Am I cut out to be an ER nurse?

[Fiveeighteen]

I'm feeling at a low right now. I worked on a cardiac intermediate floor for one year prior to transitioning to the ER. New to ER nursing, I had about 3-4 weeks of training with a preceptor and then was let off orientation. I didn't feel ready but management and my preceptor felt there was nothing more to teach me, otherwise I'd be on orientation forever. I've learned so much since then...I started orientation in August, and started on my own in September. So I've been on my own about 6-7 months now... and for a while I felt like I was getting the hang of things. I question things that don't seem right and can almost point out if a patient needs to be intubated. They tell me I carry a black cloud as well...anyway, i felt I was getting it but the last two weeks, I've lost that feeling. I'm not sure why, mainly I feel like it's my pace. I feel too slow, and like I've taken some steps back. My manager says I'm doing fine...But i feel like when it's busy, I get overwhelmed and show it. I also get scared I'll miss something, or not prioritize correctly. I obviously won't know everything, but I hate that feeling. I was a nurse prior to this and felt comfortable where I was...now I don't feel as competent. Is this normal? Should I give it more time or am I just not cut out for the ER? I love the ER and dread holding patients...and lately we've been holding a lot. 😑 I don't miss the floor whatsoever.

[Armygirl7]

Hiya Fiveeighteen,

You sound kinda burnt out as opposed to not cut-out for ER!

Holding pts in the ER is such a drain, it is a completely different rhythm to be managing an admitted pt at the same time as multiple acute patients - it hurts your brain! And stresses you out, and it does slow you down.

If your manager and co-workers are giving you good feedback then look deeper inside. When you say you don't feel competent get very specific with yourself. Pick one or two things that you can set measurable goals on - host your own personal Olympics and try to improve on just a few categories that are making you feel slow. Imitate the nurses whose style you admire - every good nurse has some little nugget of practice wisdom that can help you and you are really still brand new at this ER stuff so ask the RNs you respect for advice.

I didn't feel remotely competent my first year in the ER, I was constantly overwhelmed and felt like the slowest nurse on the planet.

After a year things were better, after 2 years I really liked my pace! But no question having to manage 2-3 admitted pts (in the hallway!) on top of a full load of ER pts is a super drag.

Are you taking care of yourself? Massages? Exercise? Good times/hobbies? Healthy food and enough sleep?

Those things also make a big difference.

Also 3-4 weeks training is abysmal. Seriously! So don't beat yourself up - set small chunks of goals and then new small goals - and incrementally your flow will improve.

[amzyRN]

The feelings you have is normal. The priority setting takes time. I think it's easy when you have a sick, sicker, sickest patient to prioritize. Its obvious that the respiratory distress takes priority over the abdominal pain and that's patients interventions come first, but when they are equally sick or not sick the tasks can be harder to prioritize I have found. I was fortunate to have a good preceptor and a solid 10 weeks of orientation before venturing out on my own. 4 weeks is not enough time. If I were you, I might ask someone to evaluate your flow and they way you prioritize to see if they would do it that way. Perhaps a trusted mentor could evaluate it and give you pointers.

I also wonder why you are not taking in the positive feedback you have received? Perhaps that is an esteem issue unrelated to your job?

[RN-dancer]

I am kind of in the same boat. I work on a cardiac step down residency but am eager to transfer to the ED before I get to set in my ways. It really is a different kind of animal down there.

[Dallas_RN, BSN, EMT-P]

Everything you are feeling is completely normal, especially transitioning from the floor to the ED. Prioritizing and gut instinct will be your greatest ally. Over time you will find your groove and things that once frazzled you will be second nature. One thing I have noticed when precepting is many new ED nurses tend to get anxious when a they have an intubated patient. Over time you will appreciate them as for these patients you know the airway is secure. Also when prioritizing and you have several patients "trying to die on you" remember pain has never killed anyone. It sounds cold, and it is, but when you have to pick one patient who is #1, it's not the one on the call light crying for pain medication. After everyone is safe, certainly get this patient comfortable and to a tolerable pain level. But the paint hollering, cursing and on the call light can be delayed a few minutes for someone who's ABC's are not secure.

You will get more comfortable with time, stick with it. :)