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.
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.
Thank you for your response. I truly appreciate everything you had to say. You must be an amazing preceptor if you have been precepting for 18 years. Im sure the newbies are grateful for you!! Thanks again.
... 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?
...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?
Yes, if you could provide some measurable evidence other than a generalized statement regarding ACLS standards that change regularly anyhow, then we could possibly advise you. What discrepancies? You only quantified with the statements 'many seasoned nurses are not up to date' and 'a lot of discrepancies' with not one complete real example. We all are required to do the continuing education work and pay the fees to keep 'up to date'.
'How can one bridge the gap between old knowledge vs newer knowledge?' Respectfully, by sharing with specific examples and teaching and not so much with vague, divisional 'us vs. them' and 'not up to date' statements like above without any evidence.
The seasoned nurses have learned and fine tuned the art of nursing through the school of hard knocks. We were once new too. No need to say we're not 'up to date'. We're as 'up to date' as any of you young or new whipper snappers just with a little more nurse seasoning!
You may have just been taught a new and improved way of doing a task at school. By all means if it is indeed that much better for the patient please share with us. Have an inservice. Ask for input from the seasoned nurses. Showing respect for them and their knowledge is also showing respect for yourself, for the spot you will be standing in before you can even wink an eye.
Though medicine has made major advances, the human body, anatomy and physiology remains the same. We're truly all in this thing together, nurses, patients, families, doctors, RT, PT, OT. We all learn from each other. We have to learn to look and listen and be grateful for teachers of all kinds.
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?
You will have a preceptor, you must follow THEIR guidelines. When you are on your own.... you will do the same as the rest of us... learn as you go. There will be discrepancies, common sense helps.
I would do things the way you learned them in school, just as those experienced nurses are likely doing things the way they learned in school. It's not about correcting your coworkers (which is not how I read your post). It's about giving your patients the best possible care by utilizing current nursing data. EBP is the way to go, and some nurses are going to be resistant to that. It's okay to thank them for their insight and attempts to help. It doesn't mean you need to pick up bad habits or adopt outdated practices though. Just be aware that this is one of the reasons behind nurses eating their young. People get stuck in their ways and everyone believes their way is best.
It's about giving your patients the best possible care by utilizing current nursing data. EBP is the way to go, and some nurses are going to be resistant to that.
Do you people honestly believe that those of us who have been around for awhile don't incorporate EBP in our practice?!!! Just because you were taught it in school does not mean it is the most current practice or that it is even correct. FTR, it isn't nursing schools who are advancing nursing care it is the bedside nurses in collaboration with nursing innovators. 6 pages in and I have yet to hear one concrete example of a nurse using an out-dated practice (that isn't forced in them by facility policy) that put a patient at risk or provided sub-standard care. I'm not talking about the stupid nurse who can't critically think themselves out of a paper bag and repeatedly do ridiculous things. No amount of training can fix that. I'm talking about the experienced, respected nurse who firmly holds onto a practice that has been proven to not be beneficial. There are multiple ways to do things and as long as the rationale is sound doing something differently cannot be categorized as "wrong". Sometimes the "old" ways produce better outcomes. We have to adjust our care to each patient and rigidly applying something just because it's evidence-based is folly.
Yeah I know we have been waiting in my ER for decades for some new nurse to come along and describe the wonders of Evidence Based Practice or what their nursing professor thought about whatever. Nursing is a fluid profession and change is a constant. Good Nurses keep up with the changes and if they don't they won't last in a critical care or ER setting. All of the Nurses in my ER have a BSN. Probably half have or are working on their MSN. Four of us are in dnp programs. If some twit nursing professor planted the idea in a nursing students head that they were the proper vehicle to update all us relics in the ER they did that new nurse a serious disservice. I'll go back to my original advice. Unless you see something that will negatively impact a patient your job is to watch, learn and work hard. Seriously asses your audience before offering any sage pearls of wisdom based on the sole qualification of just getting out of nursing school because the reaction to this shared insight might not be what you want and have lasting effects
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?
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.
This to me says that you believe certain practices to be outdated, no? And if those practices are outdated, then one would be practicing incorrectly according to new EBP guidelines, correct? I do apologize if I took it the wrong way, but my reading comprehension and my ability to read between the lines are normally on point. I gave you some sound advice in my original post though, I believe. Pick something you're passionate about in the ER: minimizing repetitive sticks for IVs, improving the triage process, improving the flow for psychiatric patients from ED to final destination, etc. Just make it something you're passionate about. Do research on your topic, and present your findings to your unit manager/director, or at your next unit meeting. Unless there is imminent patient harm, do not correct your seasoned nurses about their practices. Let this come from the higher ups.
Alexx_xox
169 Posts
Thank you for your response. I truly appreciate everything you had to say. You must be an amazing preceptor if you have been precepting for 18 years. Im sure the newbies are grateful for you!! Thanks again.