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'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.
All the best to you and your colleagues.
Your hospital sounds like an awesome place to work. I have a feeling that your facility has low attrition rates, good outcomes and pretty happy patients as well.
I do see your management's point about bad habits. However, not every experienced nurse has bad habits but some employers assume we all do, so it can be frustrating to try to convince someone to hire you when you do have experience. (It's weird...new grads can't get jobs because they can't get experience but some experienced nurses can't get jobs because they have too much experience....but I digress....) At any rate, I do understand why there might be hard feelings from med-surg nurses but I am glad there is support for the new grads that are hired and that they are given the tools they need to succeed. In the OP's facility, it sounds like the new grads are just thrown to the wolves and that is not fair to them, their colleagues, or their patients.
I had a rather unorthodox orientation, but I would do it again in a heartbeat! I transferred from med/surg where I was already on the desired & open shift, nights, I LOVE being on this side of the sunset lol I did a month on nights where I picked what days and with whom, (small ED so I had a choice of 3 people lol) that was when I got alot of the book work part of orientation done, like my conscious sedation course and certification, various ED modules about the equipment. Then the rodeo began, I spent 3 months working M-F 9-5, when the majority of patients come in, this way I could see the most patients humanly possible lol I also found it was a good way to reinforce concepts if I performed them daily for 5 days, rather than once and then off for 3 or 4 days. Management needs to be involved in orientation as well, I developed a great working relationship with my unit manager, which is sometimes difficult to do when you work nights. A friend of mine that graduated with me started out here as a NG and did great, and it sounds as if the student who is doing her practicum here may land a possible job as they are piloting a new concept of no unit clerk on days when we go to CPOE. THAT idea just need not come to night shift lol. Maybe the preceptor pool and whole idea of 12hr 3 day a week orientation needs to be shook up some.
Specializes in Ortho/Uro/Peds/Research/PH/Insur/Travel.
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.
I have 3 years of M/S ortho experience and the clinical director of the ED where I just interviewed said that I would receive 3 weeks of orientation. 3 weeks and I'm neither ACLS or PALS. Thoughts?
Our ACLS must be current to work in our ED. You might want to check with the director on that. Three weeks doesn't sound like much time! We had an experienced m/s ortho nurse who came to work in our ED, and I think she had 6 weeks of orientation. She rocked, we loved her! She stayed a while, then moved to a cath lab. She transitioned well to us, though. Good luck!
I started in the ER as a new grad as well. My experience is mixed; I have been in the ER for a little over 2 years. When I started in the ER, I had preceptors however they were also the part time er managers (they shared the position). I worked with them for about 5 months and then got a set schedule for the night shift with just one other nurse. In essence I was a staff RN. I remember being scared out of my mind and trying so hard to do the right thing, that more often than not I would mess up just out of sheer nerves.
One of the night nurses turned out to be the toughest nurse to work with but also the best preceptor/mentor/friend I could have asked for. She took me under her wing and started really teaching me and making me think and rationalize as an ER nurse. It so happened that she was also a critical care transport RN, a flight nurse, and had worked in the ER at trauma centers. I can honestly say that although others have molded me as a nurse; she molded me into a professional.
I have since moved on from the original ER I started out at. I have worked through registry at a few other places. I have not worked in a trauma center because frankly I don't really want to do hard core trauma. I worked for many years as an allied health specialist and did work in a trauma center in my 20s. Not really interested at this juncture in my life. I work in a couple of ERs now, and find that the lessons I learned with my mentor have helped me even now; we keep in touch, and she's still there to give me supportive advice and motivation to keep moving forward. I continue to learn and to grow as a nurse; and I remember fondly the first time I cardioverted a patient and the first defib pt I had; I also remember the first death and also the first smile and hug from a patient. The first thank you, and also the first punch.
Yep, these first couple of years have been monumental; they have been trying and also fun. I am grateful for my mentor and also for those nurses who by their example showed me what kind of nurse I wanted to be someday, and what kind of nurse I really never want to face in the mirror.
So, give new grads a break. And remember they too deserve a chance to learn and to grow. Nobody arrives to the ER knowing it all. Some new grad nurse may either look to you as an excellent example of nursing professionalism; or as an example of a person they never want to face much less emulate.
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!
There is some truth to the "survival" comment. I'm not entirely convinced that new grads should be ruled out entirely of specialties, including ED. As a new grad that started in the ED, I've managed to do quite well (my last annual eval confirms this). However, just because a new grad spends time on a med-surg unit, be it 6 months or 6 years, does not mean that they will be any better adjusted to life in a radically different environment such as the ED. I once worked at a hospital where the ED manager refused to hire anyone who had not spent 2 years on a floor. Several of the techs were long-term ED employees, paramedics, etc and none of them were considered for positions when they graduated nursing school. Many of the "experienced" nurses, however, were just as lost if not more so for their first several months.
Fortunately, this antiquated thinking is slowly heading out the door. Just as shortsighted, however, is randomly hiring new grads into a specialty they have absolutely no background in and thus no idea of what they're getting themselves into. TiVo'ing Grays Anatomy and ER reruns doesn't count. I graduated with a couple of people who expected to get hired into ED positions as new grads simply because they were men, even though their grasp on the most basic concepts was questionable at best.
Hospitals also need to realize that when it comes to new grads they will end up costing money one way or another, be it on the front end or the back end. A facility can either invest on the front end by first picking them right candidates for a given job and investing in an adequate orientation or invest money on the back end with the resulting high turnover that comes from a lack of investment in orientation and training. As for the OP's question of "inept new grads," without seeing them work in person it is probably a combination of the reasons listed, combined with a lack of properly selecting the right candidate for the job and possibly a lack of adequate orientation or deficiency in preception.
Be realistic as well. How long did it take us as inexperienced nurses to become "fast?" Did we cut anything out along the way to become faster, such as time interacting with patients and building a rapport, or providing adequate discharge teaching? I've noticed that a number of the recent grads I've worked with, while "slow," are very in tune to the interpersonal aspect of nursing and the importance of AIDET, discharge teaching, and so forth.
Begin a new grad nurse who was hired directly out of school for the ER with no hospital experience, I can totally relate to everything said on this thread, from the newbies to the veterans. It's a helluva ride.
We had 6 month training program, combo of class and ER work days during which I had a preceptor. Did I feel ready when it was time to go solo? Nope. Some days now, I am scared to death.
I have been doing this since August which means I have had, give or take 100 - 120 days as an RN. That has given me tons of skills. I try to pat myself on the back for what I am successful for; other times, I mentally beat myself up for things I could improve. I would love for honest, objective feedback from anyone. I have asked for it. I ask for pointers and get some. I ask on how to do things better and I hear, "it takes practice, it'll come." No one says anything to my face, yet I know comments are being made about me. It would be nice to have someone show me/tell me/mentor me on how to improve/speed up/document when times are balls to the wall/any other little tricks. It seems the more I'm there and the more they are used to me, the more they will speak up. It's like I have passed some secret test and now they are more willing to share. For which I am extremely grateful. Thanks guys.
I know that I'm a good nurse now. Not perfect. I know that I do the best I can. I'm slow. But I'm gaining in everything. I know that I'll become one of those great nurses, if I can hack it knowing that when I go to work, I gotta watch my own back. I gotta be and try that much harder since I'm new. I feel like my fellow RN's don't forget all the times I couldn't get an IV started or couldn't get blood or whatever the skill. Now if I need help, it takes the veterans a couple of sticks too.
I'm happy to have a job. I'm happy they hired me. I'm happy to know that I have some friendly faces at work every day. I know that when the student is ready, the teacher appears. All I can do is keep on keeping on.
Is there a way to do it better? Sure, make the training longer with stated goals and competencies, have the preceptors go thru training to have know how to teach, put personalities together that mesh, all these ideals that folks just aren't willing to do or flat out can't pay for. It can't be ideal since everyone, every situation is so different. And, heck, it's the ER. We get everything.
The learning curve is huge and we all learn or see something new every single day. It's got to be a group effort where everyone pitches in and meets in the middle somewhere. Like someone previously stated, I don't want you to do all my work for me, but if I just got 4 new pts and all of them require IV, blood work, urine, if another RN isn't doing something, then they could pick up a chart and help me out. My pts don't need to sit without care, the docs don't need to wait on blood/urine work needlessly just because it's going to take me longer. One day I'll be able to get the 4 done in a blink of an eye with assessments, but really, why watch and time me without stepping up to help the pts?
And, if you are going to help me out, do me a favor and do it right. Please get a last set of vitals if you are discharging my pts. Please note that you gave discharge instrux and chart them out if they are gone. Please document somewhere that the iv was taken out, meds given, urine collected, ekg done.
Sometimes, a thank you or a compliment would be much appreciated. Even asking how my day is going would rock my world. I think everyone needs to be appreciated for what they do. So, if you read this, next day at work, just thank someone for doing what they do. Cause sometimes, that's all you need is a smile, a nice thought and to know there is a reason for doing what you do, whether new or old.
Sorry this rambled, but it sums up my first 9 months of nursing.
I became interested in this post because I had just interviewed for ER position, I am new grad with 10 years LPN experience, with 3 years in the ER. I see that the opinions run the full spectrum of for, against and in the middle. I appreciate the honesty that everyone brings. I just hope I can be successful if I am chosen for this position. I enjoy the variety of experiences that working in ER gives a person. It can work out to be a great foundation of experiences or staying and making a great career of emergency room.
I am a new grad currently working in the ER. Yes, it is intense and a completely different world. However, I am blessed to have such a wonderful opportunity. Everyone at my job has supported me except a couple of nurses. Those are the ones that DO turn a cold shoulder and are rude and inconsiderate. I feel that the support from the other nurses in the ER including my preceptor has allowed me to currently succeed in the ER. Without that I would not be where I am in my orientation process. So I hope and pray that instead of turning your shoulder and giving the GNs grief you support them and show them the way. I rely so much on the experienced nurses and without them I would not be able to keep up and understand the world of the ER
I spent 3 months working M-F 9-5, when the majority of patients come in, this way I could see the most patients humanly possible lol I also found it was a good way to reinforce concepts if I performed them daily for 5 days, rather than once and then off for 3 or 4 days.
What a great idea for learning! Different things work for different people; knowing my own learning style, that kind of bulk exposure and repetition would be very effective for me.
Wow. I think I got maybe 5 weeks of orientation as a new grad. I also did an internship on an oncology unit as a nursing student, but really? In this economy what hospital is going to give new grads more than 3 months of orientation? Maybe I just worked at crappy places, who knows.
I would suggest being more kind and considerate to those new grads cause Im sure they are pretty scared and running around like chickens with their heads cut off.
However, I can understand the situation where Ive worked with the "know it all" NGs that are just begging to be thrown under the bus.
I guess I feel that in the world of nursing we rely so much on eachother for help and support. Why are we always out to get others and complain about their performance? Nurses need eachother to make it through the day.
"the ED is no place for a new grad!" my instructor said it a hundred times and I, a new grad AGREE! you just don't have the knowledge or the skills, its a huge liabilty and the patients are at risk!
when we go to CPOE. THAT idea just need not come to night shift lol. Maybe the preceptor pool and whole idea of 12hr 3 day a week orientation needs to be shook up some.
Moogie
1 Article; 1,796 Posts
Your hospital sounds like an awesome place to work. I have a feeling that your facility has low attrition rates, good outcomes and pretty happy patients as well.
I do see your management's point about bad habits. However, not every experienced nurse has bad habits but some employers assume we all do, so it can be frustrating to try to convince someone to hire you when you do have experience. (It's weird...new grads can't get jobs because they can't get experience but some experienced nurses can't get jobs because they have too much experience....but I digress....) At any rate, I do understand why there might be hard feelings from med-surg nurses but I am glad there is support for the new grads that are hired and that they are given the tools they need to succeed. In the OP's facility, it sounds like the new grads are just thrown to the wolves and that is not fair to them, their colleagues, or their patients.