During my time as a nurse, I find myself often asking “how do you do this here?”, a question often used; yet, the frequency of this question seemed to quadruple while I was working in the USA. I guess it is a typical question asked at many new jobs; however, getting a reply of “that’s the way we do it here” was unsettling.
Healthcare is more than just fixing boo boos. And nursing is more than just “caring”. We are educated and should be using our brains with each assessment, intervention, or treatment we do. There should be evidence-based research that supports what or why we do things, and we must be cautious of not falling into the “that’s the way we do it here” attitude…
When we accept the “that’s the way it’s done here” attitude, we are not taking an evidence-based approach. Sure, potentially when the action was first introduced into the department, it was evidenced-based. And initially, nurses were taught the “why” related to the action; however, over time details become blurred and content becomes saturated with “I don’t knows” or “I don’t remember why we do it this way” until the telephone game is played for so long that we no longer remember the “why”.
One of the things that struck me while working in the USA, was the lack of specialty training for emergency nursing. Yes, eventually one could study the NENA (National Emergency Nursing Association) book and write an exam to be ED certified, but as we know nursing is more than book work. The norm for training USA ED nurses, in my experience, was preceptorships. Now, this is a changing field of study, and in 2017 there were some more formal education processes being initiated and developed to help establish some standards of education. However, prior to this point, nurses were hired into the ED, received approx. 12 weeks of preceptorship, and then were “ED nurses”. I’d also like to say, that I have worked with some amazing nurses whose knowledge base is/was tremendous; however, it’s a long road for some and no one can deny the gaps in knowledge discovered along the way.
As an ED nursing specialty certified RN (BCIT) and a grad student (at the time), I saw an opportunity to look at this issue deeper and found that very few schools in the USA offered specialty training but awareness on the lack of specialty training was gaining ground and specialty training was emerging as a new norm. The research indicates that patient outcomes, length of stay, and patient satisfaction are all improved with advanced trained nurses on staff. The numbers are significant enough to support advanced training for nurses and encourage employers to set this as a new standard!
Through developing these programs, even in-house ones, the field of emergency nursing can only benefit. Through standardization, nurses will receive the same education with smaller variances in information delivery, thereby increasing the understanding of why we do something verses the “just because” answers. Although, the USA is slow to introduce this level of education (in BC it’s been established since 1985), it is refreshing to know that it is in progress!
I am happy to share my research on this topic and encourage nurses to advocate for advance training in specialty areas! Keep up the brilliant work!
Well done my USA friends!
Do you have a story or comment you’d like to share, please feel free to contact me or leave a comment!
Trudi
The Nomad Nightingale 
Good post!! As a former ER Nurse, RN, BSN, CEN in the US, along with 20 years experience and certified in ACLS, PALS, TNCC, NRP, Hazmat, Avade and MOAB I am more than properly educated for ER. The problem, at least where I live in the US, is admin doesn’t want nurses over 45 because we cost too much. So, we get bullied and end up quitting. As my boss had told me, “I can hire three new nurses for what you two older nurses cost me.” It isn’t that ER nurses in the USA aren’t qualified or given the chance to excel in the ER, the problem lies with administration not wanting to pay for the nurses who have the experience, qualifications, education and the background. I also would go to yearly trauma conferences to become more educated in current evidence based practice. I must say when I would go back to my workplace and try to utilize any of this I would hear, well that’s not the way we do it!! NowI can’t say that all of this is entirely true for all the United States but in the Midwest where I live and the ER I worked at, all of the senior nurses in ER quit within a year of each other. So sad that money is more important than experience and knowledge!!
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Thank you kindly for your insights! I am sorry for your early leave of the profession, experienced nurses like you are invaluable to the profession! I agree there are many dynamics to the issue. I hopefully conveyed in my post that I also had worked with some AMAZING nurses while working in the USA; however, what you have said is true that recruitment is focused on hiring and training new grads, for many reasons. A strategic balance of new and experienced nurses is needed to provide a safe environment for patients and a good learning environment for new nurses. Do you feel a standardized training program might aid in having these new nurses prepared for ED nursing?
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Absolutely! I one hundred percent agree also that it is good to have other experiences before working ER, such as a year or two on a telemetry floor. And I agree there needs to be a healthy mix between new and old nurses for many many reasons, I have learned a lot from both new and seasoned nurses. I also do believe it’s good for nurses just out of school for a year or less becoming charge nurses or triage. I had been a house supervisor for 10 years before being an ER nurse and I think it takes a couple of years just to get the ER routine down. I do firmly believe that training in ER is essential I was given three days training when I went to ER since I had hospital background and they were so short staffed. I’m going to tell you that is not good for even a nurse with experience! I felt thrown to the dogs!! Lol! I think the idea is to get them out there as fast as they can and I don’t necessarily think that is the right idea! The bottom line is what is best for the patient and the more training a nurse has, the better it is for the patient! I too have worked with amazing nurses! Again, great post!!
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