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.
Thanks for your great post. It seems that the 2 of us were trained & started our careers very similar.
I also found my 2yrs of MED/SURG training strengthened my clinical skills,exposed me to various clinical situations that HELPED ME IMMENSENSELY IN HOMECARE,Pulmonary Critical Care Research, & Stepdown Cardiac Surg/Telemetry, & SICU-fresh CABG pts. What I frequently came across from my coworkers who jumped directly into Surgical Critical Care is the lack of expertise of colostomy management,foley inserts,management of decubitus care,GT/NGT management & trouble shooting,etc......
I find it sad that having a good foundation of Med/Surg is not valued anymore. IMO-I would still make all new RNs work there for @tleast 6months. I guarantee they wouldn't regret having a good,solid,learning foundation to start with would be more helpful in every area of practice than most realize. to the post below who is in peds-IT DID TEACH YOU HOW TO BE ORGANIZED & PRIORITIZE YOUR PATIENTS during your shift @ the very least-jmo-fwiw.
Sad isn't it. It seems to be getting worse since I graduated in 1987. I wish the hierarchy would realize ALL NURSES ARE IMPORTANT-NO MATTER WHAT SPECIALITY OR LOCALE YOU WORK IN,alas it seems the great divide is getting worse,sadly..
I graduated in 2010 with a BSN and we spent one class day on the basics of bathing, turning, etc. and I don't really know how you can learn those things except for working in the trenches and getting hands on experience. Did I feel clueless and overwhelmed when I first hit the floor? You betcha! But I took every opportunity to learn from the experts- our CNA's.
As for starting out in an ED? I would have felt way too uneasy starting my career there. To me, there is a greater risk in the ED of missing something important and I would not want my inexperience to cause harm. But maybe other people have more confidence than I had.
Nursing is a very serious field. I myself as a student nurse feel like I am not being prepared well enough as an RN. I believe the best way to fix this would be if all nursing schools require at least 6 months of prior nursing experience either as an LVN/LPN or CNA. If not then at least have all new grads require completion of a nursing residency in order to receive their license before applying for work. But we know that won't happen anytime soon due to supply and demand and the "shortage of nursing."
The old adage that nurses eat their young has never been so prevalent as it is today. Most experienced nurses would rather complain about what the "babies" are doing wrong, then take them under their wing to help them improve their skills. Every single nurse posting in this forum has been a brand new nurse at one point and time. Feeling the uncertainty of doing a procedure for the first time, and the trepidation of asking experienced nurses advice on a difficult patient. This problem is not unique to other professions, but the response that experienced nurses give these new grads is. Ironically many other professions with much less at stake for peoples lives do a much better job bringing their young up to highly effective skill levels. Some have said here that many new grads are arrogant, I would argue that the same holds true for many experienced nurses, and their treatment of new grads. WE WERE ALL NEW NURSES ONCE!!!
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.
Well I have been called out for being a constant deviant, but here is my opinion. Nurses (even though I despise the pay scale) are hitting the floors with BSN and MSN degrees. It is not elitist to enter an entry level nursing job (no offense but any specialty with a basic requirement of "RN" is entry level) and act as if they know something, they are trying to show that they should be there.
The old head down victim nurses are being replaced by new nurses who are demanding respect right out of the gate, and this is not a bad thing. Regardless of your approach to nursing you will make mistakes but you will also shine. Stop giving a **** about how someone got there and be a team member and start supporting them.
FYI.... APRNs are not even required to work bedside anymore so if this bothers you wait till your CNS teaches you to change a central line drsng, and they have never actually done it themselves:)
In my facility all of the units are a specialty. Even the med/surg units, for instance we have a Neuro/Neurosurg unit, HemOnc, Ortho/Trauma, Cardiac, General Surgery, GI/Transplant all as individual units. There is no area in my facility where a new grad could start that isn't a "specialty". To say that new grads shouldn't be in the ED seems absurd to me as I know ED nurses who could not make it on some of these med/surg units. Would it be a good fit for all new grads, absolutely not, but some of these other units wouldn't either. New grads need support and someone willing to educate and train them. More and more schools are focusing on Nursing Theory and less on actual nursing skills through no fault of the students, which unfortunately leaves it up to their employer to teach them how to actually be a nurse.
Reading through a good chunk of this thread, I feel like there's a lot of bitterness between new grads and more experienced nurses. What I think everyone should take into account is the difficulty in finding jobs. Out of nursing school, I applied for everything under the sun, and the only interview I got was in psych nursing. I had coworkers treat me like trash, because I didn't work in med-surg first. I applied in med-surg. I would have gladly worked there, had I gotten the opportunity, but I didn't. Because the reality of the situation is that I live in a major metropolitan area where it is hard to get a job as a new grad without any sort of connections. So I worked in psych for six months and stumbled around awkwardly. My next job was in a teaching hospital in the GI lab, doing GI and pulmonary procedures, and I love it there.
I'm blessed that I was able to be precepted for three months and that my hospital paid for education and classes (a three-day basic EKG class and then a two day 12 lead class, for example, although I took more than that) on top of that. Working in the environment in which I work (in what will next month, when we move to our new facility, be the largest hospital in the US), a teaching hospital, a safety net hospital, a county hospital, I feel like I see more than 90% of people in my similar position in different hospitals. I still stumble and fall regularly, even after a year, but I feel capable. And I feel like some skills translate but others do not. When I am floated to pre-op, I start 30 IVs a day, and the patients are dehydrated and often very, very sick. A good chunk of our floor nurses could not start a line outside the AC to save their life. I also bet you they can't respond to emergencies the way that I can (because they don't have to have ACLS, and when their patients code, they call rapid response, nor are they floated to PACU the way I often am). But I also bet you they can program a pump twice as fast, bathe a patient twice as fast, and can assess a good chunk of systems better than I can.
I think it's good to have basic skills coming into a specialty, but if you don't, you learn what you need to. And those specialty skills diminish when you move. In psych, I more-or-less could spit out the DSM at you, could verbally de-escalate any situation, practically knew how to restrain in every way possible, etc. The other day, I had a patient roll in with restraints, and it took me a solid five minutes to remember how to properly tie them.
Anyone who says they are an expert at everything and retain everything they learn is lying to you. I think it's important to stay humble, do your best, and always keep in mind that we are from different circumstances. The nurse you have with you that doesn't know what to do might be there, because she was unable to find anything else and wants to do her best to learn. I recommend teaching. Getting into the GI lab was a miracle, and I did not think I would like it, but I cannot imagine working anywhere else now. I adore it. And I'm relatively competent. And my preceptor played a pretty big part in both those things.
I have had an ICU nurse with 20 years experience royally screw up at my prn job 3 times in the last week. (And I mean royally!!!!). Should I refuse to work with all ICU nurses with 20 years experience? Do I give her a pass on her med error because of her experience? Or should I try to help her learn from almost killing someone?
What is the difference in considering all ICU nurses with 20 years experience the same and considering all new grads the same?
Specializes in OR 35 years; crosstrained ER/ICU/PACU.
We all had to start somewhere. I knew in college that I wanted to be an OR nurse. However, when I finished, the only job I could get was on a Surgical floor (before the Same Day/Ambulatory Surgery days) where we took care of patients having surgeries ranging from cataracts, tonsils, mastectomies, TURP's, hysterectomies, thoracotomies, cholecystectomies, herniorrhaphies, etc. We had to know many surgeons & their idiosyncrasies, many special needs for various procedures, a lot of technical equipment & machines. I was a grad nurse, started on day shift, then went to evenings for the extra pay. Boy, did I learn a lot in 2 years! Prioritizing, organizing, planning treatments, passing meds, assessment & dealing with patients crashing, rounding with docs. These are things that I feel made me a better RN, & gave me a platform to build my skills on when I transferred to the Operating Room. I already had the skills to assess, plan, implement; I had to organize, be prepared for anything & everything, anticipate my patients', my surgeons', & my anesthesiologists' needs; to know how to put my hand on a specific piece of equipment or instrument set. I think on-the-job training for a specialty unit can work for a fresh grad, with the right preceptor. But I do think there's something to be said for having a year or two of "general" nursing practice, to hone those skills & build confidence.
kmsussman
26 Posts
Susie,
Thanks for your great post. It seems that the 2 of us were trained & started our careers very similar.
I also found my 2yrs of MED/SURG training strengthened my clinical skills,exposed me to various clinical situations that HELPED ME IMMENSENSELY IN HOMECARE,Pulmonary Critical Care Research, & Stepdown Cardiac Surg/Telemetry, & SICU-fresh CABG pts. What I frequently came across from my coworkers who jumped directly into Surgical Critical Care is the lack of expertise of colostomy management,foley inserts,management of decubitus care,GT/NGT management & trouble shooting,etc......
I find it sad that having a good foundation of Med/Surg is not valued anymore. IMO-I would still make all new RNs work there for @tleast 6months. I guarantee they wouldn't regret having a good,solid,learning foundation to start with would be more helpful in every area of practice than most realize. to the post below who is in peds-IT DID TEACH YOU HOW TO BE ORGANIZED & PRIORITIZE YOUR PATIENTS during your shift @ the very least-jmo-fwiw.