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 guess it should be OK to let a med student with aptitude and motivation to do thoracotomies.
There is a lot more to orientation than just learning tasks. And I wonder...if the BON for these indiv. found out that they had done these procedures before they were graduates of a nursing program, I wonder how they would explain themselves.
Motivation can count for a lot, but I liken this to building a house without a foundation.
And I am sorry, but to me it is just pure arrogance to say that after one week of orientation, there was nothing else to learn.
Glad it has worked out for some of you, but you are extreme exceptions to the rule.
(I don't think that a hospital that allows unlicensed personnel to perform skilled procedures is much to brag about, to be honest.)
JMO, which I am entitled to, if I am not mistaken.
C'mon guys! You all have valid points, but the hostility is corrupting the board. We are all professionals and of course as individuals have a right to our opinions and to voice them on the site, but let's not get downright vindictive. We're ALL above that, am I right?
Scis RN CEN
I second this. Not to mention a few here are close to a TOS violation. Maybe we can all calm down a bit before the mods say something...
I am a new grad (graduated May 2003) and am working in the ER for my first RN job. There were 4 new hires: me, another new grad, and 2 nurses with a year of med-surg. I worked as an LPN for 2 years before I graduated RN school, did an extensive internship in a local ED during my senior semester. I had a 12 week orientation, took many courses (EKG interpretation, ACLS, critical care), and have even taken a critical care med course on my own. I had good and bad preceptors, but the knowledge I took from them was a huge help in getting my own routine down. I am told by the other nurses and management, all of which have years of experience, that I am doing very well. In fact, it has been said that there is no difference between how I am doing than the other 2 nurses who have the year of med surg behind them. They are also flustered because the floor is nothing like the ER, and they are in the same boat I am. I am always asking questions when I am not sure of something, I double check unfamiliar meds/drips with another nurse, and although I am gaining confidence in myself, I still have a healthy dose of fear in me. I do not feel like a "liability" to my coworkers, and believe me if I was I would be outta there so fast. We all ask each other questions and check with each other when we are dealing with unfamiliar things, so its not like I am the only one asking. I dont do anything I am not familiar with unless I have detailed instruction/supervision, which my nurse manager is more than willing to accomadate for me and the other new nurses. They are supportive, and dont want any staff member to be put in a position where they are doing something they are not familiar with. For example, I had a nurse with me the first time I did a consious sedation to show me how it was done. After that, I was comfortable doing it on my own. I believe that a new grad can do well in the ER. Not all with the year of med surg will do well either. It all depends on the person.
just for the record to all involved in this thread. My opinions are not meant to be an attack on any of you.
I have some pretty strong convictions in this area, and I have found that there are also many other nurses out there with the same opinions.
For those of you who started in the ED as a new grad, please dont take my opinions as a personal attack.
I am always up for a good debate on a topic that I feel strongly about. I also acknowledge that people have their own opinions and I respect that.
No offense taken, though you did get personal in that you questioned the veracity of my posts...
FAB4, I wasn't even a part of the BON at the time, they likely could have done nothing (to me, though I could be wrong.)...And for the record, the nurses came to me w/ new skills (at first) that I hadn't done, then I just almost was expected to do them after a while, and just did the (w/ their blessings...)And your thoracotomy analogy is way out of line, and an imbalanced one at that...And check my posts, I NEVER said I "had nothing else to learn" I felt I was done w/ orientation. A BIG DIFFERENCE. Leave the dramatic posts to you Fab4...:)
I still learn things EVERY SHIFT that I work, so back off the overdramatization
Yes I was in triage alone many times, and an RN signed off. Was this wrong, YES. But they trusted me. I was giddy, and loved the respect, as I wasn't even licensed yet.
Anyway, believe me or not, it all happened at MARYVALE ED 9 years ago, in urban Phoenix...
I will say this, I have a friend who is orienting a new nurse, who sounds like she belongs nowhere near an ER (When my friend asked for a side effect of Morphine, the new grad said "don't operate Heavy Machinery" :roll
Some new grads definately don't belong in the ER. I have said this all along. It's the "We don't ever hire new grads in the ER" mentality that angers me, as there are some of us that did it well, and would have been missed:o
For what it's worth, I left ER nursing after 8 years, 6 months ago, and now am house supervisor for an ECF/LTC 150 bed facility, NEVER having even set foot in a nursing home prior to then. I love it, they love me, and I'm doing a hell of a job...That's not arrogance, that's confidence, and that's my DON (40+ years in LTC) telling me so. (Though it's different AND harder than I ever imagined:imbar)
I do LTC as an agency RN. I figure I needed a break from the hairy-scary and the fact that I'm almost 60. (Still got the Right Stuff, though). So, I work with a lot of LPNs.
Often, they will try to apologize for their lack of the kinds of knowledge they know I know and, knowing they must defer in some clinical actions, I tell them that, all-in-all, I'll take a seasoned LPN over three RNs anytime. And I mean it.
I consider LPNs, as much as RNs, colleagues. No, they may not have run the awesome gauntlet of RN training we did, but nearly all of them, through years of hard practice, have shown themselves to be every bit as professional (sometimes more) as RNs. I think they respect my opinion and the fact I have practiced for so long.
Do I think an LPN can do ER? With the right training, you betcha.
Just how much more exotic is it to learn to sink an anticubital line, intubate, stop bleeding, do dressings, give injections, defib, hang an IV, draw blood for labs or prep for suture?
I am not in favor of letting an LPN do ER admission workups, titrate cardiac IV meds, read and post EKGs or do poison interventions, nor would I feel good with them assisting in cutdowns and threading CLs, doing cardiac outputs or IV pushes. And I don't think they would be much help with thoracic procedures. But there is a lot they can do- and learn. More than I've mentioned.
I say, if they got the Right Stuff, put 'em in there and let 'em go to it. Let's use the resources we have. That means using LPNs in more than Nursing Homes and Home Care. And let's pay them a helluva lot more. Otherwise, what a goddamned waste!
How about LPN clinical levelling. LPN I, II, III with LPN III the minimum requirement for ER.
And let's get these darned fresh RN grads out of ER and onto a Med/Surg floor where they belong for at least a year. They scare the living daylights out of me. "Don't operate heavy machinery" indeed!
Everyone has to start somewhere, why not the ED? All of this "serve your time on med/surg" mentality is ridiculous in my opinion. Things have a way of working themselves out. If a nurse, new grad or not, wants to work in the ED and has the motivation to learn the skills then give them the opportunity. If they like it and can learn it then that's great. If they don't like it and can't learn it then they will move on. Same thing for an experienced med/surg nurse.
Imagin916. Hope my letter didn't disturb you. I seems you are the exception- and kudos all round. You are in the groove unlike so many. You have the fire. Great going!
I must recognize you as a colleague.
But, just between you and me, you know as well as I, most can't cut the mustard right out of the gate. They have to learn, to season, to adjust. For the few, like you, it's "natch'll". You have the Right Stuff.
There is only one thing I want to warn you of and that is the dreaded "ER Attitude". Most of our colleagues don't understand it and we should pay more attention to it. I know we get in the groove and do the "St. Elsewhere" thing. We can be pretty abrupt. But, we have to try and at least understand that when a nurse from, say, a detox facility, a nursing home, a rehab facility or a nurse doing home care calls, we treat them with the same ethical collegiality we would wish for ourselves. God knows I've been on both ends. (I once actually caught myself from saying, "Why don't you send us something besides your trash?" Every patient is precious and human. I felt so bad about it afterward. What in hell was I thinking?)
I still am convinced that the vast majority of new grads belong in an internship of Med/Surg for at least a year. That way they can decide what specialty they are drawn to. I'd also want them to do a bit of CCU or Telemetry before applying to ER. and, I'd first look to see if they had ACLS. With an ER jammed with very sick people it's just too hard to split myself off as teacher and ER Nurse at the same time. Guess I'm just Old School.
Gee guys, no wonder we can't attract and/or keep younger, more inexperienced nurses in the profession. If I had to work with either of you (v-tach or cadeusus) I would need some serious counseling and question why I ever became a nurse. Come on!!
I would like to hear what you think of new grads starting out in the Emergency Department. I just finished an 
fab4fan
1,173 Posts
veetach: I am in total agreement with you.
I guess it should be OK to let a med student with aptitude and motivation to do thoracotomies.
There is a lot more to orientation than just learning tasks. And I wonder...if the BON for these indiv. found out that they had done these procedures before they were graduates of a nursing program, I wonder how they would explain themselves.
Motivation can count for a lot, but I liken this to building a house without a foundation.
And I am sorry, but to me it is just pure arrogance to say that after one week of orientation, there was nothing else to learn.
Glad it has worked out for some of you, but you are extreme exceptions to the rule.
(I don't think that a hospital that allows unlicensed personnel to perform skilled procedures is much to brag about, to be honest.)
JMO, which I am entitled to, if I am not mistaken.