Newbie in ER, feeling hopeless

[MsPebbles]

I've been an RN for only 9 months. I spent 1 year as a tech on a gen-surg unit, then transitioned to an RN and worked another 7 months there. While I loved the people I worked with, I hated (or thought I hated) floor nursing and always felt a strong draw to the ER, especially after a few days shadowing there during school.

Two months ago I was hired at a level 2 ER at another hospital, and I was elated. But my excitement has turned to misery as I'm feeling regret and questioning my decision to come here.

I realize I'm still very new, and I'm in my final weeks of a 12-week orientation. However, there has not been one day I haven't come home and cried my eyes out. This hospital is very unorganized, and their charting system is very antiquated (Paragon). I come from a hospital that uses Epic, and things there were organized and state of the art, for the most part. My preceptor will be approached by a doctor (unbeknownst to me) to administer meds, and since they all chart everything after the fact, I'm often finding myself feeling like I'm running around like crazy trying to get things done, having pulled meds or preparing to do something, only to be told by her that she's already done it. So it's just frustrating. She's often telling me to stop doing one thing and start another that has greater priority, yet when I ask her why that is, she just gives me a runaround answer that the other thing just needs to be done stat, so just do it.

I'm very inquisitive by nature, and I also want to learn as much as possible, so I ask a lot of questions. But it seems to annoy my preceptor, as she often responds with "just do this," or "this is what you need to do now, we have no time to question things." I get that it's a busy ER, but if I don't understand why I'm doing something, how will I learn? I've asked to be given a different preceptor thinking perhaps my learning style and her teaching methods don't jive. But I was told she's the best for new grads, so I'm stuck with her.

I get zero feedback on my performance, so I leave work every day feeling like a failure because I'm very hard on myself. It doesn't help that even after 2 months most of the doctors refuse to talk directly to me about my patients and seek her or another RN out to discuss my patients and their orders. I'm told that they need to get used to me...well, what's gonna happen in a few weeks when I'm on my own? Are they going to bypass me then too and seek out a trusted RN to discuss my patients?

Sorry for rambling...I'm just feeling hopeless and just wanted some reassurance that these feelings are normal newbie growing pains because none of the other newer RNs I've talked to have expressed these things themselves (although they're not recent grads like myself). I dread going to work each day, and I am often near tears throughout my shifts. Can anyone relate, or even just tell me that it gets better?? I'm so miserabe. :-(

[amzyRN]

I would ask your preceptor for some honest feedback either before or after the shift. It's good you are honest about what you know and don't understand. Are you also working with a nurse educator? It sounds like you really need more info on how you are doing. I'm sorry you are having difficulty. I haven't started in the ED yet but will do so in about 6 weeks. I have a few years experience in another specialty, so I commend you on going for it after only having 7 months. Don't doubt yourself, it just seems like you need more guidance in the learning process. Good luck and let us know how it goes.

[lucypear]

Hey MsPebbles.

It takes a special kind of nurse to be an ER nurse and I believe you are one, please don't give up just yet!

Can I suggest you go back to your boss and tell her that you've taken in to account the comment that your preceptor is best for new grads but its just not working out and you would benefit from a different preceptor. It's all about keeping you and your patients safe at the end of the day and it doesn't sound as though this is a safe situation for you or your patients.

I really feel for you. I'm in my fourth year of being a RN. As a new grad and following, I worked in busy surgical wards. It was an amazing experience but I always felt I was destined for the ER. I moved to the ER and have been here almost for a year now. I had the exact same situation as you when I first started in the ER, my preceptor wouldn't really answer my questions and doctors would give their orders for my patients to other nurses, leaving me feeling left behind and not up to scratch. Like you, there were a lot of tears shed and all I wanted was to move back to my old hospital. I began to hate the ER. But I'll tell you something.. I didn't give up and things started to change. Things are better now. (most of) my colleagues now see me as a colleague and not a burden, and doctors do now come to me instead of other nurses to discuss my patients. It just took time.

So keep your head held up high, I bet you are an amazing nurse and soon you'll be shining. Remember that if you stay there, one day you are going to be the nurse that the doctors go to or the preceptor of the new graduate, and that gives you the power to change the culture of your workplace - to say to the doctors that they need to be speaking to the nurse in charge of those patients and not you, and to explain to your preceptee what needs doing and why.

Best of luck to you, you can do this :)

[Lunah, MSN, RN]

Please do not wait until your 12 weeks is up to raise a red flag with your preceptor and nurse educator. This preceptor does not sound like a good fit, especially if you are at the tail end and you are still having difficulty with prioritization — but it sounds like you are being told to just do it, and not why. You need to go have a sit-down meeting away from the ED floor. Good luck!

[memo636]

Hi MsPebbles,

I recently started in the ED, after years in a walk-in clinic, and I have had a rough start too- but things are slowly improving. I'm leaving my first ever comment because I can definitely relate to a lot of what you are saying.

My preceptor and I weren't a great match, our communication was not great, I was confused about why I had to do this instead of that, and further confused about what had and had not been done already. I thought I could ride it out with my preceptor and figure things out, but after a meeting with my manager regarding my performance (based on preceptor feedback) I realized not speaking up was only hurting me. So I told my manager that I felt like I connected better with the teaching style of a few other nurses and requested to orient with them instead. I'm glad I did, because I felt much more comfortable communicating with them and things did start to make more sense.

If you really can't change your preceptor, maybe try asking for planned time off of the floor where you can ask questions and discuss things without having to worry about patient care. Write down any questions that come up throughout your shift so you can ask them during time off the floor or during downtime (if ever).

Reach out to other nurses in the department (or on here) for support beyond your preceptor. Try asking them for clarification on anything you're confused about, or even just for any tips or tricks that they have for prioritizing and planning. I ask everyone I work with for time management and prioritization tips- and most people are more than happy to share some advice.

It's definitely not easy, and I have felt confused/frustrated/dumb on many days. But I keep returning each shift, ready to face whatever comes my way, and feel myself becoming more comfortable and confident every day.

An ED nurse I trust and respect told me, It will take a year to feel competent and another year to feel confident” – we both have a ways to go but we'll get there.

Don't be too hard on yourself, and don't give up on too quickly!

I believe everything you're feeling is totally normal and felt by many others- whether they admit it or not.

[LV3677]

Oh my lanta. I've worked with Paragon in an ED. It is a nightmare of a charting program- makes your job so much harder and you spend way more time trying to chart things. I am so sorry. I denied a job offer from a facility because they had it because it was so bad.

You are going to feel uncomfortable for a little bit in the ED as you are adapting to your new environment. Communication is key- ask your preceptor to update you if she pulls meds or speaks with an MD. I usually update the EMT I work with as well as the plan of care changes so that they know what's going on- i.e., planning to discharge, planning to admit, needs XR/CT, etc.

[MsPebbles]

I really appreciate everyone's replies and feedback.

I did have a talk with my manager and she had the three of us discuss these issues. My preceptor told her that my biggest problem is that I am unable to prioritize my tasks appropriately, and that I am still in "floor nurse" mode. My response was that while I understand this, that is why I am asking questions, so that I can understand the ER flow better and use that knowledge to help me prioritize better as I go along. My preceptor continued by saying she doesn't feel I will be ready to be on my own next week (after 12 weeks) because she fears for pt safety. I said, "well, it would have been nice for you to give me periodic feedback on my performance if you felt I was not cutting it." She said she shouldn't have to because it should be clearly evident to me that I am struggling. So a preceptor's role is simply to observe a struggling trainee and let her drown?

My manager also addressed the issue of my preceptor performing tasks without my knowing, leaving me feeling unsure of what I need to do throughout my shifts. She suggested I manage my own team for an entire shift, with my preceptor sitting back and not doing anything, only to jump in and offer guidance or help if she feels I am struggling or making a mistake. I had this shift, and I felt I did well. Communication with drs was great, I anticipated certain orders based on cc, discharged and admitted in a timely manner, etc. At one point, I told her I was going to use the restroom, and a few minutes later had an overhead call that I was getting an EMS admit and was needed to triage. In literally 30 seconds I was at the room, yet she was already there. When I attempted to get report, she snarkily replied, "I got it." I said, "well, I'm here now so I can take over." She said again, "I said I got it. The ER can't wait for you." EMS still hadn't placed the pt in the room yet, but apparently I was too slow for her.

Of course, she reported this as a further example of why I am not good at my time management because SHE was FORCED to triage my pt while I was UNAVAILABLE. It was my word against hers. No way to win that battle.

Also, she never once (per usual) gave me any feedback throughout my shift, and I thought I did pretty well. However, she told my manager that I struggled the entire shift, and when I tried to defend myself, she listed a number of issues she had with my work, such as asking other staff stupid questions and not charting vitals q2h. The policy is to chart q4h vitals on low-side pts, which is what I did (except for cardiac pts, who I charted on more frequently). Her response was that policy is a guideline, and I was wrong, period. Whatever. When I asked again why not bring it to my attention at that time, she looked at my manager and rolled her eyes, as if to say, "I don't need to explain this to her."

Ultimately, my manager has decided to extend my orientation, and re-evaluate my performance in a couple weeks. So I am stuck with this horrible person. I honestly don't think this will end well for me because it seems no matter what I do or try she will find fault in it.

Edited to add: We have no educator because he quit shortly after I started. And when I asked for a different preceptor (again) I was refused (again).

[_Skittles_]

I would ask for a different preceptor. She's not working out and you shouldn't suffer like I did. If they ask why just say I learn differently and try to have someone in mind to suggest.

[Lunah, MSN, RN]

MsPebbles, your preceptor is clearly not invested in your success; on the contrary, she seems invested in your failure. Precepting isn't for everyone, and some people really are not good at it. I would insist on a new preceptor, or start looking for a new job. This place doesn't seem to support you, though I am glad they gave you extra time. Do you have anyone else there that you can talk to informally about your performance and how to improve to where you will feel more confident/competent?

[amzyRN]

Exactly what Pixie RN said, insist on a new preceptor or find a new job.

[MsPebbles]

MsPebbles, your preceptor is clearly not invested in your success; on the contrary, she seems invested in your failure. Precepting isn't for everyone, and some people really are not good at it. I would insist on a new preceptor, or start looking for a new job. This place doesn't seem to support you, though I am glad they gave you extra time. Do you have anyone else there that you can talk to informally about your performance and how to improve to where you will feel more confident/competent?

As I've already asked for a different preceptor twice, and was told no both times, I don't think a third attempt would work unfortunately.

When I left my old unit my manager there said she was sad to see me go and would welcome me back should I decide to go back. So, I'm contemplating that offer. A couple questions though...am I still required to give a 2 week notice since I'm still an orientee? And since it's only been a couple of months, would it behoove me to leave this job off my resume for future job searches?

Again, I truly appreciate everyone's feedback.

[meeky71]

I am feeling exactly the same way. I am a UK nurse recently moved to USA to a busy level 2 trauma centre, I had 2 week orientation on the floor. I am just starting my 2nd week on my own and I feel like I am drowning, I am fed up of coming home in tears. We have staff shortages to the point we don't get breaks. There are multiple vent hold patient's because there are no beds as well as all the other holds we have. The paragon charting system looks like a computer system from the last century!!!!

Are all the ER's like this or have I just been placed I a really crappy one? I just feel isolated don't know who to go and speak to.

I am trying to get a handle of the complete difference between the health care system and the one I have been working in for the last 20 years. I feel like my previous 20 years experience meant nothing and I feel like a new RN all over again. I am hoping that this feeling will not last forever