Inexperienced/New Nurses- Give Them A Break !

That old ‘nurses eat their young’ comment from less experienced nurses gets VERY old, but there is some truth to it, depending on where someone works.  I worked in Illinois and Texas, and I would hate to have been a new nurse in Illinois hospitals; being an experienced nurse in Illinois when I returned 17 years after leaving wasn’t so bad. Being a nurse in Texas was generally positive, as they’ve had REAL nursing shortages for a long time- not just a shortage of adequately educated new graduates– for a long time.  When I moved to Texas  in 1985, employers were very thankful to have a nurse- even a new grad- because new grads had to have the basic skills done before graduating nursing school (and even being eligible to take boards)…. there were no ‘internships’ to finish schooling.  Now, hospitals have to finish educating the new nurses, and they don’t like it. They have been put in the position of paying for the ‘internships’, or running out of new nurses. It’s expensive, and finding older nurses who want to ‘babysit’ isn’t always easy; that wasn’t part of nursing school- that is part of being a nursing instructor (who may be some relative newbie who mainlined their Master’s degree to avoid working on the floor- so she has no floor experience)  I don’t blame the hospitals for resenting what they’ve been left with, but it isn’t the newbie’s fault either.  Orientation in any new job used to be two weeks maximum… if the new employee hadn’t figured out enough to be cut loose on her own in that job (with the expectation she’d have questions along the way), she was let go.  End of story.

When I graduated in May of 1985, we had to finish a checklist of skills in each class. If we didn’t pass those skills checklists in each class, we repeated the class. Period. End of discussion.  We may not be experts by a longshot, but we could get the job done without damaging someone.  Like with anything, there are always many things to learn and improve on, but we had enough learned to be safe.  We weren’t told that ‘all hospitals have IV teams’ (which isn’t true- and if you work in long term care, you are ‘IT’… there is no IV team anywhere).  You don’t know where you’re going to end up working to pay the rent and pay back those freakish student loans.  You go where the money is- and that very well may not be what you dreamed of doing.  If you have tens of thousands of dollars in student loans (instead of going for an ADN at a relatively inexpensive community college,  and getting an employer to help with further education), you work where there is work- or you never leave your parents’ basement.

I went to nursing school to work peditrics. That didn’t happen for 17 years, and I ended up finding it extremely depressing with the abuse cases, and permanently damaged preemies that got older, but never got any more  developmentally advanced than  the day they left the NICU 15 years earlier. Very few generally healthy kids ever showed up; most were absolute train wrecks. But I was glad for the experience. By the time I got a job on a pediatric floor, I’d taken care of kids on other floors that were in hospitals that didn’t have specialized peds floors.  So I’d taken care of kids; that helped me get the pediatric job- as well as having had 17 years of honing various skills that are good for any job; I just needed to work on the specific things to pediatrics- which was challenging enough to keep me interested.  I’m glad I did it, and glad I got out.  All experience is experience in something that will be useful in any other nursing job. 

So what makes an experienced nurse?  Having actively worked for over 20 years in healthcare as an RN (and a few as a student nurse/CNA), and since being disabled, having watched nurses for 8 years as they took care of me or a family member or close friend, I’d have to say that a nurse is no longer ‘new’ after about 3-5 years- but  it depends on the nurse. It takes a lot of time to integrate the information in nursing school, which generally focuses on one body system at a time, to be able to take care of a 19 year old pregnant diabetic drug addict who is in the middle of a sickle cell crisis, and is a post-op appy.  Or an actively dying AIDS patient with pneumonia, a perforated bowel, and his Port-a-Cath has clogged past the point of being ‘clot busted’, that is intense pain and has no current orders for any pain med besides an IV delivery route.  Or an elderly nursing home patient  on dialysis, a tube feeding, a trach, and has diarrhea (first thought in that situation is fecal impaction) and a UTI.  It takes time to see the WHOLE patient- not just the parts assigned to you !  You’re assigned to all of them as a nurse- new or not !

New nurses are supposed to have questions (including nurses who may have experience, but are new to a  different specialty).  The quiet new nurse is the most dangerous and the most disliked on any unit/floor. There’s always the question that she may be too dim to know what she doesn’t know, OR that she is too meek to ask. Both are recipes for wrongful death, and no other nurse is going to want to be associated with that type of nurse for anything.  They ARE the plague. Those who talk as if they’ve been nurses for years aren’t far behind. If you’re new, ASK.  If you haven’t done something very many times (like at least a dozen), it’s GOOD to just run something past someone with more experience, until the skill is something that you do without even realizing that you’re doing it automatically.  You’re not stupid for asking; you’re stupid for thinking you have it all figured out when the ink on your license is still wet.

That leaves something for the older nurses to remember. We’ve all been new.  For those of us who graduated a few decades ago, we didn’t have the horrible situation of being turned loose after an incomplete education.  We didn’t pass boards by chance of getting 75 questions that we happened to know the answers to (we had 1000 questions over 2 days in 4 groupings of 250 questions; if we got less than 600 right, we weren’t nurses; we got two tries to get it right, and after that it was back to school). We’ve been able to adjust to things as they came along (and that’s something for the newbies to remember- the older nurses know how to do things in many different ways, including the old, new, and in between). The newbies have been cut loose having to deal with medical technology AND the alive and breathing patient.  That can be overwhelming.  Older nurses have to be role models and mentors, not antagonists. Or, expect those calls on your day off when someone calls in because you’ve run all of the newbies off.  But, if you know you don’t want to be a mentor or preceptor to a newbie, tell your manager !  Don’t get paired up with someone you have no interest in helping learn the ropes 🙂

For those nurses who went into nursing for the relative job security and decent pay, leave.  Nursing needs people who are doing the job for the patients.  Yes, everyone goes to college for the purpose of getting a job.  But those who are simply in nursing for a paycheck aren’t what the profession needs. If you can’t get into someone else’s shoes and learn to appreciate what they are going through (also known as empathy) you’re not much use.  Go be an accountant or electrician. The hours are better anyway 🙂

For those nurses who will do anything to get a nursing job, consider this:  I got an ADN. Nothing else. And I worked staff, charge, supervisory, and department head jobs.  I never needed a BS.  I got to teach CNAs (which was fun!).  I had desk jobs doing assessments and care plans. But I was also willing to go where the jobs were– meaning smaller, more rural communities.  I ended up in the Texas Hill Country, and that was wonderful. I loved my different jobs- and they were glad to have an RN who was glad to have the job.  XTXRN was born in those hills…. those who have been on a specific nursing social site will know what that means 🙂

So, old school nurses, remember what it’s like to be new… newbies, remember that those who have been doing this longer than you may have been alive know a lot more than you do. Learn from them.  Lose the superiority thing.  Explain what it is you are having trouble with, and it’s much easier to help you 🙂  Never be afraid to ‘look stupid’.  The nurses that are truly stupid don’t ask questions.  They may know a fair amount, but by not asking questions they limit their potential.  And nursing as a whole.

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