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.
The attitude is unacceptable. However, besides that (the attitude), I am that type of new grad. Fortunately, my preceptor is more understanding than you and others seem to be. I know I am intelligent. I know I can critically think through situations. Most of all, I do not have too much pride to admit I don't know how to do something, no matter how basic. Yes, as a new grad in the CVICU, I asked my preceptor to show me how to prime IV tubing. Is this something I should have learned in nursing school? Maybe. Is it something you can show someone in less than a minute? Yes.
There are things that cannot be taught that I know how to do, however. Like when to ask for help. When to call the doctor. How to talk to my patients, or how to treat my coworkers and be a good team player.
I don't claim to be a nursing prodigy. I knew what I was getting into when I accepted a job as a new grad in the CVICU. I also knew that whether I got a preceptor like the one I have, or one with an attitude like yours, could make or break my transition into real world nursing. Fortunately, my admission of knowledge deficits isn't a sign of weakness in the eyes of my preceptor and coworkers, but a sign of strength.
Nurses have to learn somewhere; might as well be in the kind of unit where they want to work.
No IVs???? Seriously?!!! I'm halfway into my first semester and we have been introduced how to insert Iv. The nurse asked me the other day whether I could do it for him but that was like a week before we were introduced that skill. Also, we are allowed to flush, IV med, prime, but perhaps not push meds. Everything with supervision of course. Trach and wound care have been introduced as well in sim and we must get checked off, then we can do it at the hospital
No IVs???? Seriously?!!! I'm halfway into my first semester and we have been introduced how to insert Iv. The nurse asked me the other day whether I could do it for him but that was like a week before we were introduced that skill. Also, we are allowed to flush, IV med, prime, but perhaps not push meds. Everything with supervision of course. Trach and wound care have been introduced as well in sim and we must get checked off, then we can do it at the hospital
We never learned IV insertion (I'm not sure if it's because of the BON's policy or our clinicals' facility's policy), but we are able to connect IV bags into an already inserted IV (woohoo!). Have yet to do trachs or NGs in the clinical setting too. Hence, my firm decision to do a residency program.
I started in PICU. Well, to be fair, I had a couple weeks on a adult long term vent unit, then about 2 months in gen peds, THEN PICU.
I feel like I did well starting there...the PICU staff seemed happy with me, much happier than the floor staff was. Maybe I just had an ICU brain/personality. Anyway, now I've been in PICU/CVICU for, oh, about 8 years and am now a travel nurse. To be honest, I think a year of adult med surg would have ended in a career change.
I'm not saying that going directly into a specialty is right for every new grad, but it was right for me.
I'm sure it's region dependent but it's weird to read that OP is dealing with new grads who need to learn some basic on the job, in addition to the specialty, but then there's a thread by a new grad with LPN experience who can't find a job anywhere.
As a fairly new grad, I agree that nursing students are not taught what they need in nursing school, to survive in the real world. In my clinicals we were not allowed to push IV meds. We weren't allowed to give narcotics. In some hospitals we weren't allowed to take blood sugars. We weren't allowed to start IV's. We weren't allowed to pull meds.
In clinical we were glorified CNA's: Other than assessments, we took vitals, did AM care, answered call bells and gave meds to one patient if we were lucky. If we were looking up information about our patient to try to understand their condition and their plan of care (not that we had access to the computer systems), to ask ourselves what we would do as the nurse, we weren't "working". Why weren't we rounding and answering every bell? The patient in 256 is thirsty.
At one point during clinical I asked my instructor if I could just shadow/observe a willing nurse for a day...something, anything...to give me an idea of what it's like in the day of a nurse, how a nurse organizes his or her day, how a nurse thinks and manages time. Or if I could just forgo my bed baths for one day so I could observe what the nurses were doing. I was told, "You'll get that in orientation."
I was absolutely 100% willing to learn everything I could in clinical. I tried, but constantly hit road blocks. Nursing school clinical these days is excellent CNA training but hardly anything more.
Honestly, it's not fair to lump all new grads together. Some new grads are very bright, and some would sink no matter what floor you put them on. We orient our new grads for six months on my unit, and some are doing 100% of the work all shift, every shift after the first two or three weeks and some are still drowning at the six month mark. Some people are even still drowning with two years of experience.
Nothing wrong with going into a specialty to start with - especially if they did their preceptorship in that specialty. It's entirely possible that new grad was taking a full patient load in that specialty - meds, assessments, and all - before he/she even graduated. I know I did.
We were just talking about this at work. Many of us believe that maybe, eventually, nursing may become a 5 year program like so many other degrees. This allows internships to take place and therefore more time to learn the basic essential skills. We are getting so many new grads who possess no basic clinical
skills such as IV's, placing ngs and catheters. It is starting from scratch for the first few weeks of orientation. Internships can allow more time on floors and working on actual patients to hone those skills. Even my one daughter, who is going to be a park ranger/wildlife biologist, will be in school for 5 years so that she can obtain hands on experience.
No need to make nursing a five year program to accomplish this - most of the major hospitals in my area already have an internship program. It lasts three months, and current rising senior nursing students are partnered with a preceptor for those entire three months. They are only technically "allowed" to do CNA II activities, but they usually do the full workload of a nurse with a few exceptions like hanging blood products. It's a paid position and they are paid a heck of a lot better than regular CNAs. I took advantage of it myself - made $15/hr to hang out with a nurse for three months while the other CNAs were only making $10/hr. And they let me stay PRN after the internship was over and I got to keep my $15/hr. It was a pretty sweet gig.
I sucked at IVs (still do) but I was definitely proficient at placing NGs and Foleys way before I graduated as a result of the internship. Even had my first two codes during my internship so I got the messy my-first-patient-death emotions out of the way before I graduated.
I am a NG, literally in my first week of work at an ED. I'm nervous about some of the skills--such as IV. I was taught them in school and able to do a few in clinicals, but I literally mean a few (less then 5). I also have never done an NG and only done 1 catheter. Most of that, however, is due to clinicals. I would take over care for 1-2 patients and help with all aspects of their care--I'm really good at IV meds and push, talking with patients, educating, them. But my senior preceptorship was on a surgical-acute floor where everyone already had IVs. And if they didn't, the RNs would call an IV team to come start the IV. Most patients didn't need an NG tube, so I never got to practice them. They already had catheters because it was post surgery (I'm excellent at taking them out, however).
I'm hoping that my preceptorship in the ED will help with things such as IV, etc. However, basic care? I have worked for the past year as an aide and feel really, really comfortable cleaning patients, rolling them, ambulating them, talking with family, etc. I kind of think everyone in nursing school should work at least 6 months as a CNA because it makes people more comfortable and capable regarding basic patient care. I kind of wish it was a requirement for getting into nursing school.
Why do they hire new grads in the ED??? It seems silly. A lot of people have not had a "clinically rich" school experience, esp in the specialties. We have lots of NG's in OB. Mostly, they are pretty good. Our ED has lots of new grads and it it obviously not a good idea. I guess no one else applies??? I would not work there!
Obviously? Do you work in emergency? Your profile says l&d, so how do you know it isn't a good idea?
What about all of us who went straight into the ER as new grads, learned and flourished? Yeah, some new grads don't make it, but that happens in m/s as well. And as llg pointed out, with a solid orientation program, new grads are set up for success.
Plus, emergency is a team sport. You want to see nurses, doctors & techs move fast, really fast? Just call out "i need help in here now".
cracklingkraken, ASN, RN
1,855 Posts
Our program doesn't teach IVs either :/