Struggling with ED Orientation, advice appreciated

[AvaRN22]

Hi Everyone!

I'm going into my 3^rd week of ED orientation next week and I'm struggling with the floor-to-ED transition. I'm contemplating turning back to my old unit until I gain more knowledge in emergency medicine. I came from an antepartum floor where my patients were mostly medically stable and low acuity. I have 3.5 years of experience with antepartum and I did tele/PCU for 1.5 years as a new grad. I'm rusty with my tele/PCU knowledge, which would have been VERY useful for me right now in the ED.

I've always wanted to be in the ED since nursing school, so I eagerly jumped at this ED training program opportunity at a sister hospital, even before I was truly "ready." However, I am finding that the teaching style of this training program is not working for me. It consists of self-learning via online ENA modules and 7 weeks of a preceptorship with one knowledgeable preceptor who had a few hours of preceptor training.

I feel like I would do better with a multimodal learning approach to orient me to the ED, as recommended by the ENA in their ED Nurse Orientation Position Statement (2011). This would include a traditional didactic classroom setting with lecture and discussion, scheduled out-time for return-demonstration skill-simulation, case scenarios, and a trained preceptor. Another hospital in our system is a magnet, "flag-ship" hospital with an ED training program that includes these components in their program.

I have identified some potential options for me at this point:

1. Stick it out at this current ED and take as many courses as I can in order to supplement my lack of ED knowledge, such as a CEN review course, which will be offered in January.

2. Contact my old manager on my other unit this week and prepare to transfer back and spend 1 year preparing myself through self-study, which would include PALS, EKG course, TNCC, CEN review. After a year of self-study, apply to the "Flag-Ship" Hospital with the stellar ED training program in July 2015 for a more thorough training program. The "Flag-Ship" Hospital is where I really want to be, FYI.

3. Complete my orientation and then decide if I should go back to my old unit.

4. Some 4^th option that is unbeknownst to me (any ideas??)

Any advice on which direction I should take?

Thanks for reading :-)

[OldDude]

I'm with Farawyn - #3.

[Sassy5d]

You're only in your 3rd week of orientation.

I would put in a full year before you make a choice.

It's amazing how far you come.. How you go from hating/feeling overwhelmed to loving/breezing through

If you *want* to be an ED nurse then the *last* thing you should do is consider going back to your old department.

The only way to learn to function in the ED is to function in the ED. Sure, book learning helps, but only if you're actively applying the material to your daily experience and vice versa.

ED is a tough place to get the hang of and floor nursing is very little preparation.

The longer you do the ED thing, the fewer times you'll experience the sphincteritis and palpitations of wondering, "What do I do?"

Even learning to work the equipment or handle certain medications takes time and repetition... and in the heat of the moment.

For example, a Belmont rapid infuser is a pretty simple device that's about as sailor-proof as a device can be... I can set it up over and over in the peace and quiet of an empty trauma bay without any difficulty. And yet, when the patient's SBP just dropped from 105 to 65 in the course of about 10 minutes and I have a room full of trauma docs saying, "Get blood in him, NOW!" I become all thumbs -- at least that's how it feels. That's not the way it actually is though.

Quick story: I don't remember the patient or situation but I do remember at the end telling on of our senior nurses, "Gee, I feel like I'm fumbling along and taking forever... I just want to step aside when these cases show up." She siad, "Really? It doesn't look that way at all." What I concluded is that my fumbling is mostly the dissonance from my mind being 3 steps ahead of my hands.

I comes with time... I was horridly ill-prepared to begin my initial ED role... after three years there, though, I basically had it down... and then I moved to the large, urban ED where we get multiple traumas, super sickos that can't even be sent to the ICU because they're too unstable for transport, where we sometimes have 4 nurses in the room... and I was LOST... Two years in, though, and I've pretty well got it down. I know the docs, nurses, and anicillary staff... I know where stuff is... and I've seen most stuff... but still haven't used the internal pacer... so, what do you think scares me? Duh, the internal pacer. Now, I crave that experience rather than simply fear it... because I *KNOW* that I will make it through and I *KNOW* that my docs and nurses have my back and I *WANT* to master it.

Hang in there, young Padawan... you will probably get there with time... but only with "stick time"... that is, flying the plane yourself... you never learn to pilot the plane by reading about it or watching it... only by doing it.

[five_apples]

I was a new grad when started ED. Had a 6 month orientation and still didn't feel ready when I got off it. Only way to learn ER is do ER. Books will only take you so far, but this is on the job training.

The biggest challenge was prioritizing, and the only time I really learned that was when I was finally off orientation & on my own.

Orienting in the ED can be distressing. Take these feeling and use them to build yourself up. Ask question and read about things you're not sure about.

Give yourself time (it took me a full year to feel like I have this ting down and I can really do it), and be gentle with yourself!

[joyful_wanderer]

Honestly the only way you are going to feel more comfortable with emergency care is through experience. Certs are great to have but really only mean anything if you have experience behind them. I transitioned from a primary care clinic to ED after about a year as a nurse. The first septic patient (I was only in the ER for about a month) I had that needed drips I asked my charge nurse for help and was told "Well the scenario is always if it is just you and the doctor in the middle of the night what are you going to do?" and then she walked away. It was a painful experience and now after 4 years in the ER I try to help every new person to our unit. My dream was to always work in the ER and at that moment I wanted to go back to the clinic as fast as I could. Somehow I managed to make it through and the patient survived but after that I identified nurses that I felt were good and knowledgable and willing to help. Don't be overly hard on yourself and realize you don't have to have the answer to everything. Its ok to ask questions. Ask a lot of questions. Maybe, you can identify someone that you look up to and ask them to be a mentor? I still learn new things almost every time I work.

[guest464345]

Chiming in to agree with others....hang in there, OP. The certs, the lectures, the book stuff, all nice to have but you will never know what you're doing until you're forced to do it. I wanted to quit/cry/run away almost every day in the 2nd-4th month of orientation (I was hired as a new grad, with a preceptor for nearly six months). I still do on some days, but I can see that it's gradually getting better, and I can imagine that in a few more months I'm going to feel MOSTly like I know what I'm doing MOST of the time.

It is very tempting to tell yourself that with a different educational approach the process would be less painful....but every ED RN I know (new grads and experienced floor or even ICU nurses) says that acclimating is just scary and hard. It DOES get better, I swear.

[AvaRN22, MSN, RN]

Thanks everyone for your input. I actually feel more reassured that what I’m going through is a somewhat common experience with orientees. Maybe my expectations were initially too high for myself and for the training program. Some of you pointed out the on-the-job nature of ED training, indicating that only way to learn ED nursing is to do ED nursing. As I finish up my 4^th week of training, I can see that now.

I’m going to continue pressing onward and (God-willing) upward, supplemental educational material in hand and eyes and mind wide-open in the ED as I continue to learn. I almost gave up; thanks so much for your encouragement.