new RN's in specialty areas

nickola · Apr 19, 2008

Yes, you are right, new nurses are going into specialty areas w/out proper assessment skills. This is not fair to the patients OR the nurse. Management seems to be desperate for anyone w/a pulse to fill vacancies- they expect staff to TRAIN these people- it is causing a lot of morale problems where I work. Nobody minds orienting a person but to train someone in a critical care area who has never done it is another story. I see close calls nearly every day w/these newbies & that raises the stress level of the whole unit; and it's not just inexperience, it's over-confidence too. You can not possibly teach a nurse to have that "6th sense" or the assessment skills acquired over years of caring for patients. Their lack of experience is very apparent & management doesn't see the day-to-day problems, nor do they want to hear about it- believe me, I've tried, b/c that is seen as "not being nice to newbies" & "contributing to poor morale". I am of the belief that a solid year (at least) of Med-Surg is very helpful b/f moving to specialty areas; even then it is still a HUGE learning curve. Let the inexperienced nurses become proficient in one area b/f trying to move on to another- and then only w/the proper precepting & classes. At my hospital they have put nurses w/no or little experience in ER, ICU, OR & PACU- pretty scary- and very apparent when dealing w/these nurses. More needs to be done to retain experienced nurses & staff so that training these new nurses is done in a organized & efficient way, even then they shouldn't be expected to 'fly solo' until they have met certain criteria & have done it fulltime for at least 6 mos to a year. Instead we have an influx of RNs that come w/a sense of entitlement & lists of what they will and will not do-- certain days/times/shifts/holidays they "can't" (won't) work- & management allows them to call the shots, while the rest of the experienced staff picks up the slack. I'm seeing a new trend in the medical field that makes me never want to be a patient!!

elkpark · Apr 19, 2008

Yes, you are right, new nurses are going into specialty areas w/out proper assessment skills. This is not fair to the patients OR the nurse. Management seems to be desperate for anyone w/a pulse to fill vacancies- they expect staff to TRAIN these people- it is causing a lot of morale problems where I work. Nobody minds orienting a person but to train someone in a critical care area who has never done it is another story. I see close calls nearly every day w/these newbies & that raises the stress level of the whole unit. You can not possibly teach a nurse to have that "6th sense" or the assessment skills acquired over years of caring for patients. Their lack of experience is very apparent & management doesn't see the day-to-day problems, nor do they want to hear about it- believe me, I've tried, b/c that is seen as "not being nice to newbies" & "contributing to poor morale". I am of the belief that a solid year (at least) of Med-Surg is very helpful b/f moving to specialty areas; even then it is still a HUGE learning curve. Let the inexperienced nurses become proficient in one area b/f trying to move on to another- and then only w/the proper precepting & classes. At my hospital they have put nurses w/no or little experience in ER, ICU, OR & PACU- pretty scary- and very apparent when dealing w/these nurses. More needs to be done to retain experienced nurses & staff so that training these new nurses is done in a organized & efficient way, even then they shouldn't be expected to 'fly solo' until they have met certain criteria & have done it fulltime for at least 6 mos to a year. Instead we have an influx of RNs that come w/a sense of entitlement & lists of what they will and will not do-- certain days/times/shifts/holidays they "can't" (won't) work- & management allows them to call the shots, while the rest of the experienced staff picks up the slack. I'm seeing a new trend in the medical field that makes me never want to be a patient!!

I completely agree!

nickola · Apr 19, 2008

Yes, you are right, new nurses are going into specialty areas w/out proper assessment skills. This is not fair to the patients OR the nurse. Management seems to be desperate for anyone w/a pulse to fill vacancies- they expect staff to TRAIN these people- it is causing a lot of morale problems where I work. Nobody minds orienting a person but to train someone in a critical care area who has never done it is another story. I see close calls nearly every day w/these newbies & that raises the stress level of the whole unit. You can not possibly teach a nurse to have that "6th sense" or the assessment skills acquired over years of caring for patients. Their lack of experience is very apparent & management doesn't see the day-to-day problems, nor do they want to hear about it- believe me, I've tried, b/c that is seen as "not being nice to newbies" & "contributing to poor morale". I am of the belief that a solid year (at least) of Med-Surg is very helpful b/f moving to specialty areas; even then it is still a HUGE learning curve. Let the inexperienced nurses become proficient in one area b/f trying to move on to another- and then only w/the proper precepting & classes. At my hospital they have put nurses w/no or little experience in ER, ICU, OR & PACU- pretty scary- and very apparent when dealing w/these nurses. More needs to be done to retain experienced nurses & staff so that training these new nurses is done in a organized & efficient way, even then they shouldn't be expected to 'fly solo' until they have met certain criteria & have done it fulltime for at least 6 mos to a year. Instead we have an influx of RNs that come w/a sense of entitlement & lists of what they will and will not do-- certain days/times/shifts/holidays they "can't" (won't) work- & management allows them to call the shots, while the rest of the experienced staff picks up the slack. I'm seeing a new trend in the medical field that makes me never want to be a patient!!

nickola · Apr 19, 2008

I'd also like to add (since my 5 min editing window expired) that even if a nurse is coming in w/experience, it depends WHAT that experience was in. We've have management try to put nurses from Home Health, GI Lab, & Radiology in specialty areas. In my experience these areas hardly qualify if you want to move on to a critical care unit- this is how you get nurses panicking over something they don't recognize (like artifact) on the monitor! Just my 2 cents!

MikeyJ, RN · Apr 19, 2008

Yes, you are right, new nurses are going into specialty areas w/out proper assessment skills. This is not fair to the patients OR the nurse. Management seems to be desperate for anyone w/a pulse to fill vacancies- they expect staff to TRAIN these people- it is causing a lot of morale problems where I work. Nobody minds orienting a person but to train someone in a critical care area who has never done it is another story. I see close calls nearly every day w/these newbies & that raises the stress level of the whole unit; and it's not just inexperience, it's over-confidence too. You can not possibly teach a nurse to have that "6th sense" or the assessment skills acquired over years of caring for patients. Their lack of experience is very apparent & management doesn't see the day-to-day problems, nor do they want to hear about it- believe me, I've tried, b/c that is seen as "not being nice to newbies" & "contributing to poor morale". I am of the belief that a solid year (at least) of Med-Surg is very helpful b/f moving to specialty areas; even then it is still a HUGE learning curve. Let the inexperienced nurses become proficient in one area b/f trying to move on to another- and then only w/the proper precepting & classes. At my hospital they have put nurses w/no or little experience in ER, ICU, OR & PACU- pretty scary- and very apparent when dealing w/these nurses. More needs to be done to retain experienced nurses & staff so that training these new nurses is done in a organized & efficient way, even then they shouldn't be expected to 'fly solo' until they have met certain criteria & have done it fulltime for at least 6 mos to a year. Instead we have an influx of RNs that come w/a sense of entitlement & lists of what they will and will not do-- certain days/times/shifts/holidays they "can't" (won't) work- & management allows them to call the shots, while the rest of the experienced staff picks up the slack. I'm seeing a new trend in the medical field that makes me never want to be a patient!!

I disagree to a certain extent. I do agree that hospitals that have little or no orientation for new nurses in an ICU area is incredibly scary. That is no fault of the new nurse though, but rather the hospital.

However, I will be working in the PICU when I graduate and I have to go through a 6 month orientation program that includes classroom and preceptorship. Will I come out with those skills that a 10 year veteran has? Absolutely not. But I will come out with the ability to practice safely and there is no shame in asking for help and asking questions if I am unsure of myself.

I will not work in a med/surg area when I walk out of nursing school -- I despise working with adults. If they wanted me to work on a general pediatrics floor, I would. However, I will have worked an entire year as a nurse apprentice on a general pediatrics floor when I graduate and move to the PICU.

And many experienced nurses refuse to move into the ICU setting and hospitals NEED to fill these positions -- the only way is to hire new grad's who are willing to at least try it out. And you speak as if every new grad wants to go into a specialty area. In my class, there are only about 10 or 15 out of 40 who want to go into a specialty area. Otherwise the rest have no preference yet and will probably start out in a med/surg area.

In regards to new nurses coming in with a sense of "entitlement". I know new nurses on the floor I am on do not get a say as to when they work. We are self-scheduling and the new grads understand that the days they want to work do not necessarily mean they will work those days. It is all based on seniority. And there is nothing wrong with a new grad coming on with the attitude of "no one is going to walk all over me" because hospitals will walk all over you if you do not stand up for yourself.

It bothers me immensely when people generalize about new grads because of their experience at one hospital. It is different everywhere. Also, I know of new grads who have quit nursing altogether because of the horrible work environment because the way the experienced nurses have treated them as if the new grads did not "belong" in their department. Instead of this attitutde, nurses should embrace the new grads and promote a healthy learning environment and help them along. If you have a problem with a new grad on your specialty floor, go to your hospital administration, not to the new grad.

MikeyJ, RN · Apr 19, 2008

I'd also like to add (since my 5 min editing window expired) that even if a nurse is coming in w/experience, it depends WHAT that experience was in. We've have management try to put nurses from Home Health, GI Lab, & Radiology in specialty areas. In my experience these areas hardly qualify if you want to move on to a critical care unit- this is how you get nurses panicking over something they don't recognize (like artifact) on the monitor! Just my 2 cents!

Every single ICU nurse (those with 40 years of experience and those with no experience) have all started in the same place. Regardless if you have experience in radiology or med/surg or GI lab or home health -- none of them had ICU experience.

sunny261 · Apr 19, 2008

and some day you will be one of them....

MAISY, RN-ER, BSN, RN · Apr 19, 2008

I am sure any placement of nurses should be tailored to the nurses personality and ability to learn.

I started ER as a new grad, but I had worked as a ER Tech so was accustomed to the flow. Personally, I would take an ER tech nursing student, over a nurse from another area any day. In my experience, the floor nurses who tried the transition have not stayed, didn't like the craziness, or the constant stress level.

I think it's hard for a nurse used to waiting for orders, or directions to be thrust into an are where YOU must initiate these same orders, meds and other things quickly. It's hard to learn as a newbie, but for some reason harder for some of the med-surg nurses. I just think its a "role" thing and maybe just "what you are used to". Newbies just acclimate to pushiness (I think) or not and leave.

In the same respect, I have to agree that education and experience are key when precepting. Our program was 20+weeks, unfortunately, newbies are now teaching(precepting) newbies-THAT IS SCARY! I was fortunate and had seasoned ER nurses who I admired and who passed on alot of knowledge. This is not the case right now. As much as I like what I do, I am in no position to teach a new grad all the things they may need to know. I don't know it all!

I think a teaching hospital is probably safer for all involved, as there are always people on site. You are never alone, however, I am not sure I'd want to be a patient somedays.

JMHO

Maisy

futurecnm · Apr 19, 2008

I am going into a specialty area (ED) in July after I graduate in May. This post makes it sound like it is a bad idea. I was not able to get an interview for a med/surg position in one hospital and this manager requested to interview me as I precepted in the ED and interned with this hospital system last summer. Should I have turned down a job in an area that i am interested in, and just hope a job in med/surg comes along? It is very competitive for jobs around here, even med/surg jobs. Would I prefer to work a year in med/surg? Probably, even though I don't have a desire to stay there. But do I feel that I can be trained properly to work safely in an ED. Yes. I specifically asked the manager about new grads and she has had many start there with much success. She has had a couple that do not work out but not many. I asked many staff while i was precepting there what their opinion of new grads was and no one seemed to have issues with it. I obviously have tons to learn but even if I started in med/surg and moved to ED I would still have tons to learn. Would one yr med/surg make me a better RN? Not sure. I have had some tell me that every area is so different it is like starting over. I think it is unfair to say it is unsafe for new grads to work in these areas. Yes, we have much to learn but that doesn't mean we will do our job unsafely. That is my biggest priority, is pt safety. I have no sense of entitlement. I do not find this statement true at all of new grads. I would think that all RN's should try to work together to provide care. New grads are a necessity. without them, there would be no one to fill the open jobs. It isn't our fault we are new. It doesn't mean we can't do things or that we will do them wrong. I'm sure there are many experienced nurses who do unsafe things daily.

MikeyJ, RN · Apr 19, 2008

and some day you will be one of them....

:rolleyes:

MikeyJ, RN · Apr 19, 2008

I am going into a specialty area (ED) in July after I graduate in May. This post makes it sound like it is a bad idea. I was not able to get an interview for a med/surg position in one hospital and this manager requested to interview me as I precepted in the ED and interned with this hospital system last summer. Should I have turned down a job in an area that i am interested in, and just hope a job in med/surg comes along? It is very competitive for jobs around here, even med/surg jobs. Would I prefer to work a year in med/surg? Probably, even though I don't have a desire to stay there. But do I feel that I can be trained properly to work safely in an ED. Yes. I specifically asked the manager about new grads and she has had many start there with much success. She has had a couple that do not work out but not many. I asked many staff while i was precepting there what their opinion of new grads was and no one seemed to have issues with it. I obviously have tons to learn but even if I started in med/surg and moved to ED I would still have tons to learn. Would one yr med/surg make me a better RN? Not sure. I have had some tell me that every area is so different it is like starting over. I think it is unfair to say it is unsafe for new grads to work in these areas. Yes, we have much to learn but that doesn't mean we will do our job unsafely. That is my biggest priority, is pt safety. I have no sense of entitlement. I do not find this statement true at all of new grads. I would think that all RN's should try to work together to provide care. New grads are a necessity. without them, there would be no one to fill the open jobs. It isn't our fault we are new. It doesn't mean we can't do things or that we will do them wrong. I'm sure there are many experienced nurses who do unsafe things daily.

Not that I want med/surg, I live in an area where med/surg positions are actually hard to come by in some hospitals. Our state brings in a ton of Filipino's to take med/surg positions and fills specialty areas with local graduates.