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?
"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!
We're going to have to agree to disagree. If the new grad has the right personality/tempement for the ER and is given a comprehensive orientation with a competent preceptor, that new grad will do just fine in the ER.
As terrifying as my 1st year was at times, I knew the ER was where I belonged and am very glad my manager likes to blend new grads in with experienced nurses as slots are filled.
There will always be those who can do just about anything they set their minds to. I'll bet there are very knowledgeable, talented motivated folks out there who could make very good surgeons without completing a full residency or even med school.
The question is what one thinks the minimum background experience should be for *most* who might fill that position. Of course, when it's hard to find qualified people with good potential for certain positions, the requirements may suddenly become more negotiable.
Embt2rn, I'm curious how you would've handled it if you HAD to work med-surg for a least a year prior to starting in the ED. I mean, you might not have *liked* it but how much do you think it might have actually hindered your eventually moving on to the ED? Do you think you just would've considered it an unnecessary inconvenience to getting where you really wanted to be? Would you have not considered becoming an ER nurse if you knew you had to work med-surg at least a few years first? Just curious!
"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!
Not all new grads are created equal. Just my opinion ... it works for some.
Embt2rn, I'm curious how you would've handled it if you HAD to work med-surg for a least a year prior to starting in the ED. I mean, you might not have *liked* it but how much do you think it might have actually hindered your eventually moving on to the ED? Do you think you just would've considered it an unnecessary inconvenience to getting where you really wanted to be? Would you have not considered becoming an ER nurse if you knew you had to work med-surg at least a few years first? Just curious!
Interestingly enough, my original plan was to work 1-2 years on a cardiac floor and then move to the ER.
So what happened to that plan you ask? Welllllllll, I did an externship on the highly rated tele floor at a highly rated hospital. Really liked it overall and thought that's where I would work after I graduated and passed the boards. Especially since the staff, NM and assistant NM said I should come work with them. Started my last year "knowing" I had a job waiting....
Cut to 5 months later. Go to my interview with the NM and assistant NM (both of whom had told me to set this interview up last summer). It's bad. No eye contact, generic "what would you do" questions, just very uncomfortable in the room. Finally after about 45 minutes of this, the conversation winds down and I ask, "what's the next step?". The NM says, "I'm not going to hire you. You're background has Emergency stamped all over it. You would just leave here after a year, so why should I bother". I was stunned. Said thank you and hit the road.
The next interview I set up, (at a different hospital) I put cardiac as my 1st choice for a unit. The recruiter called my and told me she arranged my interview in the ER as she thought I would be a good fit. Went to the interview. It was great. Offered a job on the spot. Here I am.
So, in answer to your question, yes, if I "had" to work m/s, tele or another floor prior to going to the ER, I would have done that as part of the route. However, that's a black or white question and we live in a gray world.
Your logic puzzles me too. If I "had" to work m/s before going to the ER, why would I not consider going to the ER if my path required that I gain experience first?
Some people are specifically interested in a nursing specialty (eg OR, ED, L&D, etc) and aren't really interested in any other area of nursing. Some of them seem to think it's the most ridiculous thing that some nurses think it's best to get acute care nursing experience prior to starting in a specialty. I was just curious what your feelings were on it. It sounds like you were more than ready to start somewhere besides the ED.
Personally, I go back and forth on this. Certainly, new grads can survive starting out in specialities. We see it all the time. Those same successful people likely would have managed to survive in those roles even if they never had RN training, either, though, wouldn't they? An RN license in required for speciality positions but only a very small percentage of RN education covers specialty areas while the bulk of it covers acute care floor nursing. Do the various specialties build upon general acute care floor nursing skills? If so, then it makes sense to require acute care experience prior to specialization. Are some areas of speciality nursing so different from general acute care nursing that such experience would be useless and might even be a hindrance? If so, why require the same basic RN training that primarily focuses on acute car floor nursing?
...Those same successful people likely would have managed to survive in those roles even if they never had RN training, either, though, wouldn't they? An RN license in required for speciality positions but only a very small percentage of RN education covers specialty areas while the bulk of it covers acute care floor nursing. Do the various specialties build upon general acute care floor nursing skills? If so, then it makes sense to require acute care experience prior to specialization. Are some areas of speciality nursing so different from general acute care nursing that such experience would be useless and might even be a hindrance? If so, why require the same basic RN training that primarily focuses on acute car floor nursing?
I assume you mean experience not schooling.
I think that basic training is the foundation for all critical care/specialty nursing. Gotta start with safety and the ABC's. Interestingly, the NM of my ER says that many, but not all, floor nurses do have trouble adapting to an ER environment because the pace and mindset is so different from that of a floor.
Totally off-topic here but maybe you can give me perspective on this...
The basics of safety and ABC's that all RNs should be trained in could easily be covered in a pretty short course, couldn't it? If many areas of nursing care are NOT built upon strong inpatient acute care nursing skills, then why is so much of RN clinical rotations and coursework specifically directed towards inpatient acute care nursing?
Sometimes I see nursing as kind of like teaching. There are some general principles of teaching that can be applied across many different areas of teaching, but there is no one standard "teaching school" that all teachers must attend prior to choosing a specialty. Pre-school teachers and high school chemistry teachers aren't required to do several different student teaching assignments in K-8 covering reading, writing and arthimetic with a just few observation days in a high school physics class, at a tutoring center and at a music school. Yet that's kind of what RN education is like, isn't it?
I'm a recent grad who landed in the ER after a 10-month stint on a rehab unit. I don't think I appreciated what a supportive environment I enjoy until I read this thread.
To those who say new grads should start on the floor, I agree. And I would have, happily -- had just one of 60+ applications resulted in anything but "we're truly sorry, but we're not hiring." A lot of pluck and hustle led to an interview with an ER director who liked my attitude and the months I'd spent building skills on my own time. There was no way I could say no when she offered me a great job.
As Patricia Benner notes in "From Novice to Expert," every nurse stands on the shoulders of the nurses who preceded him or her. With personal experience -- over and over and over again -- come speed and expertise. No orientation program, no matter how good, can replace experience over time.
That said, to those who gripe about new grads to their managers, I ask: What are you doing about the problem instead of complaining? Is anyone standing on your shoulders?
As Patricia Benner notes in "From Novice to Expert," every nurse stands on the shoulders of the nurses who preceded him or her. With personal experience -- over and over and over again -- come speed and expertise. No orientation program, no matter how good, can replace experience over time.
Reminds me of something I heard: it's not the people above you that pull you up the ladder, but the ones below you that push you up. Or something like that ... I'm tired.
We take new grads in our ER, most have done their preceptorship here. My take on it is this... NG's are a blank slate. I don't have to unteach them things that they may have learned elsewhere. I always tell them that if they have a question or want advice to come to me or any of the other nurses.
I'll use this as an example. GN comes to me and asks for help putting a foley in an elderly lady. We go in, I look but dont see the meatus. I tell her to get a coude tip catheter because you can aim them better than one that comes with the kit. Got it in no prob.
Most of our NGs are very smart, very dependable and because thy're new they want to learn. They are very teachable. Every now and then we get one who thinks they know it all. Oh how the mighty fall when they make a mistake.
I know some of you are thinking that you don't have time to teach someone/ babysit someone. Our ER nurse director recently told me that the positions we have open, the applicants are either new grads or those who left nursing and because of the economy were seeking employment. She said most of them were over 60. Who would you rather have? A new grad who knows the things that are relevant now or a retired person who hasn't worked in 15 years?
As A New Grad and New ER Nurse I'm a lil insulted. Don't lump everyone together pls. I used to think it was wrong for someon to go straight from EMT school to Paramedic School then I got the Best partner Ever she was way smarter than me and a better medic, she had gone straight from EMT to Medic. Im a experienced ParaMedic and Combat medic veteran. I have extensive EMS/ER experience to include triage, So my learning curve should not be so bad. I expect to snag myself a great mentor. BTW an experienced Med-Surg nurse stated in another thread she was overwhelmed by the ER tempo after she had moved there.
so help a brother /sister out and make them a better RN than you are.
I think the answer to this debate lies in the OP's post. She or he went to the manager and the manager indicated that they saw no problem with the new graduate RNs. It is OP's "problem", not the new grads.
The fact is that, regardless of your level of experience (and note that the OP is new to ER), you have to help pick up everyone's slack. It is always that way in the ER. A new critical patient means a swarm or discharging a patient that isn't "yours". New grads might be slow but experienced RNs might be tied up with an unstable patient.
Perhaps OP, you need to reconsider your own perspective. You might be used to the med/surg way of doing things where everyone is responsible for their own set of patients but this mentality will not work in the ER. Unless you were precepting the new grads or directly responsible for picking up their work (ie charge nurse) then going to the manager is really kinda hostile IMHO.
I would suggest that, having expressed your opinion to the manager, that you let the issue drop. The unit educator and manager are better equipped to assess the skills expectations for the new grads on your unit.
emtb2rn, BSN, RN, EMT-B
2,942 Posts
We're going to have to agree to disagree. If the new grad has the right personality/tempement for the ER and is given a comprehensive orientation with a competent preceptor, that new grad will do just fine in the ER.
As terrifying as my 1st year was at times, I knew the ER was where I belonged and am very glad my manager likes to blend new grads in with experienced nurses as slots are filled.