New ED nurses who "know it all"

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How do you all handle the new (some have a couple years experience some are new grads) ED nurses who think they know best and won't listen to the preceptor?

For example CP no IV "the doctor didn't order it", "that's not how I do it" etc. Even after you provide rationale/critical thinking why issues need to be done a certain way - the next time you work, they have chosen to revert to sloppy practice. Never ask a question - when explaining procedures, labs, etc. "Yeah I know"

I feel bad for them and us as staff because they so want to be thought of as an "awesome ER nurse", but it's tough when they don't know what they don't know.

I take it personally as a preceptor that the nurses coming off orientation are strong and critical thinkers - but I feel I'm failing! Any advise from both new nurses and other "seasoned" nurses would be wonderful - thank you:banghead:

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Specializes in ICU/Critical Care.

Thats exactly why new grads shouldn't be in ER. They need one year of med/surg experience, i don't care what anyone else says. And since when do they start IVs by doctors order?

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Specializes in ED.
Thats exactly why new grads shouldn't be in ER. They need one year of med/surg experience, i don't care what anyone else says. And since when do they start IVs by doctors order?

So, you truly believe no new grad can succeed in the ER right away? I am curious as I start in July as a new grad. I did precept there in school and unfortunately (and fortunately) this was my only job offer and I Loved the unit so I felt like I should take the job. I do believe that many people would benefit from starting in med/surg but I was not able to get a med/surg interview. what would you suggest???

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Specializes in ICU/Critical Care.
So, you truly believe no new grad can succeed in the ER right away? I am curious as I start in July as a new grad. I did precept there in school and unfortunately (and fortunately) this was my only job offer and I Loved the unit so I felt like I should take the job. I do believe that many people would benefit from starting in med/surg but I was not able to get a med/surg interview. what would you suggest???

Ok, I take back what I said. If the ER is offering some type of internship with a bit of classroom time, go for it. Otherwise, I suggest med/surg or stepdown. I just feel that new grads need time to get the skills down before moving into the ER. I only base my opinion on where I come from, the facility I worked at fired several new grads over poor practice i.e. running tube feeding while a patient is laying flat, not notifying the doctor that a patient who came in totally a/o x3 was now obtunded, not obtaining abgs on patient with COPD on 100% NRB and stating that the pulse ox was positional so when the patient came to me they needed to be intubated. Just my two cents.

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You mentioned that you had some ppl that had some experience too so the OPs who are bent about the no new grads in ER need to start another thread. The thing that bothers me about your problem is that the newbies won't take any initiative even after you gave them rationale. This is scary to me as a potential patient. If I am having chest pain or my "lung rot" is acting up and I come to your ER I da++ well expect the nurses to step up and start an IV, put me on some O2, heart monitor etc. Lord knows I've worked ER and we nurses initiated what needed to be done till the doc got to the bedside.

Why is your facility keeping ppl who obviously are sloppy in their practice, unmotivated to learn and lazy in their care???? Do you document your concerns to your NM??? If not, you need to. If you do...what happens with the information?

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Specializes in Nephrology, Cardiology, ER, ICU.

New grads can succeed in the ER provided they have adequate orientation (12-16 weeks of combined classroom and clinical). That said, without adequate orientation and the knowledge that they don't know everything, they are doomed to fail.

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Specializes in ICU/Critical Care.

I don't understand why they would think that the doc would need to order an IV especially with someone coming in with chest pain. Wouldn't it be the obvious thing to do if they were suspecting an MI and the patient might be started on Nitro/heparin gtts?

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Specializes in LTAC, Telemetry, Thoracic Surgery, ED.

I'm assuming most ER's have a protocol for what needs to be done when a person comes in with certain complaints, most complaints justify a standing order for either IV access or some other med/infusion that obviously requires and IV so you can always educate the newbie that protocol allows you to proceed with initiating IV access without a specific order....that being said it's always been drilled into the heads of new grads "don't do anything without an order because if something bad happens it's your hard earned license".

Just being devils advocate....I agree everyone should do a year on a floor before going to ER or ICU but if a facility hires new grads they need to also take the responsibility to make sure they are safe before being on their own and that is individual for each person.

I work on a floor that hired approx 6 new grads at the same time and all of them are on different levels. JMHO.

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Specializes in ICU/Critical Care.
that being said it's always been drilled into the heads of new grads "don't do anything without an order because if something bad happens it's your hard earned license".

Even after two years, that's still drilled into my head.

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Specializes in Cardiac, ER.
Even after two years, that's still drilled into my head.

That is why we have protocols!! You should have a standards manual, in writing available at the nurses station. Every hospital I've ever worked in has a set of protocols for specific c/o,.especially in the ER. We have a pre treatment area at triage. If someon comes in with c/o CP and I can't get that person back ASAP I am expected, according to hosp protocol to start an IV, O2,monitor, EKG, troponin, ASA, and nitro SL X3. All of that can be done w/o the pt ever seeing a Dr! We have similar protocols for suspected pneumonia, abd pain, fever, stroke etc. Those protocols are orders!

I agree with previous posters,.new grads need to spend time in a med surg setting. The ER is very fast paced and you need to have a strong background and a wide general knowledge base before you get there.

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Specializes in ICU/Critical Care.
That is why we have protocols!! You should have a standards manual, in writing available at the nurses station. Every hospital I've ever worked in has a set of protocols for specific c/o,.especially in the ER. We have a pre treatment area at triage. If someon comes in with c/o CP and I can't get that person back ASAP I am expected, according to hosp protocol to start an IV, O2,monitor, EKG, troponin, ASA, and nitro SL X3. All of that can be done w/o the pt ever seeing a Dr! We have similar protocols for suspected pneumonia, abd pain, fever, stroke etc. Those protocols are orders!

I agree with previous posters,.new grads need to spend time in a med surg setting. The ER is very fast paced and you need to have a strong background and a wide general knowledge base before you get there.

I'm telling you, protocols are a wonderful thing. It beats having to constantly call the docs. In my ICU, we have electrolyte, tight glycemic control protocols. Never knew they existed before I got in ICU. I'm not sure about ER, but i'm guessing they have some standard protocols in place.

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Specializes in ICU, PACU, Cath Lab.

Have the new grads been able to see...or been told how to access such protocols?? I started as a new grad in the ICU..and I wanted these protocols..I wanted to read them and study them...not one nurse on my floor could or would tell me where I could find them. Some honestly did not know, and the others..well they thought it was a waste of time. I took upon myself to search and search on our computers until I found them.

However they should take your advice and words of wisdom seriously..I NEVER once said..I already know that...I mean even if I did...9 times out of 10 I would get additional info from a different nurse.

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