[Neferet]

Help!

It seems like emergency nursing is my ideal job right now……

This sucks I always criticize myself…I have decrease confidence…because sometimes I really don’t know what I’m doing. I get scared when people don’t know what the heck they are doing, but act like they know what they’re doing. Some people have told me…”just act confident, then you’ll be confident”……true I’d probably feel more confident…but that doesn’t change the fact that I didn’t know how to do something. I can’t do that to my patients…..I want to know everything. An emergency can send me to my books in less than a second, but throw something that’s not an emergency to me…I’m not gonna move…..(well, I will but at an unmotivated pace)…

Ughh,…I really do feel like I didn’t learn all the real stuff in school. I’ve always wanted to know a lot of things…to know what I am doing and be good at it. But what I always heard people say is that, “you’ll never know everything.” Yeah, that’s true…but I WANT to. Or at least be up there. I’m so interested in mass emergencies…I’m into studying all about survival and stuff and always imagine myself doing CPR or emergency care on people….I really do day dream about these things…I catch myself doing it sometimes, and it’s just drives me crazy now that I’m looking for a job….I just realized that maybe I should just start in the ED …it feels good for me IF I can feel confident and know it all. Or at least know what to do in an emergency. But the problem is I don’t really know it….that’s the reason why I’m not so confident.

I really have low self-esteem. I hate med-surg nursing. Not because it’s bad…but it’s just not the thing for me….I imagine working in an isolated place where people are counting on me and my team to give them great emergency care. Yep, I imagine myself sewing skin and doing other surgery and weird things……But I can’t work with staff who are biting eachother every chance they get. I’ve heard the posts about how ED staff watch out for one another, and a lot of teamwork…and I love that idea…..until I got to reading about how they will treat you if you’re not confident or know don’t what you’re doing….that’s sad….but I don’t blame them….If I was an ER nurse and someone didn’t know what they were doing, I’d probably not want them there also…they’ll put the patients at risk…but people have got to get THERE somehow….and there’s gotta be a more easier way than going through hell, making youself miserable and giving up on nursing. I love knowing about everything…that’s what makes it exciting but I can’t stand when a teachers/mentors steps on me. I need to know that they are supportive and even though I’m dumb…that they will be a great mentor and teach me ALL they know.

The thing that scares me the most is when I don’t know what I’m doing. I wish I had a great mentor who could teach me all that stuff. I’m sick of preceptors and teachers that I’ve had who new nothing about teaching!.....They could have at least been enthusiastic or patient…there were only a few of those, but it only takes a few to make you lose hope….I wished I was some of those lucky students who got those great mentors. I felt like I was intimidated most of my nursing education…..that sucks…it just made me less confident and gave me low self-esteem in my work. Also, it’s my fault too…..I’m always so hard on myself.

There’s a hospital I know that are taking new grads for ER. But if it’s a place where I’ll get torn apart…then I’m not gonna do it. I can’t do that to myself. I’d be suicide on my career. That is the place where I would need the most help in the world, because people are dying in there. But then I don’t want to be doing something else. I’m not exactly type A personality. I’m not totally type B either.

I’m just going crazy right now. I didn’t exactly enjoy the ER on my clinical rotations…and most of that was because I didn’t feel like I had any of skill to do hands on. I really just felt like I was in the way. But I can’t get over it…can’t get over the scene of the person dying, the person who needs medical help now, can’t get over it….there’s so much adrenaline there…just thinking about it makes me excited…….! Darn! I’m a mess…..shoot I don’t want people to hire me just cuz they need an ER nurse….I want them to do it because they believe they can train me to be a great nurse….I would be glad to study forever if someone would be glad to give me great training and respect….darn…thinking too much again….

Worst things why I'm worried if I take a job in ER: not organized, and not as "fast" a thinker as I'd like to be, yet....low confidence....and I don't like selling myself as something I'm not.....

ER? <sniff>

Tell me about it?...were there people who you thought was hopeless, but made it through ER?


p.s. I like psych…so that’s a plus right?

[locolorenzo22]

You know, your post sounds similar to what I'm thinking about for when I get out of school....although I don't believe I could EVER do ER nursing. Have you looked into ICU or tele nursing.....still important, but not always as "urgent"....just a thought.

[JMRBH]

Im fresh out of university as of last year and started working in ED in Febuary and had the same thought as the title-but loving it now, i will admit it was very scary-and you do feel like you know nothing somtimes, i will admit it is also a hard setting to learn the 'nitty gritty' of situations in a resus but if you have good supportive staff around you i find they help alot and are willing to go through everything with you when everything starts to settle. i will tell you that it is not easy but there is just something about it that gives me a thrill. I say give it a go stick it out for min. of 6 months if you can, and you will soon know weather you like it or not.

[carachel2]

Yep, I imagine myself sewing skin and doing other surgery and weird things

Most ER's I know of don't let RN's suture and perform other procedures.

[emtb2rn]

You'll never "know everything". Nobody does and anyone who claims otherwise is truly dangerous. And to me, that's the beauty of nursing (and one of the reasons I'm going into it), there's always something to learn.

My limited experience with mass emergencies (in the field, multi-vehicle MVA's & bus rollovers) is that intially, they're all about triage. Beyond that, as a nurse, you'll be treating your patient(s), but not everybody involved.

If you're going into an ED without ED experience, you'll be on orientation (I would expect), not flying on your own. Why would the other RNs expect you to know everything?

"An emergency can send me to my books in less than a second, but throw something that’s not an emergency to me…I’m not gonna move…..(well, I will but at an unmotivated pace)…"

Books? I'm not sure I understand. What's the context? Plus that "unmotivated pace" comment frankly scares me. What constitutes an emergency to you?

I'm not flaming you, but something in your words disturbs me. That said, I'm not an RN yet much less an ER nurse, but I do have more than a passing acquaintance with CPR and emergency care.

[Altra]

Neferet, I'm not sure how "new" you are to nursing. Lack of confidence is pretty common for brand-new nurses. My preceptors routinely told me it would take a year to feel competent and another 1-2 to feel confident.

I'm not sure I'm clearly understanding everything you were trying to say in your post so I'm going to try to tackle it in pieces.

Originally Posted by Neferet

An emergency can send me to my books in less than a second, but throw something that’s not an emergency to me…I’m not gonna move…..(well, I will but at an unmotivated pace)…

Not sure I understand this at all. You're saying you want to work in an ER environment but an *emergency* sends you ... to your books, and not to your patient? I'm sure that doesn't fly any better on a med-surg floor than it would in the ER. Perhaps that's not what you were trying to say. And to be honest, there are a considerable amount of patients who present to the ER, even in a trauma center, whose conditions are not emergent right now. That does not mean that care is not required right now. Even if you read through EMS forums, you'll find that their days are not always filled with one life-threatening emergency after another.

Originally Posted by Nerferet

I imagine working in an isolated place where people are counting on me and my team to give them great emergency care. Yep, I imagine myself sewing skin and doing other surgery and weird things

"Surgery" in the ER is limited to suturing (which you will not be doing as a nurse), chest tube insertion, and, in my experience in a Level I trauma center, very, very occasional thoracotomies and chrics. There are things you'll do to assist with these procedures, but you will not do them yourself.

I think confidence is gained from providing great care to the best of your (gradually increasing) ability day in and day out, more so than the occasional moments of "glory."

My suggestion: try to set up a shadowing experience with an ER nurse. Think through specifically why you think you are better suited to the ER than a med-surg unit.

Good luck to you.

[GilaRN]

Yep, about 70% of your ER experience will be filled with screaming snot faced kids and their demanding ignorant parents. It can actually be quite redundant. I know of several facilities that allow nurses to provide basic wound care and in some situations very basic uncomplicated laceration repair. If you can find the time to suture a 1/2" arm laceration when you have an active MI, a screaming kid with an ear infection, and a gang banger wannabe who took a couple of rounds to the box, then you are a better man than I.

Not to say that you will have several emergency situations, just do not think it will be like all of the television shows.

As far as lack of self esteem, I cannot help you on that one. You need to take a look inside and find out what keeps holding you back. Just like many others posted, you will need a couple of years of nursing experience before you start to put it all together.

[jjjoy]

I understand the frustration with people always saying "you can't know everything." Of course not! But I can know SOMETHING... so teach me SOMETHING!

In nursing school, I didn't feel like we learned a lot. We covered a lot of material but it often just came back to a few basics - such as manage pain, prevent skin breakdown, educate the patient. Good stuff, but it doesn't take 2+ years to learn that. So after covering a zillion different conditions at a rather surface level, the new grad comes to a job without having much to offer but a willingness to learn.

Except that no one wants to teach. Instead, you learn by trial-and-error. Common sense and school should keep you from making any really dangerous errors in judgement (the non-breathing patient takes priority over the person asking for water; double and triple check all meds you are giving). But beyond that, the newbie gets underfoot and learns by getting stepped on (don't just stand there, get the XXX! What's an XXX? Oh, forget it, I'll get it myself!).

I learn by observing, asking many questions, learning the background information, observing more, asking more questions, gaining confidence in my knowledge and then acting. Nurses (and perhaps other health care providers) seem to work a bit differently. First, you learn the background info. Without being in the situation, though, it can be hard to know to ask. We spent clinical time on long assessments that had little to do with acute care; we spent lots of time on being careful with medications (important, but again, you don't need two years to get it). We spent lots of time on long care plans in which we had to document over and over why it was important that patient cough, deep breathe and turn.

Then. boom, you graduate, and are confronted with being responsible for everything: several patients with competing needs, rushed MDs, a ton of paperwork, etc. The newbie can see that the experienced nurses are barely getting everything done, though they're not even sure what 'everything' is. So the newbie is trying to figure out all that, AND also has to juggle competing patient needs and yet doesn't yet have the experience to really be able to recognize how to prioritize. Yes, they will learn in time. But meanwhile, they have to continue to show up to work each day knowing that they DON'T know how to prioritize, manage their time, etc and have to fumble through it, hopefully not creating too many problems along the way... though they have to create some problems, otherwise that means they're not taking intiative and are hanging back until they know can be perfect and never learn what they need to learn (eg they HAVE to make mistakes to learn).

It can feel rather confusing. The newbie hears "Be careful. Prioritize. Manage your time." why? so you don't make mistakes. And yet, you HAVE to make mistakes in order to learn - I don't mean careless mistakes or blatantly dangerous mistakes. It's just that the newbie doesn't have much experience or good time management/prioirization skills and thus WILL perform relatively poorly until they do. And too often the culture is such that newbies are shamed for not knowing something (rolling eyes, being scolded, talked to sarcastically) or if hesitant are judged as "dangerous" "unprepared" "having no intiative" and the like. As the OP noted, the newbie must act confident even while being acutely aware that they don't really know what they're doing and won't for some time.

[TrudyRN]

Perhaps it is your font, maybe it is a couple of the things you say (unmotivated pace, grabbing a book in an emergency, sewing skin) but I think you are in need of a counselor, maybe a therapist, to help you evaluate your present condition and your future plans. You have an understandable fear of rudeness from teachers/mentors but the ER pace requires more of a tougher skin, I think. Not that people there should get away with being rude but the nature of the setting requires speed. Maybe you're just not quite strong enough mentally/emotionally to deal with that right now and would be better off in a slower-paced setting, where people are more likely to take time to teach you slowly, courteously.

I wish you well.

[jjjoy]

Originally Posted by TrudyRN

a slower-paced setting, where people are more likely to take time to teach you slowly, courteously.

What setting is that? I must ask because the low-acuity settings tend to give more patients to the nurses (eg 30 patients in LTC) and thus the pace isn't really any slower and the nurses aren't any more likely to have the time, patience or inclination to teach slowly and courteously. When a newbie is having trouble adjusting, the advice is often to find something "slower." Perhaps when people say that they really mean "less acute" because passing med to 30 patients, each of whom have many meds, may have dementia, can't swallow well, etc, in two hours, charting on those patients, checking notes, and running yet another med pass is NOT slow.

Anyway, I agree the OP might be able to use some counseling to sort out what she's (he's?) feeling. I can appreciate, however, that the OP was very honest in her fears and fantasies. It would be tempting to hide those thoughts for fear of being judged negatively and then never getting the necessary feedback to determine how to deal with her feelings and how to progress in her career.