New ER Nurse - Feel Like Quitting Job

Specialties Emergency

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Hi everyone. I recently started a position as a Staff Nurse in a ER in October. I graduated with my ASN in May 2015 and obtained my RN license in July 2015. Before starting in October in the ER, I worked from July 20-September 28 as a RN in a LTC facility. This ER is my first hospital job. I worked in a nursing home for two years before becoming a RN (worked as a LPN). I didn't really like LTC and wanted to work in a hospital really bad. I was so excited when I got the job. I was a fairly new RN, I only have my associates (I live in NYC and it's so hard to get a hospital job without a BSN) so I considered myself to be very lucky.

So even though I have prior nursing home experience the hospital is like a whole new world to me. I started orientation during the first week of October. We were in the classroom part of orientation until the end of October. Then we were on the floor with a preceptor from November to the 1st week of December. We were told we were going to receive 3 months orientation. This never happened. I was hired for over night (7:15p-7:45a). Our orientation was only in days. When we transitioned to nights to continue our orientation, we didn't receive any. Our first night we were put alone. They gave us 1-2 rooms and said if we had any questions to ask another nurse. Then the next day we were completely on our own with our own assignment. And it has been like this ever since. We were still supposed to be on orientation but I believe they cut it short because they are so short staffed. Our head nurses or the director of the Ed who hired us never once told us we were being let off orientation early. We were never asked how we were doing. We were never even evaluated to see our status. I was so frustrated but I went along with it. I didn't complain or anything. But now I have gotten to a point where I get so overwhelmed. The other day I came on shift and was assigned 4 rooms. I had a ICU patient along with 6 other patients of varying ESI levels. I was so stressed out. I had to hang propofol for my pt and then I had all my other pts to worry about. And the triage nurses kept triaging more pts to me despite the fact that I already had a icu pt. In our Ed there is no set nurse-pt ratio or set number of rooms. But I think it's so unfair and unsafe. On regular icu units, the ratio is 1:2. From what I heard if we have a icu pt, we are only supposed to have 2 other stable Ed pts and that's it. But that's not happening here. The head nurse was aware of the whole situation and didn't do anything. I started crying at work and felt so embarrassed. The next day at work was no better. I again had a icu pt with 5 other pts and I kept getting more pts triaged to me. So now I don't know. I am honestly terrified of going back to work and see what awaits me. I have work tonight and am already saddened just by thinking about it. I want to quit. I know I just started and I am not even 3 months into this new job. What should I do? Also this is a city hospital. I'm afraid I might be burning bridges with all the other hospitals it is affiliated with. What should I do? Is this normal? How are things in your ED? And tips or advice would be really appreciated

I find that often, especially for new grads, it's not a "safety" issue so much as a confidence issue. You just don't THINK you can handle what you really CAN handle.

At the same time, new grads do need a lot of hand-holding that a lot of departments can't afford, because they need bodies out on the floor NOW.

As a result, these "sink or swim" situations are exceedingly common.

Personally, I do well with sink or swim. But I recognize that one size does not fit all.

My personal opinion, based on what you have posted, is that you should try to find a more supportive environment to first learn how to be a nurse- then, once you have your feet on the ground, transfer to something more specialized. I hate to tell new grads to cut their nursing teeth in Med/Surg, because IMO, Med/Surg *IS* a specialty- and it's not fair to that specialty to use them as a stepping stone or training ground for people that don't really want to be there.

And yet, at the same time, Med/Surg units are really fertile learning grounds from which to step off into something more specialized once you've learned the basics of nursing, such as head to toe assessment, pathophysiology and pharmacology, the "soft" skills of therapeutic communication, and of course, prioritization and time management.

There is absolutely no shame in admitting that you need more nursing experience before starting in the ED, and while I respect M/S nursing for its role as a specialty, there is no better learning ground for those who want a solid foundation before they make the leap into an area such a ED or ICU.

I was actually considering speaking to the nursing director of the ED. She hired me but I'm afraid to ask her cause I think she might get upset. She is always saying how they are short staffed and I feel me asking to leave may not fly so well with her? I don't know what to do. I'm so confused. I know working in a ER is a great opportunity that not every own gets. But the fact is that I don't feel I was adequately trained to learn what I need to. And I can't blame the preceptors that I had either because they were so busy themselves. I think working in a slower environment like you mentioned med surg might be better for me to learn. But idk if my director will allow it. I've heard that sometimes she gives people a hard time when they try to transfer

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You won't be able to get every single thing done at work and you will feel anxious but can you decipher between being able to do the more important things and being able to stick with this versus not being able to cope at all? Which is it?, because if you can cope some, enough to get the job done safely, then stick it out, gain some kind of experience, then go to another unit. Having experience will help you move around versus none at all, and if you can fight the fears and you feel you can safely work this job, do it. You don't want to get a bad habit of job hopping, however if you can't cope you can't cope. Don't stay and harm yourself or someone else. Make a decision and stick with it, indecision and trying to work will hurt your confidence. As you work speak positive to yourself, allow yourself some mistakes. Talk to yourself in a place where others won't see you, positive talk.

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Specializes in Med-Surg, Emergency, CEN.

Ok I have a few things to suggest. First, the ED (as others have already stated) is a teamwork place. Never be be afraid to ask the nicer experienced nurses for help. They want you to do well because, as previous posters have stated, new hires are extra hands and that is always good.

Second, we've mentioned the other nurses, but the techs are also usually experienced paramedics. Tell them how you feel and they will usually go out of their way to help you. They will keep their eyes open for you on your less acute patients and let you know if they need something. If you have CNAs count yourself lucky because hopefully they will be like ours and patients will have VS done and help to the bathroom, giving you more time to keep the critical ones stable.

Last, keep some post its in your pocket and make lists of what you need to do/monitor. It will go a long way to keeping your head straight, more organized, and less panicked.

Going into any new specialty is a gawd awful experience at first. It's very normal to be overwhelmed, especially when you are sort of thrown in like that. But there is help and it really does get better. If not, then there are other options still open too.

:)

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I am interested in your statements that in NYC (#1)it can be hard with an associates degree to obtain a job (#2) you are afraid to talk to the ED Nursing Director because the Director is always saying how "short staffed" the department is. This would indicate to me that the hospital you work at probably chews thru nurses like candy.. and I can see why that might be the case. I work at a rural hospital ED and we have 3 patients apiece. Most importantly, we have some great team work. Everyone steps in to help when they have free time to get rooms "turned over".. from the charge nurse to the triage nurse. I have been a nurse over 20 years and I know this is not the case in every hospital which is why I drive 45 min one way to work where I do. You are in a tough spot because it would be great to change hospitals but you dont have enough experience to do that yet and stay in ED. Its not you (you're smart enough to see how dangerous this situation is).. its not the job (ER nursing is very rewarding).. its where you work. I would go with the suggestion to start pushing back but again that may be hard given your general learning curve. See if you can find a friend in the department... see if you can buy them breakfast and be honest and ask for their help... and try following their advice. When you leave work try keeping a journal of what your shift was like.. the problems and ways to improve on your own what you can. It is a good opportunity if you can make it work long enough to gain experience. Obviously if you can work in THAT hospital you can work anywhere.

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I was hired into the ED out of nursing school with an ADN. I had three months orientation, no classroom time, the last month was on night shift which was what I was hired for. I was terrified my first shift alone, although I just had to realized that I wasn't alone. I often asked questions of my pod-mate, I called the pharmacy A LOT, and I just took things one step at a time until I figured out how I was going to practice nursing in a way that I felt good about. We have up to 6,7,8 patients a piece where I work. When someone has an ICU patient, the pod mate handles the rest of the pod the best they can until that nurse gets the patient upstairs. If there is a code, everyone helps, and the rest of the patients in the ED just have to wait, because they aren't dying.

Take control of your assignment, prioritize, and ask for help. Ask other nurses how they chart, take advice from everyone and develop your own practice that allows you to sleep at night. Learn how to maximize your time and try to be as efficient as possible. This comes with time. And I think the most important thing is to know what you don't know.

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Specializes in Med-Tele; ED; ICU.

I think you'd be foolish to leave after three months.

It takes awhile to get the hang of any new department, even if you're experienced in that specialty.

I would give it a solid 9-12 months before I made a rash decision to cut and run.

For sure, though, talk to your charge nurses about your difficulties and seek their guidance.

I will also relate a story from early in my tenure at a large academic ED. One night I was in the trauma room when something big came in. One of our clinical resource nurses was in there helping me. After it was settled down I said, "Boy, I feel like I'm going so slowly and stumbling and bumbling through it all." She replied, "Really? It doesn't seem like that at all to me."

You need feedback and support.

But don't just up and quit after a few months.

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Specializes in Cath/EP lab, CCU, Cardiac stepdown.

When you feel that you really can't take any more patients you need to speak up. Talk to charge and let them know that you are stretched too thin. I have done that before as a new nurse and the charge nurse should be someone you can go to. Not someone you're afraid of. And if they still insist on giving you patients then document this. File a safety report on the patient ratio. Cover your own butt.

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I started working in the ER in July as a new grad and definitely have had a few days where I just wanted to give up. Now six months in, I don't regret challenging myself by working starting out in the ER. My orientation was only seven weeks and was challenging, but it pushed me to bring my best every day. I am lucky, though, to be in an ER with patient ratio's of 1:3-1:4. There are rare times where we may have more patient's, but it is by no means the norm. We don't have patient's sitting in the hall, they have to wait and continue to be triaged in the waiting room unless they are a class 1 or 2 patient. We have two designated CCRN to take on 1:1 critical patients if they come in during our shift. When that occurs, we report off our patient's to other nurses and go down to a 1:1 with the critical patient.

Hang in there!!! As a new ER nurse, I feel your pain and frustrations. What I have learned, though, is that you need to stand up for yourself. If you have an unsafe number of patient's due to their acuity, speak up! Don't risk your nursing license that you worked so hard for because your hospital allows you to work under unsafe conditions. As I can atest to, there are other hospitals to work at that actually allow you to work in a safe environment and give your patients proper treatment.

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Before flat out quitting, I'd ask whoever hired you if there's an option for more orientation because you don't feel fully ready yet. I know this was an option in HHC a little while back.

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I think this is very common for new nurses. I started out in a high risk OB, and I had no confidence when orientation was over. I was sick going in every shift. It took longer for me to become comfortable than the nurses that started with me. But I finally found my confidence. I ended up staying there almost 8 years. I NEVER would have thought that I would. And to be honest those stressful working conditions, short staffing chaos made our unit such a team. We all counted on each other, worked well together. I learned so much. Its good to be a bit nervous, if you weren't that is even scarier!

I think you do however need to voice your concerns. Its much better to raise your hand and ask for help, ask questions! Be an advocate for yourself and your patients, that's what makes great nurses! Give yourself time to learn and adjust. 6 months seems to be a good reference point, if you still aren't feeling supported and you feel it is unsafe, start looking elsewhere. That is the beauty of nursing! maybe a slower, non trauma ER would be a better pace. But give yourself a break nursing is hard, and unfortunately school is a formality. Its all about on the job training, and it is scary! good luck to you!!

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Before flat out quitting, I'd ask whoever hired you if there's an option for more orientation because you don't feel fully ready yet. I know this was an option in HHC a little while back.

This was a HHC facility I was referring to. Orientation was cut short because they were short staffed and needed people to work the floor asap. We were never asked if we were ready.

After I made this post, it didn't get any better. In fact it got much worse.

I brought this concern up to the DON of the ER she said she wasn't aware this was happening. Although the ADN said it was indeed approved by the DON.

I resigned last month.

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Specializes in Emergency.

Second, we've mentioned the other nurses, but the techs are also usually experienced paramedics. Tell them how you feel and they will usually go out of their way to help you. They will keep their eyes open for you on your less acute patients and let you know if they need something.

Yeah, make friends with your techs! (gum, chocolate, make sure they get lunch, give gratuitous compliments, haha j/k). The good, nice ones can help you a lot! Whenever a new nurse comes to my ED, I always introduce myself and tell them I'm there for them and give them my extension if they need help. I'm sure it can be a little overwhelming, new role, new dept, etc. I remember how I felt when I went through my Critical Care internship. So I always help the new nurses when their patient is unstable.

Regarding your manager not being happy with you wanting to leave, well she probably won't be, because that means hiring someone new and training them, but, it is what it is. You've got to do what's best for you. I had a friend in the CC internship with me that felt the same as you. She kept telling the manager that she was not comfortable and she was so stressed, she was developing stress ulcers and nearly got divorced. I'll tell you what I told her. If they get mad, so be it. It is what it is. You do you, woman. If you do decide to leave, just make sure to leave as gracefully and professionally as possible. And it's not the end of the world if you do leave. There are plenty of jobs out there. If there is another specialty that you'd like better, go for it. My friend just accepted a position in Mother-Baby which was her dream job. :woot:

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