I would like to hear what you think of new grads starting out in the Emergency Department. I just finished an Accelerated BSN program. Some of my classmates are starting in the ER.
My clinical instructor and my preceptor killed my chances by giving weak references and using the "everyone needs to start in Med/Surg". But I loved my clinical preceptorship in the ER and another (more experienced than my preceptor) nurse even said I should apply to work in the ED.
I am a 46-yo, ex-accountant, no medical background, but I did have straight-A's in our program.
I work in ER and see many new grads...floundering...I don't care what your GPA is or how well your clinical evaluations were on the floor. In ER you have to be multitasked, organized, efficient and competent. (The same with the floor BUT usually not STAT with situations). The best advice I had ever received was get floor experience first, fine tone your skills then get into your specialty of preference.
For example, last p.m. I was working with a new grad...who was so fixated on dept. restocking...PRIORITY was 8 admitted pts. to our ER with no beds. ?&*%^$ Needless to say...I was quick to get her attention on the tasks at hand. Also, we had a 3rd year student mentoring with her preceptor who was very thorough and the NEW grad said "I am so glad I am not a student anymore." "I've never felt insecure in anyway, not even now." OMG red flag if I have to work with her again.
Sorry...rambled....just got up from nights.
Sarah
That is just a person who is clueless all around. That girl would have done the same thing on a med-surg floor if she didnt know how to prioritize in the first place. Myself, another new grad and a nurse with 1 year med surg experience are the recent new hires in my ER. The one with the experience is falling fast..We work on teams in our ER (3 nurses to a team), and we are supposed to divide up patients in the beginning of the shift, and then again if one person is getting too many. She wouldnt take patients from me and my other teammate, we both had 8 and she had 3. She often gets flustered if she has any more than 3 or 4 patients. I think the experience of the floor has in a way trained her in that mindset, and she cannot adjust to the ER setting. Me and the other new grad are doing a lot better than she is. I was in LPN and worked in LTC before and the other new grad has nothing but an ER externship. I think when you start in ER, you learn that way, and you are better able to adjust instead of breaking old habits. There will be new grads who just cant cut it, but I disagree that all cant do it.
How in blazes the experienced one got through that year of M/S I'll never know. How she got put in ER is even more perplexing.
I don't know what to say about it.
Experience, or what we call it, has some pitfalls. One of them is the mindset. If she carries a real M/S mindset with her and hangs onto it, it will be tough to change.
Another problem is bad habits. In the service it was proven that new recruits who had never held a rifle usually scored better than those who had had prior experience with them. Why? The hunters and civilian marksmen had developed certain personal habits that did not translate well into combat fire. (I had to take some of my own troops and retrain them on how to use the combat weapons. Those bad habits die really hard. I tried really hard and most passed muster. I feel bad the rest didn't because they would be of no help in a fire fight. I made sure the results were in their service jackets, hoping they would get only guard duty assignments. I just hope I didn't get anyone killed.)
The "Dump" factor will always be with us. "dump her on ER and we will not have to deal with her anymore." Some Nurse/Managers think that way. I feel sorry you had to be the goat.
So, don't be shy. Get the "Experienced" one out of there. Keep the new grad with no bad habits or bad mindset. Train her the way you need. I can guarantee your super will agree with you and act accordingly.
But, there is still hope. On downtime, instead of letting this one sit there and play "Weakest Link" or "Poker" on the computer, have her review her priorities, find out what is bugging her and fix it, if you can. If you can't, she's gotta go. Pronto. Before her confusion kills someone or screws up the whole team.
You have several things on your side:
1. There are docs around to go to.
2. The super is there.
3. The team is there for support.
4. The procedures manual is right there.
5. You are there.
Finally, the rules of professional collegiality dictate that you must help out. You, as a specialist RN, have a duty to teach and train and share, and also evaluate and act accordingly.
Here is one last thing: She, and only she, has the responsibility to recognize when she cannot truly hack the routine. she must be honest enough with herself. She must recognize her limitations- and act in a professional manner. and, if that means getting out, then she must. (I had to do it once. This self-realization is a strength, not a weakness, and a sign of wisdom and maturity.)
I would like to hear what you think of new grads starting out in the Emergency Department. I just finished an 
athomas91
1,093 Posts
i agree w/ you - there are new grads who cannot cut it....but there are those who can.... i think the whole point is not to generalize...