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.
Until we come up with some hybrid of university education and diploma school education there is going to be the problem of people graduating without basic skills under their belts. How to do this in a cost effective manner is what no one seems to have figured out.
I think new grads CAN learn basic skills on a specialty unit, but I think it's harder and slows down their progress. I also worry about assessment. If you've worked in a less acute area first, you've already learned what is "normal" progress for any specific disease process, so you can more easily pick up critical "abnormal" symptoms that will need to be caught early in a specialty. Again, I suppose you can learn this all at once in the specialty area, but at the cost of taking longer to be up to speed.
On the other hand, I have heard some nurses in specialties say that they would rather teach a new grad the "right" way to do things, rather than have to break them of "sloppy" habits learned in the less acute areas. (Don't jump on me, it's just what I've heard--not sure I necesarily agree.)
I admit, I've only read a quarter of these responses, so forgive me if my post is repetitive.
I'm going on 45 this year and will be one of those older grads. I've been in childcare and other medical areas on and off after I left nursing school over 20 years ago. I have just completed my CNA and let me tell you that the BSN grads have it differently than those starting from the bottom! No pun intended!
There's a difference from going through the BSN college route vs working as an actual CNA and working your way up so to speak.... The "basics" are not emphasized enough in most schools and that is where you'll see a lot of new RNs miserable and regretting entering into the nursing field or dropping out or winging it on the floor.
With hospitals requireing a BSN to be hired, it's easy to neglect the importance of basic skills. Which is strange and ironic because it's about liability... The new grads with BSNs just aren't getting that education and training.
I think the post above mine says a lot- some RNs would rather teach newbies to avoid bad habits...but that's a double edged sword.
I think a CNA should be a requirement along with prerequisites to help determine which specialty to consider, along with whether or not nursing is the right field in general for someone. Most of the online BSN programs don't require anything more than the 2 wk deal and it's simply not enough experience.
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?
It is different because you have oversimplified the topic with your singular anecdotal experience and then attacked your own oversimplification.
Specializes in OR 35 years; crosstrained ER/ICU/PACU.
Very well said, amzyRN! I agree with you. I was a preceptor in an ambulatory surgery center, after working for almost 25 years in a regional trauma center OR. We had nursing students from a local college do about a 4 week OR rotation. One of the guys was "Joe Cool", acting like he knew it all. I had my hands full, & despite my objections, my supervisor hired him as a GN after graduation. His attitude didn't change, so I let him fly on his own, learning some things the hard way (but never compromising pt care & safety by doing so). I had tried to encourage him to take a position in a hospital, on a regular floor, & get some basic skills & experience, but he wanted to work the free-standing center. Unfortunately, he failed his boards. Twice. He finally passed on the third try, & stayed at the surgery center, but took awhile to be able to run an OR room on his own without help. Experience. It counts.
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.
Starting the occasional IV as a student just isn't going to make a difference and it's no loss if you don't learn this skill in school. It's one of those psycho-motor skills that takes tincture of time and lots of experience. I didn't learn it in school and I didn't start IV's on the floor (we called an intern because that person didn't have any experience either). It made absolutely no difference in my nursing life that I didn't start my own IV's. I certainly wouldn't have gotten enough experience on that unit to make me a whiz. However, I ended up in chemo administration and although I lacked the tactile skills at the time, I actually had soaked up a lot of knowledge (need to know purpose of the IV, how long will it be in, size of vein needed to do the job and the biggest question then...can you transfuse blood through a 22 gauge IV?) So to all you students: Don't stress about it. There's often a lot more you need to know than now to get that cannula threaded.
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.[/QUOT
This is silly. The minimum number of clinical hours is set by credentialing agencies, not by the schools themselves. ADN's do not do a semester of public health which COUNTS as hours. I heard that Obama was a Shi'ite Muslim a lot of times. Does that make it true?
I think what some people may not understand is that geography and the nursing school program attended has a LOT to do with all of these issues. I live in a severely underserved but heavily populated area (a border city in far West Texas), and the hospitals here are constantly, aggressively recruiting new grads, often hiring them on as GNs. So by necessity, new grads are hired into specialty units very readily. I was hired as an ER nurse at this city's second most busy ED (the most heavily trafficked Level 2 trauma center...there is only one Level 1 trauma center serving a city of 800,000+ including many, many foreign patients who drive over the bridge to seek treatment on US soil). There is a 13 week orientation, and I also signed up for the hospital's extended residency program, all told it will be 1 year of training. This residency program is actually funded by a federal grant, the purpose of which is to reduce this area's reliance on H-1B Visa nurses. Meaning, they are so hard up for RNs in this region, that they rely on bringing in foreign nurses to fill RN vacancies here.
The BSN program I graduated from (at the local state university) could definitely do with some improvements on many fronts, but when their bottom line is simply to push out BSN grads and keep their NCLEX pass rates above 85%, you can't expect too much. I felt that a good 75% of the program was geared towards passing the NCLEX. The other 25% was dependent on how enthusiastic our preceptors were about teaching us. Except for my very last 12 weeks of clinicals in my final semester (which only amounted to a paltry 280 hours, after being out of a clinical setting for almost 3 months thanks to the winter break and how clinicals were scheduled), almost none of the nurses I was assigned to were very good teachers. At worst, they expressed disdain for having to be stuck with a student. At best, they had us follow them around and start some IVs and Foleys, but it was never consistent enough to solidify a skill. We also wasted a lot of time in the much-hailed "sim lab" which I found to be hilariously inapplicable to real clinical settings. Granted I had previous patient care experience as a CNA, EMT and ED tech, but I feel the sim lab trend is overhyped unless you have some great programming behind it (which we did not). I do agree with some previous posters about the entitled/Joe Cool attitude that is associated with fresh grads, there was definitely a lot of that going on in my cohort, but from my observations, that's not much of a surprise given that the majority of my class was in their early 20s, had never had jobs with such great responsibility or had to act like professionals before. Not that is an excuse, and there were some students that had some level of maturity, but the embarrassingly arrogant ones are always the ones you will remember. But my point here is, I am also a new grad RN, but I have experience in other professional areas, and have sacrificed a lot to earn the "RN, BSN" after my name. This shows in my work ethic and my appreciation for what I can learn from more experienced nurses, paramedics, EMTs, techs, PAs and docs. The blanket statements about "New grads this, new grads that" are divisive and inappropriately applied to people like me, and I do hope this changes in the future. I am fortunate to be able to go forth into this hot mess of negativity with confidence of what I know and what I do not know, and that there will be some people that will just be pissed that I landed a job in my desired specialty right out of the gate. I am old, have been to a combat theater, and am beyond grateful to have this opportunity I fought so hard for, so for anyone who wants to pooh-pooh us "New Grads": Lead, Follow, or Get Out of My Way.
It is different because you have oversimplified the topic with your singular anecdotal experience and then attacked your own oversimplification.
It is a pretty low level argument. I used an anecdotal experience in a thread about someone else's anecdotal experience. It is the technique of using the same type of fallacy (in this case anecdotal) to demonstrate the previous fallacy that had been introduced.
I didn't attack my own oversimplification. I used an example to demonstrate what happens when grouping all people in the same class based simply on anecdotal experience (experienced ICU nurses vs. new graduate nurses). It is an example of an ecological fallacy or a fallacy of division.
My example of the experienced nurse who managed to screw up a decimal point on a medication is no more representative of all experienced nurses than the OP's experiences with new nurses in the ER.
The lesson being that you can be a horrible experienced nurse or a horrible new nurse and to avoid broad generalizations such as are being made in this thread.
I have been criticized for saying this before but the truth still remains- Being a nurse with many years of experience in no way demonstrates your competence. All it means is that you haven't done anything stupid enough to lose your license.
By the same token if you are a new grad all you have done is passed the test that assesses the fact that you are minimally competent to be a nurse.
Think about the worst nurse you know- that is all the title of being a nurse guarantees you. No difference than the worst doctor you know, the worst attorney you know, the worst mechanic you know etc.
Scottaprn, that is it right there, I think. At first I thought you may be just being arbitrary, but what you just posted (which I can't quote on a smartphone) is that passing the NCLEX is the bare MINIMUM not to harm (or worse) in the first three months of either passing the exam or practice. I think about that with every experience I have with a practitioner that I encounter personally and professionally... This is where patient care comes in. Not just as a career, I think. But real "care" and what it means both on a licensing level or in how you'd feel as a an actual patient. How would that come into play if we were a patient and if that would change the level of care we'd provide or strive to achieve.
It is interesting that straw man argument that you pose is the lowest level of debating used to put ones opponent on the defensive.
I'm sure there are reasons that you have taken the topic of inexperience and lack of clinical training very personally and out of context. No one has made any sweeping generalizations about about the caliber of all new grads. Maybe you are confusing us with your colleagues. You have your own agenda and that's fine. Please feel free to start your own thread.
icuRNmaggie, you are pretty inflammatory in this thread. You are coming off as someone who cannot see any side of an issue other than your own. You attack as if personally attached, and my guess is this is a direct reflection of how you are at work.
Some of us you accuse of being new, only because our opinion is different from yours. We all know someone like you at work and it creates an uncomfortable environment.
Todays "New nurses", whether you like or not, are more educated and have more access to resources than we could have dreamed of having years ago. Geeze stop digging your heels in and be their resource and then hug them, heck if you treat them like you treat the people on this thread then they will end up perpetuating the same tired animosity you present.
Two things you never want to hear said:
Day one orientation new grad states "based on my experience"
Or when a 20 year ICU nurse says "hold my beer and watch this ****!!"
maxthecat
243 Posts
Until we come up with some hybrid of university education and diploma school education there is going to be the problem of people graduating without basic skills under their belts. How to do this in a cost effective manner is what no one seems to have figured out.
I think new grads CAN learn basic skills on a specialty unit, but I think it's harder and slows down their progress. I also worry about assessment. If you've worked in a less acute area first, you've already learned what is "normal" progress for any specific disease process, so you can more easily pick up critical "abnormal" symptoms that will need to be caught early in a specialty. Again, I suppose you can learn this all at once in the specialty area, but at the cost of taking longer to be up to speed.
On the other hand, I have heard some nurses in specialties say that they would rather teach a new grad the "right" way to do things, rather than have to break them of "sloppy" habits learned in the less acute areas. (Don't jump on me, it's just what I've heard--not sure I necesarily agree.)