New RN in the ER

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    Hello all. I started working in a level one trauma center ER 11 months ago (first 6 months in orientation). I'm starting to get into the swing of things and I really like my night shift staff, but I still feel uncomfortable in some situations. For example, I had a cardiac arrest last night 10 minutes of starting my shift and I didn't feel confident and felt like I was trying to keep up with everyone. Last week I received a cardiac arrest s/p trauma from MVA, it was the first time I had to do blood transfusion and I was struggling with the rapid infuser and documentation involved with it, plus being to asked to assist with intubation, chest tube insertion, and what seemed like a million other things. Sometimes I just feel stupid, and I hate this newbie feeling.

    Despite my still adjusting to the job, I like working in the ER and I (mostly) feel good at the end of my shift. There are so much to learn, I am enjoying the challenge, and I see a lot of interesting stuff. How long does it usually take to feel more comfortable in ER? I would appreciate any comments, advice, suggestions. Thanks!
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  4. 9 Comments so far...

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    You're not going to feel comfortable with those things for a long time, certainly not after less than a year! Cut yourself some slack.

    What I was told was that it takes about 5 years to get comfortable in the ED. But I didn't stick around long enough to find out. I can say that I did feel a lot more comfortable with STEMIs and Stroke Alerts during my second year, but traumas and arrests were still a little nerve wracking. Just remember it's a team effort, stay calm and focused, and you will learn and grow and get better and more comfortable over time. You can also seek out more experienced team members that you trust and debrief with them, about what went well and what could have gone better.
    Greenkji likes this.
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    Ive heard that some of the more effective Code Teams with have a debriefing for each code, to discuss how things went and what can be improved. Maybe if you guys can't do this for every code (since you said you are in a Level 1 trauma center, this doesn't seem doable), you can do like the previous poster suggested and ask a more experienced nurse to go over it all with you, at the end of shift if necessary, or whenever you have a break. Offer to get her lunch or something as incentive if you have to!
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    It will take you 2-3 years to feel comfortable and 3-5 to really know your stuff. So you're not off pace yet ...
    erin527RN likes this.
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    Moving to ER forum.
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    Thanks all. I go through my ups and downs (and confused times hehehe).
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    I know that you say that you still feel a little frazzled with cardiac arrests and traumatic arrests and things like that, but there is no need to. I work in a level 2 trauma center in WV, but it is the busiest ER in the state. Also in this area we get all MI's and strokes and if you know anything about WV most of our clients are not the most healthy people in the world lol. We see a lot of codes and trauma especially mva, atv, and mining trauma. One of the most important things my preceptor told me when I was new was " there should always be someone recording". He was very anal about this and if your er is anything like ours if someone has an arrest or trauma there is atleast 3 or 4 people there to help. I would recommend staying back and recording for awhile until you feel a little more comfortable getting your hands dirty. Keep your ears and eyes open. Try to learn as much as possible and talk to all the other nurses about the codes and traumas. Have someone practice the rapid transfuser. It is very hard to try and keep up with everyone else and document at the same time. I am sure you are a great nurse, but def try and concentrate on getting the documentation down. Thats what killed me at first. Good Luck
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    The other night, one of the RN's of 22 years broke down nursing years and I thought it was really good:

    Years 0-2: don't know anything, know you don't know anything.
    Years 2-5: Think you know everything.
    Year 5: realize how little you knew when you thought you knew everything.
    jenfromjersey, *lorie, and Altra like this.
  12. 1
    Quote from OpenHeartRN24
    I know that you say that you still feel a little frazzled with cardiac arrests and traumatic arrests and things like that, but there is no need to. I work in a level 2 trauma center in WV, but it is the busiest ER in the state. Also in this area we get all MI's and strokes and if you know anything about WV most of our clients are not the most healthy people in the world lol. We see a lot of codes and trauma especially mva, atv, and mining trauma. One of the most important things my preceptor told me when I was new was " there should always be someone recording". He was very anal about this and if your er is anything like ours if someone has an arrest or trauma there is atleast 3 or 4 people there to help. I would recommend staying back and recording for awhile until you feel a little more comfortable getting your hands dirty. Keep your ears and eyes open. Try to learn as much as possible and talk to all the other nurses about the codes and traumas. Have someone practice the rapid transfuser. It is very hard to try and keep up with everyone else and document at the same time. I am sure you are a great nurse, but def try and concentrate on getting the documentation down. Thats what killed me at first. Good Luck
    Not sure how qualified I am to be giving you advice, seeing I work in a Level III ER and have 11 months' experience. BUT...ditto on the documenting until you feel comfortable. I didn't really assist in any codes or traumas while I was in orientation (unfortunately mine was 3.5 months, not 6)...my preceptor always had me chart. And when I got out of orientation I felt much more confident "doing" because I knew what to do since I had always charted everything the more experienced nurses had been doing.
    *lorie likes this.
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    It takes years to get this ER nursing! Every day is a learning experience! I have been the ER for 7 yrs. I am very confident in my position. Give it time ,ask questions and always ask for help your peers have been in your shoes. they should always be willing to help! Good luck!
    erin527RN likes this.


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