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:
Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
I have to give kudos to 2 of my most recent "new grads" in our ER...
We are a LVL I, University/Teaching ER with annual visits of 160K. We have over 100 beds in our ER. Anyways, these two NEW GRADS from CLEMSON University are both awesome "go-getters". They are proactive, self directed and VERY responsive to critiques and advice. They have already secured the respect of their peers.
And then to top it off, they both ponied up the money to attend a 2-day CEN review class I did for our region, mostly just to increase their knowledge base, AND to get their CEN credential....
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.
A protocol is a list of orders, that is your validation. Medical committees meet and decide what they want on these lists of orders. Starting an IV in ER would no more be considered an independent practice than utilizing a preset potassium sliding scale order based on the lab value. Most physicians would be annoyed if an ER RN did not use critical thinking and nursing judgment if a patient came in with chest pain and did not start an IV, but rather chose to wait around for an order and let said patient deteriorate. I will say that some protocols need stricter and more clear guidelines to follow, otherwise would need clarification from an MD. That's just my
Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
If it's protocols or standing orders, you can be assured that some MD has signed off on them to make them active. Probably your medical director. You will not have a standing order set or protocol set that was authorized without a MD on board.
I started in ER as a new grad, it was tough and sometimes I wish I had started in ICU, but the floor? Would not help someone in ER all that much. You would only learn nursing basics, not critical thinking if you started on the floor. If you do start in ER, Have tough skin and a humble attitude!! Good Luck
My background: 1990 certified as an EMT transport exp. 1998-2006 NREMT-P with FD exp. 2001-2006 ER Tech. 2007-Present RN.
I am a "newbie". I graduated from nursing school and my first position was/is the ER.
First off, I do agree that the ER is not the place for every new grad. (that can also be said of "seasoned" nurses) but I do get tired of hearing Er nurses in general say "the Er is no place for a new grad". Instead of eating your young why not encourage them.
I personally have had no problems adjusting to the ER. Perhaps that is directly related to my background, who knows but I do have my days where I feel overwhelmed and those are the days when I ask for help. I dont feel as if "I know it all", just the opposite, I look at every shift as the opportunity to learn something new and I usually do. Many, many times I find myself seeking the direction of more experienced nurses. I am not embarrassed to ask for advice.
I will not however take direction or receive instruction from a nurse who looks down on me because I am "new" regardless of the number of years of experience that nurse has. Perhaps the nurses you are referring to in your original post are indeed idiots, they are everywhere, but you should also remember to keep your own attitude in check.
Just my 2 cents worth.
BTW: I agree, not putting a line in a chest pain is just dumb and setting yourself up for trouble.
If it's protocols or standing orders, you can be assured that some MD has signed off on them to make them active. Probably your medical director. You will not have a standing order set or protocol set that was authorized without a MD on board.
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.
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Personally, I think previous experience is not necessary for ICU but I think it's absolutely necessary for ER.
Specializes in Emergency/Trauma/Critical Care Nursing.
I'm a new grad in the ER and i have to say, it's such a disappointment to see some nurses on here, and in real life with such a dislike for new nurses. Throughout nursing school I encountered many "seasoned nurses" that it didn't matter how many years of experience they had, i would NEVER want them as my nurse. they were resistent to any sort of new technology, techniques, or ways of thinking, and i feel that makes them no better than all of these "know it all new grads" that they hate. furthermore, these "seasoned vets" were unwilling to share their knowledge/experience w/us nursing students, as if we were nothing more than a bother.. at what point in my nursing career should i expect to start forgetting how hard it was when i was new, and start thinking i'm better that anyone else? i just want to know so i can plan ahead to retire at that point because if i don't have enough respect for my profession to encourage the newcomers, then i don't deserve to be in that profession anymore.
its very nice to see the people that DID stick up for us new grads though, they obviously haven't forgotten that we are all working for the same reasons, we care!
In addition to being a new grad, i'm a new grad hired into a level one major trauma ceneter in Detroit, and was only an extern for 5months there before that. However, my nsg coworkers are so encouraging and willing to teach me things, or different approaches to things because it reminds them that nursing IS exciting, it only gets boring when you don't care about your job anymore. I work with other new nurses that came from working on GPUs and i can honestly say that they are no more skilled for this job than i am. some of them have told me that on the med/surg floors everything was laid out for them i.e. detailed MARs, detailed pt history etc in the charts, general assessment templates etc, the ER, at least the one i work in, is nothing like that, u need to use ur nsg math skills to calculate those IVs and drip rates, (most of the other newbies freaked out when they found out they weren't gonna get to use a pump to hang a liter of NS) u need to be able to type detailed nursing notes off the top of ur head, u can't just check YES/NO or circle answers on an assessment sheet.
therefore i think i actually am MORE successful starting right into ER and using all of those skills i learned in school rather than work GPU for a few years first and not remember them by the time i get to ER.
just my opinion.. long winded, but still, my opinion:igtsyt::prdnrs:
I'm a new grad in the ER and i have to say, it's such a disappointment to see some nurses on here, and in real life with such a dislike for new nurses. Throughout nursing school I encountered many "seasoned nurses" that it didn't matter how many years of experience they had, i would NEVER want them as my nurse. they were resistent to any sort of new technology, techniques, or ways of thinking, and i feel that makes them no better than all of these "know it all new grads" that they hate. furthermore, these "seasoned vets" were unwilling to share their knowledge/experience w/us nursing students, as if we were nothing more than a bother.. at what point in my nursing career should i expect to start forgetting how hard it was when i was new, and start thinking i'm better that anyone else? i just want to know so i can plan ahead to retire at that point because if i don't have enough respect for my profession to encourage the newcomers, then i don't deserve to be in that profession anymore.
its very nice to see the people that DID stick up for us new grads though, they obviously haven't forgotten that we are all working for the same reasons, we care!
In addition to being a new grad, i'm a new grad hired into a level one major trauma ceneter in Detroit, and was only an extern for 5months there before that. However, my nsg coworkers are so encouraging and willing to teach me things, or different approaches to things because it reminds them that nursing IS exciting, it only gets boring when you don't care about your job anymore. I work with other new nurses that came from working on GPUs and i can honestly say that they are no more skilled for this job than i am. some of them have told me that on the med/surg floors everything was laid out for them i.e. detailed MARs, detailed pt history etc in the charts, general assessment templates etc, the ER, at least the one i work in, is nothing like that, u need to use ur nsg math skills to calculate those IVs and drip rates, (most of the other newbies freaked out when they found out they weren't gonna get to use a pump to hang a liter of NS) u need to be able to type detailed nursing notes off the top of ur head, u can't just check YES/NO or circle answers on an assessment sheet.
therefore i think i actually am MORE successful starting right into ER and using all of those skills i learned in school rather than work GPU for a few years first and not remember them by the time i get to ER.
just my opinion.. long winded, but still, my opinion:igtsyt::prdnrs:
Girl you must be a fellow Henry Ford RN. I work in SICU.
Specializes in Emergency/Trauma/Critical Care Nursing.
HA, thats too funny, i sure am at HFH, nice to meet ya. is SICU 4th floor? i STILL get so lost at that hospital, each floor w/600 different unit letters... i've taken pts goin to H5 to the CCU on a few occasions lol, i think the nurses in CCU just get a kick out of waiting to see who i'll bring next lol.
mwboswell
561 Posts
I have to give kudos to 2 of my most recent "new grads" in our ER...
We are a LVL I, University/Teaching ER with annual visits of 160K. We have over 100 beds in our ER. Anyways, these two NEW GRADS from CLEMSON University are both awesome "go-getters". They are proactive, self directed and VERY responsive to critiques and advice. They have already secured the respect of their peers.
And then to top it off, they both ponied up the money to attend a 2-day CEN review class I did for our region, mostly just to increase their knowledge base, AND to get their CEN credential....
My hats off to them!!!