ED Orientation (a bit of a vent)

Emergent, RN · Dec 24, 2013

There are many issues in your vent.

You're darned fortunate to have obtained this position.

Paragraph 1) Yes a lot of losers come to the ER, it's part of the job, get used to it.

Paragraph 2) I'm assuming PCAs are your providers? Well, you are a newbie and you need more time to develop relationships.

Paragraph 3) You don't like your lazy coworkers. Well, you'd better get used to it. There are lazy people everywhere in healthcare.

Paragraph 4) More complaints about your lousy coworkers

Paragraph 5) Turns out you, yourself, aren't perfect. Advise: wait till they put their orders into the computer until you know them and their accents better.

Paragraph 6) Your charge nurse is hard to read. Advise, just keep working at it and in a year or two you may prove yourself.

BrooklynRN11201 · Dec 24, 2013

whoa, was my original post that obnoxious? sorry, really didn't mean to come across that way!

I guess it's just a bit of a shock to me at this point and I'm second guessing a lot of what I do. I am the first to admit I am farrrr from perfect. There are things I know, but Emergency Nursing is not quite one of those things just yet. I don't have anything to compare my current experiences with, hence me venting on an Emergency Nursing board.

Regardless, thanks for your insight.

Emergent, RN · Dec 24, 2013

whoa, was my original post that obnoxious? sorry, really didn't mean to come across that way!
I guess it's just a bit of a shock to me at this point and I'm second guessing a lot of what I do. I am the first to admit I am farrrr from perfect. There are things I know, but Emergency Nursing is not quite one of those things just yet. I don't have anything to compare my current experiences with, hence me venting on an Emergency Nursing board.
Regardless, thanks for your insight.

You'll do okay. Just give it time.

JB-RN · Dec 24, 2013

The original poster described this as a vent. Don't sweat it. Do the job to the best of your ability and be a team player. Becoming a good ER nurse takes a long time. Learn from the mistakes you make and move on. Don't be afraid to ask questions if you are unsure of anything. Welcome to the whacky, wonderful world of ER nursing :)

WAheartnurse · Dec 24, 2013

I understand the PCAs to be ED techs? Someone who does EKGs, vitals, urine dips etc? I am fairly new to the ED and am having trouble getting techs to do much for me that they don't want to already do. They love splinting and EKGs and blood draws so they are always willing to do that but some of them, sometimes, don't do things like urine dips or repeat vitals etc. I am not sure if they think I am not busy or they are too busy but I find myself just doing it myself rather than work as a team. I had no problems as a floor nurse and worked well with CNAs who loved me. I am being very careful to tell them how much I appreciate them and ask them to teach me things which does break the ice. I am going to just continue being nice about it because complaining will make it much worse I think.

Baubo516, RN · Dec 24, 2013

The only suggestion I have for dealing with lazy coworkers is to lead by example. If you find things unstocked, stock them. If the trash is full, empty it. I am working as a CNA while in nursing school, and I am one of those super-stocker, trash-taker-outer, only stand around and talk if absolutely everything is done kind of workers. But, it seems we are a rare breed. One of my favorite ways to get people to do things is to say, "Hey, so-n-so, let's go do this..." so that I am helping with the task. Then, when another call light goes on, I go answer it and my partner can finish whatever task we started.

Anyway - I think things will get easier for you! Don't let other people's perceived laziness quench your fire! Keep working with dedication and intensity, and you will improve the work environment for everyone. Please don't become one of those people who won't do things that need to be done just because "no one else does it, either."

Esme12, ASN, BSN, RN · Dec 24, 2013

First...the first year is the hardest.

Second NEVER!!! EVER!!! (except in extreme circumstances) take verbal orders in the ED. I'll bet a million dollars there is actually a policy against it but years of bad practice is followed because "they have always done it that way" Stand there with the chart and hand it to the MD and say...considering our last communication ERROR....I need you to put things in print so there are no more miscommunications. Period. They will probably complain but who cares...they will learn that you will not be trifled with.

Lazy staff...it sounds like the PCA staff are hazing you. When they ask...can you? are you busy" say Yes i am. I will usually state..."Can you get so and so in a gown and on the monitor for me please... it would be a big help I need to go and to xzy...thank you so MUCH." and walk away as you expect them to do their jobs. Don't leave the window open for response. They know you are new and are playing a game most of the time.

Yes....especially in the inner city...they are druggies, criminals, homeless and morbidly obese by statistics. Most poor people cannot afford gym memberships and expensive organic food. They are a victim of their environment when the happy meal is less expensive than "healthy food" and mac and cheese is all they can afford. BUt at the end of the day...they are patients that have a need. Emergency departments are the catch basin for all who fall through the cracks.

I have worked at some inner city facilities where the staff is...hummm....rough around the edges. You cannot change the culture but you can change the environment while you are there. Do your thing. Pick up. make it neat for you. Ignore the rest. Get that year in and then decide where to next.

((HUGS))

CodeteamB · Dec 24, 2013

So I'm a new nurse - graduated in June. I had an externship in an ED of a local city hospital over the summer and they hired me for the unit and I started on 12/2. Very exciting - I dreamed of starting my career in a fast paced unit (ED or ICU) and everything seemed to fall into place. It's a city hospital so the pay isn't great but the benefits are pretty good. So far I have never worked so hard for so little and I'm loving it. BUT, I am on week 4 of my orientation and am pretty frustrated with some of the things I see. First of all, the patients. Many of them are drug users, alcoholics, criminals, homeless or morbidly obese. Now I have plenty of compassion for these people, and I don't skimp at all on the care I give them, but they wear on my nerves quite a bit at times since their needs are quite different from other patients. Secondly, the freaking PCAs!! I am so nice to them, but I feel like I'm being hazed by them! I get attitude every time I ask for something! I usually say "excuse me _______, but are you busy? Would you mind...." but recently I've gotten used to sort of blaming my preceptor (which isn't going to work forever) - "excuse me __________, but my preceptor asked me to ask you to put bed 9 in a gown and on a monitor?" I just don't get it... everyone else is so nice to me! Is there something I'm doing wrong? I know I'm not entirely helpful in my description here, but any insight is appreciated! The thing I really have a problem with is the people I work with who just don't take pride in their jobs - lazy people.... cleaning staff not replacing trash bags, nurses grabbing blankets fast while knocking several over onto the floor and just leaving them there.... the specimens all over the dirty utility room which smells like the aforementioned specimens, or things just plain not being stocked! having to run between two carts (with broken drawers) digging through and pocketing (as in to hoard for my own use) IV flushes... seriously, the 12 drawers near the beds I went through to find a BED PAN today!!! really? yes! I'm so frustrated, I have this super OCD vision of just going in one night and cleaning everything, stocking everything, labeling everything, etc. as if that will satisfy some innate urge for order. MUHAHAHAHA!!!! I know it's crazy, so please tell me what the hell is going on. So far I've made two pretty shocking mistakes.... 1) I hung a bolus of 50mL D5W IV for a diabetic patient with super high BP and a BG of 64mg/dL... kind of makes sense, right?... the MD had ordered D5/0.9%NS at 100mL/hr. even though I had specifically repeated his verbal order word for word, he corrected me saying "no no, just D5" so I made the incorrect assumption (meanwhile he said he misunderstood ME originally!). So yes, I owned up to the mistake to my preceptor and she sort of rolled her eyes and laughed at me (I deserved it) - lesson learned, wait for the order for the confirmation you need when the MD has a very thick accent......2) I mixed up two urine specimens from two different patients. I threw both out, reprinted labels and asked the patients for another round, kind of embarrassing, but now I'm getting the hang of what can be multitasked and what deserves your full attention in the ED. The thing that really throws me off is the Charge Nurse who constantly tells me I was more aggressive and faster on my feet when I was an extern over the summer. yeah, man, I didn't have a license back then! I really hope he's just trying to encourage me instead of really worrying about me - I would be mortified if he told the ADN I wasn't cut out for the ED and they sent me to a less acute unit! //endsuperlongrant.[/quote']
Ok, lots of stuff here. It sounds like some of your issues are universal and some may be workplace dependent. Emergency medicine means you are going to see it all, and unsurprisingly the obese, homeless, and substance abusers are more likely to need medical attention. If you just need to have a bit of a vent about this, then join the club, if it is a deal breaker for you, then the ER may not be your home. Nothing wrong with it either way, just a decision you must make.
The PCAs are probably hazing you. This is due to a delicate power differential. They have probably worked there longer than you have and feel like you haven't any business delegating to and directing them. To get this to stop there are a few things you can do.
1: wait it out, eventually people will see you as part of the team and the relationship will normalize a bit
2: be hard working. If you have the time to do a task, do it, don't page the tech just because it is in their scope, it is in yours as well.
3: Be firm. Make it clear that when you do ask for a task that you expect it to be done without attitude. A ask for what you need and go on with what you are doing. Of they questions why they need to do it explain that you are busy and repeat the request. If they say they are too busy, ask them to prioritize the task, and get to it when they are able.
The messy environment and lack of care would be frustrating, it is not like this everywhere. My suggestion is to lead by example. Also, when there was too many specimens hanging out in our dirty utility room an anonymous elf threw them all away and put up a sign saying she would do it again. Made people realize that they really can't "save it in case we need it" and start chucking or sending their samples.
Mistakes happen, if you aren't absolutely of the order double check. I also find it helpful to label urine cups prior to collection to avoid mix ups.
You'll be fine, it gets easier!

ADeks · Dec 25, 2013

Your first year is an extreme growing period! This is when you learn everything they didn't teach you in nursing school. I had a year of experience before I started in an ED. When I came to the ED I felt like a brand new nurse so I can only imagine how overwhelming it can be.

My tip with your PCAs (I'm assuming their ED techs): I know your a new nurse and new to the ED, but if you show them you're willing to do some of the little things that are for techs will go a long way. Sometimes they feel nurses won't do "tech work" and it gets to them. If you can show them you're willing to do some of the same tasks they start to realize that you're not one of "those" nurses and they'll know you're not pawning work off on them.

Also for your rooms. One of my routines when I walk onto my shift is to check my rooms out for what supplies is in there. Then I stock it. Also for some of the more common areas if I notice we are out of something, I go and stock it. It's just one of those things!

zmansc, ASN, RN · Dec 26, 2013

I agree with ADeks comments 100%. The first year is tough. I noticed that many of the more experienced nurses come in early for their shifts just to make sure their rooms will be stocked and get a feel for the ER before they hit the ground running.

Remember, that many of these people have been working here for a while. Many of the techs and RNs have built a relationship, know what each other expects. Sometimes, it just takes time for the techs to realize you are hard working, and are asking them to do certain tasks not because you are lazy, but because your patient needs something and it takes priority over other tasks for your patients. Since they are shared, they might let you know that they have something that takes priority over your patient for another nurse. Of course, sometimes they are being lazy, or playing favorites, or just find the other nurse's tasks 'cooler' that day. All of those situations occur, and part of being an RN is managing the care for the patients, managing the ER techs, the CT tech, phlebotomist, RT, etc. And yes, even managing the provider. It's a balancing act that does get easier as you grow into the job, and as they realize you are one of the team.

As you gain experience, figure out how the feedback channels work, and remember what it was that made it difficult for you when you started. That way, you can make suggestions on how to improve the system for all.

One of the things that was done in my ER, was a couple of the nurses took it upon themselves to reorganize all of the rooms. Now, they are all stocked with a core set of items in the same way, and they are restocked at set times by the techs at a minimum. Of course it's an ER, so all hell breaks loose, stocking doesn't get done, but for the most part, the core items are in the same place and stocked in all rooms. Seems like a little thing, but it's the little things that make or break you!

When I started, my preceptor was someone who had been working in the ER for 10+ years, she was nice, and helpful, and knew the answers to all the questions I could possibly have about any critical issues in care for the patient. However, she had no clue what I was going through with being new and fitting into the ER team. Fortunately, another nurse on the crew had been in my shoes just one year ago. He was great at helping me understand and fit into the crew, what my role was and how to approach my teammates and get done what I needed to get done. It took both sets of experiences to make my transition smooth.

1fastRN · Dec 27, 2013

As a new nurse in a fast-paced ER, I can relate. I've been at my facility almost a year. It DOES get better.

Half the struggle is building those relationships, especially with the patient-care techs. Show them you're a hard worker, treat them with respect, and you'll be fine. You have to be stern at times (but never be snotty!). Ask politely but if you're always just asking you might not get very far. I also try to show my empathy and treat them like a human! I generally don't ask though, I'll say something along the lines of, "I know you're busy, but I need an EKG and vitals in 4A when you get a chance, thank you!" And leave it at that. I've always make a point of saying thank you. I see some nurses talk down to techs/NAs... that's just uncalled for! We are a team!

Some of the techs that used to intimidate me now crack jokes with me. And the ones that are still rude are well, rude... but I'm there for the patient and don't have time to bicker and get sassy with co-workers.

My motto has always been, "kill em with kindness!"

Good luck! Have a thick skin and a good attitude, you'll be fine!