New grad staffing on speciality units

[greyseal]

Hi

I work on a new telemetry unit, 21 beds. Our new unit is staffed with 75% new grads and nurses with less than one year experience, the rest of us have differing backgrounds, sub-acute, long-term care, med-surg. No one has any experience with telemetry. About 8 of us had a 6 week orientation on the other tele unit. All 8 of us are spread out on the shifts, most on days. All nurses are required to take a 3 day class on cardiac-tele nursing, which by the way we took months and months ago.

Our hospital does interventional caths, open-heart surgery, etc. Our unit also has surgical patients that require tele monitoring after surgery.

I do charge 7p-7a on all my scheduled shifts. There is no one on nights (on the unit) to use as a resource or to just pick up on subtle changes in rhythms. There are rapid response nurses, supervisors, etc to call, but I feel we first need to know that there is a problem in the first place. The major arrythmias we can pick up on, but as any tele nurse knows some are subtle and it takes years of experience to pick this up.

Has anyone had any experience with this type of staffing on a speciality unit? We also have two other tele units who are staffed well with a nice balance of experienced and new grads.

I really feel unsafe and it is just a matter of time before something happens. We have had tele about 4 months and the unit has been open about 8 months. I have spoken about this to my managers but they don't agree.

[Q.]

Unfortunately, this was typical on my labor and delivery unit. After one year of experience, I was charge nurse on the PM and night shifts; over 75% of our staff was new grads, new nurses to L&D, or travelers. And I was to be the "resource?" It was very unsettling. As a new grad myself I remember working on nights and having ONE experienced charge nurse who was the nursery nurse, stuck in the nursery and unable to monitor much of what was going on in Labor, much less post-partum. It was very unsettling.

With the high turnover and lack of nurses, this is the type of staffing that is commonplace. And that's because organizations don't seem to find a value in experienced nurses or think much about retention. Myself, after 5 years, left. There was a new grad to replace me.

[seanymph]

I want to start out by saying this is my own opinion and I don't want to offend anyone.

I am a strong believer that all new grads need to do at least one year of med/surg before doing any specialty unit. I have worked OB for 7 years and cringe everytime I have to work with just me and a new grad, especially since I work nights.

When I received my RN I was orientated for 1 month then was the night charge nurse. There were many nights I was in tears before we ever got out of report!

Godd luck.

[Lela RN]

I also agree with Dawn, that new nurses should have at least 6 months to a year as med- surg. nurses, or work mother-baby prior to just jumping right into L&D. Specialties aren't to be taken litely, you have to know what your doing right away, where as med-surg is a little bit more flexible.

Personally I've been an RN for 3 years in med-surg and I'm just starting in ICU. It bothers me to have had to pay my dues for 3 years after nursing school before finally being able to get here; then to see a new grad be able to jump right into a specialty. Not that a lot of them aren't good, cause some are very smart and fresh. But there's the "seasoning" that only comes with time. Crawling before you walk- so to speak.

[llg, PhD, RN]

About the "you must work a year on med-surg before going to a specialty unit" belief. I really don't think that applies in all cases. It really depends on the new grad, the specific unit and how much support they can offer, etc. For example, some students work in ICU's as nursing assistants or summer externs and others do extended ICU preceptorships in their senior year. Some of these students can handle the ICU as new grads. Some units offer extended orientations and mentorship programs that make it easier for new grads. One has to take such factors into consideration before making a judgment about whether or not a new grad can handle a specialty unit.

I have coordinated NICU orientation programs in a couple of different hospitals for years and now work in an all children's hospital. All of the educators in my institution believe that a year on an adult med-surg floor does little good for a new grad planning to go into pediatrics. In fact, it can make her orientation a lot more difficult in a couple of ways.

(1) When the nurse switches from adults to peds after a year or two of practice, she may feel as if the rug has been pulled out from under her. Just as she has come to feel comfortable with her judgments about adults, suddenly, she'll be in a whole new field and have to go back to being a "beginner" again. She'll have to establish an entirely new foundation of what's normal, how to things, etc. I have seem many, many good nurses struggle with this change and go back to working with adults -- not because they don't like pediatrics, but because they don't like "feeling like a beginner" again.

(2) The skills of some units, such as NICU, are so dramatically different from adult med-surg that the experience isn't of much use.

(3) Things come up in a person's life (e.g. marriage, children, etc.) that sometimes make it easier to stay in your old job than take a risk and try a new one. I can't tell you how many people I have interviewed for jobs who have said, "I always wanted to work in NICU, but I was told that I should work adult med-surg first. Then things happened and it just never seemed like a good time to try it. Now I wish I had tried it when I was younger."

Each situation should be considered on its own merits. What is best for one person may not be best for another.

llg

[sjoe]

I also agree with Dawn. Some people might need more than a year to pick up the basic assessment, organization, judgment, medication, communication, and equipment-handling skills--but I doubt many people could learn these things in less than a year. At least, I wouldn't want any of them "specializing" on me.