Does the ER get easier or is it time to call it quits?

[RNTEE]

Hello! I'm a new grad in a high acuity (level 2)/high volume trauma center in California. I've been part of a "residency" program for the past 4 months with 2 months to go. While I have nothing to compare it to, many of the nurses have told me the residency program and hospital suck, and to get out as soon as I can to a better hospital where my license won't be at stake. We are usually short staffed and have recently had a mass exodus of nurses, doctors, and techs. Still, I'm grateful to have a nursing job straight out of school and the very position I dreamed of.

The problem is that after 4 months I am still having trouble taking on three patients and there's no way I am able to take 4. I have read and been given so much advice and feel like I am following it to the best of my abilities but the bottom line: I'm slow at everything I do! It's killing me!!! I love the ER, I love the people I work with, I even love the dysfunction and chaos of our ER, but I'm starting to ask myself if I'm fooling myself because I can't seem to keep up with the flow no matter how efficient I try to make myself. My question is this: do I stick it out and hope that in two months I will be faster, or do I leave while I'm still seen in a "good light", and try a different floor like telemetry where I have more time to hone my skills and time management? Is there a point when you know you are not cut out for the ER? And if so, how do you know?

[WKShadowNP, DNP, APRN]

Everyone is different, but I would like to think that it takes at least a year to feel really competent. If you look at Brenner's novice to expert model you can visualize the different stages of professional growth.

[emtb2rn, BSN, RN, EMT-B]

You may not be appreciably faster in 2 months, but 2 years out, yeah, you'll be faster. Try to hang in there at least a year.

[Vince_RN]

Don't worry about finding three ED patients difficult 4 months into a residency. I've seen hundreds of new nurses start their ED careers, and few were really capable of properly taking care of three ED patients at that point. Many thought they were, but that showed they were overconfident, not competent.

It does get easier, but it takes time. Starting in a residency at the kind of hospital you describe is the right way to do it. Stick to it, work there for at least a couple years, and you'll have a great career ahead of you.

On that list posted above, expect to be at the "beginner" level when you finish residency. "Competent" perhaps a year later. I would say "Proficient" is perhaps 5 years into your career.

[Guest219794]

The people you really need to ask are the nurses at your place that like the job and are good at it.

[NickiLaughs, ADN, BSN, RN]

I'm with everyone else, stick it out. I went from ICU to ER, took me 6 months to feel somewhat comfortable, like I could survive a shift,and a year to feel safe at least. At two years, you have some confidence. It gets better, if you love it don't give up yet. Some U.S. U.S. Get frustrated when we aren't where we want to be. It takes time, and give yourself that time

[iluvivt, BSN, RN]

Please do not get bogged down in the path of other nurses or workers, There will ALWAYS be someone who will be unhappy and misery loves company. If I listened to others I would never be working where I am and found my true path in nursing. Stick to your path and concentrate on getting better at it every day. It will be a slow process, so just accept that fact an keep moving forward. You must keep working at it though by identifying your weaknesses and working to improve them. This means you may need to study at home. I still do even after a very long career already!

[foragreatergood]

Stick it out for a year. I lost track of how many times I almost quit, walked out in tears and felt like I was never going to manage 4 patients. 6 yrs later - I still have days I struggle. But I am so glad that people encouraged me to stay.

[bebbercorn]

Many years in and 4 patients one shift means very different things on another shift. Hang in there. It gets easier. Learn from your mistakes, don't be scared to ask questions, and don't be afraid to triage and re-triage... someone needs CPR? The sandwich for room 5 can wait... Pt needs bipap? Your vomiting pt has to wait, too. It's tough, but you'll get there, I promise!

[akulahawkRN, ADN, RN, EMT-P]

I've been at this now for 9 months and I'm between "Beginner" and "Competent." While I can manage 4 patients, 3 is more manageable. Trust me, I have difficulty when attempting to manage more than 2 critical patients at a time, hoping that I don't end up getting 2 codes... at the same time. That would be really tough...

[Kristenlaurenw]

I moved to the ER after 9 months on the floor at a small rural hospital and for my first 4 months, I was an idiot. I contemplated going back to my old unit because I felt so incompetent. I'm going on 2 years in the ER now and I can't see myself anywhere else. I LOVE going to work everyday and I'm at the point where I can help new orientees learn the ropes. It WILL get better. Just keep learning all you can and when something new comes in, try to get involved and learn from it!

[Racer15, BSN, RN]

Four patients in the ER can be tough, even with a few years under your belt. I was brand new as a nurse and started in the ER. I was convinced I was going to be fired. Three years in...ehhh. I have bad days where we are swamped and I am close to stroking out, but those don't happen all the time. I get put in our fast track routinely now because I have gotten so fast that I can run laps around some of our more experienced nurses. It took me about a year to feel ok, and when I'm in the main ER I can get behind if I've got a lot going on, but we have a new director that is very focused on getting staffing where it needs to be which is a HUGE help. Check out other ERs, if your facility is bleeding staff it may be them, not you, that is the problem.