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?

[akulahawkRN, ADN, RN, EMT-P]

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.

Just to amplify something a bit, perhaps...

I'm usually in the Fast Track area and while I've become pretty darned fast (today I saw around 14 with 2-3 beds occupied for 3+ hours each), the entire ED was just swamped and then some. Those days are few and far between, so... OP, don't get discouraged when you hear of this happening. We all get just completely slammed with patients that it feels like you just showed up at work only to hop onto an already spinning hamster wheel that takes half your shift just to catch up! You just do what you can, the best you can, keep learning and one day, you'll amaze yourself just how far you've come.

[jorgecrn]

Im a new grad and have been in the ED for going on 4 months. I was suppose to get 12 weeks orientation but at 8 weeks they thought I was ready. I have had my good days and my bad days, yesterday I just kept getting slammed with patients and I fell behind on a few things, but I just tell them that Im working as efficiently as I can, and Im prioritizing who is more critical and who can wait. At the same time im being sure to be a safe nurse and do my nursing checks on giving meds. I tend to fall behind when I get an elderly patient or an obese patient, because they are hard sticks, which delays my labs, which delays everything, I have Lab come to draw them or I get an experienced nurse by then 30-40 minutes have gone by. My hospital tends to hold a lot of ED patient due to no rooms, and that's when it gets tricky, especially if there are no PCU,ICU,MED/Surg nurses available to come and help out. Overall, advice don't forget what they said in nursing school, Be Safe, Be efficient, and Prioritize.

[akulahawkRN, ADN, RN, EMT-P]

Im a new grad and have been in the ED for going on 4 months. I was suppose to get 12 weeks orientation but at 8 weeks they thought I was ready. I have had my good days and my bad days, yesterday I just kept getting slammed with patients and I fell behind on a few things, but I just tell them that Im working as efficiently as I can, and Im prioritizing who is more critical and who can wait. At the same time im being sure to be a safe nurse and do my nursing checks on giving meds. I tend to fall behind when I get an elderly patient or an obese patient, because they are hard sticks, which delays my labs, which delays everything, I have Lab come to draw them or I get an experienced nurse by then 30-40 minutes have gone by. My hospital tends to hold a lot of ED patient due to no rooms, and that's when it gets tricky, especially if there are no PCU,ICU,MED/Surg nurses available to come and help out. Overall, advice don't forget what they said in nursing school, Be Safe, Be efficient, and Prioritize.

You should be careful about generalizing the elderly and "obese" patients as being "hard sticks" because often they really aren't. The difficulty with the elderly is that their skin can be very mobile so anchoring the skin relative to the vein is a key thing. The difficulty with the obese is that sometimes their subQ fat can make palpating a vein challenging but often, if you let your fingers do the "seeing" you'll notice one or two really good veins that are trying to hide from you. The patients I have trouble with are IV drug users and cancer patients because their veins are often so chewed up that finding any vein is challenging at best.