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?
I am a nurse who started in the ER with no hospital experience at all! I had 4 months of orientation, left on maternity leave, then came back. I must say it was difficult, but I never would have gone to the floor. The ER is where I wanted to be and the ER is where I was. I still love the ER to this day, and now I do ICU. You have to have the ER mentality to survive there. Many have tried, but you can't just do it. You have to be flexible, confident, quick, willing to be a team player, and be able to trust your instincts. Most of this comes with time. But if you are finding a new nurse is not flexible or not a team player, than maybe he/she is not right for the ER. There are much more structured areas of nursing that might fit that nurse better! But be gently, be patient, be willing to help and you just might be surprised at what great ER nurses they may be!
People have such short memories and such short tempers. It is awful to be busy and have little time to teach. It is also part of the job. The one thing I do admire about physicians is that they do know that they should teach the newbies. Sure they are not always patient and kind teachers, but it is a given that at each level the docs will have a new gal or guy to shadow and teach. If you want help and relief and someone to switch with for vacation, you need to get new staff on board and teach them how to do the job in such a way that they will stay and be a productive part of your unit. Sometimes, they are not well suited for that area of nursing. That is life, it happens. It is okay to complain about an issue, but you also need to think of how to solve it. One of the issues I see is that managers are not looking at who they hire. All grads may be created equal (we should treat everyone well) in a sense, but they are not all the same. Lunah talked about her background. It sounds like she might have a good grasp on what to expect in this setting. A twenty one year old grad who has always worked at McD's and had a two day rotation in ED during her ADN program, may not be as successful. The 21 year old might be a good fit by sheer luck, but Lunah is a better bet. It would be great wouldn't it if SON's could do an exit interview with students about what they may be well suited for as a first job. I do not agree that everyone should go to med-surg first. It is a good idea for many, but not all. Many new grads do well in various specialties. The problem is that often there is little exposure to the "meat" of many of the specialty areas for the grad to really judge if he/she would do well in that area. Also, I would hope that professional experienced nurses and faculty could help grads see what talents or strengths may be needed for various specialties. Just because you do not have it today, doesn't mean in a year or five years, you won't be well suited for another clinical area.
You cannot go back with a new grad and change his or her education. You can only move forward from where you are when you meet. If the person's education has been poor to this point, then be the changing point where it becomes an excellent education. If we were as good to other nurses as most of us are to patients, then things would go a lot better. The people who funtioned like Florence Nightingale and Clara Barton as new grads probably have poor memories or they are simply lying. Let's face it, with someone's life in your hands it is daunting when you have little experience. There is also the computer charting, the physicians, the families, the lab, xray, etc. As a new grad more than twenty years ago, I was a real dud. I think I am now a pretty good nurse and a much more mature person. Many of the mean things people did and said to me, still make me cringe today. Constructive crticism and encouragement helped me. Slamming did not. Some of us oldsters remember and try to be kind. Some nurses believe that now they have earned the right to baptize the next generation by fire too. I get frustrated with people who are slow, but I know I have been slow too. My biggest frustration with the new nurses I have worked with as a clinical educator is those who do not do as they were asked to do in terms of reading, practicing a skill, etc. I know everyone gets sick of school. I have been there believe me! However, if I ask you to read about Magnesium sulfate in the policy book and it is a week later and you still have not done it and do not not know what you are doing, then I a abit upset with you. When a nurse is new to a specialty, she/he should treat it like being in a new educational program. There are things you may not get. That means you may have to go home and google it or look at one of your texts or buy a new book from Amazon. We are there to teach you, but you must make yourself available to learn.
By the way, I know my typing and grammar may sometimes be poor. For that I apologize up front. This is not a morificecript, so I may not have been extremely careful with my editing.
All the new grads are slow and incompetent? Every single one? Every single day?
I don't know how to be tactful about this so I'm just going to say it - maybe your expectations are unrealistic.
If your manager doesn't think it's a problem, and he/she's a reasonable and competent manager, then maybe it's not a problem. And if you have to help them out once in a while, so what? You've never gotten help from your coworkers? You don't ever help out the non-new grads?
I've been nursing for almost two decades and I still learn something new every single day. The other day I turned a patient over and saw a bart (sp?) bag. I've never seen one before, never even heard of such a thing. My first thought was she'd swallowed a glove and now it was coming out her. So we are all inexperienced at times.
Just to make sure I'm not coming off as a total b:eek:ch, many of us have tried to help them, and 1 in particular. She's not receptive to females, though. Saving the details, others in power haven't been receptive to our concerns either. Otherwise, they will get defensive when some of us offer help.
I *know* they are stressed out, but we're not just letting them flounder, although I may have painted it that way. When it comes down to it, esp situations in which patient care may be jeopardized, no one hesitates to step in! The problem is when they don't ask for help, and patient care is jeopardized... We can't help if we're unaware of the problem.
That sounds like a very frustrating situation for everyone. It might be that some of the new grads are too intimidated to ask questions and don't want to sound ignorant. It might be that some are too arrogant to ask. That's scary.
It's even worse if the powers that be are not receptive to your concerns. They have created a problem for the new grads and the rest of the unit and have pretty much dumped it all in the ED staff nurses' laps. I don't think you're letting them flounder but it seems that the rocket scientists who made these hiring decisions are setting up these new nurses for failure.
It just seems that all of you are in this lose-lose situation no matter what and that if the decision-makers at your facility would put an end to this practice of hiring totally inexperienced new nurses into the ED, you wouldn't be having these issues. (Exceptions made, of course, for new nursing grads with previous experience as paramedics, EMTs, military medics or corpsmen, LPNs or techs in ED.)
ETA: I just read your last post about talking this over with a friend at a different hospital who said that new grads are not given adequate support in ANY area. Don't the people who make the hiring decisions ever talk with their nurse managers and direct care staff to see what their needs and concerns might be so they can improve the orientation of all new staff, not just new grads?
Maybe your ED hired on too many new grads at once. That is what happened in my ICU when I was a new grad/new hire. There were TEN of us NGs, and not enough resources to train all of us properly so it was sink or swim. Sadly, half of us sank. I stopped counting how many preceptors I'd had after I reached twenty. I got three months of orientation/precepting, and my three month evaluation was done by a nurse who had only worked with me for the shift on which it was due. My managers try to spin this crappy orientation in a positive light by saying that the four of us new grads who survived this treatment (three years later) are the cream of the crop blah, blah, blah. But I know that they burned a few really good young nurses who might have been stellar employees with the right support.
I place all the blame on your ED's management. They shouldn't hire new grads if they don't have the resources to train them. Perhaps all of them are not cut out for ED, but maybe one or two of them are. Could you maybe take one under your wing and make it your special project to effect some improvement in this nurse? I myself was "adopted" (forced him to adopt me, heh) by the world's grouchiest charge nurse, who let me bug him for his many decades worth of experience and advice, and that is the only thing that saved me in this job. For the sake of your ED, try to help at least one of these new nurses. And find a way to bring up this situation to management so that you can prevent a repeat the next time they hire.
I think this is an area that strikes a cord with many people, from the new grad to the seasoned nurse. I have been a new grad in the ER for 10 months and the biggest problems I have seen in my ER are too many new grads in the department at once, too short of an orientation, and lack of support.
I can understand the frustration of the seasoned nurses as far as the number of new grads. I have only been in the department for 10 months and I already have seniority over 6 other new grad nurses. Sometimes the only nurses in the department who have over 2 years of experience are the charge nurse and the triage nurse. This can be a frustrating situation for the seasoned nurses who are being pulled in every direction to help the newbies. However, just think of the frustration of the new grad who turns to someone to ask a question only to find a nurse less experienced than herself. What I am sick of hearing, and I hear this almost every time I come to work, is the seasoned nurses complaining that the department is no longer "safe" due to the number of new grads, and how everyone is sick of working with the new grads. Nobody has ever personally pulled me aside to tell me I am too slow, doing things wrong, etc. Everybody likes to complain about us, but nobody seems interested in helping us become better nurses. How can we improve if we are not getting any feedback (positive or negative)?
My orientation was 12 weeks on the unit with no additional classroom time. This is too short!! Think about it. The ER nurse is the jack of all trades. We are cardiac nurses, peds nurses, psych nurses, OB nurses, you get the picture. And what are the chances that you will see everything you need to see on the unit in 12 weeks? There is a huge learning curve when you go to the ER as a new grad. The common theme I see at work with all the new grads is the constant anxiety we feel that we will not be ready when something serious walks through the door, due to the minimal training we have had. This anxiety is relieved only by education, experience, and support.
New grad nurses need tons of support and they need their senior nurses to pull them aside and tell them when they are doing things wrong. If the new grad then refuses the advice, that sounds more like a personality problem than an inept new grad problem. This is a vicious cycle. Whether people agree with it or not, new grads will continue to be hired into ERs without experience. We are cheap nurses who fill the holes in the schedule. That is the big picture of corporate hospitals today.
I'm wondering what school you went to, imanedrn, that you came out into your first job so fast and efficient, full of confidence too... I'm looking into schools and want to go to a top-notch school so that I don't read a post like that on here about myself
Specializes in Emergency, Critical Care (CEN, CCRN).
I'm a second-degree recent grad who started straight in emergency, and am just about to complete my Phase 1 orientation. Far from the norm, my department actually looks for selected new grads to hire in, as our management has a philosophy that we can do better educating GNs to our standards from the start rather than trying to undo N years worth of bad floor habits. (For various reasons, there are some... issues with med-surg nursing in my hospital, but that's a discussion for another time and board.)
The two things we do look for in our GNs, though, are strong time management skills and strong clinical experience - either through a previous job as a tech/aide, EMT or military medical training, or through a high-level preceptorship in school. (For example, I precepted in CV-SICU; of the new GNs who just hired in, one was a tech in our department previously and the other two came from critical-care preceptorships.) We pride ourselves on our education and orientation package; Phase 1 is 12 weeks of official classes plus 1:1 preceptorship. In Phase 2, you're unit functional, but you continue through a year of advanced education (ACLS/PALS, TNCC, ENPC, etc) and frequent observation and evaluation by the department educator, managers and peers. To the best of my knowledge, we've only lost one GN in the last year, and that prompted the addition of a "core emergency skills" class to the program. We also make a big point of the orientation being orientee-directed; we expect that our orientees will speak up if they're missing skills, have poor rapport with their preceptors, etc, and we will make every effort to get them the support they need.
Based on what you're saying, I don't think it's you and your colleagues who are at fault here, and not necessarily the fault of the GNs either. Rather, this sounds like a process failure r/t hiring and education of new grads. After going through our program, I know I'm no Supernurse, but I also know I have the skills to function safely and effectively while I continue to acquire experience, and I know from whom and how to get help if I need it. I feel badly that your GNs don't seem to have that support. It also sounds to me like you may have some hospital-wide issues with new hire orientation, if you're seeing the same pattern from friends in other units. Does your hospital have any kind of quality improvement process in place to look at these issues? Perhaps this might be something you want to bring up to your nursing council or QI department.
I think that you HAVE to have a very supportive environment for a new grad to be successful in an ER setting.
I had 2 years exp as an RN (adult ICU) and 2 years as an LPN (LTC) when I went to the level one trauma center. Absolutely loved it and still miss it but it is not for the faint of heart.
You have to have some grit and maturity to make it.
Its hard enough being a new grad, let alone in an ER. 3 months is the bare minimum for a community-based ER. In the level one where I worked, new grads had 14-16 weeks and then had a mentor/buddy for an entire year. That way they weren't just thrown to the wolves.
I was a new grad so long ago, my preceptor's first name was Florence.
All kidding aside, my first job as an RN was CCU in 1968. I was incredibly fortunate in that the staff took me under their wings and treated me with care and respect. Critical care was very exciting as we kept inventing the wheel. When I made the change to ED after 12 years I was again treated with tremendous respect as I went through that challenging process. You know, lose the ICU mentality and get REAL.
I have been in this ED 25 years and was recently honored with an award for excellence in education, I guess because I have precepted just about everyone, including my current manager. We have a 16 week residency for our new grads and most of them start out just fine. I am so proud to be associated with them, and what a pleasure to see them progress in their careers. God bless the new grads...someday we are all going to need them to take care of us !!
(who started their as a NG), . I had to sign up just so that I could reply to your message. I have a big problem with someone who calls her fellow coworkers inept when that same person does not know how to write. Please try to help them instead of criticizing them, if they seemed to you as if they do no want to ask for help then maybe they feel that you are not being genuine.
wow, good for you standing up for all the new nurses to be!!. But i think that "their" was probably a genuine mistake which happens everyday. If she is an RN in an ED department, i am pretty sure and hopeful that she can spell "there". But you are right though, offering a helping hand is a wayyy better thing to do.
Congrats on your upcoming 20011 graduation, that is my best friends year too for the BSN program.:)
Don't the people who make the hiring decisions ever talk with their nurse managers and direct care staff to see what their needs and concerns might be so they can improve the orientation of all new staff, not just new grads?
. But i think that "their" was probably a genuine mistake which happens everyday. If she is an RN in an ED department, i am pretty sure and hopeful that she can spell "there". But you are right though, offering a helping hand is a wayyy better thing to do.
ER nurse78
1 Post
I am a nurse who started in the ER with no hospital experience at all! I had 4 months of orientation, left on maternity leave, then came back. I must say it was difficult, but I never would have gone to the floor. The ER is where I wanted to be and the ER is where I was. I still love the ER to this day, and now I do ICU. You have to have the ER mentality to survive there. Many have tried, but you can't just do it. You have to be flexible, confident, quick, willing to be a team player, and be able to trust your instincts. Most of this comes with time. But if you are finding a new nurse is not flexible or not a team player, than maybe he/she is not right for the ER. There are much more structured areas of nursing that might fit that nurse better! But be gently, be patient, be willing to help and you just might be surprised at what great ER nurses they may be!