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:
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 just recently passed my boards and will start in a month at a Trauma Level 1 ER. I think it's should be on a person to person basis. There are some people that are just strong minded, it doesn't mean ALL new grads should be forbidden from starting in an ER. I keep hearing that, but from clinical, I know that floor nursing is NOT for me. I would get burnt out quicker that way than doing something I love.
I just recently passed my boards and will start in a month at a Trauma Level 1 ER. I think it's should be on a person to person basis. There are some people that are just strong minded, it doesn't mean ALL new grads should be forbidden from starting in an ER. I keep hearing that, but from clinical, I know that floor nursing is NOT for me. I would get burnt out quicker that way than doing something I love.
Don't worry. Some nurses are just old school about paying your dues on the med-surg floor. The ENA has an excellent curriculum [ENCC-Emergency Nurse Core Curriculum] that many level I trauma centers use to educate the newbies. With the right training program, educator and preceptor, you will do very well. Anyway, with the amount of holds in today's ERs (those that are admitted but have no room available), you will get your med-surg, tele and ICU experience. Nowadays, it seems that there are more holds than actual emergency patients.
I just recently passed my boards and will start in a month at a Trauma Level 1 ER. I think it's should be on a person to person basis. There are some people that are just strong minded, it doesn't mean ALL new grads should be forbidden from starting in an ER. I keep hearing that, but from clinical, I know that floor nursing is NOT for me. I would get burnt out quicker that way than doing something I love.
Congratulations!!! Have fun, learn a lot and good luck!!!!!
Don't worry. Some nurses are just old school about paying your dues on the med-surg floor. The ENA has an excellent curriculum [ENCC-Emergency Nurse Core Curriculum] that many level I trauma centers use to educate the newbies. With the right training program, educator and preceptor, you will do very well. Anyway, with the amount of holds in today's ERs (those that are admitted but have no room available), you will get your med-surg, tele and ICU experience. Nowadays, it seems that there are more holds than actual emergency patients.
I am old school-- but unless your precepting program allows your preceptor the luxury of teaching and training and NOT having to do this and maintain their normal work assignment, then look elsewhere.
Training inexperienced nurses while caring for your own assignment is very difficult and unfair to the preceptor who is pressured to keep up the pace with their interventions to keep the pts moving through the dept AND expected to take the time to explain evverything they are doing, the WHYs for what they're doing and then delaying interventions so the new nurse can 'try' the procedure themselves
I had to actually TEACH nurses how to give an IM, IV starts, etc. I had to find time to get them trained through PYXIS, med validation, etc while I was caring for my own group. I felt so bad for this girl because she was getting the bare minimum. When I was the educator, it was fine, we spent the morning going over certain systems, assessment, equipment and then we took patients at a rate that we could LEARN from. I was not considered part of the 'team' those days so I had no assignment, and could take the time needed to train appropriately
Now, our manager has gotten rid of the educator positon (she wants an education committee instead so needless to say there has been no education) and staff are given new grads with no prior hospital experience to train as well as care for 4-5 patients at a time. We get these nurses for about 2-3 days and then they switch to someone else, new shifts. There is no continuity to their training. These new nurses are often given no explanations, no information about why things are being done in a certain way because the nurse is just too busy
THESE are the grads who don't make it through orientation. The ones that were ED techs, or had M/S experience, etc managed to make it through because they were not totally unfamiliar with the words being used, the meds being given, the disease processes being treated, etc
So, new grads-check out your orientation program. Find out about HOW you will be mentored in the ED. What other requirements would your preceptor be handling bESIDES your training (at least initially)
I am old school-- but unless your precepting program allows your preceptor the luxury of teaching and training and NOT having to do this and maintain their normal work assignment, then look elsewhere.
Training inexperienced nurses while caring for your own assignment is very difficult and unfair to the preceptor who is pressured to keep up the pace with their interventions to keep the pts moving through the dept AND expected to take the time to explain evverything they are doing, the WHYs for what they're doing and then delaying interventions so the new nurse can 'try' the procedure themselves
I had to actually TEACH nurses how to give an IM, IV starts, etc. I had to find time to get them trained through PYXIS, med validation, etc while I was caring for my own group. I felt so bad for this girl because she was getting the bare minimum. When I was the educator, it was fine, we spent the morning going over certain systems, assessment, equipment and then we took patients at a rate that we could LEARN from. I was not considered part of the 'team' those days so I had no assignment, and could take the time needed to train appropriately
Now, our manager has gotten rid of the educator positon (she wants an education committee instead so needless to say there has been no education) and staff are given new grads with no prior hospital experience to train as well as care for 4-5 patients at a time. We get these nurses for about 2-3 days and then they switch to someone else, new shifts. There is no continuity to their training. These new nurses are often given no explanations, no information about why things are being done in a certain way because the nurse is just too busy
THESE are the grads who don't make it through orientation. The ones that were ED techs, or had M/S experience, etc managed to make it through because they were not totally unfamiliar with the words being used, the meds being given, the disease processes being treated, etc
So, new grads-check out your orientation program. Find out about HOW you will be mentored in the ED. What other requirements would your preceptor be handling bESIDES your training (at least initially)
Good luck
You volunteered to precept right?????????? If you hate it...don't do it.
No- I was the educator-- I love to teach, the educator position was removed by the ED director, and the staff nurse who does the scheduling just assigns new grads to various staff members who are working that day.
I love to orient and no where did I say that I did not-- but I want these new nurses to get a GOOD orientation, not have to deal with different nurses on different days so there is no continuation or follow through on previous learning. These new nurses NEED consistency and time for explanations.
If you're new to the ED , you need to make sure the orientation program will meet your needs in order to be successful, and not just toss you in with the staff and hope everything clicks. Having prior experience before heading to a specialty area helps you out. You get the basics in a setting where you don't need to make frequent, continual critical decisions. You have a foundation in place with prior experience that benefits you before you go to a critical or specialty area. If you are a new nurse and are going to a specialty area and don't have that foundation in place, then my advice is to check out your orientation program thoroughly so you know what you will be getting into
When I trained new GNS, I was removed from the clinical schedule for 3-4 weeks - by then, the GNS were more comfortable with the flow, the equipment, they only had to work on documenting (we have a very POOR computer system) on 1-2 patients, they were able to float to other areas if something interesting was occurring to observe with me explaining what was occurring, they had the ability to do procedures on patients with me one on one-- not under pressure because "we have to get it in NOW"--
We had the ENA modules which are excellent-I think our director put them in a box somewhere with the rest of my files- (we no longer use them because the orientation program is no longer the way it was)
You volunteered to precept right?????????? If you hate it...don't do it.
It sounds as though she was merely trying to point out how the new grads were being hung out to dry by a educational component that was lacking in their orientation. That is just sad. It sounds like, as a preceptor, she was aware of the struggles and was perhaps trying to make a difference to those new grads that will want to go into the ER. It IS a good idea for them to know what they should expect on the front end.
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.
standing orders (ED protocols) are (hopefully) in an ER for CP, abdominal pain, SOB, that kind of thing... which means that a nurse can take the initiative to start that line, draw labs, order the rads appropriate to the c/c... BUT the protocols are orders that have been approved by the docs.
But then I did work in an ER that did not have protocols, except if a person came in diaphoretic, gray, sob.... if you didn't start a line, fluids, while someone was yelling for the doc, your butt would be on the line. And that's an understatement.
There is a certain amount of autonomy that should be provided to an ER nurse - you know what needs to be done, well.... you know there are those that don't know and won't lift a finger...
It is quite frustrating, though, when you know what is needed but don't have that M.D. or D.O. behind your name to get it done. Guess that means it's time to go back to school!
...the educator position was removed by the ED director, and the staff nurse who does the scheduling just assigns new grads to various staff members who are working that day...
It sounds as though she was merely trying to point out how the new grads were being hung out to dry by a educational component that was lacking in their orientation. That is just sad. It sounds like, as a preceptor, she was aware of the struggles and was perhaps trying to make a difference to those new grads that will want to go into the ER. It IS a good idea for them to know what they should expect on the front end.
Exactly!! And that inexperienced nurses will have MORE difficulty in these situations than those with some experience. So, if you're new to nursing--make sure you are signing up to train in an environment that will be accomodating to your needs
SMY2367
12 Posts
I just recently passed my boards and will start in a month at a Trauma Level 1 ER. I think it's should be on a person to person basis. There are some people that are just strong minded, it doesn't mean ALL new grads should be forbidden from starting in an ER. I keep hearing that, but from clinical, I know that floor nursing is NOT for me. I would get burnt out quicker that way than doing something I love.