New Grad-First Day in the ER--Feeling Overwhelmed and Foolish

Specialties Emergency

Published

I was so excited to start as a new grad in the ER. After three days of training (not ER directed, just hospital orientation) and taking two ECG/rhythms classes, I was introduced to the person I'd be with for floor orientation. I was so excited and felt like I would be comfortable with this nurse since she has a fun/outgoing personality. I am so eager to learn and want to be a great nurse. Unfortunately, my first day did NOT go as planned and I feel overwhelmed and completely foolish. I feel like they're already regretting their hiring decision with me.

I did my school preceptorship (64 hours) in the ER back in June and then took NCLEX in August, so I've been out of the clinical setting for about 4 months. Everything that could have possibly gone wrong (with the exception of killing someone) went wrong. Mistake, after mistake, after mistake. Things I was comfortable with as a student.

Here is a summary of my day. During all my experience in clinicals, I never left upset. I was crying the entire way home and cried for a good hour after getting home. I'm so overwhelmed and I feel like I'm letting the department down. I also feel like they just expect me to know how to do everything, and I don't. I just really need to get these feelings out.

1. Foley: My hands were sweating so bad, I couldn't get my sterile gloves on. I finally got them, but it took forever. Then, I was blank on what to do with antiseptic and even blank on what the syringe of lubricant was! I hadn't seen a foley kit since first year (I had done lots of straight caths throughout clinicals--just not foleys). I finally got the catheter in, but I was embarrassed.

2. I couldn't start an IV if my life depended on it! During my preceptorship, I was able to start them and take blood without assistance. It's like I completely forgot how to even do the steps. Plus, the person I'm with does things completely different than the person I precepted with over the summer which is frustrating.

3. Glucometer. Yeah, doesn't get much easier than doing a glucose reading...wrong. She asked me to find out what his blood sugar was and I was so excited, like "finally! something I won't mess up and can look competent at while doing"...While the machine was reading the results, I pulled the strip out (not even thinking!!!!), so of course, got an error message.

4. Went to connect IV tubing to the IV....couldn't figure out why it wouldn't go on...oh yeah, because I forgot to take off the cap. She teased me on this one and I smiled, but I was feeling so stupid.

5. Almost forgot to swab the IV port with alcohol before doing a saline push, but the trainer caught it and tried handing me a alcohol pad...that I dropped on the floor, so she got me a new one.

6. Put like four of the stickers for ECG on incorrectly because I couldn't figure out how to count the intercostal spaces. I've never done these before.

7. Was asked to reconnect a patient to monitoring...forgot to hit start on blood pressure cuff and didn't hook up the leads.

THIS IS ONE DAY!!!!!!! I FEEL SO FOOLISH. It looks even worst seeing it all written out. Any past experience you've had or hope you can share would be so greatly appreciated right now. I hate feeling this way. Plus, I have ACLS training next week and I'm terrified of that as well.

Did I mention I'm 6 months pregnant? Yeah, I'm just a wreck, lol.

I've been anED nurse for 25 years. And you know what - all ED nurses were new to the department once upon a time! If you have a good crew to work with, they will take you under their wings and turn you into an awesome ED nurse! I remember when I hired my first new-grad.....my staff wanted to hang me by my toenails! The first couple of months were tough, we had a long conversation about if she was cut out to be an ED nurse, then she surprised all of us and turned into a very capable ED nurse. I'm not sure I would hire a new grad again - I think it is wise to get at least 6 months med/surg experience underyour belt first -- it helps you to make better care decisions. But I have no problem bringing in a nurse who has no ED experience. BTW....the IV thing -- don't sweat it -- I still have days I couldn't hit a vein if it was a garden hose! We all have those days.....Take a deep breath and remember .... this too shall pass! Good luck!

Up Vote Up Vote ×

If it makes you feel any better....

During nursing school I had the opportunity to shadow in the emergency department. The staff was really eager to involve me in patient care and I was really excited to be helpful.

I managed to put labels on the blood tubes....in the wrong direction so they couldn't be read by the automated machines (aka the blood needed to be redrawn on the patient).

Later in an attempt to redeem myself, I thought I would do basic tasks like emptying the foley on our Lasix patient...only to forget to clamp the tubing and walked away...URINE EVERYWHERE (did I mention the patient had some foul smelling UTI-esque urine?).

Completely embarrassed and useless I decided I would take a "backseat" approach and just observe the nurse and the interactions. My nurse was inserting an IV on a pediatric patient and asked me to hand her the armboard that was on the side of the bed, closest to me....I knocked over the armboard, the patient's sippy cup and pacifier, as well as the baby bag along with the dozens of condoms that mom apparently kept in the baby bag.

This was a 6 hour observation. Talk about mortified!

Sounds like you just had a bad day, it's okay. You are competent, your nurses seem supportive and receptive to your learning. FOCUS ON THAT. Remember to smile, shrug it off and realize, you CAN do this!

Up Vote Up Vote ×
I still catch docs ordering urine Hcg tests on males and 80 year old ladies all the time. It's funny - doesn't mean they're dumb or bad docs or something. Try to laugh at some of the mistakes.

Do they ever come back positive? LOL!

Up Vote Up Vote ×

Don't beat yourself up, we've all made mistakes. I was not a new grad when I started but was new to the ER and often times left at the end of the day saying to myself "what in the world came over me?". I'm sure your coworkers know and understand you will be nervous. My preceptors would share their mistakes and I knew I wasn't alone.

One of my "doh!" moments came when I was hanging an antibiotic and plugging in the rate into the machine (I was on my own at this point). The machine said the infusion would go over 2hrs. I looked at the order and Rx on bag and saw it said to infuse over 120mins...yup, I went out to ask a coworker (an ER & ICU RN) why the machine would give me a different infusion time and how I can override or fix it! DOH!! Usually I catch myself and answer my own question or realize my brain fart before I finish asking my question but this time it wasn't until she said 'well, 60mins in an hour and...' that I realized "OMG, 120mins is 2hrs". I was so embarrassed, I could feel my cheeks and ears turning red as I said "thanks" and walked back into the room. I am pregnant too so she just laughed and told me my pregnancy brain got the best of me.

Just take a deep breath and know tomorrow is a new day :)

Up Vote Up Vote ×
Specializes in Pediatric, ED.

OP, thank you so much for sharing your first day in ED! I started as a new grad in July in ED and just came off of orientation 2 weeks ago. Since The first weeks in ED, I have come a way. Knowing where everything is really is half of the battle and now I know where to find things i need Or who to call if I need something. One advice my wonderful preceptor gave me throughout orientation was "Be patient and kind to yourself"and to "find people you feel 'safe' with for help and questions. I have been on my own for the past 2 weeks and my day at work is so much better when I have 1 or 2 RNs that I can go to. I feel like I'm up against a wall and my heart tanks on days that I stand in the huddle and only recognize very few faces. That's why I feel connecting and getting to know my coworkers are so important. I always thank the techs who helps , and compliment for their thoughtfulness or for their skills... Really goes a long way in making their day better too. If you are working with an educator in your unit, keep a close and positive rapport with him/her. She's one of your best allies as you go through your orientation! Best wishes to you with your new career and for your pregnancy!

Up Vote Up Vote ×
I always thank the techs who helps , and compliment for their thoughtfulness or for their skills... Really goes a long way in making their day better too.

I second this! Techs and CNAs can be an enormous help to a new nurse, and if you treat them with respect and thank them (profusely!) for all their help, they can make your life easier. And they seem to know where everything is. LOL

Up Vote Up Vote ×
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I second this! Techs and CNAs can be an enormous help to a new nurse, and if you treat them with respect and thank them (profusely!) for all their help, they can make your life easier. And they seem to know where everything is. LOL

I learned most of my "skills" (IV starts, how to take a blood pressure, how to clean up poop, etc.) from the techs at my first job. The nurses were too busy to teach me anything except how to hand blood and get into the med room. A good tech is invaluable!

Up Vote Up Vote ×
Specializes in ER, progressive care.

We have all been there. You'll get your groove, don't worry. It just takes time, especially in a busy environment such as the ER. Don't beat yourself up so much ;)

Up Vote Up Vote ×
Specializes in ER, progressive care.
I second this! Techs and CNAs can be an enormous help to a new nurse, and if you treat them with respect and thank them (profusely!) for all their help, they can make your life easier. And they seem to know where everything is. LOL

I couldn't agree more! When I was a baby nurse I learned a lot from them. Respect your techs! lol

Up Vote Up Vote ×

I've been taking plenty of the advice offered. :-) I found nurses I feel comfortable with, so that has helped tremendously. One of the nurses had me start an IV without assistance and then said "I'll be right back" while I was in the process of inserting the catheter. I waited for her to come back once I got a flash, but she never showed up! I did the entire IV, drew blood and sent the blood to the lab with NO assistance. I walked out of the room and there was my nurse laughing with a bunch of other nurses. THEY SET ME UP! :-) It was nice not having someone hovering over me since that's nerve wracking for anyone and even better that it was successful. I've also done like 15 ECGs without assistance, accessed a port (I was sweating on that!!! Luckily wasn't by myself), did a foley with no problem, and now I'm finishing ACLS tomorrow. I feel like I've improved in one week, so that makes me feel way better. Still worried about codes, traumas, etc. (and obviously not ready to be alone yet for everything).

I just felt I should report that you were all right and things have been better. :-)

Thanks again.

Up Vote Up Vote ×

Awesome! I remember my first day. I wanted to watch everyone.. Nope they made me jump right in

Up Vote Up Vote ×
Specializes in Emergency.

This is DAY ONE! Don't be so hard on yourself. If you made it through the day, and didn't cause any harm to a pt, then it was a good day. We ALL make mistakes, even seasoned nurses make mistakes. Learn from them. Make it a point to ask as many questions as you can, and seek out any opportunities that you can for areas you feel you need the most practice in. You can do this, I promise. Just take a deep breath. It will all be okay, and you will look back and think about how far you came since that first year in nursing. I cried ALL.THE.TIME when I was a new grad. It's hard when you don't know what you are doing, and don't have confidence in yourself, and you feel like you didn't learn anything in nursing school. I think we've all been there. I have days even now where I come home and cry because I am so stressed out/ frustrated every once and a while. The only other advice I'd have is if you don't feel comfortable with your preceptor, you might want to ask to change. You want to work with someone who will help you learn, and make you feel comfortable, even when you make a mistake. Good luck, I hope it's all working out for you.

Up Vote Up Vote ×
+ Add a Comment