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 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
Prior to making the ER move in 2004, I had worked with Oncology and dialysis patients, mainly (and med/surg before that). That tremendously translated to the ER for starting IV's, as most dialysis patients are very challenging to find access. Throw in more than a few regular Sickle Cell patients and you learn quite a bit about some rare things. I think having floor time is crucial to time management and organization. Absolutely.
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. here here! i couldn't have said it any better myself, there are those that really spread the bad, negative cloak over us on our shift. there are truly idiots at every facility. those are the times you find a nice patient to talk to, another nurse to help.... just get away from the idiot quick!
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.
what every nurse should realize is that we each bring individual thoughts and experiences to the job. it may be in nursing, but some may have been in iraq, afghanistan... many diverse and interesting backgrounds. that can really be a learning experience if some of those nurses would close their mouths and open their ears, they just might learn.
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.
The other possible reason these new nurses might be difficult with criticism might be because ER nurses can be so WITCHY to any change (be it new staff, new equipment, computers, etc.) Maybe to sit them down and talk to the new nurse and see what the deal is might be a start.
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
I understand where you're coming from - I have found that I need to keep my mouth shut and nod, rather than say anything. I come off the same way, I fear. It's definitely a personality thing. I try to always be aware of that and be mindful of that also when explaining something to another.
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!
what are handoff sheets given to the transporters?
I'm kind of put off by the fact that a new grad would not be willing to take advice and learn from experienced nurses. I remember my Introduction to Nursing class and the instructor told us the slowest way to success and the fastest way to make enemies is to walk in as a new grad thinking that we know everything. . . because we don't. Experienced nurses can be a new nurse's greatest asset starting out and why ignore their help because someday when their help is needed most they may decide that they don't want to help the new "know-it-all" nurse. I know that not all nurses think this way but some do. . .and I don't blame them at all. I'm doing my internship hours now and will be graduating in August and I am ready and willing to any advice that is given to me regardless of if I already know or not. . .because it doesn't hurt to hear something more than once! As far as what to do. . .besides kickin' them in the butt :chuckle . I don't know, because it is so hard to change that "know-it-all" mentality until something happens and they realize the error of their ways themselves. Hope everything works out for u!
So, I too do not agree with new grads in the ER. If they have worked as a tech in the ER, they succeed more readily. In the last few years we have failed numerous new grads because they are unsafe and don't listen. This summer at my facility we have 15, yes, 15 new grads training. I work in charge on night shift, and it is so stressful with all of these new grads running around behind them to make sure their pts are ok. I think we are "eating our young". Sorry all you new grads out there, just my opinion. Take all you can from the preceptorship, and listen.
new grads in the er...or so many of them...tend to be a liability. but, when you have so many tenure nurses leaving.....there's not much they can do. management likes new grads because they can mold them the way they want. we need to be patient and good teachers, work as a team, show them the ropes, teach them "our" way so that within a year they are wonderful members of a team. i was a new grad in the er, but i must admit i was an rrt for 14 years prior and that helped.....getting around the patient's and acute episodes. we need to welcome the new grads and realize that without them.....our jobs, our workload would be awful.....the healthcare system is in need of nurses....and we need to be thankful there are new nurses to replenish the suffering system we are now finding and fighting. i say welcome......is there anything i can help you with?
i have 1 year medsurg, and i think its a good experience.
i believe that *new* nurses should do atleast 1 year in medsurg, just to get a feel of it and what its like when the ER nurse agrees to send the patient to the wrong floor and has to be transfered to telemetry or icu within 30mins of being on the floor.
this has happened plenty of times at my hospital. just because the doc says to admit to regular floor with a cardiac history, doesnt mean its ok to send to a true regular floor with no telemetry whatsoever. you the nurse can question if its really ok, most of the time the doc will agree wit you.
i cant even count how many times i have to call the admitting doctor for a patient STILL in ER to make sure the doc knows exactly what kind of floor his patient is being sent to.
if there are new nurses in the ER ill be going to telling me how to do things, ill probably flip.
I certainly disagree with newbies who won't listen at all. I hope, though, that it IS okay for newbies to question what they are told. If something doesn't make sense or conflicts with what was previously learned, the newbie *should* ask questions, shouldn't they? To blindly accept and follow whatever an experienced nurse tells them, even if the reasoning isn't clear to them, isn't safe practice, is it? When I say "I hear what you're saying but I was taught XYZ in school" I don't mean, "you must be wrong and I'm right" I mean "please help me understand given the fact that I was taught XYZ which doesn't match up with what you're saying."
I certainly disagree with newbies who won't listen at all. I hope, though, that it IS okay for newbies to question what they are told. If something doesn't make sense or conflicts with what was previously learned, the newbie *should* ask questions, shouldn't they? To blindly accept and follow whatever an experienced nurse tells them, even if the reasoning isn't clear to them, isn't safe practice, is it? When I say "I hear what you're saying but I was taught XYZ in school" I don't mean, "you must be wrong and I'm right" I mean "please help me understand given the fact that I was taught XYZ which doesn't match up with what you're saying."
You ARE right - a new nurse to the ER may be questioning a "seasoned" ER nurse and that seasoned RN might not like it - that the new nurse is right. We ALLLL know this to be true. It's as if the new nurse, who knows better, just has to keep quiet and do it the right way, despite the seasoned nurse being wrong. Just like a previous poster wrote about existing staff not knowing where policies and ED protocols are.... it's a silent epidemic. As if the new nurses coming in are upstaging the ones who have been there awhile.... what's with the egos, I say!
so, i too do not agree with new grads in the er. if they have worked as a tech in the er, they succeed more readily. in the last few years we have failed numerous new grads because they are unsafe and don't listen. this summer at my facility we have 15, yes, 15 new grads training. i work in charge on night shift, and it is so stressful with all of these new grads running around behind them to make sure their pts are ok. i think we are "eating our young". sorry all you new grads out there, just my opinion. take all you can from the preceptorship, and listen.
MassED, BSN, RN
2,636 Posts
Prior to making the ER move in 2004, I had worked with Oncology and dialysis patients, mainly (and med/surg before that). That tremendously translated to the ER for starting IV's, as most dialysis patients are very challenging to find access. Throw in more than a few regular Sickle Cell patients and you learn quite a bit about some rare things.
I think having floor time is crucial to time management and organization. Absolutely.