being a new grad doesn't make someone stupid, they passed the same NCLEX you did, and have the same license you do. Being a new grad just makes you inexperienced, which is a place EVERY nurse has been. Nursing is a profession of compassion...have some for your co-workers too.
Why can't we all just get along??????? Instead of gripping about these nurses, tell them what they need to be doing and show or tell them how to get it done. I had negative zero confidence in being a nurse on meds~surg when I first came out of school. I also remember how I HATED to have to ask from help from the other nurses. I could always tell quickly who liked mentoring and teaching, so I seeked them out asap.
You must have been amazing coming out of school sooo experienced. If u have a true problem can't u report to ur superior or ur nurse manager??I was in med~surg my first year, would've never made it in er. I really just wish nurses could be more like caretakers to their own(nurses) instead of sooo nasty. Let me just say there r some amazing nurses that don't eat their young because I have worked with some of them...
badtz_maru, MSN, RN
46 Posts
I totally agree. I have heard many students say they never want to work in med-surg. I think it is the best place to get your feet wet in nursing - there is so much to learn in that department. Then, after your time, go off into the specialties. Or stay in med-surg :) I could not fathom starting out in the Emergency Department as a new grad. Too fast paced IMO.