research ?'s please help

llg, PhD, RN · May 5, 2008

See my response in the other, identical thread you started.

Dixielee, BSN, RN · May 5, 2008

I can't help you write a research paper, but I can offer an opinion. If you are doing this for school there should be guidelines for you to follow.

I, for one, do not think the ER is a place for new grads. Yes, I know there are some great nurses out there who started as grads in the ER and have succeeded. But as you pointed out, the retention rate is low.

The ER is a fast paced, no BS area where you need to have such a variety of skills. A successful ER nurse should already know how to assess a patient, already know how to deal with pushy doctors, and worse still interns and residents who are trying to learn as well.

You should already be familiar with "machinery", i.e. infusion devices, blood glucose machines, monitors, computers, and a multitude of others.

There are so many things we see in the ER that you just don't see anywhere else. Just the other day, at one particular time, I had 4 patients...

1)2 week old with vomiting, fever, diarrhea...required O2 sat monitoring, IV placement, lab draws, LP, x-rays, etc., and admission to the hospital.

2) Alcoholic GI bleeder with a HCT of 18%, BP hovering in 90's/, requiring fluids, blood, NG tube and frequent clean ups

3) 12 week pregnant vag bleeder requiring IV, labs, pelvic exam, ultrasound, and TLC.

4) 85 mildly confused female (in a hall bed) with a fall, lac to head, and lumbar compression fractures. IV, pain meds, admission stuff, MRI.

Three of the 4 were admitted, 2 of the 4 had the real potential to die, and they all required frequent re-assessment. These were not anywhere close to being the sickest patients in the ER, they were more of the average.

Generally new grads do not have adequate assessment skills (and thats OK, we all had to learn), do not have the technical skills, i.e. rapid IV placement, NG tubes, ability to pick up subtle changes in vital signs and patient behavior (those also come with time and practice). New grads generally are not comfortable with insisting that certain things be done when the doc may or may not be doing what has to be done, assertiveness also comes with time and practice, but you have to have the CONFIDENCE that you are right and know when to go to the wall for some thing and when to let it go.

I am not saying ER is the most difficult place to work, I personally love it, but it is so fast paced, so much is at stake, there is very little time for learning the basics. Getting a year or two under your belt on a med-surg floor gives one the time to learn, to gain confidence and grow professionally.

Sorry, that is not what you wanted to hear, but it is one old nurses opinion.

laurainri · May 7, 2008

I can't help you write a research paper, but I can offer an opinion. If you are doing this for school there should be guidelines for you to follow.
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No, I am not doing this for school. I have decided to take some time off before going back to school and while I have the "free time" my plan was to improve my skills to make me a better ED RN (port-a-cath access/infusion, ACLS, PALS, TNCC and then later on CEN. Doing this research paper was for my own benefit, not only to learn how to do them but also,t hey are not going to stop hiring new grads in the ED so I would like to show them how his model would work rather than the one they are using now. thank you for your input regarding new grads in the ED. It is not the first time we have heard it. I started out as an intern and when I got hired they put me in the ED. before that I was not even thinking ED. Now it is my home and I plan to stay.