ED nurse feels "stupid, unappreciated" and "sucks at IVs." Advice, please.

[Nurse Beth, MSN]

Yes, it is probably time to move on.

I highly doubt you are stupid or unskilled. It does sound like you are unappreciated, or at least the appreciation is not expressed.

I'll start with the IV skills issue since you said it's your biggest concern. It has to be difficult for you not to feel good about your IV skills as an ED nurse, and you've stuck it out for two years. That's a long time to feel a certain kind of way, and I'm sorry you've endured that.

While IV insertion practice could be beneficial—like mannequin exercises in Staff and Development, if available—the root issue is not a lack of practice. I don't believe the problem is psychomotor skills. Rather, it's performance anxiety resulting from a mismatch.

The ED is not the right fit for everyone. The ED is suitable for a particular type. Read Are You Cut Out To Be An ED Nurse?

You are not in the right environment for you. You deserve to be in a practice environment where you feel accomplished, where you contribute, and where you are appreciated.

You say you overthink, double, and triple-check things. Have you ever considered ICU? The characteristics that hinder you in the ED could make you an excellent ICU nurse.

Here are some additional thoughts:

• Acknowledge your stress. It's a tough job. EDs are notoriously high-stress. The unpredictability, the constant pace, and the emotional toll can make it hard to feel competent and confident. Feeling stressed and anxious doesn't mean you're not cut out for nursing—it means you're human. You're in a pressure cooker that most people can't handle, and you've survived for two years. That's something to be proud of.
• Take care of your mental health. It might be helpful to talk with a counselor, mentor, or therapist to work through the anxiety and insecurity. Overthinking and self-doubt are natural but can be alleviated with strategies like mindfulness, cognitive behavioral therapy, or even venting with someone who understands your struggle.

Communication and Feedback

It's a travesty that a new nurse (I'm assuming) or a nurse new to the ED has not been given regular, helpful feedback. Your educator and manager should acknowledge your progress and be working with you on your professional development to set goals. You can take the lead here and ask specific questions like, "What's one thing I could focus on for my development?"

I'm confident you've had performance evaluations in the last two years. Could it be that you've overlooked positive feedback? The absence of feedback outside of performance evaluations often indicates that you're doing well, as your manager and educators are likely directing their efforts toward those underperforming.

• Peer support. Don't hesitate to lean on your coworkers. Maybe some colleagues in the same position as you can offer guidance on managing stress or handling difficult situations. The camaraderie in an ED can often be a source of strength.
• Explore options within nursing. There are so many options out there. Plenty of other nursing specialties exist without the same intensity if you decide to step away from the ED. You could consider areas like outpatient care, urgent care, or even nurse education if you still want to stay in a clinical environment without burnout. You could also think about telemedicine, home health, or roles in nursing management, where the pace is slower, and you can develop skills at a more manageable rate.
• Trust your instincts. You're not alone. It's easy to feel like you're the only one struggling, but almost every nurse has been through a moment of doubt, especially early in their career. The fact that you have enough insight to reflect on these issues shows a level of maturity and responsibility that many don't have. You're not stupid, unskilled, or a danger to patients. You're just going through a tough time and deserve space to process it.
• Make a decision when you're ready. It's healthy to take a step back from the ED if it's affecting your well-being. You don't have to decide in haste. Reflect, talk to mentors, and think about what will make you happiest and healthiest in the long term.

Ultimately, no matter what direction you choose, the fact that you're asking for advice means you're dedicated to improving, and that says a lot about your professionalism and commitment to patient care. Don't let this temporary struggle define your worth or your skills. You're on the right track by seeking guidance.

Very best wishes,

Nurse Beth