In Defense of On-the-Job Learning in the ICUNovember 2, 2011
By Marcy Phipps, RN, who is a regular contributor to this blog. She emphasizes that the identity of the impatient practitioner described in this post has been altered in significant ways to prevent any chance of recognition.
“This is why new nurses have no place in critical care!” said the trauma physician. “I’m sure she’s a fine nurse, but she should be getting experience with these situations on the floor!”
The issue of whether new nurses should work in critical care comes up from time to time. It seems to polarize people, and it always touches a nerve with me. I was hired directly into the ICU upon passing the boards, as were many of the nurses I work with. My hospital offers a program to new graduates that includes training and education specific to critical care and an extended clinical experience with a preceptor. Admittedly, there is a steep learning curve, but I wouldn’t consider it unsafe—and comments that suggest the contrary irritate me, because they undermine new nurses and foster negativity.
This patient probably would have pulled his PEG tube out no matter how experienced his nurse was, and I’m not sure the step-down floor would have been a “better” place for a new nurse to manage that situation. The patient acuity is lower on the floor, but there are also fewer nurses around to help out, and a patient would probably have more opportunities to pull a PEG tube out, assuming that was his intention, given the more private nature of the rooms. These things do happen occasionally, regardless of the precautions taken, and I don’t know any nurse who wouldn’t have been at least a little flustered, no matter where they were. I certainly would have been.
The new nurse came back the next night and had the same patient assignment. She was composed and professional, and it occurs to me that the trauma physician was right about one thing—she is a fine nurse. And she’ll get better all the time, here in the critical care unit, where she’s losing her “fluster” and thickening her skin, despite the glare of a doctor who doesn’t think she should be here in the first place.
*PEG = percutaneous endoscopic gastrostomy