Hey all, looking for some advice today. TL;DR at bottom
Just got hired in the ER and so far I'm loving it. Recently, I was trying my best to handle two codes (not at the same time) and I felt so hopeless. Granted, I'm only in my third week of orientation, but I feel like I'm dropping the ball in a lot of places. I ended up trudging the rest of my way through my shift since the codes were so emotionally exhausting. My preceptor, of course, was busy handling those situations. I don't feel like I'm getting much feedback from her. She has told me that I'm doing well on my paperwork, which is a relief. My patients like me, and they tell me they do, so that makes me feel better.
What I'm wondering is how exactly do you know what to do in the chaos of a code? Will this get better once I'm ACLS certified?
TL;DR - I feel like I'm doing a bad job and codes are scary please help
Hi OP and GaJen! I just returned to the ED after a hiatus of 8 years on a PCU unit. I am copying down all the wonderful comments here and from other threads to read when I have my OMG moments. I keep saying "I know enough to be dangerous" but I need to stop that. I ask a ton of questions, even as an experienced nurse, and I'm learning who the go-to-gurus are in the unit. Hang in there, it does get better, the brain needs time to digest and store everything we're encountering.
Actually, yes. Things got a LOT better. I ended up with a different preceptor whom I vibe with very well. I'm learning a lot. If there's anything I can say, don't give up. Charting is hard, but you get into a routine. Seek help and guidance from everyone you can and don't be afraid of doctors, they know what they have to do . If it helps any, I've been told not to run to them for every little thing, but if your have questions or don't understand orders, ask. It's better to be safe than to do harm to a patient.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Hey all, looking for some advice today. TL;DR at bottom
Just got hired in the ER and so far I'm loving it. Recently, I was trying my best to handle two codes (not at the same time) and I felt so hopeless. Granted, I'm only in my third week of orientation, but I feel like I'm dropping the ball in a lot of places. I ended up trudging the rest of my way through my shift since the codes were so emotionally exhausting. My preceptor, of course, was busy handling those situations. I don't feel like I'm getting much feedback from her. She has told me that I'm doing well on my paperwork, which is a relief. My patients like me, and they tell me they do, so that makes me feel better.
What I'm wondering is how exactly do you know what to do in the chaos of a code? Will this get better once I'm ACLS certified?
TL;DR - I feel like I'm doing a bad job and codes are scary please help
I would be extremely surprised if anyone you work with in the ER expected you to be able to handle yourself in a code. Codes are scary. They're scary even if you're experienced. Sometimes, anyway. But the more experience you have, the easier it gets. ACLS gives you a framework for running codes, but codes don't always follow the ACLS algorithm. It's a starting place, but that's all it is. That said, you should definitely have that arrow in your quiver.
As an experienced preceptor, I'll tell you that the orientee who doesn't question herself, her knowledge and here future as a nurse scares me. It's the ones who think they know everything who are dangerous. The orientee who is a little bit scared is the one I'll trust not to do anything stupid without telling me. I might not breathe down your neck as much as I would the new grad in your orientation class who is convinced they're supernurse and will never make a mistake.
Orientees make mistakes. They're anxious and unsure and lack confidence and that's all a good thing. Maybe it doesn't feel like it, but you sound as if you're progressing right on schedule.
It gets easier, believe me it does. After a couple of years you'll actually be competent and rightfully confident. The first year is the hardest, though, and it's miserable for most of us. The only way to GET through it is to GO through it. Keep us posted. I hope to be reading in August 2018 that you're loving your job!
I actually had an instructor in nursing school who told me "The first year in your first nursing job, you will constantly think 'what did I get myself into?!." He wasn't kidding.
I'd been a nurse for 5 years with 15 months of ER experience when I transferred to another, larger ER. I had the "what did I get myself into" feeling for a good year or more. I've been there 4 years now and still occasionally find myself thinking that I feel a bit more comfortable as time goes on.
It'll get better with time. You know more at 4 weeks than you did at day 1 and will know more at 4 months than you do now. Pray, take a deep breath and do your best. Thats all you can do right?
Hey all, looking for some advice today. TL;DR at bottom
Just got hired in the ER and so far I'm loving it. Recently, I was trying my best to handle two codes (not at the same time) and I felt so hopeless. Granted, I'm only in my third week of orientation, but I feel like I'm dropping the ball in a lot of places. I ended up trudging the rest of my way through my shift since the codes were so emotionally exhausting. My preceptor, of course, was busy handling those situations. I don't feel like I'm getting much feedback from her. She has told me that I'm doing well on my paperwork, which is a relief. My patients like me, and they tell me they do, so that makes me feel better.
What I'm wondering is how exactly do you know what to do in the chaos of a code? Will this get better once I'm ACLS certified?
TL;DR - I feel like I'm doing a bad job and codes are scary please help
it'll get better over time. Codes are hard to handle and as you gain experience, they will be less scary. You have others to lean on and learn from. Good luck and hang in there. Try to decompress, learn from each interaction and code. Write down notes and look up stuff.
I just hit 10 months in the ER as a new grad and had a 12 week preceptorship. I'm far from a seasoned nurse, but I'm not the same RN I was last November.
Those first few weeks/months should feel like a slow motion train wreck, at times. Don't jeopardize patient safety or your safety at any time.
When the tasks started piling up, sometimes I had to "slow down to speed up". Meaning that in order to tackle a mountain of tasks, I needed a quiet moment in the med room to develop a plan of attack. I found that if I slowed down a (tiny) bit, made sure to get the supplies I needed in one trip, was prepared for whatever I was doing, this makes things go so much easier and less stressful. You will be slow getting things together and setting them up but with repetition comes efficiency.
Lots of people on these threads have said that with exposure and experience comes confidence and comfort and at this point I agree. Something clicked around six or seven months for me and every month or so other things click, or at least I notice things fall into place with what feels like less effort or stress. Lots of things happen in what feels almost like automatic mode now.
Until then, you gotta stick out the tough shifts, the terrible patients, the (hopefully occasional) degrading comment and keep asking questions and taking notes and looking things up. Figure out who your pillars are on your shifts, lean on them (but not too much) and learn from them. You'll get it.
So I guess my question, especially for the new grads, is: why on earth would you expect NOT to feel out of your depth and be drowning? This is all new to you. You just graduated and this is your first nursing job. You haven't even had stable med-surg patients, let alone people trying hard to die on you. OF COURSE you feel overwhelmed. And you SHOULD. There is **so much to learn** in nursing, whether it's inpatient, outpatient, ER, wherever. I am amazed that people seem to feel that they should know more than they do when they've literally never done this work before.
IT. IS. OK. NOT. TO. KNOW. THINGS. That's what orientation is for. That's what your coworkers are for. This is why we have (endless) ongoing education. When you don't know how to do something, you find out. Then some day you teach someone else who doesn't know.
You are not a failure for feeling overwhelmed. You're not a a bad nurse for being slow.
Hey just curious if you are feeling better about working in the ER? I just started an ER job four weeks ago and I feel like I'm drowning in a sea of unsuccessful IV starts, intimidating docs and a crazy hard computer charting system. Trying to hang on but my grip is weakening.
Hello! Yes, I found that things did get better on the technical front. I find that I did much better once I was able to control my own workflow and decide what order I wanted to do things in. The part that's difficult is keeping myself emotionally healthy, and I have been seeing a counselor for that and am currently working with a nursing educator at my facility that I really trust.
I highly recommend speaking to someone you trust and focusing on absorbing as much information as you can. If you have to take notes, take notes. I've gone so far as to journal on what I've learned so I can look back and see how much progress I've made. When you get home, decompress and decide if venting about work at home works for you, as for me I find I get on an endless cycle of complaining. Then I feel no better than I did to begin with.
Most importantly, take care of your mind and your body. Sleep. Eat. Enjoy your hobbies. Socialize. I'm still figuring this out myself, but it's getting better with time. ER is incredibly difficult to work in, and nursing in general is an emotionally and technically demanding job.
Good luck to you, happy to answer any other questions if you have them!
. If it helps any, I've been told not to run to them for every little thing, but if your have questions or don't understand orders, ask. It's better to be safe than to do harm to a patient.
akvarmit
109 Posts
Hi OP and GaJen! I just returned to the ED after a hiatus of 8 years on a PCU unit. I am copying down all the wonderful comments here and from other threads to read when I have my OMG moments. I keep saying "I know enough to be dangerous" but I need to stop that. I ask a ton of questions, even as an experienced nurse, and I'm learning who the go-to-gurus are in the unit. Hang in there, it does get better, the brain needs time to digest and store everything we're encountering.