working without experienced nurses-help!

[missnurse01, MSN, RN]

Hello everyone, hope this finds you all great!

i have a problem with my ER and figure i could ask you guys your opinions. I work in a small Er, 9 beds and 3 fast-track, with one nurse doing triage and two nurses in back. On nights we do not have a unit secretary and half the time are without a tech too. This works out when all three nurses are EXPERIENCED, but somehow we have gotten to the point where this is not true. There are only 3 of us on nights that have any ER experience at all. Our other staff is either new to the ed, or brand new nurses. Everytime I go into work I pray that nothing major comes through the door b/c it may be only me that knows what it going on and what to do...this is getting stressfull!!! Sun night I had my charge nurse in triage (and of course tied up in triage) and a new grad in the back with me and a new grad orientee. It all went to heck with the weather change that day sparking the asthmatics and of course superbowl making it worse with them being around smoke. Soooo, we come on to shift with a back up in the lobby and the rooms full-but nothing major. Then the first thing to go wrong was a lady at the back door holding her seizing nephew and screaming. Of course as i was helping that little guy out the other two nurses are standing on my heels to see what is going on and i am barking out orders to tell them what to do-thank god respiratory was already in the unit. I don't like hollering at people but i'm afraid i did a lot of it that night, or at least i felt like i did. So after we get the little guy stabilized, in comes 2 severe asthma attacks and here i am again giving orders, pulling pts out of the rooms so we can use them, and stressed out. Then ems comes with a chest pain that my cohorts were going to leave in the hall until i explained that someone could come out of one of the monitored rooms. So they do that while i am running from room to room and come tell me that they are finished with that. So i say, good, you've got them on the monitor, started an iv, drawn blood, put on o2, did an ekg...and they look at me blankly and go back to the room. I have no problem with nurses learning a new unit-god knows we could use all the help we can get! But we have no formal orientation program for these nurses and one of them came on after working 3 months in med-surg and getting maybe 3 days of orientation. That night in particular we had a supervisor who is not inclined to help us out clinically and would prefer to spend her time talking to the guys in radiology. It is a major lifesaver when we have other supervisors on who jump in and help. I have tried talking with our nurse manager who basically said that we have all the staff that we are budgeted for-so there will be at least 2 nights a week without a tech, and of course if we get bogged down why don't we just call her. She said that she would come in for a few hours. At a loss for what else to do, I told her to expect me to call!! After that night, i know the other experienced nurse I work with is seriously thinking about leaving and i know that i can't handle many more nights like that. The nearest next hosp for me is an hour away-i already drive 30min for this one...and they do not hire lpn's in their er. I am trying to hold out here till i finish my rn which will be mid year...but this is getting scary. thanks so much for listening!! i just need the support only my fellow nurses can give. i know that this is a no win situation and i figure that most of you are going to tell me to move on asap!!! before it becomes my license on the line. thanks again to all!!!

[errn7]

I feel your pain and anquish.....I have had shifts like that myself and cringe until its time for me to clock out. Unfortunately, in this day and time unless something tragic happens nothing will change. Because you are a caring individual you will see that what's right gets taken care of and that everything gets done. From your description you seem to be able to "think on your feet" thats something that comes with time and exp....however, there are those that are in the ER that you would swear couldnt even find the strings to tie up their scrubs. Hang in there.......Hopefully, when u are finished with school you will get paid close to what you are truly worth to them in critical situations.

[mattsmom81]

You are better off in that place as an LPN, believe it or not.When you get your RN you should skedaddle as your liability will only increase. I have been in similar straits as an RN in ICU's working with new nurses who are scary and the hospital expects me to hold things together...not good. I feel your pain. And believe me, after years of this the stress just gets to a person. Finding a job where one doesn't go into 'fight or flight' every night is a worthwhile goal...good luck!

[missnurse01, MSN, RN]

mattsmom-that is exactly one of the reasons why i am so freaked out! it is not in my job description to manage the unit and some nights i am the most experienced person there which means that everyone comes to me with questions. i feel like i am walking a thin line between working outside my job description but making sure that everyone gets proper care-esp the critical pts. i have asked to only work the w/e now, since that is when one of the other experienced nurses works so i won't be completely alone. but when it is busy she is stuck in triage and unable to help, and the other option is to put the new grad in triage which can create another mess. uugghh, i think i'll just try to work with the experienced 2 and hold my head above water...and call my nurse manager when we are sinking!! thanks so much you two for the support.:) it really means a lot. i ran into this when i use to work the floors, but it is different in the ER!!! maybe more caffeine will help?!!:chuckle

[ERNurse678]

Sounds like there is some serious problems with the unit you are working on. First off, the fact that new employees, especially new grads are only getting 3 days of orientation??? In my ER we get 12 weeks of orientation. How do you guys justify to JCAHO that your nurses are trained to do the job? We are required to have paperwork on file for every employee showing what they did on orientation and the classes and training that they have been provdided. Granted, the ED I work in is a good bit larger than yours but I feel like the nurses still need the orientation that we get. I would move on if I were you, your license is on the line. Congrats on going back for your RN!!!!

[unknown99, BSN, RN]

I agree that it does not seem safe on some of the nights that you work. I would have a hard time with it also. But, in defense of the new nurses, they are learning and you can be a valuable "learning tool" for them. Remember, you were once new and inexperienced too.

[mattsmom81]

I agree that it does not seem safe on some of the nights that you work. I would have a hard time with it also. But, in defense of the new nurses, they are learning and you can be a valuable "learning tool" for them. Remember, you were once new and inexperienced too.

There are serious problems when a facility uses the 'warm body' approach, staffing a unit/shift with 90% newbies and one experienced nurse to hold everything together. Too much room for disaster in a critical care area where minutes count, and inexperience can hurt....the patients pay the price, as well as the one goodhearted experienced nurse who tries desperately to be in 10 places at once.

I don't see this as being a good learning tool for anybody personally.

[missnurse01, MSN, RN]

Sounds like there is some serious problems with the unit you are working on. First off, the fact that new employees, especially new grads are only getting 3 days of orientation??? In my ER we get 12 weeks of orientation. How do you guys justify to JCAHO that your nurses are trained to do the job? We are required to have paperwork on file for every employee showing what they did on orientation and the classes and training that they have been provdided. Granted, the ED I work in is a good bit larger than yours but I feel like the nurses still need the orientation that we get. I would move on if I were you, your license is on the line. Congrats on going back for your RN!!!!

I don't know why they don't try to orient more...I got 12 weeks when I started, but it wasn't very structured either. They do have these long checklists that get signed off-but its basically 'did someone talk to you about this' without evidence of learning or skills. I think i would feel better in a bigger er, then at least i would have more experienced nurses (i hope!) or some support staff! doing all the clinical stuff plus answering the phones and putting all the orders in can get hairy. thanks for your input and the congrats!:)

[missnurse01, MSN, RN]

I agree that it does not seem safe on some of the nights that you work. I would have a hard time with it also. But, in defense of the new nurses, they are learning and you can be a valuable "learning tool" for them. Remember, you were once new and inexperienced too.

I love to show other the ropes, but feel it would be more beneficial to the new grad to have a more formal preceptor process. When I came to the ER I never even new that they took new grads (and would have been freaked if it was me!), and at our little hosp where we do it all I can understand why you may need extra experience behind you. I just think its unfair to both sides, with the pt losing out big time. I have no idea even what d/c instructions are being given...i feel like it is all on my shoulders and that isn't being just a 'learning tool' like i would like!! thanks for your input!

[missnurse01, MSN, RN]

There are serious problems when a facility uses the 'warm body' approach, staffing a unit/shift with 90% newbies and one experienced nurse to hold everything together. Too much room for disaster in a critical care area where minutes count, and inexperience can hurt....the patients pay the price, as well as the one goodhearted experienced nurse who tries desperately to be in 10 places at once.

I don't see this as being a good learning tool for anybody personally.

thanks again mattsmom for seeing my point. glad its not just all in my head and i'm not being a 'team player'!!!

[emergencyrn101]

I agree that it does not seem safe on some of the nights that you work. I would have a hard time with it also. But, in defense of the new nurses, they are learning and you can be a valuable "learning tool" for them. Remember, you were once new and inexperienced too.

I totally agree. It seems that some nurses forget where they came from and it makes new grads afraid to ask questions.