When will "IT" click?!?

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    I'm new to ER...6 years prior med/surg...when will I get it? When should it click for me? I get so stressed out and am losing my confidence. I just keep hearing "stop freaking out"...but, I feel like I'm in way over my head! I no sooner get a rescue, I'm getting a possible miscarriage, then another rescue rolling in...how can I be 3 places at once?!?! Help!!! Will it ever "click"??!
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  3. 9 Comments so far...

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    ER nursing is all about priorities and organization. It is extremely difficult to switch from floor nursing to ER nursing (and vise Versa). You need to be able to figure out which is the biggest fire you have and put it out and then go on to the next biggest fire. You have to be able to multi-task and to switch direction in midstream. Learn the ER protocols. Learn the docs idiosyncrasies. Ask a lot if questions from the nurses that the other people seek out for help. NEVER ******** your way thru because once you do and your co-workers find out, they will never trust you. Work as hard as the hardest working person there and don't sit down until everyone else is sitting. Don't boss the techs around and help them out, if you think you are above the techs, you'll be screwed. You'll earn everyone's respect if you can handle a "code brown".
    Ciale likes this.
  5. 0
    LOL!!! I am a Code Brown Queen! I was a CNA before I became a nurse, and I really praise and rely on my aides. Thank you so much for your advice!
  6. 2
    Personally I think it takes about 2 years before you feel like you can take care of anything that walks in the door but even the most proficient ED nurse has hard days when you just don't feel like you ever caught up. You just do your best and learn something everyday and don't waste a SECOND...while you are assessing you're charting, while your doing vitals you're medicating, while your chatting with a buddy you are charting, while you are eating you are charting...he he...a lot of charting :-) Just plug along, you'll get it if you work hard and keep learning--sounds like you have the right attitude for success.
    Larry
    NickiLaughs and Altra like this.
  7. 0
    You just need to know what is more important. Find out as much about each patients condition as you can, form a self assessment of them and go.

    For example we had a major burns Vic stabbing Vic and bi lat severing come in 2mins apart so for me my priority was the burns vic as the other two went to surgery from the ED. he had 80% 3rd degree burns, need escarotomies (spelling?) to chest, lower and upper extremities, RSI intubation and fluid resus also a friendly face.
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    Ask yourself these questions...Are they breathing? Is there any reason to believe they won't be soon? Are they pink, warm, and dry? Are they bleeding massively? Do they have bones protruding from their skin? These are the #1 folks to take care of.

    Baby comes in with a fever....take the temp. under 102', you have a minute. Someone comes in with low BP/P....is it under 90/60 or 60 BPM? Then you have a minute (put them on a monitor and set it to beep if it falls). Remember, you can't stop a miscarriage. The problem is if they are bleeding heavily.

    I'm new to the ER, my first job, and I was thrown to the wolves. Mid into my 2nd week, I was taking pts alone. 3rd week, triaging on my own. 4th week, getting possible MI/stroke pts on my own. At the same time, hearing how I shouldn't be doing any of these things because I was too new....but no one jumping in. Luckily, I know enough to know what I don't know and not afraid to "demand" help/answers. Also got read the riot act by a few how I should have never taken an ER job as my first job--I need to have floor first. I disagree. Sure, it strengthens a lot of your core skills, but the pace is so much different, I think it would have been detrimental. Getting good at IVs is easier in the ER than floor, but floor sees more G-tubes, etc.

    You are never alone in ER. If you are at the limit of pts you can handle safely, say so. I told my super (about 7 weeks in), when she said another pt came in (back pain), can I take them, NO! I have a baby with a 103.4, head injury, and a bad GI bleed. I cannot handle any more! (being new, no cert's yet, and we are a very small ER, usually 2 pts to a nurse max, and the long-term nurses had only 1 or 2 pts)Have a voice!!! It does get easier!!!
  9. 0
    Yeah, it took me about a year until I first started feeling really comfortable. But even then, I was thrown off a lot. It was maybe two years until I felt on top of my game. Stay at it, it will click.
  10. 0
    I'm a new ER nurse as well, at it for nearly 6 months. Luckily, I've had fantastic preceptors who have engrained upon me...

    *Perform one task at a time, make sure it is finished before moving on.
    *Develop a "flow" to your routine.
    *Act on what isn't WDL. i.e, If you know you're getting a code 2 satting in the low 80's-get RT there before the gurney hits your dept.

    Most importantly


    *Utilize your resources, i.e. preceptor, charge, other RNs, house sup...as a newbie the experienced nurses are well aware of your knowledge deficit. There is NO WAY you're going to be able to handle every situation thrown your way efficiently. If another nurse offers help, take it-even if it is just getting a set of vitals or grabbing the pt some water.

    Hang in there, I'm just beginning to get a feel for it. Still not comfortable, but not feeling overwhelmed each shift.
  11. 0
    3rd week triaging on your own!?! WOW! Kudos to you. At my ER, you have to be an ED nurse for at least one year before they'll let you triage.
  12. 0
    You may have benefited from spending at least a year on the floor, before transferring to the ED. It really is a whole different ball game, where every pt comes in WITHOUT a diagnosis. Yes, there are MD s around, but you have to multitask to get your work done. Focus on the big stuff. Are you pt's safe? If so, who looks sickest? (attend them first). Send off labs and other w/u stuff asap, since that will determine the diagnosis faster. Know what and when you can delegate tasks to others. Stay on top of your charting so you're never behind. Work WITH your patients for calm, flexibility and understanding that you are working as fast as you can but must care for several patients at once. Also, try working on off shifts, when it's not so crazy. For example, the 11p-7a shift usually chills out more. Seek our your educator if you need some objective advice on how to improve your speed and organization. Notify your CN when you get a heavy pt (maybe a septic work out) who you know will take a good hour in the room to assess, place lines, labs, BC's, foley, and start IVFs), same thing if it's a Peds work up. Ask for help when you need it. They should have float RNs to help put out fiers when acuity exceeds the resouces of just one RN. And then make friends, help each other out. When you're not busy, jump in and do tasks for your peers. They'll be much more likely to reciprocate.


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