We have several new grads in our ER. I'm starting to think that most nurses should have at least a year on a more general ward before learning a specialty.
I'm seeing some clueless mistakes, and lack of basic skill in pt care. That includes things like how to clean a pt and roll and change bedding. Basics about IV med administration, dose calculations, prioritizing, and realities of inpatient care. They have no idea how the rest of the hospital functions.
On top of that, some of them seem to harbor elitist attitudes, as if they are already big hotshots. Yet, they themselves seem to lack the above mentioned skills.
I can't believe these posts I'm reading.....nursing students who never started an IV, foley cath, NG tube, etc during nursing school? Shame on your schools and on you for choosing a school that you didn't thoroughly research before applying. I'm proud to say I'm a BYU graduate!! It's a phenomenal program!! I hit the ground running as a new grad nurse BECAUSE my nursing program prepared me to do so, prepared me to be an RN from day one. My 2nd to last semester we had an ICU course and did full rotations in the ICU, I did my capstone in ICU where I worked a regular RN's schedule for the entire semester; I had almost an entire year of ICU experience in my nursing program. I then took a job on a cardiothoracic ICU as a new grad.
I think that most of the responses all have a good point. I spent 37 years mostly in specialty areas. When I first became a nurse and I started as an LPN, one year on med/surg was required before anyone would even look at you and consider you for a specialty area. When I worked in the ER, we loved getting med/surg nurses who wanted to transfer to the ER. The majority of patients are M/S patients. These nurses had great organizational skills, and then we taught them the higher acute patient care. After 37 years I decided to go in to academia and stepped into a role of Director of a PN and NA program. I require the CNA or MA to enter the PN program. Students then are able to quickly test out of their basic skills and we can spend more time on the higher level skills. I make sure the students get time in an ER where I know they will get a great deal of opportunities to do skills, IV starts, NG, foley's etc. This year we added chaos theory into our simulation scenarios, providing students with real life situations rather than a book list of things to do. The RN program at our college does not require a CNA or any previous health care experience. Their Sim scenarios are very strict and by the book. One day we had an RN student making up time with us in Sim, and we were doing a chaos theory scenario. As the RN the student was in charge of the PN students, when they were going to the RN student with issues the student became so frustrated that he did not know what to do. In post he said he thought it was great, and he wished they did the same in their program. By the time my PN students reach their second semester they have surpassed the RN students in skills. Yes I am bragging a little, and maybe I do things this way because I have been in the same situation as all of you, and saw the students coming out of school with little to no skill experience. I think that there are some new grads that can step into a specialty area and succeed quite well, especially with a good orientation and preceptor. I believe it is individually based, and not all nurses or new grads are good at some areas, but may fly high in others, it is finding your niche. That said, having too many new grads in one area at the same time is detrimental to the safety of patients and is very stressful on the experienced nurses who are trying to care for their patients as well as watch over the new nurses patients. (poor staffing as one example). Quality interviewing techniques can help to choose the right nurse for the right role, and just because a new nurse may not be doing well in one area does not mean they are going to be a bad nurse, it just means that may not be their area. Management should help the nurse find their place, so we do not lose future quality nurses. I have seen nurses that were just not made to be ER, or MS nurses, but flew and accelerated in ICU, or cath lab. or interventional radiology, hospice or other areas. It is all about good teaching, good support, good preceptors, good orientation, and good management. Support, team, and take care of each other. But I also agree that the new nurse needs to be proactive with their learning. When I was in school, I would go on the floor and tell the nurses what skills I needed and they would let me know when they had some for me, other students were shy, or frightened and would wait to be told. But the great thing about nursing is there are many areas, and there is something for everyone, you just have to find your fit. Quality management can make or break a new nurse. They can help grow these seedlings in to great trees.
Was my question about extern programs irrelevant? Are hospitals no longer hiring nursing students?
My 800+ bed hospital hires less than a dozen externs per summer. The program is there, but it is not deemed appropriate to commit funds to a larger program.
Students can pursue employment as a CNA, tech, patient sitter, etc.
I can't believe these posts I'm reading.....nursing students who never started an IV, foley cath, NG tube, etc during nursing school? Shame on your schools and on you for choosing a school that you didn't thoroughly research before applying. I'm proud to say I'm a BYU graduate!! It's a phenomenal program!! I hit the ground running as a new grad nurse BECAUSE my nursing program prepared me to do so, prepared me to be an RN from day one. My 2nd to last semester we had an ICU course and did full rotations in the ICU, I did my capstone in ICU where I worked a regular RN's schedule for the entire semester; I had almost an entire year of ICU experience in my nursing program. I then took a job on a cardiothoracic ICU as a new grad.
I actually did thorough research on my school, and it has a good reputation for providing excellent grads throughout IN. However, when you have 1 instructor and 10 students in the clinical setting, and you are required to have your instructor with you should you do an NG tube or Foley insertion, the chances of you having that opportunity are significantly reduced. I'm not sure how I could have researched the specific clinical experience I would have, as it widely varies with the facility's policy, your clinical instructor, the pts on the floor etc. etc. I am offended that you presume I did not research my program before making my decision to enroll.
One of the new grads in our unit just made an almost fatal mistake the other day, I heard. The risk with new nurses in higher acuity units are that the pts are more unstable, and a newbie error with a more critical med can more easily kill a pt. Yes, things can go south on a medical unit, but generally the pts are more stable, and the pt is not on high risk meds.
Late to answer because I was working FT hrs. this week...my new gig. LOL But I agree 100%. They are taking new grads into specialty areas a lot in the hosp. I work in too. I guess they must feel they have enough experienced nurses to nurture the newbies...but I don't think it's a good idea.
However I would think a new grad who's 21 years old with no life or healthcare experience should get some skills basics experience.
It's sweeping generalizations like these that make me laugh. I just turned 21 and I've been in the CVICU for a month now. Am I a new grad? Yes. Do I have what it takes? Absolutely. To write off someone's potential and drive based on their age alone is laughable.
What is their orientation like? Do preceptors have a standardized method of introducing new grad orientees to the unit? Are they given instructional material? What I saw when I worked in the ER as a tech was that they would give new grads six weeks, and not all preceptors taught them everything they really need to know to be successful. Then others thought the new nurse was bad because they didn't know things that could hurt the patient.
My new unit loves new grads. We get 12-16 weeks of orientation with a standardized instructional program (that we are tested on and is worth CEUs when completed). Preceptors attend training and are given a booklet that tells them at minimum what the orientee needs to learn and experience. Most nurses on the unit were new grads when they started and do well out of orientation.
Some flourish as grads in specialties, others fail. It's impossible to generalise, it's a case by case scenario.
As for the obvious lack of training in Nursing school, it's frightening. I work with colleagues who were "hospital trained" nurses in the 80s. They told me when they graduated they were WORK READY. The idea of a new nurse not knowing skills like IV preparation still baffles some of them.
One of the new grads in our unit just made an almost fatal mistake the other day, I heard. The risk with new nurses in higher acuity units are that the pts are more unstable, and a newbie error with a more critical med can more easily kill a pt. Yes, things can go south on a medical unit, but generally the pts are more stable, and the pt is not on high risk meds.
At dinner tonight with a NP at a correctional facility. An experienced nurse gave 1.25 mg of digoxin to a patient instead on 0.125 mg. Should no experienced nurses be able to work in corrections?
I started out in the ED right out of school, so I would have to disagree that one needs to start in general ward before specializing. When I started, I was anxious, didn't have a clue, but also realized that nursing school did not quite prepare me to be a clinician; instead it taught me how to memorize lots of information and to take a test. If you think about it, just because someone majored in something in college, it does not make them an expert; rarely will you find someone hit the ground running in any profession.
I learned in the last couple of years as an ED RN, that this profession is learned by doing. One can't rely on textbook knowledge, because it doesn't always apply, and we need to teach each other. When I started, I had several nurses give me a hard time because I didn't start on the inpatient floors when they had to. Sounded like jealously or resentment to me, but it was unpleasant enough that they wanted me to "figure it out", which is the wrong attitude. So you want me to harm or kill a patient to make your point? Yeah, that makes plenty of sense. You want someone to be able to help you in the future? Then it's best to get them up to speed by showing them how the ED works. Harboring resentment towards new nurses or bullying them doesn't help anyone on the floor.
I currently work with nurses who have more years of experience than me, who are struggling with their transitions into ED nursing. They were awesome on their previous floors; we knew it, they knew it, but being in the the ED is very different. I teach them what I know because I want them to be able to help me when I really need it. In exchange, they teach me stuff too! It's a win-win!
Emergency is a specialty, and while having the basics is important, it's not important to get the basics elsewhere. I think that it's important to get hit the high level of stress, anxiety, noise, and overall chaos of the ED early in one's career while learning the basics. This builds a unique resilience that a nurse needs to handle the ED, or show them that it's not for them. And either outcome is fine. Being a med-surg nurse is also a specialty, with its own kind of chaos; it's a different kind of hard that I learned to appreciate when I had to care for six boarders in the ED with no tech help. Not for me.
Finally, I see the elitist attitude as a defense mechanism. Being responsible for the lives of others is a privilege, is humbling, and very scary when we start. I say, be gentle, be kind. People often extend the same type of kindness that was extended to them. So if you want someone to help you out during your code, trauma, or to switch a day in your schedule, it pays to be patient and help the new nurses learn.
I started out in the ED right out of school, so I would have to disagree that one needs to start in general ward before specializing. When I started, I was anxious, didn't have a clue, but also realized that nursing school did not quite prepare me to be a clinician; instead it taught me how to memorize lots of information and to take a test. If you think about it, just because someone majored in something in college, it does not make them an expert; rarely will you find someone hit the ground running in any profession.
I learned in the last couple of years as an ED RN, that this profession is learned by doing. One can't rely on textbook knowledge, because it doesn't always apply, and we need to teach each other. When I started, I had several nurses give me a hard time because I didn't start on the inpatient floors when they had to. Sounded like jealously or resentment to me, but it was unpleasant enough that they wanted me to "figure it out", which is the wrong attitude. So you want me to harm or kill a patient to make your point? Yeah, that makes plenty of sense. You want someone to be able to help you in the future? Then it's best to get them up to speed by showing them how the ED works. Harboring resentment towards new nurses or bullying them doesn't help anyone on the floor.
I currently work with nurses who have more years of experience than me, who are struggling with their transitions into ED nursing. They were awesome on their previous floors; we knew it, they knew it, but being in the the ED is very different. I teach them what I know because I want them to be able to help me when I really need it. In exchange, they teach me stuff too! It's a win-win!
Emergency is a specialty, and while having the basics is important, it's not important to get the basics elsewhere. I think that it's important to get hit the high level of stress, anxiety, noise, and overall chaos of the ED early in one's career while learning the basics. This builds a unique resilience that a nurse needs to handle the ED, or show them that it's not for them. And either outcome is fine. Being a med-surg nurse is also a specialty, with its own kind of chaos; it's a different kind of hard that I learned to appreciate when I had to care for six boarders in the ED with no tech help. Not for me.
Finally, I see the elitist attitude as a defense mechanism. Being responsible for the lives of others is a privilege, is humbling, and very scary when we start. I say, be gentle, be kind. People often extend the same type of kindness that was extended to them. So if you want someone to help you out during your code, trauma, or to switch a day in your schedule, it pays to be patient and help the new nurses learn.
The point that more experienced nurses are making, is that what you consider is best for "you" is not necessarily best for the patient. It's not about the nurse; it's about the patient. A new nurse in the ER, who doesn't "have a clue" is a danger to the patients. The knowledge that one gains from working on med-surg, a unit which is not as fast paced as the ER, where one sees a wide variety of diagnoses and medical problems; learns to hone one's assessments and patient monitoring; learns medication administration; time management; prioritization; organization; charting; dealing with doctors and other team members; dealing with unstable patients and emergencies; performs a wide variety of clinical procedures; learns to move/transfer patients etc., is all relevant knowledge and experience when one moves to the ER, where one hopefully receives a structured orientation/preceptorship. Starting in the ER as a new grad, without this basic foundation, and a very structured orientation/preceptorship, puts patient safety at risk, as experienced nurses on this thread are attesting to.
And yes, patients on med-surg deserve nurses who are well-prepared to take care of patients too. With a good orientation and preceptorship/structured new grad training, this can be accomplished.
goodgrief
114 Posts
I can't believe these posts I'm reading.....nursing students who never started an IV, foley cath, NG tube, etc during nursing school? Shame on your schools and on you for choosing a school that you didn't thoroughly research before applying. I'm proud to say I'm a BYU graduate!! It's a phenomenal program!! I hit the ground running as a new grad nurse BECAUSE my nursing program prepared me to do so, prepared me to be an RN from day one. My 2nd to last semester we had an ICU course and did full rotations in the ICU, I did my capstone in ICU where I worked a regular RN's schedule for the entire semester; I had almost an entire year of ICU experience in my nursing program. I then took a job on a cardiothoracic ICU as a new grad.