ER ORIENTATION x 1 week

[JVoEDrn]

Hi everyone! Just thought I'd check in and share some news on how I've been managing on nights in the ER. I don't really have a solid preceptor and have so far had three, my last one has been my most informative but they all have been good to precept.

Things have been good! In my first four shifts alone I have gotten pretty detailed with my charting, learning CERNER and getting the hang of hospital protocols for patients. Ive already had two codes of which were very positive learning experiences for me. Our ratio is 1:4 and per my request Ive gotten used to taking on two patients, with my last shift working up to 3! It's been a lot of time management learning but I think I am doing really well. The preceptors I have had have said they were impressed with me and have offered constructive criticism but ultimately have told me that I am doing really well for only having worked 4 shifts. My last shift was the most stressful so far and it was Bc I came on shift to a shitstorm. Last nurse was stuck in a room and had two patients that had been there for over 30 minutes and hadn't been seen.

I had a newly dxed septic pt, with bps dropping significantly over a course of an hour 120/80 to 88/44, a respiratory distress patient, and a pt with Tia/stroke symptoms.... And that was my start.

Definitely put my deodorant to the test with each patient having so many meds and procedures ordered ! The Tia pt was very combative and was practically chasing me down the halls. But! I survived.

I even managed to find time to pump (I breast feed)! I've got a great night shift team and no one makes me feel stupid for being new and lost on somethings. I think it helps that I vocalize without qualms when I am uncomfortable or uncertain on a few things and always ask questions.

The only thing that has been frustrating is that I am a very detailed nurse. I came from a nurse only model with narrative charting. I'm used to charting EVERYTHING...but in the ER my preceptor will show me paperwork that should be filled out for a procedure and then say "but you don't have to do that...technically we should but we have to much to do"....

And that's ALL OF THEM. I will go to chart a missed IV attempt and will be stopped and told "don't chart that".

I had a pt come in non emergent ems with a bgl of 479 and s/s of N/V/D x 1 week.

When the doctor ordered insulin I went to recheck the bgl before the admin of insulin and was told "you don't have to do that"...

But I did...and I should.... I mean ***** Did he really expect me to use a bgl of >1 hour ago??

These are incredibly smart, efficient people but this has been the hardest thing to understand. One preceptor cut me off after talking to a patient for LESS than 5 minutes. I was assessing her, all for her to tell me...you have no time for that, in and out.

I mean I get it, but my god, can I create some relationship with my patient??? That's the only thing. Part of the reason I am looking forward to being on my own is just so I can be the kinda nurse I AM and do my due diligence ! Anyone have thoughts on this??

I titrated levofed for the first time and assisted in multiple central lines!!

All in all I am excited and am happy I haven't gotten eaten alive yet! I come home and study as well.

Just trying to be the best me I can be!!

[ParalyticAgent]

Welcome to the ER.

I'm going to be honest with you- you are not going to be the incredibly detailed nurse that you once were. Get used to VERY focused assessments. It takes time and for a while you will feel like you're being negligent. You are not.

To give you an idea, in five minutes, I can have a complete assessment done, IV started, blood work obtained, EKG obtained, and patient placed on the monitor. It is a rare luxury to have five minutes to only assess a patient.

It takes time to get a pattern down. Be patient with yourself. You are doing a completely different type of nursing now.

[WKShadowNP, DNP, APRN]

Exciting! I understand the rechecking the blood sugar after an hour. I mean if the patient is in DKA that's a big deal, especially if N/v/d x 1 week. My question is why the delay in getting the med? (I know it happens, BTDT).

Keep up the hard and good work. I still love it years later.

[emtb2rn, BSN, RN, EMT-B]

Change your user name to something anonymous. And you have way too much identifiable info in your profile.

[Beth0504]

Day by day...let your preceptors teach you what you need to know. You can pick and choose what you like. When you are on your own you will develop your own rhythm soon enough. Everyday you will learn more and more and you make some mistakes along the way. You will learn from your mistakes and you will become the nurse that you want to be and that you are! Don't let others make you feel bad for being kind or paying too much attention to someone. Chin up!! :)

[JVoEDrn]

Change your user name to something anonymous. And you have way too much identifiable info in your profile.

I don't know how I tried!!! Help!! Actually I just googled it. I'll do it before nights end- thanks!

As for everyone else, thank you too! I'm learning the concept and I'm getting on ok with it! Yay for becoming a master of time!