Our first collaborative post! A dear friend of mine, who would like to remain anonymous as Freya, RN, contributed the below post. I’ll be posting another of hers tomorrow as well. Keep a look out!
I find it hard to organize my thoughts regarding this topic. It’s been the bane of my existence for the last year, and I’m running thin on my patience and my understanding at the moment.
I am by no means an experienced nurse. I’ve been a nurse in the ICU for four years and I’m getting tired of babies teaching babies. I was a new graduate in the ICU. I’ve been there. I should be more empathetic. The thing is, I was raised by nurses who had 5-20 years of experience in the ICU alone. I always had someone with more experience than I do to rely on. Someone who could help me with my critical thinking and decision-making process. Now, with my few measly years of experience, I’m a top dog at many of the hospitals I’ve worked at.
I have worked in situations now where I am one of the most experienced nurses on a busy unit. These new nurses are so intimidated by working in the ICU that some of them don’t ask questions. If they do ask questions, they feel more comfortable asking their peers and it becomes and issue of the blind leading the blind.
I’ve overheard some conversations that I’ve interjected myself into, just to be able to guide these nurses in the correct direction. Recently I heard a nurse of less than 6 months ask another nurse of only a year if she had to call the doctor back to clarify whether the doctor wanted a heparin drip with or without boluses (HUGE difference). The nurse she had asked said “I know what I would do, I’d just order it this way.” I couldn’t help myself (and probably looked like the biggest jackass in the world) – I walked over and I sad, “I would 100% call the doctor and clarify. It sucks that you didn’t think to ask the first time about the boluses, but really he should be putting in the orders anyways. Think of it this way, after paging and talking to him a second time because of this, you’ll never forget to do that again.”
I’ve heard some scary things out of these new nurses mouths, and I honestly believe it is because the person training them has only been out of nursing school for six months to a year. I’ve offered to train new graduates while in a permanent position and I’ve not had a student for the last five or so months while these babies are training babies. I believe it has been due to my complete honesty and my expectation that if you have a question for me, you’ve thought about the patient, the problem and have thought about what you would want to do. I do not give out answers for free, I train nurses to THINK. You cannot be an ICU nurse without thinking.
The scariest part of this whole thing is that management doesn’t seem to find an issue with nurses that have 6 month of experience, training new graduates in the ICU. There are always better nurses than others at any level of experience in the hospital, but I feel we aren’t setting up our new graduate nurses to succeed when the people training them have barely had time to be nurses themselves. The blame isn’t all on management and the higher ups though. The issue is that more and more bedside nurses don’t stay at the bedside. Bedside nursing is no longer a career – it’s a stepping stone. It’s a starting place for CRNA, NP and other advanced nursing careers. Many new graduates start out in the ICU with the plans of being a nurse practitioner by the end of 3 years. I can understand the appeal, a lot less physical labor, less time with the patients, more knowledge, and (what it’s ALL about) better pay.
The more these stepping stone nurses come into the work field, the more older nurses begin to leave the bedside. They leave because staffing becomes difficult and patient to nurse ratios become unsafe when turnover becomes so high. They leave because the people they work with are inexperienced and a danger to their patients. They leave because they can’t physically bear turning a 300 lb+ patient with only the assistance of one other person (and that is the only person they could find after ten minutes of searching.) To be honest, I LOVE bedside nursing, but I don’t blame these nurses. I’ve experienced the issues, I’ve heard the excuse of “It’s been worse before,” and I keep coming back. I’m not sure if that just makes me a glutton for punishment, a martyr, or more likely, a silly gal with a heart for helping others.