How long before I feel comfortable?

[sharkbacon]

So, a little background here, just so you know where I'm coming from-- I became an LPN in 2012, worked for awhile in LTC, went back to school and became an RN in 2017, worked for just under 1 year on med-surg (with occasional cross training to ED) then was offered my dream job in ED in the rural hospital near my home, which I accepted without hesitation.

So I've been in ED less than a year, maybe 6 months or so. I'm comfortable with the smaller things-- sore throats, rashes, even the chest pains and abdominal pains-- but when something critical rolls in, I just feel so lost. Even if I know what to do, and I act on that, theres always this nagging in the back of my head saying "oh, I should have done this, I should have seen that coming, etc."

A quick example-- just this morning, I was alone with a patient in the ED (which is not unusual, it's a small hospital and the ED operates with one RN, the RN supervisor-who has duties on med-surg also, and the provider), a waiting lab results, when he went into a tonic clonic seizure. I immediately ran to the room, hit my staff emergency button, and got him positioned on his side because there was quite a bit of foamy sputum coming from his mouth. The other nurses arrived very quickly, one grabbed a non-rebreather and one got an IV started, and another basically took charge.

I'm not saying what I did was wrong, but I just felt like I should have done more. I should have had the non-rebreather. I should be able to take charge on my own patient. I'm embarrassed that the whole experience left me shaking, and it honestly went fairly well.

I'm just not that comfortable with any of it yet. When is this going to get easier? I wish I could just read a book and feel okay about everything. Anyone have any tips for this newbie?

[JKL33]

My best tip for someone really anxious about emergencies is to slow down, and narrow down. Some of the anxiety appears to be perpetuated/made worse by letting the mind reel in a frenzied state without focus. So start training yourself to focus and be quickly methodical. Commit a narrowed-scope of information to memory for those times where an instant reaction is required. So - ABCs. Know them, and know them well. For the time being, if the only things you can remember are "call for help" and "ABCs" you will be able to act in the patient's best interest.

It'll be okay!

[amzyRN]

You're new and won't know everything so it's the perfect opportunity to grow. I would try not to get bogged down in what you did wrong. In your scenario, you called for help and protected his airway by turning him on his side. That was the correct thing to do since everyone knew their part and jumped in to help the patient. I suppose you could have called for help, put him on his side, suction if needed apply a non-rebreather, then the IV. But you had help so didn't need to do all those steps by yourself.

[Rebelution]

At least a year, and then some. I don't mean that in a negative way.

[Heylove, BSN, RN, EMT-B]

In my previous career, I answered 911 phone calls. I wondered the same thing during my first few months of training..."when will I feel comfortable?" A coworker told me it would take about one year before I could answer calls without that initial "oh my god, please don't be something I can't handle" feeling. She was right.

So, I haven't worked ED, but I'm interviewing next Wednesday! I would say just approach each patient and situation with a new slate. Learn from your mistakes, and don't let past mistakes bring you down.

[amzyRN]

I think it takes about 2 years with experience in resus/trauma rooms to be "comfortable". By comfortable, I mean confident in abilities and knowledge base to handle most emergencies or that you could quickly locate a person who could help. But there will always be something that a person might not be comfortable with, like a pediatric code or something in an ER that primarily treats adult populations. If I had to jump in and place an IO on a pediatric patient in a code I would feel uncomfortable and ask for help. In fact, that would make me very uncomfortable so would doing any task in a pediatric code.

I have nearly 2 years experience and there are things that I am still not comfortable with, that I know I am still learning. Unstable critically ill patients are still very challenging for me and this is an area I am still developing and I ask for help and ask questions when I don't understand or am unfamiliar with something. I encourage you to ask for help and ask questions about things you are uncertain of.