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.
this is exactly my argument... They knew you wouldnt sink because they wouldnt let you.... It becomes the responsibility of the established nurses to "not let you sink". This means they have to watch you along with their own patients. It puts a strain on everyone involved. We could debate this topic all day, and we are all entitled to our own opinions. I am sure you are all safre practitioners, even if you knew it all when you graduated from school. Please give some credit to those RN's who bailed you out when you got in trouble.
gee! i thought that the whole point of it all is that we are all a team! i am glad to work with people who will not let me sink! i am also glad to be there so that others will not sink. veetach, you must be one hell of a nurse.
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!
I totally agree. In our ED we have only 4 LPNs (we used to have 9) and I would put them up against any RN on any floor in the hospital. I trust them explicitely and our hospital used to have the levels applicable for letting the LPN advance up a "clinical ladder" so to speak. Unfortunately our Administrative DON thinks LPN's should stay in LTC and she is working diligently to phase them out. It is a bloody shame...
As far as getting the fresh RN grads out of the ER and onto a med/surg floor, please read my previous posts. That is still my opninion and I will stick to it!!
Too many people think that LTC is just a cakewalk. They do not realize the complexities involved, especially if you are a house supervisor or DON. One of my best friends in nursing school obtained her NH administrator license shortly after our graduation, she has been in LTC now, 9 years and loves it!!! For those of you who are working to make a home for the elderly who are unable to live in their own homes, my hat is off to you!
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!!
Just because we are recommending you spend a little bit of time learning outside of the specialty units doesnt mean we are telling you not to become a nurse.
All I am saying is that most new grad nurses do not have the ability to keep their heads above water in a busy ED. That is not meant to be a criticism, Lord knows when I was a new grad I couldnt either! I went to the ED after working 2 1/2 years on a med-surg telemetry unit and 8 months in CCU, it was a fairly smooth transition, but I still had lots and lots to learn. I see the poor new grads in our dept flounder and receive such stern retribution from the experienced nurses, especially when they are done with their 12 week orientation and they are "out on their own". You cannot control the abrasiveness of a seasoned ER nurse when you are working a pediatric code, or working with a trauma patient or victim of a gunshot wound that is circling the drain. We have to think fast, work fast and work intuitively. Lack of experience can become a hinderance in these situations.
For those of you who are working in the ED fresh out of school, good luck. Hang in there, it sounds as if you are doing well. I am just saying that it is more beneficial IMHO to allow most new grads the time to learn to become an RN before being thrown into the ED... JMHO of course.
Magikgirl, I AM a good ER nurse, I am proud of that. But I am not the one who said I only needed a weeks worth of orientation in the ER!! Please go back and read what I said. I know we have a team atmosphere, but it puts more weight on the shoulders of the experienced RN's when they have to keep an eye on the new grad along with taking care of their own patients....
duely ntoed! thank you for your reply. i am a good er nurse too. i am also proud or that. i can only applaud all of us. we all do good jobs, no matter what we post.
Wherein lies the harm of letting an LPN take the class??
Can you say:
1) Breaking their spirit
2) putting those "pesky" LPNs in their place
3) deflating morale
Please, let go of the control
No, I don't think LPNs are "pesky"
I think they're just, well...NURSES!!!
sean
It doesn't have anything to do with control..according to the ENA only RNs or GN's (who are awaiting test results) are eligible to take the certification exam for both ENPC and the TNCC. Only RNs can sit for the CATN certification. Others can audit so I don't think it is a matter of not allowing LPNs to attend, they can, I would guess that they would have to pay for it themselves though. I do think that auditing the class would be beneficial for any type nurse..I was just referring to actually getting the certification prior to even graduating unless an individual has taken the boards or has the RN license they can't become certified. Not control...ENA policy...:) Erin
In my humble opinion, there is no excuse for abrasiveness or being rude. I have been in healthcare for 24 years and started in the ER as an army medic and then RN. After several years in the ER and critical care areas I considered myself "seasoned" or experienced and wasn't abrasive then and am not abrasive now. Working in the ER or critical care area does not give a human being a free ticket to justify being rude, controlling, and arrogant. Let us call it what it is. Much of it is a petty control and competition issue that seems to continue to plague nursing thus contributing to making it very unpleasant especially coupled with the other issues nursing faces today.
I am currently working in hospital administration as a chief operating officer in charge of clinical operations including the nursing department. I have yet to be able to find a valid reason why an experienced ER nurse should be rude to another nurse, patient, or doctor. Simply no excuse.
well veetach - instead of name calliing and arguing w/ you about my career - i will tell you just as hogan did - you cannot GENERALIZE all new grads - i started in a er that saw approx 40,000/yr - w/ 2 nurses and 1 tech at nite.....so there was no one to "guard me" - as well i was made a charge nurse - i believe that there are those who excell at what they do - i believe that if you work hard for what you want then noone has to carry you - like i said prior to graduation i new how to read monitors, i was acls, tncc etc.....and i don't think you will ever find an "experienced" nurse that i worked w/ that would tell you i couldn't carry more than my fair share.... if you want to call me a prodigy or whatever - feel free - but it is attitudes like yours that keep nursing from furthing as profession rather than a job.....
do new law grads HAVE to go to a certain area??
do new docs HAVE to go to a certain area???
no - they train for and seek out what they want and accomplish it - just like nurses.....
and for the record i am a woman and i graduated at age 21 -
as well as being accepted into a top 75 CRNA program at the age of 26 with only ER experience - which everyone said "couldn't be done"
hmmmmmm.....guess everything is possible veetach....
so for those new grads out there - don't let these old sterotypical ideas dissuade what you want to do - if you feel the ER was meant for you - learn your critical care data - be familiar w/ alll your cardiac meds/doses etc.... and you will do just fine...
i am soo glad that i worked w/ ED nurses who encouraged my strength rather than shrugged it off - rather than those who generalized everyone --
i don't suppose that veetach liked being generalized as an old nurse w/ old fashioned ideas either....
Scis
My reply was in response to the above stmt that athomas had the TNCC prior to graduation. I was under the impression that this was not possible so I went to the ENA website to lookup who could actually take the certification exam and found that current RNs or GNs which have taken the NCLEX but are awaiting results are eligible. There is mention that others (PAs, LPNs etc) can go to the classes but can't sit for the actual exam. In MY OWN experience it is difficult for a new grad in the ER although there is the exception..:) Erin
thanks for clarifying the TNCC rule, Erin. The incident I wrote about LPN's not being allowed to take TNCC applied to my first class 7 yrs ago. At that time the class was too full to allow them to audit. Also the cost was exorbitant for just auditing.
The hospital would pay for TNCC for RN's but not for LPN's.
Veetach..makes sense, I am sure that RNs get top priority esp if the class is given at the hospital. When I did ENPC we had to have two seperate classes due to RNs wanting to take it..we had a few LPNs that wanted to audit..they had to draw straws since only a certian number could attend. I didn't have to pay but I think it was in the neighborhood of 200.00 or something like that.
I think Barb Pick on here is a SANE nurse, could be wrong..I know she is a Forensics nurse..is that the same? Erin
a SANE is a sexual assault nurse examiner. I have been a SANE since 1998. We are now starting a program here in PA. The nurses who used to be called SANE's are now being called SAFE's (sexual assault forensic examiners)
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
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