Originally Posted by shell911rn
Hi,
I hesitate discussing new grads in the ER with ER nurses especially online b/c I know the opinions are often negative towards new grads. I just started in the ER three weeks ago after graduating in May. I worked out in the field as an EMT and also as an ER tech both for over a year. What I found is that my experience in the ER was no where near experiencing the role of the RN in the ER. The responsibility is great and overwhelming at times. My assessment skills and history taking are good, but the one area I seem to struggle in is my technical skills (i.e. IV's, blood draws, IM injections). It's not that I can't do them, it's just that I don't do them at the speed of an ER nurse and I still have many a time where I can't get an IV on a patient. I did not have much experience with these skills on Med/Surg or Telemetry which is ultimately why I decided that spending a year in Med/Surg or Telemetry would be a waste of time. I have been very stressed out the past several weeks (much more than my friends who went to med/surg or telemetry), but not b/c I'm incompetent, but b/c I first had a preceptor who wasn't comfortable precepting a new grad and expected too much from me, while not allowing me to do much of anything, and b/c I expected too much of myself. It led to an emotional breakdown in the ER, but I came back the next day and surprised both myself and my preceptor with how well I could bounce back and proved that I belonged there. Make sure you have a preceptor who has the confidence to allow you to practice your skills and doesn't let the patient know you are a new grad. There's nothing like being treated as though you are still a nursing student, when in actuality you have your RN LICENSE! We have done all these skills before at least once. Now it's time to fine tune them. Review the procedure with your preceptor before going in to the room if time permits and have him/her walk you through it. If you've never done the skill, observe your preceptor doing it first. I'm now with a different preceptor who doesn't expect too much (except at times when it gets chaotic) and is allowing me time to master my skills with guidance. I am taking an ER class for the next month followed by Basic Dysrhythmias, ACLS, PALS, and courses (splinting, cardiac meds, CHF, etc.) with our nurse educator. I chose not to stay at the hospital I worked at as an ER tech b/c they don't have an extensive ER orientation (mine is 6 months with a preceptor) nor ER courses. They place you with a preceptor and that is it. I didn't apply to any other hospital but this one and am glad I did. I'm still struggling emotionally and I have days that I feel like the most incompetent nurse in the world (quite a contrast from several months ago when I did my preceptorship for school on a tele floor and took care of 4-5 patients on my own and felt like I could handle anything). But I'm not gonna give up. My friends on med/surg or telemetry aren't gaining anything near the skills or experience I've so far been faced with in the ER. In fact, they are being babied too much in my opinion. I'm being put through a lot and I'm constantly having to prove myself to nurses, but I didn't work so hard in school to give up on my dream. Take it one day at a time and be good to yourself. Expect some days of crying. The ER is competetive, especially among new grads. Sometimes a fellow new grad is not the best support b/c they are trying to raise their own self-esteem through your failures. Sometimes your family or friends from nursing school are not the best support either. They don't understand the turmoil of spending years in school working towards a dream to feel as though it is falling apart. I'd recommend visiting the new grad board for support. Whatever you are uncomfortable with, read about at home and practice. And this actually goes for any new grad on any unit.
Michelle
(quite a contrast from several months ago when I did my preceptorship for school on a tele floor and took care of 4-5 patients on my own and felt like I could handle anything).
Now see, not trying to bust your bubble or hurt your feelings, but you said yourself that you felt you could handle anything...on a tele floor. Why not work that floor where you do feel confident, and capable and get your sea legs and your nursing skills down pat, instead of working in a unit that constantly makes you feel inadequate. ER is not a place to work, just to prove yourself, ER needs nurses who are confident and competent. It's great that you aspire to be an ER nurse, but it sounds like from your post, you should really have started on the tele floor. ER does require that you "prove" yourself; timid, shy, new nurses that take their time mastering skills really don't belong in the ER where the pace is fast and the docs want things done yesterday. You're probably lucky your preceptor is patient, but the longer you take to master your skills and become confident, the more obvious it is going to be that you need to be somewhere that you can master your skills at a slower pace. It sounds like you have thrown yourself into the deep end of the pool without knowing how to swim well. Again, not trying to hurt your feelings, but realize there is no shame in not being ready to be in the ER. You can't keep feeling low self esteem after work; it isn't fair to you. I'm sure you are a great nurse, but I just think you would be better off working somewhere where you can feel like you are a great nurse after work. After you have gotten experience and confidence under your belt, then come back to the ER; I'm sure your orientation would be much more comfortable to you at that point. I just don't want to see you quit nursing or feel inadequate because you started out in an area that is too difficult for you. Just a thought. I'm sorry if this hurts your feelings, guess I'm just being brutally honest. If you do choose to stick it out, then jump at every chance to do your skills, both advanced and basic. Ask your preceptor if you can go in with other people if there is something going on that you haven't seen before, even if it is just to stand in the corner and watch. Try and keep in mind things you see that go well, as well as things you see that don't work out so well. Try to learn from others mistakes as well as their good tricks. Don't sit around waiting for your preceptor to ask you to do something, if you see something that needs to be done, jump up and do it, even if it is only checking someone in for another nurse. Don't make your preceptor have to come and find you. Always let her/him know where you are at all times, if you are not with them. If you have down time, go in your assigned rooms and familiarize yourself with where everything is. The biggest reason I have seen nurses fail in the ER, is they weren't self motivated. They waited to be told what to do. Don't do this! Good luck!
Pam
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