Seasoned Nurses VS Newbie Nurses

[Alexx_xox]

As I've stated in multiple other posts, I am a new grad in the ER. As a new grad, I do not possess the EXPERIENCE that a seasoned nurse has; however, I have noticed that many seasoned nurses are not up to date with new standards that were taught to us in school.

How can one bridge the gap between old knowledge vs newer knowledge?

Here is a perfect example. We were doing ACLS and all the new grads were very knowledgeable regarding the new ACLS protocol; however, a more seasoned nurse was there as well and was following a different protocol that was practiced years ago and not up to date.

With preceptorship coming soon, how do I as a new grad decide what to follow as far as their experience and advice, versus what was taught to me in school?

I am not talking about ACLS protocol here; OBVIOUSLY I am going to follow what the AHA recommends, but I am talking other things here for instance:

-skills

-assessments

-charting

etc.

I have noticed seasoned nurses also don't chart the same as newer nurses, especially because when they had originally started, there was no such thing as an online charting system.

I respect all seasoned nurses and love learning from them and their knowledge is absolutely invaluable, but I have noticed a lot of discrepancies between what we learn and what they do.

Any advice?

[LiveTheNurseLife]

As a full time bedside nurse for 21 years and preceptor for 18 years, I can say that I made sure to keep an open mind when working with my preceptees. As much experience as I have, and as much pride as I take in my personal touches to patient care, I take my role as preceptor seriously and realize that educating someone is never a one way street. I pose questions and situations to my preceptees and I expect them to do the same to me. I also encourage them to branch out and speak to doctors, the charge nurse, and other staff nurses to build camaraderie, bring them out of their shell, and realize that we are not alone in caring for our unit and our patients. Our patients are people from all different walks of life that require different types of care. Not one person and not one algorithm can teach us everything we need to know in caring for our patients. Guidelines from the AHA are to be followed for obvious reasons. But the bigger picture here is the experienced nurse following her own internal guidance instead of following well studied protocol, and a new nurse wanting to assist the experienced nurse in understanding the implicit danger of not following said protocol. Yes, there is a tactful way of doing this, and I applaud the new nurse for having the gumption to observe and question dangerous practices. Conversely, new nurses need to understand that real life is not and will not be text book perfect. Observe the experienced nurse in her practice and the end result of patient care. You want positive outcomes for the patients. This occurs by bridging your new found knowledge with that of the well seasoned nurse and yes, following life-saving protocol.

[CaCRNA]

I've experienced this when I was a new grad. Sometimes other new grads were taught differently as well and some were very stubborn to try and listen to reason. I'd say make sure what you're practicing is within protocol and meets the standards of nursing care. Also, confirm with your superior as they should be up to date on everything as well. I'm sure they explained that once you get out into the real nursing world not everything is done exactly textbook and being in the ER it's a high stress environment but maintaining efficiency under pressure is essential. Make sure everyone is on the same team and maybe come to an understanding if you want to question something. Sometimes egos get bruised but the end goal is all the same, deliver the best care to each patient. Working as a team is very important especially in critical situations.

[Nurse Beth, MSN]

Don't throw out the baby with the bath water :)

[Dragonnurse1, ASN, RN]

Nursing school is to nursing as law school is to the practice of law and the police academy is to policing. School gives you the basic knowledge, the outline if you will with some parts written in stone but it is only a starting point. Every facility in this country has protocols and often those protocols are very different, in fact in my city the protocols between the two major hospitals are quite different. Every ER runs differently with the desired results being the same stabilizing patients or in some cases saving their lives then moving the patient on to the floor/unit for further treatment.

My first day working the Nursing supervisor told all the new grads - school is the ideal but you are in the real world now and now you learn. My first day in the ER my preceptor was also the day charge nurse and he told me with each patient he sent me to care for - go take care of this and if you get in trouble call me. So many things that day were the basics from school, ng's, foley's, dressings and so forth. Unbeknownst to me he had other nurses watching from a distance and my second day he handed me a burn patient to work with one of the most difficult ER physicians we had. After the Doc complained how I was doing a dressing I turned to him and told him he had given me two different sets of instructions and I was following the one the burn protocol listed. He left the room to calculate the drip rate which I set while he was gone and surprise we had the same rate and that Doc often requested me to assist him. Now to make a longer story short, yeah too late, I took school, hospital protocols and my own extended learning and created my style that got me sent (the only nurse sent) to more advanced teaching such as WMD training, Burn training and Chest Pain Center training.

I never openly corrected any of the "seasoned nurses" but they would ask why I did certain things. Example why I pushed methylene blue on an overdose patient. My Nurse manager had to pass on compliments from the physicians and I was often asked to come in to take care of certain kinds of patients. Fire medics wanted me to teach them to start an emergency IV on burn patients in less than normal places. I never corrected, inferred or suggested that the more "seasoned nurses" were not "up to date" as what is "up to date" today may be out of favor next week but what I did do was watch them, listen to them and discuss the nights patients. It should never be "seasoned" vs "new grad" in a place like the ER it should be about all working together exchanging information. discussing the new, comparing with the "old", helping write new updated protocols for the unit and designing tracks to help with keeping the flow through the ER running as smoothly as possible.

[bgxyrnf, MSN, RN]

I am not talking about ACLS protocol here; OBVIOUSLY I am going to follow what the AHA recommends...

From an experienced nurse to a new grad: What you're going to follow are the orders of the physician running the code.

[Workitinurfava, BSN, RN]

Tbh this still occurs regardless of student vs seasoned nurse. It happens with orientation, so you will have to figure out how to let it go or you will write a post titled, "During my orientation I am being trained by different nurses on how to do things 10 different ways.".

[nursej22, MSN, RN]

I have occasionally worked with students at immunization clinics. They invariably are unable to demonstrate where to give a deltoid injection, they attempt to z track an immunization, and think they ought to aspirate. I'm sure they think I am a COB, but no one is getting an intra-articular injection on my watch. My point being, not all nursing schools are up to date.

[squishyfish]

As a new grad, there were often differences between what I learned in nursing school and what my preceptors or other nurses did. Even as a student, my clinical instructors did things differently. I would often ask why they did things a certain way, and I learned a lot from this. First, that there is often more than one correct way to do something. Second, that if I learn 5 different techniques to reconstitute Geodon, I will be able to adopt the best of each in my own practice. I've learned so much from the experienced nurses I work with!

[Alexx_xox]

My suggestion is learn as much as you can from everyone you can. There is something to learn from every person from the environmental services folks through management. Take what you learned in school and intermix what you learn on the job. Create your way of providing safe, efficient, and timely care. Most importantly, make friends with the CNAs and ER techs. They can make or break a shift. Always ask questions when you aren't sure.

I love your advice. It is absolutely true! We do learn something from EVERYONE. Thats the best part of this job.

[Alexx_xox]

My advice is don't critique your preceptor. He/she has been in the ER long enough to be respected and trusted to precept you. Nurses in the ER have exceptionally long memories and this will be thought of as disrespectful at the very least. Unless they are going to make a mistake that will have an adverse patient event suck it up. You can add your nuisances to your practice when you are on your own.

This has nothing to do with my preceptor. I never one mentioned my preceptor in this. In fact, I have an amazing preceptor and never once did I mention this was regarding my preceptor. Read the post.

[Alexx_xox]

I don't think anyone was "trying to throw an ego around." All the seasoned nurses here are saying is that real nursing practice is often nothing like what you're going to read about in a textbook, and that having a new nurse fresh out of school (or still in school) telling them that their practices are incorrect and outdated is... aggravating. This is especially true when the seasoned nurse has years of positive patient outcomes, and does not have the time to go "by the book."

As far as evidence-based practice goes, yay EBP! The only thing about EBP is that, even after the research has been done, it takes a while to disseminate the findings, and even longer to put them into practice. If the OP is truly concerned with EBP and better patient outcomes, she should find a specific focus, do some research, then present this to the unit manager/director, or ask to present it at the next unit meeting. However, until the change is implemented, I would caution the OP about practicing with EBP if it does not follow current hospital policy and protocol. Even with more recent EBP, if there happened to be poor patient while following the EBP, the OP would not be covered, and could be fired, sued, or worse.

Pretty sure I never said I told anyone their practice was wrong or outdated, I'm not so sure where you came up with that. I never once mentioned actually saying ANYTHING to any nurses, I asked for advice on how to bridge the gap between what was learned in school and what I see done in practice. Apparently you didn't see that when reading the post?

[Alexx_xox]

As someone who has seen both sides of the coin, here's my little bit of advice:

Follow the golden rule before anything else: Keep them breathing, keep them safe. If your preceptor does something that puts either of these into question, then you have the right to speak up and speak up quickly.

For the rest of the time, pay attention to your preceptors assessments. Most seasoned nurses (especially ER nurses) have the ability to quickly whittle away useless information/physical findings and hone in on what is pertinent. This will be difficult at first for you but will be a huge time saver as you develop this ability.

I would also encourage you to pay attention to their procedural skills and get all of the education/tips and tricks related to these procedures that they will give you. We can all read the procedure of how to place an NG tube, but what separates the experienced nurse and you is experience from having done these procedures over and over again. They will have knowledge that the book simply can't provide.

Another thing that I encourage new grads to do is ask why. Some people find this annoying, but there are so many things that experienced nurses do that are like second nature, that they don't even think about or realize they are doing. However, asking them why will give them the opportunity to explain to you, which will help you understand why they are doing what they are doing, which will in turn help you to understand your job better.

Go with the flow and follow what your preceptor teaches you and like previous posters have said, unless it is going to cause harm to the patient or directly goes against your hospitals policy and procedure, just pay attention and change your practice as you see fit when you are on your own.

Good luck with your new nursing job!

Thank you so much for advice. Throughout school I actually learned much more from the nurses on the floor then I ever did in school. They taught me tips and tricks that I will carry on with me forever. And as you stated, patient safety is always priority and I have never seen that being compromised. Thanks for your reply.