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.
Specializes in OR, Nursing Professional Development.
But you know, there are certain habits you pick up from certain units that make it harder on others.
And this is why some units prefer nurses who have only worked in the specialty or are new grads. No bad habits to break and they (new grads) can be molded into exactly what the unit wants.
Specializes in Mental Health, Gerontology, Palliative.
Any new grad who knows nothing about my specialty area and comes into the ICU "demanding respect right out of the gate" is deluded. You are on probation and you can easily be terminated and replaced during your probationary period. You can not function independently and you do not have a right to be there just because you have demonstrated the minimum requirements to practice by passing NCLEX.
You do not have "the right to be there" at all. Not until you can demonstrate that you are competent to practice independently. Get over yourself. You don't even count as staff during a preceptorship. Your future colleagues will be the judge of whether or not you have the potential to practice safely and independently within our departments.
If you have been offered an opportunity to be taught by CCRNs and CENs with 20 years of experience you have been given a gift. We will invest all of our energies in helping you succeed. I have taught dozens of nurses how to function and think like a Critical Care nurse. It is no easy task to teach the massive amount of information that a new graduate needs to function safely and independently both as a nurse and a critical care nurse in six months. Just know that I expect the same investment of time and energy on your part. I will not waste my efforts on a new grad who doesn't think that his or her mistakes are serious. Respect your preceptor. His or her opinion carries a lot of weight.
We hire for personality and train for skill. If you are lacking in both you we don't want you on our team and you will be terminated during or at the end of your probation. That I'm the big dog, or call it an elitist attitude or cockiness will be your downfall.
This is not nurses eating their young. This is me protecting my patients from an unsuitable and unsafe new nurse.
What are the basics? There really is no clear definition.
Even if you go to nursing school for 10 years, you dont become a nurse until you start working as one. It is not a matter of schools not preparing students for the "basics". Most people learn by doing. Working as a nurse is the only way to gain the experience needed in any department or specialty.
What are the basics? There really is no clear definition.
Even if you go to nursing school for 10 years, you dont become a nurse until you start working as one. It is not a matter of schools not preparing students for the "basics". Most people learn by doing. Working as a nurse is the only way to gain the experience needed in any department or specialty.
There are basics. Can you start an IV, prime the line, and run and infusion? Can you do basic skills like cathing someone or suctioning a trach? Can you look at a patient's EKG, labs, or their person and recognize, "****, this is going to go sour if I don't intervene." There are things that, fundamentally, you will probably encounter in every unit. I've had to do all these things everywhere from PACU to mental health to in a procedure room as a circulator.
The philosophical question posed here was whether or not people in critical care or specialty areas will be able to adequately recognize these things or do these tasks without training on a lower acuity unit/is it safe to let them learn on less stable patients?
The question wasn't about the definition of basics. Not everyone's list is EXACTLY the same, but we all share some common ground. Not arguing the pedantic. Debating the outcomes.
And that is my point - gain the basic experience in a LESS acute area than the ED.
Says only the person who thinks every day in the ER is the Knife and Gun Club. It isn't, any more than every M/S day is an acute stroke or DTs. There are plenty of ways to start with lower-level care, watch and learn from others, and progress.
I think that ER orientation sounds terrific, and I am sure that the people who do well in it will begin their ER careers with adequate support.
In Northern Nevada word around suggests the ADN grads are in higher demand than the BSN grads due to the fact that they spend more clinical hours doing the very skills you describe. I've heard it enough times to know there's truth behind it.
Probably not true at all, since the BoN that accredits a school of nursing specifies the same number of clinical hours for each. But it makes SUCH a great sound bite ...
Says only the person who thinks every day in the ER is the Knife and Gun Club. It isn't, any more than every M/S day is an acute stroke or DTs. There are plenty of ways to start with lower-level care, watch and learn from others, and progress.
I think that ER orientation sounds terrific, and I am sure that the people who do well in it will begin their ER careers with adequate support.
Grn Tea, I remember you writing a post some time ago where you complained about how inept the nurses were who assessed you in the ER when you were pretty ill, and how you had to tell them what to do. Have you changed your mind now? I seem to remember you didn't appreciate receiving less than optimum care. As for knife and gun club, well, you are free to use hyperbole.
Specializes in Medical-Surgial, Cardiac, Pediatrics.
As a new grad, we were taught the following explicitly:
Nursing school doesn't exist to teach you to be a nurse anymore, it exists to teach you to pass the NCLEX. Your employer will teach you the skills/attitudes they want you to know.
Med/Surg is absolutely the boring basic standard unit that most people start on. Its a good place to learn the basics, but making a career out of it is a poor choice.
I'm not saying I agree with these sentiments, but that is the attitude that faculty had.
Having worked hard to become a certified Medical Surgical RN, I hate the imposed idea that Med-Surg is somehow a terrible career choice.
Med-Surg nurses take more patients than anyone, have more diversity and consequently more complexity with the patients they take on, and have to do their job without the monitors, specific and fast lab results, and availability of resources that many other specialities have on hand at any time.
We have to know when a patient is crashing not by the fact that their ABGs are off, or their telemetry readings are abnormal, but by their breathing patterns, changes in mentation, or sometimes just that gut feeling of "there is something wrong here".
We have to coordinate with discharge planners, multiple specialists, different hospitalists, primary care docs, surgeons, home health, hospice, and so many family members that it would make the heads of most ER nurses spin. We have to do all that while maintaining the safety and stability of other patients who can range from post-op lap chole to TURP to cellulitis to pneumonia to sudden onset heart block or respiratory failure.
People leave Med-Surg because it's hard, and you don't get the reward or recognition of other specialty units like ER or ICU. They leave because it's often downgraded and ignored and considered "less than" other specialities.
We rock. We work hard, and we get ignored, and we go back anyway.
Because we're not standard, and we're not boring. And man, I DESPISE that so much of nursing still craps all over us, because damn, our job is hard and it takes special nurses to do damn good med-surg care.
I went to a AS/ADN program and graduated. I went on for my BSN, snd they changed the curriculum to "more theory" to prepare for BSN. I'm glad I went the way I did; labs; classroom, clinicals/sim labs. The new group drew collages the first year on pt health. Needless to say, our only hospital now has new grads work for up to 6 months as a CNA, then an LPN/Tele rotation, and if you make it past all of that, boom, your hired as a RN/BSN. I think it makes sense. However, my classmates spent most of their time learning NURSRING, not just theory. Our classmates were hired right out of the ADN because we were prepared... For the most part. Our mandatory preceptorships helped that, also. And we were reminded "you know nothing, new grad. So don't act like the King or you'll be sent off to the Wall"
Grn Tea, I remember you writing a post some time ago where you complained about how inept the nurses were who assessed you in the ER when you were pretty ill, and how you had to tell them what to do. Have you changed your mind now? I seem to remember you didn't appreciate receiving less than optimum care. As for knife and gun club, well, you are free to use hyperbole.
"The Knife and Gun Club" is a term commonly used by ER nurses everywhere as a rueful description of the occasional night where everyone who comes in seems to be a member. Not my hyperbole, can't begin to take credit for that.
As as I am growing old and feeble and can't remember crap, I do not remember posting any such thing about an ER visit for myself. I've only been in an ER as a patient a few times in my life, thankfully. I've gotten lousy care as an inpatient, but not from nurses that much. Sure that was me?
As as to my opinion about training new nurses in ER, you will note that I specified observing and learning from others as part of the progression from novice to expert would be the same there as anywhere else. Combine that with "hire for attitude, train for aptitude" and that would be a good description of how to do it.
I was a new grad hired into a critical care area, a 17-bed PACU in a 700-bed hospital, and thus began a 20-year career in critical care, ICU, grad school p, and clin spec in the field. I did have an excellent nursing university school education and had worked for three years as a nursing assistant (one year of full-time) too before graduating, so basic care and handling was second nature by then. As a student I never put in one IV, Foley, or Salem sump, but seriously, those easy tasks were never my focus. I figured, correctly, that when the time came I'd do 'em, master them, and that would be that. A year post grad and while I didn't need to stick veins much because all my patients came with central lines to draw from, all those other manipulative things were just... stuff. The real skills were assessment and knowing what to do next, how to anticipate problems and head them off, and teamwork. Those are the real skills of nursing. I do believe that the right person can learn them in ER or any other place, given attitude and aptitude.
Someone who may not be ready to start in ER or critical care WOULD be well-advised to spend some quality time in M/S to learn assessment and patient-handling, however.
And this is why some units prefer nurses who have only worked in the specialty or are new grads. No bad habits to break and they (new grads) can be molded into exactly what the unit wants.
And ruined for the future by dysfunctional units. There are two sides to that coin.
Rose_Queen, BSN, MSN, RN
6 Articles; 12,051 Posts
And this is why some units prefer nurses who have only worked in the specialty or are new grads. No bad habits to break and they (new grads) can be molded into exactly what the unit wants.