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.
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.
And that is my point - gain the basic experience in a LESS acute area than the ED.
My family member has had new nurses on med-surg. While I have not been completely comfortable with the situation, I have been able to watch what happened as my family member has not been in a situation that requires critical or emergent nursing and medical care. In the ED there is no time for that; if my family member deteriorates or needs specific care and they need it now, this is not the time for the patient and family member to be hanging around hoping the new nurse will get their act together in time.
Gosh, I sometimes think we forget what it's like to be new. Did I know how to do a log roll? In theory, yes! But had I had the chance to do that on a million living, breathing patients yet? No. And it's very daunting when you first start. I know it's frustrating. I find myself getting frustrated when teaching a newbie the ropes as well. But they have to learn it somewhere. It's why proper orientation in the unit is KEY. So important.
I started as anew grad in the PICU. We had a great 6 month orientation. Classwork along with our preceptorship.
I think that Meds/Surg is a specialty in itself. ER/ICU/Hemonc/MedSurg are all specialities. As a new grad you are going to learn the assment skills needed for that specialty. Many skills are transferable, but not all.
For the OP, if new grads are having a hard time, maybe the program needs restructured and have them start off in the less critical areas of the ER. All orientation programs should include basic skills that can be used across the continuum.
Some new grads should be repeating another year. We have also noticed at work that 50 percent of the new grads within the last few years are ill prepared.
Many new grads lack fundamental nursing skills that should be taught at school. Instead, we are now extending the orientation period and teaching labs that a second year nursing student would usually have. I have recently provided a few new grads with a written study plan for the licensing exam because they have been unsuccessful.
i think all nursing school prospects should have to work as aides first.. i have been an aide for 3.5 years and just passed my nclex.. i could get a job in the ED here where i work but i wont because i want the expirience of floor nursing first..
Specializes in ED, Cardiac-step down, tele, med surg.
I think med/surg or tele is a good first step in a specialty. It is a specialty in it's own, but it builds confidence in a more predictable environment. It also teaches the nurse how to interact with member of the healthcare team and basic nursing skills that they will use on adult patients. Going into NICU is very different, but one can still learn reasoning in med/surg or tele that apply at least in a small way. Primarily the confidence and ability to make a decision quickly and familiarity with equipment are helpful when going into a specialt.
I don't think nursing school can teach that, it's learned from practice again and again. For me, I no longer have to think about priorities that much, I just do. It is more automatic. I do very well with prioritizing now. It would be challenging to go to another specialty but I could handle it. There'd be a big learning curve but I know I could do it. If I started in a specialty like the ED or ICU, even with 6 month of training my ability to prioritize and do things quickly would still be lacking. Maybe I'm just a slow learner. I wouldn't want to do it. Even the one of the best students in my nursing program didn't get into the ED as a new grad. They didn't let him but after a year on a surgical floor, he was able to get in. I think this works better in most cases. But perhaps there are programs that could provide a basic foundation that a brand new grad could be successful in a specialty. The other staff would have to be willing to provide a lot of guidance though and I know many places don't want to do that since it places additional burdens on the staff.
I also think that there is a sweet spot for experience, meaning that too much in one specialty might make switching more difficulty. Certain ways of thinking might become too ingrained.
I'm a first semester nursing student and from clinical this is what I've thought: most students are very hardworking and motivated, but there will definitely a few lazy ones, but none in my cohort. I've noticed at clinical that there are nurses who don't like to teach and think we are slowing them down, etc. If we don't have the opportunity to learn, when will we learn the skills? Also, some of our instructors do not allow us to do certain things, such as push meds... so when would we learn? on our first job as new grads.
As for going into specialty, it'll probably depend on person and character. Some learn faster, slower, and others might have relevant experience such as CNA, etc.
I am personally interested in OR nursing, but know that in this economy, I will have to be open to other specialties as my first job.
I was a direct hire into the ED as a new grad. I don't see how working on any floor before hand would have helped me. EVERY area of nursing is vastly different and it is time to stop thinking of med-surg as a beginning spot for nurses. It is disrespectful to the nurses who specialize in med surg.
When I started in the ED I had zero IV skills. In one day I started ever IV in the 32 room department for a 12 hour shift. I learned how to do IVs. How many shifts of floor nursing would I have had to work to get that much IV experience?
Med-surg nurses are the queens/kings of time management but the ability to manage the ratios on med-surg doesn't help you on the day you have 3 patients intubated and the ICU is full. By the same token if you are an ICU trained nurse and are working in the fast track and your tech called in sick there is nothing in your ICU training that is going to help you when the doc orders a sugar tong splint that you have to make. The ED is the only place to learn go be an ED nurses.
And finally the advantage of working in the ER is that you have docs and NPs right there with you. There is no sitting there wondering if you need to call the on call person because you have the ability to turn around and ask the doc if you have concerns
Specializes in ED, Cardiac-step down, tele, med surg.
I've noticed at clinical that there are nurses who don't like to teach and think we are slowing them down, etc. If we don't have the opportunity to learn, when will we learn the skills?
Nursing students in most cases do slow down the flow of the day and that can be a problem when you're trying to get things done on time. There are also many nursing students that don't try to quicken their pace or aren't focusing on their patient or doing their charting when they should be. Last week I had a student, very polite and stuff, but she wasn't checking her patient enough and didn't do a lick of charting. She also wasn't walking fast enough. If she wants to follow along she has to walk faster. I think this might have been the fault of the nursing program she was in because I've had stellar students before. And to give her the benefit of the doubt, this was her first clinical experience.
I think a lot depends on the characteristics of the orientation program -- and whether or not the particular unit has experience with new grads and welcomes them into the unit or not. Any department who is going to hire new grads needs to be prepared with the fact that there will be some knowledge & skill that will be weak in the new grad. Not all schools are alike -- and until they are alike and all produce identical graduates -- we will need to assess our orientees and help them to make that transition from student to professional. For a unit to be successful in hiring and retaining new grads, the staff needs to understand that and embrace their role in the process. Too many nurses sabotage the process by being overly critical and not willing to approach the new grad with a positive attitude.
The new grad who is weak in one aspect of practice may be wonderful in another. After giving him/her some special attention to strengthen the weak area, the unit will benefit by having the other wonderful things that person brings to the unit. If a particular new grad brings NO knowledge or skills ... that person probably shouldn't have been hired in the first place. A good orientation program works with the orientee to strengthen the weak areas and help the strong areas to shine.
Susie2310
2,121 Posts
And that is my point - gain the basic experience in a LESS acute area than the ED.
My family member has had new nurses on med-surg. While I have not been completely comfortable with the situation, I have been able to watch what happened as my family member has not been in a situation that requires critical or emergent nursing and medical care. In the ED there is no time for that; if my family member deteriorates or needs specific care and they need it now, this is not the time for the patient and family member to be hanging around hoping the new nurse will get their act together in time.