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 Medical-Surgical/Float Pool/Stepdown.
Please don't forget that Med-Surg is a specialty and that we need new nurses to know the basics just like any other specialty! I think this "phenomenon" has been happening everywhere because more and more of the nursing schools are expecting the student's first employer to teach them the basic skills instead. Couple that with children growing up thinking that they're all special snowflakes and we end up being the ones to have to burst the bubbles...AKA...NETY.
My personal opinion is that now so many schools are focused on getting their grubby mitts on the graduate tuition from all their students who are encouraged to climb the ladder without ever taking a first step as a nurse. The basics aren't considered valuable any more. Perhaps I'm no longer objective but in most cases I don't think the new nurses today have been taught the skills we had when we graduated. Not saying there aren't some with excellent potential and great attitudes about learning just that they really don't seem to get much actual nursing in nursing school.
This hasn't been my experience. Former new grads are some of the strongest nurses in the ICU where I work. This may be a failing in your new grad program.
The best place to learn to be an ER nurse is in the ER.
IMO the schools are failing students in preparing them for the real world. In that environment a great orientation along with patience of the staff is necessary. Encourage and teach.
Specializes in Nurse Leader specializing in Labor & Delivery.
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.
Scott made a great comment. Nurses learn to be an ER nurse in the ER.
Do you think a new grad in Med/Surg knows how the rest of the hospital functions, or is great at dose calculations or prioritization? Of course not. A new grad is going to be clueless at this, regardless of where they start.
I am participating in a new graduate residency in the ER. It is modeled after the ENA's standards of orientation & customized by the hospital's most experienced ER nurses with supervision/input from the clinical nurse specialists & manager. Those same ER nurses work as preceptors for new nurses. My schedule is 40 hours per week: three 12 hour shifts & one 4 hour class focusing on case studies, skills practice & other "lecture" type content.
Not saying I am going to be an expert in the ER when it is over. But, I will be better prepared because my orientation is so intensive.
I wanted to work in NICU. When I didn't get the job, I asked the overhead manager how I could make myself a competitive candidate the next time around. I was surprised to find out that she had a year of med-surg experience as a new grad before working with neonates. I told her that I was afraid that working in med-surg would make me undesirable. She laughed and said that having med-surg adult experience wouldn't hinder me at all.
But...very few med-surg skills are applicable to sick babies.
Having Med-Surg/general experience can only open doors. It is also a great place to refine nursing skills and master assessments. At the same time, if one can get a great orientation and support into a specialty, then I think the right new grad will be fine without Med-Surg.
Scott made a great comment. Nurses learn to be an ER nurse in the ER.
Do you think a new grad in Med/Surg knows how the rest of the hospital functions, or is great at dose calculations or prioritization? Of course not. A new grad is going to be clueless at this, regardless of where they start.
Med-surg does not commonly receive patients who are as unstable and critically ill as the ED does. While I believe that nurses starting out in med-surg should have received good clinical preparation in nursing school, I think the point that Emergent is making, and that I agree with, is that starting in an area such as the ED, where one can expect critically ill patients, not just acutely ill patients, when one does not even have the background of a preparation in med-surg, and is essentially completely inexperienced and completely unprepared to function as a nurse, is not a good situation for the new nurse, the new nurse's co-workers, or the patients. In urgent situations, and in emergencies, when a timely response is imperative, there is no time for a delayed response, or for not knowing what to do, or for fumbling around. The last thing I want to find when I take my very sick family member with multiple complicated medical problems to the ED, is an inexperienced nurse taking care of them.
Specializes in Nurse Leader specializing in Labor & Delivery.
Hmmm....I am a little conflicted on this.
I wanted to work in NICU. When I didn't get the job, I asked the overhead manager how I could make myself a competitive candidate the next time around. I was surprised fo find out that she had a year of med-surg experience as a new grad before working with neonates. I told her that I was afraid that working in med-surg would make me undesirable. She laughed and said that having med-surg adult experience wouldn't hinder me at all.
But...very few med-surg skills are applicable to sick babies..
It's been my experience that nurses who worked M/S before going to a specialty think that M/S before specializing is a necessity. Nurses who went directly into a specialty think it's not necessary. And never the twain shall meet.
Specializes in Nurse Leader specializing in Labor & Delivery.
The last thing I want to find when I take my very sick family member with multiple complicated medical problems to the ED, is an inexperienced nurse taking care of them.
And I bet families of patients going into Med/Surg (or the ICU, or L&D, or OR) feel the same way. I've never met a patient who said "Yes, I TOTALLY want a brand new inexperienced nurse taking care of me!" But yet, new grads can't become experienced nurses without...experience.
AJJKRN
1,224 Posts
Please don't forget that Med-Surg is a specialty and that we need new nurses to know the basics just like any other specialty! I think this "phenomenon" has been happening everywhere because more and more of the nursing schools are expecting the student's first employer to teach them the basic skills instead. Couple that with children growing up thinking that they're all special snowflakes and we end up being the ones to have to burst the bubbles...AKA...NETY.