Am I not cut out for this?

HiddencatBSN, BSN · Sep 26, 2017

Can you speak with your manager or educator about identifying areas you are uncomfortable with and making plans to gain more confidence and experience? You're still pretty new, so it's not unreasonable to still ave areas you need support and study on.

I'm concerned that your environment sounds unsupportive- if the culture involves a lot of talking behind backs it might be an issue of culture and not specialty fit.

Editorial Team / Moderator · Sep 28, 2017

What are you doing outside of work to learn more about unfamiliar presentations or procedures?

jdub6 · Sep 29, 2017

It is not abnormal to be nervous with things that are unfamiliar. Since you started as a new grad and have been there less than 2 years I'm guessing they have not assigned you to the trauma or major med rooms as much as the more standard stuff. If your facility is smaller and has overall low volume of serious trauma or whatever it's harder.

I personally find that I can't become comfortable by research alone. I have to be hands on with our supplies that I find where they are kept and charting it in our system etc.

Thus, I can't avoid the things that scare me. Its tough but if I'm able to step away from my assignment even briefly when something big comes in, I try to observe the primary nurse or if able/needed do tasky stuff (IV/labs/glucose/Foley) while listening and watching.

Best yet is documenting-this is hard to do in a busy facility and works better if you have advance notice about the patient (and coworkers willing to support your learning by covering you.) Observe whatever you can and document it for yourself. try to be there while they're determining and startingthe initial plan, then keep checking in and "charting" when you can. When you have time, go through the chart. Look at what the nurses were doing, what interventions were done and why so you learn how to assess and anticipate/prepare (primary assessment-how do you assess airway? what was done to address abnormalities found, what supplies were needed?) If there was a major change in condition what were the signs of that and what was done in response?

I find it helpful to read the MD note. look at what assessment findings they highlight as rationale for what they did. If procedures were done read the note. What was needed or done to prepare/assist/finish? what complications were ruled out and how? their physical exam: what details did they feel were worth noting? What findings/symptoms are noted as being absent? It was mentioned for a reason-figure out what it is.

Ask people to show you how they set up the equipment-step by step, what buttons did they press to adjust what setting when and why? Supplies like Pleurevacs generally have great guides from the manufacturers online that show you step by step with illustrations of the specific model you use. If something like that is ever opened but not used(now unusable on patients) grab it and practice setting it up.

Find the whys. If you weren't expecting the DKA to get intubated but nobody else was surprised ask the doc what they saw that was concerning. Don't just try to memorize which drips are used in a situation: go back to the patho and pharm and learn the cliffnote version of what the problems are and what the med does that helps. When things go badly for you or someone else try to find out what the issue was. Use hindsight to your advantage to put together the reason things happened and what should have happened instead.

Last its never productive for coworkers to gossip or put down others. You may be way behind expectations but some people will be negative matter what. At 15 months out there is no way you should be expected to be proficient with every emergency. If they are discussing sincere concerns about your performance those should be addressed with you directly. Otherwise they are just making people too nervous to ask questions or practice--meaning no one will improve. People who do this should be ignored and if it's the whole facility or if management is involved you might consider a change so you can continue to grow.

amzyRN · Sep 29, 2017

I think they should be teaching you the trauma rooms by now and you also have to make your interest known. Your department sounds like mine (the one I'm getting the heck out of), the gossiping and favoritism. My last department would always assign the most experienced nurses to the trauma rooms which totally makes sense except that there are other nurses in the department that have put their time in and worked their tails off and should be given the opportunity. Instead they would put all of the newer nurses in 4 patient assignments for days on end. The problem with that is the 4 patient pods are work intensive with less help and it is exhausting and gets boring after a while. While there were lots of things to learn and there are critical patients that get thrown in their once an a while, after a year of just that, it's time to branch out into triage and trauma/resus. I think 1 year is the most someone should have to wait to do higher functions in the ED.

Do ICU nurses have to wait a year before they get super sick patients? I'm guessing probably not. For some reason though, some EDs like to put all the "elite" nurses into the critical assignments. Those EDs are not the ones that retain staff.

Sorry to digress. In short I think you probably are "cut out" for this, but you need the experience. Either you ask your educator or charge or manager to assist you or you can start looking for another ED. Just make sure you ask them in the interview how they develop their newer staff.