Advise Needed for new ER nurse

[Dwedge]

Help! I graduated from nursing school May 2003. I currently work in an extremely busy ER. I have had the most awsome preceptor and feel like he has given me the best of start possible but I am now considered a staff nurse with 4-5 beds that I am responsible for on 12 hour shifts.

I love my job but I am a little overwhelmed at times:confused:

I went through @!$# getting my license and don't want to loose it, ever!!!! Does anyone have any organizational suggestions or any suggestions of how I could be a little quicker with my skills. I realize that everyone doesn't need a full head-to-toe assessment each time but I do that to keep from missing any s/s information.

The people that I work with say that I am doing a great job. They are extremely encouraging but I feel like I am too slow and some of the ER doctors think you should be able to get the client in and out by the time they finish their "check list documentation". I am not sure they realize how long it takes to carry out orders on several clients while assessing the one that was placed in your clean room without your knowing it.

I know this sounds like I am complaining too much and maybe I am. I don't want to be like that. I just want to figure out how to provide the best of care in the least amount of time and gain the knowledge that the seasoned nurses have without bothering them constantly.

Thanks for any advise available.

[sammycat]

I was once told, if you don't come to work each day afraid you might make a mistake, then it's time to leave. A good nurse is always learning and caring for their patient. Don't worry about being the fastest at assessing, it will come with time. Do each task correctly, treat each patient with the care you would like to recieve, listen to the doctors who like to teach and any nurses who like to teach as well. You will learn more on the floor than you ever did in school. From what you have already said, it sounds like you have what it takes to be a great ER nurse. We all started the same way. Just give yourself time. Repetition and patience with yourself will pay off. Good luck, you will make it.

[cbj066]

Welcome to the ER. That being said, I can speak for myself and say that everything you've mentioned is pretty par for the course for a newer ER nurse. Like others have mentioned, give yourself some slack.

I transfered down to the ER which is a level one center here in Houston) after working a little over 6 years in our Neurotrauma ICU. I initially thought it would be a cakewalk, but after a day or so, I realized it was the hardest work I would ever do. For the first 3-4 months, I left work every day saying to myself "you sure sucked". I came to recognize that time is what it would take.

As the clinical educator for our department now, I get the same questions that you posed on a regular basis. The technical 'skills' you learn are only the beginning. The development of critical-thinking skills, time-management, prioritization, and basically learning the hows-and-whys of ER nursing take time.

If you have the desire to not only survive, but to rise above and beyond, you will. My advice is pretty simple:

1. Ask a lot of questions (of nurses, doctors, radiology, etc.). You can learn something from everyone.

2. Seek out learning opportunities - they usually don't present themselves to you.

Remember: Responsibility for learning rests with the learner.

3. Wake up each day, take a deep breath, and live.

[avigail]

It takes 6-9 months to feel entirely comfortable in a new job situation. It sounds to me like staffing pressures may have cut you loose too early. You will speed up with time but here is some practical advice:

1. Think of required treatment for all types of pt.s and do that on arrival (or when you first see them on those surprise pt.s). If a person is complaining of flank pain, collect a UA on the way to the room. If chest pain, get an EKG, set up the monitor, start a saline lock and draw labs. Most ERs have protocols that will give you an idea of what you can do initially. Try to memorize these. This helps to keep you ahead of the MD.

2. The two minute head to toe assessment: Pt a/o x 3. PERL. Speech clear. Lungs CTA, bilat, all lobes, HR reg. Extrems warm/dry with palp pedal and radial pulses bilat. BS x4. Abd soft, non-tender to palpation. Pt denies CP, SOB, N/V. Address chief complaint here.....Obviously, my description is a relatively healthy pt. You would note differences, but this covers every major system: neuro, ABCs, perfusion, pain, etc. Memorize this template (or one you like better) and use it to document all assessments.

[dm2]

you've been given some great advice here. I agree, relax and just do your best..... it will become easier and easier with practice! Do what is right by your patients and believe in yourself as well as the abilities of your co-workers!

[MrsWampthang, BSN, RN]

I agree with everyone else, it does sound like you on the right track. I think ER is one area where you either catch on or you don't and it sounds like you have caught on well. I know it is hard not to feel overwhelmed, but don't let anyone criticize you for asking questions. If you're not asking questions, you're not learning and there is no such thing as a "dumb question." I would rather ask a thousand "dumb questions" than to do something that I think is right and have it be detrimental to my patient, so by all means don't hestitate to ASK!

Sometimes I don't think the doctors do realize the load the nurses are carrying, but then, in our ER, our docs sometimes have as many as 16 patients to care for so I have no doubt that they probably put a lot of trust in us nurses to take care of our part of their load. It is overwhelming at times, not just for new grads but all ER nurses, old, young, new kid or seasoned vet, all of us feel overwhelmed at times! So never feel bad if you are feeling that way. Hopefully you are working at an ER where everyone pitches in to help when things pile up on one particular nurse or they are tied up in a room with a high acuity patient.

Again, don't worry! You're doing fine. Keep coming here for encouragement and also to your coworkers. I'm sure many of them have BTDT and got the T-shirt!

Pam