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?"
Hi. I will be starting in the ER as a new grad next month at a level one trauma hospital in Los Angeles. It is extremely busy. And I will only have six weeks of orientation. I will not be one of those who think they know the answer, because I may not. I dont know why everyone thinks that new grads are like this. Everyone is telling me that new grads dont belong in the ER and Im really getting discouraged. I know all of you didnt go into the ER knowing everything...We all have to start somewhere. Maybe thats why new grads fail because they think they know everything, but how can we? Weve only had clinicals...but maybe they should be told that up front. Those are my two cents...Wish me luck as I enter the world of the ER...I KNOW I wont "know everything" I need the experienced nurses, you guys are what keeps the world of nursing going...We need each other...I hope I do great :)
You have to document! Let your unit educator or manager know also, arrange a conference. Nothing is more deadly than a new RN who thinks
'they know everything' and won't listen. When I was a manager, this was the RN who after counseling and mentoring wouldn't change; had to go before they killed someone.
When I precept a new nurse to the hospital or a new grad, I explain what i am doing and why I'm doing it. IE putting a heplock in the chest painer, nitro (if not contraindicated by allergy) ASA, O2, even before I call the doc.
The ER I work in does not have protocols...and of course common sense should prevail always. It is a one nurse show with the doc in the hospital and you have to call him to come down...I try to get as much done before he/she comes...but I tell you what! One patient came in with complete liver failure...jandiced as all get out, the doc came in while I was starting an IV and drawing blood..he said "so I see YOU decided to start an IV...." and I said yes, and he repeated the same statement again with the emphasis on decided. He told me to take it out.
I was flabbergasted!
Then he wrote admit orders...to the ICU (of course) and wanted an IV (of course).
I have been an RN for two years, but with 29 years of progressive clinical experience. EMT, then EMT-P when they made Paramedics, a Navy Corpsman and then an LVN when LVN's in CA were able to practice in acute care.
So maybe I was not the typical new grad.
Having said that, I was in a program (Emergency Nurse Training Program) led by two nationally recognized RNs, the Nurse Educator and CNS.
Our program took both new grads as well as Nurses from MS.
It is a year of didactic and progressive clinical experience.
I can't think of a single Nurse in three cycles of programs who had the afforementioned know it all attitude. Rather the preceptors did... Even if for instance, the preceptee was more knowledgeable than the preceptor....
We all learned to be professional with a modicum of humility.
So, new grads can become rock stars, but it is really up to the leadership team, open minded preceptors, and the individual.
There is a pretty tough attrition rate, but that is for a reason.
Yes, Nurses eat their young. So instead of generalizing about new grads think about how tough it was for you in the stressful environment of the ED.
We all make mistakes. I have caught 4 huge med errors from Nurses with over 15 years at my place...According to a study, it is more likely to have the experienced Nurse make a med error.
As new Nurses, we are scared to death of harming our patients and most of us are taught to take our time, look up meds and do the right thing.
I would suck being a MS Nurse, but do well in the ED. Apples and oranges, I respect MS Nurses as it too is a specialty in my opinion.
As long as New Grads have a solid education followed by a wonderful program to nurture them, all is well.
I am just a lucky guy to have been trained by a lot of great Nurses. I had to ask to have different preceptors during my program as it was not a good fit. The leadership team accepted this, and the problems with former preceptors dissappeared once I finished the Program and we became professional colleagues.
clairebearrn
317 Posts
"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?"
Hi. I will be starting in the ER as a new grad next month at a level one trauma hospital in Los Angeles. It is extremely busy. And I will only have six weeks of orientation. I will not be one of those who think they know the answer, because I may not. I dont know why everyone thinks that new grads are like this. Everyone is telling me that new grads dont belong in the ER and Im really getting discouraged.
I know all of you didnt go into the ER knowing everything...We all have to start somewhere. Maybe thats why new grads fail because they think they know everything, but how can we? Weve only had clinicals...but maybe they should be told that up front. Those are my two cents...Wish me luck as I enter the world of the ER...I KNOW I wont "know everything" I need the experienced nurses, you guys are what keeps the world of nursing going...We need each other...I hope I do great :)