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:
I also wonder if in the case of not starting an IV if your facility DOES have an explicit policy that the nurse SHOULD start an IV in case of XYZ.
Just telling a newbie "you need to do that" isn't enough, no matter how good the rationale is. If there isn't a clear protocol, the newbie is doing the right thing to NOT initiate something that needs an order.
The kind of new grad mentioned, that will not listen to rationale, will not change their practice, and are sloppy....I have the sneaking suspicion that they will practice the same way no matter WHERE they are placed. If they're on med surg, then there will be 5-8 people they are treating improperly, instead of however many they're dealing with in the ER.
There are some of us that KNEW we didn't know, and tried to soak up every scrap of information we could get, watched how other nurses did things, read the protocols whenever we could, asked a million questions and actually listened to the answers, took ACLS if offered etc. Then there are those who somehow skimmed through school with a minimum of effort, picked up a minimum of knowledge and think they can give the same effort to work that they gave to school.
All of us came out of school inexperienced, inefficient and slightly dangerous. With good orientation, and a willingness to learn, I think a new grad can succeed anywhere. And I think some will fail no matter where they are and how much support they are given.
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:
I have been a nurse for almost 2 years....just went to the ER. Before that I worked MS & Tele. I can tell you I felt like a brand new nurse in the ER. I know I have soooo much to learn. I value the advice & expertise of my experienced co-workers.....could not make it without them. I just can't believe someone would try to be a know it all when you have a life in your hand.....dangerous & stupid! If they won't listen then they need to be taken down a notch or two....before someone is hurt. I am sure as an experienced nurse & preceptor you know how to do that! Good luck!
Thank you for saying this. It's the things that people "don't know they don't know" that will get them into trouble. New or experienced, I'd rather orient someone that's "teachable".
As for the OP, hang in there. Keep asking them questions about their thought process & actions to stimulate critical thinking. (Some of it is bound to get through )
... It's the things that people "don't know they don't know" that will get them into trouble. New or experienced, I'd rather orient someone that's "teachable".
It ain't what you don't know that will hurt you, it is what you do know that ain't so. --Mark Twain
We actually had step down nurses come to the ER and they were soo unfit for the E.R. ..I dont think we can generalize new grads, and say X amount of time on X floor = better ER Nurse. Ive seen seasoned floor nurses struggle, quit because they cant hack it, and staff who used to work as ER Techs exceed as soon as they graduate NS (extensive orientation on a monitored ..then step down ..then e.r.) I should also mention we're in a Trauma 2- 3
We have a comradery, everyone supports everyone. We actually had a new grad who was taking care of the Holding patients, we were soo supportive of her, still miss her to this day (didnt pass boards). So dont categorize ALL new grads because a handful arent fit for the ED. I know PLENTY of experienced nurses that are just as horrid.
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???
I think it depends on where you are and who you're working with. I know of 3 classmates (off the top of my head) who started in the ED, and they're doing exceptionally well.
I think the "know-it-alls" are just as bad as the "nurses who eat their own young": They are few and far in between, but 1 bad apple ruins the bunch...
Then again, I imagine all EDs are radically different, so, just because a NG can handle 1 ED, doesn't mean she can handle another one.
I think just as there are bad bank tellers and plumbers and garbage men....there are some bad nurses. Nothing worse than a nurse that thinks they're "done" learning and they've reached some "end of the line" intellectually.
ER nursing is so independent, yet interdependent - there is no place for know -it -alls.
When I was new to the ER, my daily prayer was "G*d bless me, bless my patients and protect us from each other."
As long as ya got a healthy respect for your own limitations - you'll go further than anyone. The other ones have already "finished" figuring it out. How sad for us and thier patients.
Thank you everyone! You've helped me plan my approach:nono: We do have protocols and standings for certain patient populations. It will all work out.
Feel better that it's not just me as the preceptor.
I believe new grads can make it in the ED as long as they choose a good mentor (not necessarily a designated preceptor), willing to learn , eager to be involved, and seek out education on their own.
I actually like new grads. (who are humble enough to learn)- it's like a blank canvus. Love to see them blossom into their own - first time watching them standing up for a patient, themselves, or a co-worker just makes me beam!
I've been a RN for nearly a year now and started as a new grad in the ER. I had my last semester high acuity rotation in the ER, so I was familiar with the atmosphere and protocols,etc. I think it's why they hired me on in the first place. I came in with an open mind and a very humble (but not timid) attitude. I got a 12 week clinical/didactic orientation and finally started to feel comfortable after the 12th week. By no means did I feel competent, but I knew I had tons of support and everyone (especially my mentor) was watching my back! THAT is the key to the success of a new grad. You don't feel that you have to exude a false confidence if everyone around you is supportive and not out to watch you screw up.
Even after a full year of being molded into an ER nurse, Lord knows I have soooo much more to learn. Hell, sometimes I say "I don't know" just to hear someone else explain their thought process. Never hurts to listen. However, I know that I'm a good nurse and if I can find the patience to allow myself more time and experience, I'll be an even better nurse!
Don't underestimate your new grads! For the most part, if you give us a chance, we'll work our a**es off and you'll see the benefits!
Like i tell new grads in the Er experience is EARNED along with respect so if you want to be respected you must respect others. Iv been an ER nurse fo 16 years and still learn new things and new ways to do things from others and im grateful they have knowledge to share with me, Er nurses are made to sponge information from each other. Like i told a new grad once who was inappropriately and completely wrong , iv probaly forgot more than you know. Like Mark Twain said once never pass up the opportunity to say nothing. Like the old timers who trained me , if they ran across something like your dealing with they d let them learn the hard way , sometimes the best lessons learned are those you learn the hardway . Hope the situation gets better for you Bryan RN
Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
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?
Be it by protocol or "common sense" - you need an ordering MD to validate starting an IV. Bottom line, I don't believe ANY board of nursing allows the ordering of any medical devices (Eg: an IV) as "independent" nurisng practice.
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jjjoy, LPN
2,801 Posts
I also wonder if in the case of not starting an IV if your facility DOES have an explicit policy that the nurse SHOULD start an IV in case of XYZ.
Just telling a newbie "you need to do that" isn't enough, no matter how good the rationale is. If there isn't a clear protocol, the newbie is doing the right thing to NOT initiate something that needs an order.