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:
Yes, it was a quite a surprise to me when I was told I was being returned to 'staff' nurse (I did 70% clinical, 30% off clinical to develop educational stuff for the staff), and during orientation weeks, I was off clinical for the first few days new hires would come to the dept to do the housekeeping stuff: dept orientation, med validation, policy/procedure stuff, equipment review, charting education. I had been training new staff since 1994 as the 'un official' educator.
Usually by the 2nd day, seasoned nurses were doing patients-- held back only because of our difficult computer system.
When GNs came, I had off clinical 3-4 weeks--worked great. I had developed a GN program in 2002, using a modular approach, added the ENA ones and they liked it.
I worry about these new nurses-we have lost several to the stress of orientation. New jobs are tough enough-
I understand that the ER is a busy place, and yes it is hard to manage your own patient plus teaching a new staff member. But think about the floors that are understaffed, it can be just as bad. I always found it funny that nurses during my clinical rotation hated working with students or new grads, its like they forgot that they were there once too...
Specializes in Emergency/Trauma/Critical Care Nursing.
what are handoff sheets given to the transporters?
hand off sheets are our ERs sheet that we print off and ad to the pts ER chart which has their most updated vitals, meds given, etc. because we use a program called emstat for our charting in the er and the rest of the hospital uses Careplus (which we also have access to), but the rest of the hospital can't access emstat to see whats been charted on that person since they've been in the ER. we also fax report to whichever floor it is that they're going to, but the handoff also has information for the transporter like the mode of transportation required, if they need an O2 tank w/them etc. hope that cleared it up
hand off sheets are our ERs sheet that we print off and ad to the pts ER chart which has their most updated vitals, meds given, etc. because we use a program called emstat for our charting in the er and the rest of the hospital uses Careplus (which we also have access to), but the rest of the hospital can't access emstat to see whats been charted on that person since they've been in the ER. we also fax report to whichever floor it is that they're going to, but the handoff also has information for the transporter like the mode of transportation required, if they need an O2 tank w/them etc. hope that cleared it up
that sounds quite efficient. No verbal handoff to the floor would be FANTASTIC, so you don't have to fight to talk with a nurse, get put on hold, hang up, get side-tracked with other EMERGENCIES (sheesh, imagine that!), call back, get hung up on, etc..... I love that idea. By the way, it just irks me that when a patient enters the ER and goes upstairs, it is one visit for the facility, ONE medical record, so the systems should communicate to facilitate flow. Just stupid that they don't. I always blame this on IT's capability, or lack of support or attention. Perhaps there needs to be a clinical person in IT for them to understand the importance of this transition from ER to floor. How ridiculous, and I'm sure irritating for the floor nurses as well.
Specializes in Emergency/Trauma/Critical Care Nursing.
even though the floor nurses don't use emstat, the sheets we print off in the "handoff sheet" is a pretty good summarization of what actually WAS done in the er and thus reflects our emstat charting. however, the MDs using that emstat phys thing i was lking about to put in their primary med history, their diagnosis, home meds, order meds, etc but they do a lot of their MAIN charting on CAREPLUS which is what the rest of the hospital uses so they get a pretty good idea of whats coming up to see them. whether the floor nurses like it or not i have no idea, but i know us ER staff are so glad to not have to call them lol fax it to em and say bye!
We used a transfer type of report that we faxed up to the floor - (that was when our mgt decided we shouldn't phone report anymore)
I think filling it out helps when giving report so the actual phone report is smooth, all your info is right there. It's a great teaching tool for new nurses so they can learn what the key points are in giving a report and then there's a hard copy to refer to for the floor nurse
In my many years of practice and orientating many different ages of nurses, it was always the ones who didn't ask questions who really scared me. And this was seasoned as well as young nurses. Every floor and specialty does things a little differently, and for one to never ask a question or take notes, truely astonished me!!! I had questions every day of my career and learned something every day. I actually wondered if something was wrong with me??? Not really!!
I worked with an older nurse who became a nurse late in life and really lacked confidence. She would always criticize the "orientation" I gave her to anyone who would listen and when she had a question or needed input, do you think she would take some one's advice, no she did it just the way she was going to do it all along!!!
It made me realize I was the better nurse, because as a nurse you can never know everything and I would rather ask questions and do the best for my patients I could possibly do, and along the way learning all the time.
Our hospital closed its psych ward years ago and a seasoned psych nurse came to work with us and so appreciated everything I taught her and she always let me know how grateful she was for letting her stay in nursing and learning a new specialty. And that is about the only nursing she did all her life. So, you meet all kinds in nursing and although I am not an ER nurse, the same thing applies, right!!!!
Good luck to all of you!! you do a hard job and I know because I was a frequent:yeah: flyer for 3-4 years till finally diagnosed with autoimmune problems and ankylosing spondylitis and fibromyalgia, but that is another whole story I want to write a book about some day!!!
And I realize if families on the floors are demanding, then ER families are many times that!!!!
Thanks for doing all you do for those of us who are ill and needing care. It is no fun being on the other end!!!!c God Bless all of you!!!
Specializes in NICU, Peds, ICU/CCU, Cathlb,ER, Flight.
It takes alot of guts for a new grad to put themselves into a busy ED. I've precepted many of them & have asked to not do this anymore. It's exhausting & most of them leave after a yr., if they last that long.
One of the worst things I've seen is when our egghead manager hired a new grad as a full time charge nurse. She had no skills at managing other people & it was obvious to most that she was in over her head. She wrote people up, spent most of the shift in the mgr's office, & was one of the most passive-aggressive people that I've ever met. When I worked under her, she tried working me to death.
If they can't carry their load after a yr., they should leave the ED. Alot of us experienced nurses get very tired of helping them manage their pts. Some new grads have surprised me, but the ones who act like they know it all are usually downright dangerous. Then again, any nurse or Dr. who thinks they know it all are dangerous to the patients.
Specializes in tele floor,cardiac icu,emergency room.
I have seen many new grads succeed in the ER but they come in with common sense and a good knowledge base. I feel that it depends on what the orientation package is. Where I worked, they gave you 8-12 weeks but they are doing everything that other nurses are doing because we were so busy. The resources were not implemented appropriately. When I went to ER 6 years ago from ICU I was put out in triage on the second day without ever being told what I was suppose to do and I also had a patient in the back. Not safe.... It just depends on the person and the resources that are available to you.
Specializes in Adult and Pediatric Vascular Access, Paramedic.
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 disagree with you. I am a year into working as an ER RN and I began as a new grad. I have been told I am one of the best new hires. Not everyone who is a new grad is cut out to start in the ER, but that doesn't mean the oppertunity should be lost on others, like myself, who end up doing just fine. The ER I work in is pretty busy, and so far I love it.
wow! strongly opinionated. i was a new grad that started in the er (er tech experienced). and my er hires new grads often. i work in a very large and busy er in the city (level 2 trauma center, private hospital) and my clinical coordinator has been in her position for almost 2 decades. we run quite smoothly considering the volume that we see. it is her opinion that new grads can succeed in the er and she has proven this opinion time and time again. one of the best er nurses i know graduated a couple of months after i did and started in the er. as for starting iv's on particular patients...our er has protocols in place for "chest pain" and "abd pain" etc. this helps new grads, and seasoned nurses also, to be confident in their "triage" and helps docs to have labs available asap. as for the preceptor that was concerned w/ new grads "knowing it all", my opinion is that you just cant take that personally. each individual has a different personality and some of us have egos. i have watched many many new grads begin their careers in the er and very few have had an ego that was dangerous. i've always heard that "nurses eat their young" and i noticed that while working on a neuro floor as a nurse tech but not in my particular er. my seasoned er nurses take us under their wings and guide us. they give us encouragement and they praise us for a job well done. they give us constructive criticism where it is due. maybe i'm one of the lucky ones but i've never regretted beginning my career in the emergency department and i can't imagine not being employed in the er. i'm almost 3 yrs deep now and i cherish the good times and learn immensely important life and career lessons w/ the tough times.
needsmore$
237 Posts
Yes, it was a quite a surprise to me when I was told I was being returned to 'staff' nurse (I did 70% clinical, 30% off clinical to develop educational stuff for the staff), and during orientation weeks, I was off clinical for the first few days new hires would come to the dept to do the housekeeping stuff: dept orientation, med validation, policy/procedure stuff, equipment review, charting education. I had been training new staff since 1994 as the 'un official' educator.
Usually by the 2nd day, seasoned nurses were doing patients-- held back only because of our difficult computer system.
When GNs came, I had off clinical 3-4 weeks--worked great. I had developed a GN program in 2002, using a modular approach, added the ENA ones and they liked it.
I worry about these new nurses-we have lost several to the stress of orientation. New jobs are tough enough-