HELP I'm falling apart!!! - page 2

I am a new grad who was formerly a ER tech/PCA with total of 17 years exerience. When I joined the ER as a nurse in June of this year, there were high expectations of me. Into my 12th... Read More

  1. by   vampireslayer
    I have SOOOO been there! I was a new grad in the ER, and stressed myself sick for months! One thing you never mentioned but I thought might be an issue is the fact that you were a tech. You have skills that the nurses don't, so I wonder if you're doing things that other nurses would request a tech to do for them, just because you know how to do it? Simple things like wound care, splinting, arm slings, crutch training, foleys, NG tubes, our techs do those things. I know some hospitals require the nurse to do some of those things (esp NG's and foleys) but ours doesn't. Doesn't mean the nurses can't do them or don't know how, but those are some of the things we can delegate to a tech, to help keep up our pace. Techs can also draw blood (can't start IVs though, but can draw blood and blood cultures) and at some hospitals techs can do d-sticks (ours can't).

    Anyway, my point is maybe you could lighten your task load a little if you sit back and think of things that can be delegated to techs, but that you're still doing on your own?

    It will get better, really. And the chest pain had priority over the DC, at least until you get them on a monitor and get IV access in them (had a CPR just yesterday, SOB, just came in, not on the monitor yet, no IV access yet, was talking when she arrived, then crashhhhhh).

    You can't do more than one thing at a time, just set your priorities. Sounds like you really do know what you're doing, it just takes time to get the speed up.

    VS
  2. by   longjourneydream
    Well,

    I must say I really have had experience since my orientation with my new preceptor.

    Must take the hardest patient's that come through the door, her and I take on 4 to maybe 6. It has been interesting as well as making my adrenaline go through the roof, but this is the only way to learn it.

    After Thanksgiving it will start becoming very ugly, but if you can survive season in SW FL then you can survive anything.

    My preceptor has 40+ years experience and I call her the "Ever-ready bunny."

    She also made me feel better by telling me that this ER is the hardest by far to work at. The acuity level is high, very sick patients.

    It will be hard, but will be challenging and good learning environment.

    Many supporters behind me...

    An amazing bunch of people!



    Quote from vampireslayer
    I have SOOOO been there! I was a new grad in the ER, and stressed myself sick for months! One thing you never mentioned but I thought might be an issue is the fact that you were a tech. You have skills that the nurses don't, so I wonder if you're doing things that other nurses would request a tech to do for them, just because you know how to do it? Simple things like wound care, splinting, arm slings, crutch training, foleys, NG tubes, our techs do those things. I know some hospitals require the nurse to do some of those things (esp NG's and foleys) but ours doesn't. Doesn't mean the nurses can't do them or don't know how, but those are some of the things we can delegate to a tech, to help keep up our pace. Techs can also draw blood (can't start IVs though, but can draw blood and blood cultures) and at some hospitals techs can do d-sticks (ours can't).

    Anyway, my point is maybe you could lighten your task load a little if you sit back and think of things that can be delegated to techs, but that you're still doing on your own?

    It will get better, really. And the chest pain had priority over the DC, at least until you get them on a monitor and get IV access in them (had a CPR just yesterday, SOB, just came in, not on the monitor yet, no IV access yet, was talking when she arrived, then crashhhhhh).

    You can't do more than one thing at a time, just set your priorities. Sounds like you really do know what you're doing, it just takes time to get the speed up.

    VS
  3. by   MAISY, RN-ER
    Sorry you are having a tough time. ER is a tough place to start, I know..where I started.

    Your priorities are to your sickest patients, and you must be able to say "the heck with the discharge, CP is #1" if the charge needs that room, either she or someone else can discharge. I believe charge needs to be told that very line. She will respect you for it.

    Not sure what your ratio is, but I agree with other posters-anyone with sob, cp, dizzy, or severe abd pain. Place on monitor, oxygen, iv with rainbow and urine if you can get it. If you have technicians, let them assist or initiate. I don't know if you have to wait for orders, but we don't. I will assume you have standing orders. If you are getting hit with the elderly, like we are being hit in NJ-I can only imagine what you are facing. Everyday has been a battleground here!

    Patients are sicker... the way to keep your license is to document, document, document! Their intake acuity is vital to set their baselines (as you know it). Taking report from another nurse-make them tell you the whole picture, have they completed everything-if not, make them. If patient doesn't know about their own health, document that too! We are not mind readers-if the statement is not there, family could always say we were told.

    Time management will come. I have seen 20-30+ year veterans crying when feeling overwhelmed! Their responses made me question my abilities in ER. It's been almost 2 years, I am still here. BUT, there are days....

    Good luck to you. BREATHE.
    Maisy
  4. by   wonderbee
    I agree with the poster who suggested that your charge nurse should have listened to you earlier on when you knew what you needed. Unfortunately the reality is that what's done is done. You now have the extra added pressure of knowing you're being watched. That's a terrible message to have to digest all day long, 12 hours a day. It's going to be hard to recover from that and stay in your current position.

    Your first experiences as a professional nurse need to be positive ones. I would start shifting my focus to finding that more positive experience somewhere else. The ER is a fast paced environment but it could be oncology or ICU or fill in the blank. Once you know you're being scrutinized and their talking "license" (though why I have no idea), why submit to what amounts to daily torture?

    BTW, I know. I've been where you are.
  5. by   steelcityrn
    You have invested time already, and its just going to take more. E.R. nurses are becoming rare, its unbelievable autonomy and stress. If you like that dept., and your co-workers, you should probably give it your best and do what it takes. By june, you probably will be totally on your own.
    Last edit by steelcityrn on Nov 14, '07
  6. by   longjourneydream
    I honestly belive Nov- April are the most hardest months to get through, season in SW FL are gruling, but I belive if I make through these hard times, I will make it through anything.

    Given the hardest patients and the best preceptor in the dept is a gift from God, they honestly are paying for me to stay.

    Only bad part is I'm not eligible for bonus pay, but I really do not need the need the extra stress at this time.

    Yes by April I think I'll be ready and yes I agree June to go completly on my own.

    All my co-workers tell me it takes one full year, after being a new grad, to function alone. I belive it...
    Quote from steelcityrn
    You have invested time already, and its just going to take more. E.R. nurses are becoming rare, its unbelievable autonomy and stress. If you like that dept., and your co-workers, you should probably give it your best and do what it takes. By june, you probably will be totally on your own.
  7. by   travelpat
    There are some days I cn't handle 4 pts. And I have 19 years experience. Other days I can run circles around the other nurses. Don't get caught up in worry. Just do the best you can. Relax. Take a deep breath. Go into the BR for a minute and think what are your prorities. Good luck!!!!!!!!
  8. by   Granted Fal
    You've been a tech for 17 years. You are familiar with your environment, take luxury in that. You are learning a new role and you'll get it if you keep trying; Don't give up. Each shift is a learning experience to add to your repertoire. Always prioritize your most critical interventions first. I think your existing knowledge base can be a real asset for you.
  9. by   bigsyis
    So, how is it going these days? Better?
  10. by   longjourneydream
    Yes bigsis, it is getting better.

    I am learning, sometimes the hard way, but I try to make everyday a lesson.

    It takes a long time to become a good ER nurse.

    I have good preceptors.

    Different types, some are better than others.

    My biggest problem now, is time managment, and prioritizing,but it is coming along.

    I have even thought about looking for a slot on the night shift, where pace at times is slower, to stop and think about what I am doing.
  11. by   bigsyis
    I am really glad to hear that things are coming together for you. It sounds like you have a pretty well-thought out "plan of attack" to succeed.
    Nights can go either way in the ER-they can be slightly slower, or they can be an absolute meat-grinder because of reduced staffing and the kinds of things folks get into in the dark of night. I have seen new folks to the ER get a good orientation and adaptation to ER Nursing by beginning on nights, though.
    Good for you, and I hope you enjoy your holidays!
  12. by   Mechi
    1.Find out how many years of nursing bedside your manager had.
    I am always seeing new nurses less than two year become managers,her attitude correlates with her fear of not knowing bedside care and how to be an efficient manager to well so she would delegate to you everything she can not handle even though you are a new nurse.
    2.She would not treat you as a new nurse because she is protecting her position(managerial) and she will pick on you so she will look better till you stop her or quit ER. This is happening all over the country with the new managers with no experience and good leadership,in corporate america this is call vertical abuse behavior , Many companies are not accepting this behaviors any more so keep it in mind .they new managers love to mandate , intinidate you with power or e mails but few of them will seat with the new nurses to talk their future needs in learning to achieve their goals in the nursing caeer.(to understand your staff you need to remember you were a nurse bedside once)They forget it very soon .They behave like Corporate executives and forget their role as patient manager care.
    3. I wuold suggest you to transfer to another departament with better orientation tool to give you the happiness of being a good nurse .
    4.Maybe another ER hospital like county teaching hospital,they are more focused in training residents and new nurses so you would get the help you need and protect your license.
    5. Do not panic this is a bad experience that will soon be in your past if you seat and think another options as a nurse .Remember nursing shortage is on rise they need you and many hospitals are willing to received you and give you the tool you need .LOOK for it .
  13. by   longjourneydream
    Quote from mechi
    1.Find out how many years of nursing bedside your manager had.
    I am always seeing new nurses less than two year become managers,her attitude correlates with her fear of not knowing bedside care and how to be an efficient manager to well so she would delegate to you everything she can not handle even though you are a new nurse.
    2.She would not treat you as a new nurse because she is protecting her position(managerial) and she will pick on you so she will look better till you stop her or quit ER. This is happening all over the country with the new managers with no experience and good leadership,in corporate america this is call vertical abuse behavior , Many companies are not accepting this behaviors any more so keep it in mind .they new managers love to mandate , intinidate you with power or e mails but few of them will seat with the new nurses to talk their future needs in learning to achieve their goals in the nursing caeer.(to understand your staff you need to remember you were a nurse bedside once)They forget it very soon .They behave like Corporate executives and forget their role as patient manager care.
    3. I wuold suggest you to transfer to another departament with better orientation tool to give you the happiness of being a good nurse .
    4.Maybe another ER hospital like county teaching hospital,they are more focused in training residents and new nurses so you would get the help you need and protect your license.
    5. Do not panic this is a bad experience that will soon be in your past if you seat and think another options as a nurse .Remember nursing shortage is on rise they need you and many hospitals are willing to received you and give you the tool you need .LOOK for it .

    I have moved to medical telemetry, starting January 7th of this year. I have been off orientation for 2.5 weeks now. Needless to say I am feeling the growing pains.


    I decided to get more experience first before I take on a specialty such as ER.


    There are times I am not leaving my unit until sometimes, 2030,and my shift starts at 0630.


    I have much to learn and the unit has been forgiving and all are trying to help me along.

    It is a hard place to work, but I try to manage day to day.

    I guess the 1st year in nursing is hard no matter where you start.

    I started working in June of 2007, so hopefully in 4 months down the road will be easier for me.

    I am attending a ER/critical care class, and have been invited back to the ER if I feel I'm ready to go back.

    I don't know how I feel at this point.

    I will see how I feel after my first year in nursing...

close