Choosing a nursing career is very challenging; because we take the responsibility of ones life. A nurse has to be competent enough and hard worker, but the critical care nurse should be more skillful and critical thinker, because they directly provide care to critically ill patients. Critical care areas have high tech monitoring, patient status changes continuously. Therefore staff needs to be experienced however for the novice nurse the environment is very new and they dont acquire enough skills. In critical care areas staff should be quick responder because patients condition deteriorates within minutes. Staff needs to respond quickly otherwise the patient may suffer. (Morrison et al. 2001).Critical care areas are designed to give care to especially critically ill patients. Critical care nurses are persons who provide care to those patients who are with life threatening problems and at high risk. The new graduate nurses are not able to provide their excellence of service because they have lack of experience, lack of communication skills, and chances of error increase.
Firstly, they are fresh graduates and have lack of experience. They directly came from school; just after graduation so they have deficit in clinical knowledge and they also dont know the policies. Their skills are not well developed due to which they are at high risk to make mistakes. They are not practical because they have not encountered critical patients in reality. So if patient have any internal deterioration in condition they are unable to understand or recognize it. According to Ihlenfeld (2005) When coming directly from nursing school and starting their careers in the critical care area, new nurses are able to start without preconceived ideas about nursing care. However, they bring with them inexperience, lack of personal confidence in their own abilities, and the need for professional reassurance. I want to share an experience that in unit I was team leader and due to lack of experienced staff I assigned a novice nurse in special care area. I was too busy so, after three hours I got the chance to assess her practice. I entered in the room and I observed that one patients heart rate was very high. When I asked her about the patients condition that staff said that monitor leads are not well secured, but I had some doubt. I went to the patient and checked manual pulse which was too high. Suddenly, patient developed arrhythmias then I called doctor and we managed the patient. After that event, I realized that novice cannot work in critical care areas. According to Morrison et al. (2001) Seven hundred and thirty five reports covering 1,472 incidents were identified as relating to nurse staff inexperience. Nurse Staff inexperience can have a negative impact on the quality of care delivered to critically ill patients, as shown by the occurrence and outcome of incidents related to such inexperience Errors are more likely to occur when inexperienced staff is combined with staff shortage, inadequate supervision and high unit activity.
Secondly, novice nurses dont have effective communication skills. They did not have worked individually in hospital setup, so their Interpersonal skills are not well developed. They face many problems while communicating with other health care workers, patients and their families properly. According to the critical care nurse Physicians demand information, co-workers are stressed, families are frightened, and patients feel helpless. Therefore, it is essential for the nurse to practice strong interpersonal dynamics both verbally and nonverbally and to stimulate optimistic health team communications this lack of impersonal skill decrease nurses involvement in patients care. Moreover, they are very new so, they try to discuss patients more for their learning purpose and this will break patients confidentiality and privacy.
Thirdly, critical care nurses should be competent and manage their work on time. On the other hand novice nurse need much time for a simple task, because of that they get overwhelmed even with very few tasks. Due to workload they get confused, and become anxious, and get frustrated easily and unable to manage their work on time which increases chances of error. Sometime these errors can become sentinel and can put the patients life in danger. Furthermore, they have lack of self-confidence due to new working environment. Its better to first assign them in ward setup to bring competence and build confidence in them. According to Proulx & Bourcier (2008) Graduate nurses are often overwhelmed with the multiple roles and tasks required in caring for critical care patients. The preceptors at Catholic Medical Center, Manchester, New Hampshire, identified a major concern with graduate nurses: too much time was required for the new nurses to become proficient at completing basic critical care tasks. I have observed that due to some reasons like increasing nursing workload, and high nursing turnover, absenteeism rates and staff shortages or not having senior staff we assign novice nurses in critical area. Moreover, due to lack of experience and skills practices they cannot make proper decisions, and are unable to manage patients which increase the patient stay in hospital.
According to Morrison et al. (2001) Nurses in intensive care are continually challenged with monitoring patients, making decisions and responding in a timely manner to make changes in patient condition. The nurses ability to make accurate clinical judgments is crucial. However, inexperienced nurses may be unprepared for the demands of intensive care nursing, requiring extra support and supervision.
We can take the example of our hospital; our management has taken the decision they dont hire the novice nurses in critical care area.
Yes, this is very right that novice has lack of experience, not competent, and dont have communication skills, but they can work in critical care area, for the reason that they are fresh graduates, subsequently can bring new changes with their new knowledge as they are up to date with new information and strategies to management patient . Work in critical care area is very important for their growth, professional development, and their learning. Furthermore, Skills and knowledge come with experience, and experience also make person competent and confidence. They should be allowed to work in critical care areas. In addition, hospital should arrange the sessions and learning programs for them to make them more competent. Unit management needs to assign novice nurse in critical area with an experienced staff for training and make that staff more competent and aware about environment. According to Ihlenfeld (2005) To provide new graduates with the education and experience that they need to independently practice in critical care, mentors are recommended to be assigned to new nurses. These role models help the graduate nurse to grow into the critical care role. When I was working as a staff, in our unit we used to assign novice nurse with senior expert staff for six to eight weeks to train them, before assigning them permanently and individually.
This is true that knowledge competency and confidence come with experience. It is necessary for novice professional growth, but we cannot let to put the patients life in danger for one persons learning. We can teach them initially in general wards. They can first get experience in ward setup and then can be transferred to critical care areas. Since they have lack of communication abilities consequently, they cannot communicate effectively with patient, and which hinders repo building between nurses and patient hence cannot help patients. Experienced staff can perform these tasks very accurately.
All in all Novice nurse should not be allowed to work in critical care area, because they have lack of experience, dont have communication skills, are not competent to work in critical care area and help patients to cope with this uncertain situation. Lastly, I would recommend that they should be first assign in general wards for their professional growth, skill practices, and to increase the knowledge.
Proulx, D. M., & Bourcier, B. J. (2013). GraduateNurses in the Intensive Care Unit: An Orientation Model.