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 Emergency/Trauma/Critical Care Nursing.
well im a new grad so i don't think its possibly to feel "comfy" anywhere just yet, but during my last semester of school on a stepdown unit while i was a nurse extern in the er, i was so BORED, or frustrated @ their policies, i mean some of these nurses would just wait for a phlebotomist to come for a blood draw even if it meant waiting two hours, for a STAT abg... they simply didn't feel they knew how, OR were too damn lazy, i wanted to jump in there and be like omg this is the easiest think to do, give me the flippin kit and be gone lol... but of course i could never do that.. so my point is.. well i forgot where i was planning to go with this coz my lunesta is kickin in and now im rambling... well even more so now that i just told u all that. wow i look crazy, END OF MESSAGE
ps not sure what i was writing in the last half of the msg.. HAHA lunesta makes me loopey!
oh i remembered another thing i wanted to ask... what "perks" or whatever does one get if they sign up for the premium service here... i dont wanna pay just to have a cute screename w/a pix lol
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.
THANK YOU! I started as a new grad in the ED and asked from the first day to see the protocols and procedure manual. The what? no one, not even the nurse manager could tell me where it was.
I found them 5 months later, in a cabinet far, far, away from the treatment areas and the last update put in was dated 2001. Can you believe it?
That's my main complaint about working. Everyone talks about following protocol, but when it comes down to it, the protocols are not provided to most new hires during orientation. Oh, except the protocol on having your nails be less than 1/4 inch in length. I got a copy of that protocol 3 times.
It's very frustrating when you're new, you want the information so you know you're doing things according to rules, not assumptions and no one can give you a straight answer.
Don't blame the new grads, blame the awful orientation programs.
Are nurses allowed to do art sticks for ABGs where you are?
We do art sticks all the time in the ER, or if respiratory is already at bedside, we can ask them to do it. I'm curious, are the floors are able to do them too (of course with orders)? With an inservice or training, I don't see why not.
We do art sticks all the time in the ER or if respiratory is already at bedside, we can ask them to do it. I'm curious, are the floors are able to do them too (of course with orders)? With an inservice or training, I don't see why not.[/quote']
I think it varies according to facility. Most facilities that I have worked at in this area do not allow nurses to do art sticks... neither ICU nor ED. The few places that I have worked at that have let me do them are all ICUs. sometimes I'm told it's a turf thing with the RT's. I mean if you trust an ICU nurse to D/C an A-line, why not to hold pressure after an art stick?
When I was orienting in a very busy level 1 trauma SICU (that had open-heart, trauma, ventrics, IABP, CVVH, blah blah blah), my preceptor and I had, AT WORST, 2 unstable patients. All days are not the worst. There was time to read the ICU BOOK, do research and get to know my patients, to practice thermodilution CO's, to watch the progression of disease in one patient over days and even weeks, to sit in rounds for 30 minutes for each patient and learn, learn, learn. It was FABULOUS! : ) Morale on my unit pretty much sucked since a good 40% of the nurses didn't feel newbies belonged there. But if you were tough enough and motivated enough, you could learn enough (with a good didactic portion of course) and be a safe and strong nurse. Above all, one learned the disease process and critical thinking.
After 4 years of working in ICU, I moved to ED about 5 months ago. I will say that I was a paramedic and ER unit secretary for 5 years before even going to nursing school so it's not like I didn't have any experience in it when I graduated.
Well my point is, and this is just my opinion, that it is almost impossible to learn the disease process in the ED simply because you don't keep patients long enough. Yet you need to have an instinct about what's going on with your patients before they're even assessed by the doc and I feel that a large part of that instinct is based on knowledge of the disease process. And not just silly stuff you read in textbooks. I'm not saying you can't get those skills in the ED, but you have the competing challenge of learning to manage the traffic and get everything done super fast which doesn't happen so much in ICU. Now I know if someone had told me that a year ago, I would have disagreed but now I really see it.
I think previous experience is necessary for ICU. It's very overwhelming especially for a new grad.
Well obviously we would not aggree on this..as I was and still am I guess a new grad in ICU. One year down..who knows how many to come. I think it can go either way...really dependant on your orientation. I really got two seperate orientations, the first was awful I thought every day...maybe they are right new grads do not belong here!! Then I went through the second one..OMG night and day!! I feel good about what I know, and when to ask questions! It can really be career changing your orientation!
Well obviously we would not aggree on this..as I was and still am I guess a new grad in ICU. One year down..who knows how many to come. I think it can go either way...really dependant on your orientation. I really got two seperate orientations, the first was awful I thought every day...maybe they are right new grads do not belong here!! Then I went through the second one..OMG night and day!! I feel good about what I know, and when to ask questions! It can really be career changing your orientation!
It just depends on your orientation and the hospital. The last hospital I worked at, they hired new grads in the ICU but they were not very nice to them, not very nurturing to their growth. My friend started there and after a month on orientation, he was sent to another floor..to work med/surg. I started on progressive care right out of school and that was as close to ICU as I wanted to be because even though we were stepdown, our acuity was as high as an ICU. I opted to leave that hospital and go to another where even though I had two years of experience, my orientation was awesome for the icu. It was nine weeks, I actually thought it was gonna be longer than that. Orientation is really key.
RN1982
3,362 Posts
LOL. to each hiis own. If you feel comfy thats all that matters.