New to the ED, scared to death...please help

  1. OK, after 7 months of a job I hated on a respiratory/GMF floor, I took a part time job at a much smaller, less prestigious hospital ED. I took a part time job in anticipation of our Eastern European adoption and having a young child, wanting to be available for the kid. But that's another thread altogether. Generally, I've had +++ experiences with the staff nurses. They generally don't appear to be snarky to each other, but they are ready to tear the head off of the "palace" of administration!

    OK, I'm scared to death of making a mistake. This hospital doesn't have any written standing orders, so I just have to "catch" on. The nurses are telling me to take the worst patients while I'm on orientation because no doubt my first patient off orientation will be a five day old baby in asystole. They also said that I am will be expected to handle a load the same as any other nurse who has been working there for 5+ years.

    Here was my day today:
    0700 -- 92 year old in massive pulmonary edema, inherited by noc's, precepter just went to work and told me not one bit of information until we had the patient settled in a regular hospital be. Weekender nurse, totally burned out, made this comment "J.J. (my preceptor) Lucky you, you have the 'perfect nurse' with you". Still not sure what that meant.

    0845 -- 70 year old c/o HA and ST memory loss, walking like a kid playing airplane, laughing all the way. Turned out he had a huge brain tumor. My preceptor treated me like a tech -- go get this, go get that.

    1000 -- 72 year old male c/o dizziness while doing laundry. My patient on my own. Nicest guy in the world. r/o MI workup, r/o new onset CHF. Luckily, he was an easy patient.

    1400 -- LOL w/SOB. My preceptor yelled at me to take this patient. He (my preceptor) is very soft spoken, and he said "I mean it! Stop charting and go get this patient!" He scared the crap out of me. I didn't hear him say one word of this to me, and before I knew it he had her in a room, nekkid, gown on, nebbed, solumedrol on board.

    1530 -- Getting ready to go home. Anther nurse said to me, after I said that the staff was being supportive, said "Well, we're trying". I tried to ask her what she meant by that because I thought maybe she was being a little snarky, but someone else came into the breakroom and she was suddenly more interested in that person.

    This is my third week of orientation. Have I bitten off more than I can chew or will I eventually get this? I don't want my co-workers to hate me, and I love the ER and I love this hospital, but there is so much I don't know. Maybe I'm better off on a tele floor? Any words of wisdom will be very appreciated.
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  2. 13 Comments

  3. by   traumaRUs
    I think this probably was an average day in the ER. However, I think I would corner my preceptor and tell them exactly what you want - why are you doing what you are doing? What's the pathophys behind this? Also - do you have standing orders or protocols? That is really a must in ERs today. Do you have the services of a nurse educator there? Can you enlist them? How many weeks of orientation do you get? If they expect you to care for peds, what classes are they providing for you???? PALS, ENPC - if given a choice, go with ENPC - much more in depth. What about ACLS, TNCC or some other trauma cert? Good luck...we must nurture our new nurses, not chew them up and spit them out!
  4. by   Stitchie
    Thanks for replying.

    yes to nurse educator, I have a specific set of goals: charting, prioritizing. No standing orders, but a three inch set of protocols I won't get thru until I'm a 90 year old patient in the ER.

    Six weeks of orientation; I'm in week three. I had one week of pointless nursing orientation specific to the hospital. (It doesn't count to the unit specific orientation)

    The hospital expects me to have PALS certification and ERCN certification within one year, ACLS and EKG certification ASAP.

    I want to add that all of my preceptors, today included, have been very encouraging. I don't want to misrepresent anything; they are a really good group. I am usually good at asking questions and understand a lot about the pathophys but I'm feeling overwhelmed right now.
  5. by   traumaRUs
    Oh that's okay - we all feel overwhelmed some days! Welcome to the unpredictable world of the ER!
  6. by   veetach
    unfortunately, the ER just runs this way. Try to prioritize your tasks, treat first, patient care comes first, charting comes second. Always remember your ABC's- airway is top priority, it overrules everything... if you have a patient in pulmonary edema, there isnt time to stop and explain everything watch and learn.

    did you just have 5 patients in an 8 hour shift? that is a very slow ER. good place to get some good experience. Good luck!
  7. by   teeituptom
    Welcome to the wonderfull world of the ER


    And what is SNARKY
  8. by   Stitchie
    Quote from teeituptom
    Welcome to the wonderfull world of the ER


    And what is SNARKY
    Snarky?

    You know, the kind of person who is sort of short-tempered and nasty, but pretends to be nice to your face. You know, the type that loves to see others flailing about and making pointless mistakes.

    That type of person wouldn't be on this board.
  9. by   Stitchie
    Quote from veetach
    unfortunately, the ER just runs this way. Try to prioritize your tasks, treat first, patient care comes first, charting comes second. Always remember your ABC's- airway is top priority, it overrules everything... if you have a patient in pulmonary edema, there isnt time to stop and explain everything watch and learn.

    did you just have 5 patients in an 8 hour shift? that is a very slow ER. good place to get some good experience. Good luck!
    No, there were more, it's just what my preceptor and I had; since the patient with pulmonary edema was critical, the workload was lessened. I rather enjoyed yesterday, and today was a great day.

    It's a small ER, lots of ICU/Tele patients holding...always.
  10. by   veetach
    Quote from Stitchie
    No, there were more, it's just what my preceptor and I had; since the patient with pulmonary edema was critical, the workload was lessened. I rather enjoyed yesterday, and today was a great day.

    It's a small ER, lots of ICU/Tele patients holding...always.
    Sharon, it sounds like a great learning environment! Have a good time with it, I think you are going to do just fine. We all have days like you described earlier, no matter how long we have been in the ER sometimes you just have a bad shift. Keep your chin up and keep learning, I see success in your future!!
  11. by   veetach
    Quote from Stitchie
    Snarky?

    You know, the kind of person who is sort of short-tempered and nasty, but pretends to be nice to your face. You know, the type that loves to see others flailing about and making pointless mistakes.

    That type of person wouldn't be on this board.

    Is that what you call it?? I think I work with a few of those Snarky's. :chuckle :chuckle
  12. by   qc rn
    :angryfire Do not give up... When we have emergent pts. in our department I as supervisor am not always sweet and kind. I tell other nurses what to do sternly at times and am always saying HURRY UP....but when its over let everyone know what good work they have done...Protocals are nice but great assessment skills are a must. If you love it hang in I hate to say this but sometimes in this kind of derpartment you need to prove yourself first.
  13. by   Stitchie
    Don't we all have our 'snarky' moments. Thanks for the encouragement. ED is the only place I've ever wanted to be.
  14. by   teeituptom
    Think I do also

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