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:
Are nurses allowed to do art sticks for ABGs where you are?
They can out here as well in the critical care areas, but most don't bother because the respiratory therapists are always around and they get a lot more practice at it.
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?
I'm a new grad starting in the ER next week... the ER I'm starting in hires new grads every year and the director told me during the interview when I was asking about orientation that its 12-16 weeks and if you aren't ready by 16 weeks they look to transfer you to another department that would be a better fit, but that so far they've never had to do that. All of their new grads have been successful there in the ER, and many still work there that started as new grads. I think it depends on the hospital, orientation, new grad and preceptor whether or not a new grad can be successful in the ER.
well this is the first year that we have had new grads in Ed, Previously we only had 2nd year grads. Personally I have not had many problems with 1st year grads and I think that it is a wonderful advancement to have them. But if you are the preceptor and your grads are not listening is that where the problem is? (No offence, I am not judging your precting skills). In our ED if there are issues with grads that cannot be resolved betwen them and the preceptor, then we get involved with the hospital wide grad preceptors (the ones who oversee the 1st and 2nd year program). But are we going back to the old argument about Uni trained v Hospital trained nurses? and another thought what about ED Nurses who have been in ED for a long time but fail to keep abreast of evidence based changes to best practice?
I was/am a new grad who graduated in Dec. 07. I am working at Detroit Receiving which is one of the busiest ER's in the country. I will admit it was a tough start and very overwhelming but with the advice and guidance of awesome "seasoned" nurses I feel as if I "kind of" know what I am doing at this point. I think it is horrible that new nurses feel as if they know it all and that is a sure fire way to compromise pt. care. I feel the ER can be a good place for new nurses who are willing to admit they do not know it all and willing to listen to the advice of others; it is not easy but can be done.
being an ER new grad is a tough job to start in, I know from experience, but I have had a very positive experience.
anywhere nurses work, nurses make mistakes because nurses are human and i think everyone should try and remember that. My preceptor was amazing and i thank god for for 4 monthes with her, but honestly it gets really old constantly being criticized (especially when you are trying to get your work done and your preceptor would rather speak to you about how you aren't going fast enough).
but yes, obviously you don't need to wait for the MD to order an IV on a patient who clearly needs IV meds or a route for meds incase something unplanned happens.
I had a preceptor gently pull me aside one day and tell me to "You are definitely a "go getter" and you jump in with enthusiasm. That's great stuff and the right kind of attitude for becoming a successful ER nurse. But you also come across as a 'know it all' sometimes. Be open to comments from other staff members and you'll go far".
I kinda, sorta have that problem - and it's not just the ER. I guess it's a personality trait. :imbar:imbarAnd it's something I try and work on every day of my life...
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.
SHAME ON YOUR PRECEPTOR, NURSE MANAGER AND CO-WORKERS!!!!!
Specializes in Emergency/Trauma/Critical Care Nursing.
Are nurses allowed to do art sticks for ABGs where you are?
yeah in my ED nurses ARE the ones who do the art sticks, the only time it seems i see respiratory is if we're transferring a patient from cat 1 or resus up to ICU and they're on a ventilator lol. i can't speak for the rest of the hospital, im not sure what their policies are, but our ED nurses have a LOT of autonomy. sorry it took so long to respond
Specializes in Emergency/Trauma/Critical Care Nursing.
michigan nurse, i just wanted to check in and see how u guys fared after the oh so fun JCAHO week? lol they came on like the WORST possible day in the ER, i have no idea how our only issues were the med reconciliations and a vial of expired insulin found in the pharmacy. it was hilarious to me to see the entire hospital just stop in their tracks and send EVERY transporter down to the ER to get rid of the pts asap. we never see transporters, we usally move a lot of pts ourselves, but honest to god that day they were LINED UP down the radiology hallway just waiting to get handoff sheets. it was the funniest thing!
I had a preceptor gently pull me aside one day and tell me to "You are definitely a "go getter" and you jump in with enthusiasm. That's great stuff and the right kind of attitude for becoming a successful ER nurse. But you also come across as a 'know it all' sometimes. Be open to comments from other staff members and you'll go far".
I kinda, sorta have that problem - and it's not just the ER. I guess it's a personality trait. :imbar:imbarAnd it's something I try and work on every day of my life...
Need to work harder on it, I guess :imbar
Hats off to your preceptor to have the guts & tact to have that conversation...and hats off to you my friend, for showing the maturity in taking constructive criticism.
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:
hate the know-it-allers of the nursing world!!!!!! hate hate hate 'em! I don't know what you should do, it's a tough position to be in. They are the ones who don't take constructive criticism. I'm perplexed when I come upon this as well - being a relatively new person to the ER that I am in now (a year in Massachusetts), I am constantly treated with the "you're new here, right?" Like I just stepped off the turnip truck and I'm a new nurse with zero experience. That is just as irritating. I have to bite my tongue and walk away.
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???
a nice long orientation with a very good preceptor!
smk1, LPN
2,195 Posts
They can out here as well in the critical care areas, but most don't bother because the respiratory therapists are always around and they get a lot more practice at it.