New To ER

Specialties Emergency

Published

Hi all, Ive been a nurse for a year, but I'm brand new to ER. Ive noticed the last couple of shifts, Ive been a little discouraged. I feel like a brand new nurse all over again. I've only done 4 shifts so far, Ive acquainted myself with the flow and where things are, the computer system, extension numbers, etc. I will say Im definately slower than the other nurses. I take more time to double check everything, espcially since so many orders get put in at once. I'm definately not an expert at IVs, so I take more time than others to insert them, especially with the older folks. We have a lot of residents in the ER and they get frustrated when things arent done right away. Today a resident wanted an xray right away and I entered it into the task book for the tech to do it. Thats what my preceptor told me to do. He came to me saying "no, I need it now." I had 2 other patients I needed to triage with my preceptor and start IVs, and draw labs on. I told him what this resident said to me, and my preceptor tells me "tell him to do it himself." I definately didnt tell him that, but eventually the tech did it. I do feel overwhelmed and my question is, is there anyone here who started in ER or moved to ER and felt they were starting from scratch? How did you handle it? Im determined to learn and succeed on this unit and would like advice.

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Specializes in ED, Cardiac-step down, tele, med surg.

ER is tough and it will be like you're new all over again! Just roll with it and you'll catch on. Try to make sure you understand why your preceptor is doing things in a certain order. It's important that you get that down during your orientation so that you develop an efficient flow. Your skills will develop the more you use them. You'll be slower in the beginning which is expected. Never sacrifice speed for safety. Don't take things personally, develop a thick skin. Take everything a resident says with a grain of salt too, because they are learning just like you! Also, learn to speak up for yourself so that people don't walk over you and think they can disrespect you. I have a hard time with that, but it's a skill that's important to develop.

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Specializes in ED, Cardiac-step down, tele, med surg.

I meant, never sacrifice safety for speed, not the other way around.

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Specializes in Emergency medicine.

I just graduated residency last summer, so wanted to add my two cents here. Don't allow yourself to be abused by the residents of course (and for the record I never witnessed this because as a resident, nurses are scary AF), however, also recognize that they are facing intense pressures and they don't want it to fall on their heads when something isn't done right. Attendings will look at them as if everything is their fault, and a single bad evaluation for a shift could have a lasting impact on their career. If you ever think they're being crusty, just take a moment and ask yourself if they are struggling, frustrated, and trying their best, because I swear they most likely don't mean any poor attitude directed at you. ( disclaimer: this does not excuse any bad behavior towards nurses, insults, bad attitude, etc)

You have gotten great advice already. One thing I would add to that, is don't be afraid to ask the residents more. For instance, in the above scenario you described, You could ask the resident why he needs the x-ray so quick. Perhaps he's worried about a large pneumothorax? Don't be afraid to communicate. And don't be afraid to say "hey, I'm new here, will get it done as soon as possible but my preceptor says we have to do this other thing right now. What's your concern? "

The ER is overwhelming for literally everyone. I'm sure you're doing just fine, you will get into the groove of things and won't have to think so hard about it. As I tell all the new residents - just be nice to people, communicate well, do your best.

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You could ask the resident why he needs the x-ray so quick. Perhaps he's worried about a large pneumothorax? Don't be afraid to communicate. And don't be afraid to say "hey, I'm new here, will get it done as soon as possible but my preceptor says we have to do this other thing right now. What's your concern? "

That's exactly right.

OP preceptor's retort and handling of the matter could not have been more unhelpful to the learning process. We shouldn't teach each other how to create fake enemies and then disrespect them. When you act like that you will cultivate disrespect and also perceive it everywhere.

Of course the residents are anxious. Nurses have been sold a load of crap that is still being perpetuated in nursing academia to this very day, that we are The Ones who have patients' best interests at heart or feel a sense of obligation related to proper patient care.

OP, your preceptor was also undoubtedly pressured by Business of Healthcare stuff; specifically, how quickly everything in the ED needs to get done, emergent or not.

I will limit myself to one piece of new-to-ED advice, especially for someone not a new grad: Do not fail to take what you know and use it to prioritize appropriately according to *patient acuity.*

Good luck!

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Specializes in Emergency medicine.
. Nurses have been sold a load of crap that is still being perpetuated in nursing academia to this very day, that we are The Ones who have patients' best interests at heart or feel a sense of obligation related to proper patient care.

OP, your preceptor was also undoubtedly pressured by Business of Healthcare stuff; specifically, how quickly everything in the ED needs to get done, emergent or not

Omg you are so, so right!

I love this forum! It's so amazing to talk to nursing colleagues who really get it!

In residency, I absolutely loved critical care. I spent my days off listening to critical care podcasts, reading more about critical illnesses, etc. When I got a patient that I was worried about, I felt like I burst into action, and maybe I rubbed people the wrong way, plus I'm a female which complicates things, but I literally got a nursing evaluation saying that I seemed "frazzled" when a sick patient was in. In my mind, I was focused, aggressive with medical intervention, passionate, and determined to save lives. Honestly, nurses ( especially those that have been in the ED a long time) are really scary to residents, we don't want to offend you, we don't want to bother you, we know that you're busy. It's just all about communication. I learned through that very difficult experience in residency to tell people why I want this, why I need this, why the patient needs whatever. But it doesn't happen overnight, it's a process.

I don't know a single doctor that would ever think anything negative about a nurse that earnestly asked more questions to understand the reasoning behind a particular order, be it medication, imaging or lab studies, or any other decision, in order to better understand what was happening. I LOVE it when nurses do that. Through those conversations, I've learned much more about why this or that couldn't happen the way I wanted it to. You're teaching them, too.

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I can 100% relate. I was a nurse for over a year and just started down in ER about 3 months ago. I am overwhelmed at times, but at the end of the day I think to myself "What can I do better?" If I am taking too long in a room I might set a timer on my phone to get as much done in there and come back after checking on something else. I am slow at IV starts too. I just try and try again and set personal goals.

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Specializes in ED, Cardiac-step down, tele, med surg.
It's just all about communication. I learned through that very difficult experience in residency to tell people why I want this, why I need this, why the patient needs whatever. But it doesn't happen overnight, it's a process.

I don't know a single doctor that would ever think anything negative about a nurse that earnestly asked more questions to understand the reasoning behind a particular order, be it medication, imaging or lab studies, or any other decision, in order to better understand what was happening.

I totally agree that so much of it is about communication and in most cases this has been my experience. I have asked for clarification in respectful way and in almost all instances have gotten it. There were a few times that I have encountered a really negative person that was hostile, arguementative and rude. These have most often been those "old school" doctors that liked that power differential between them self and the rest of the staff and enjoy humiliating people. There are people like that, nurses too.

One of my nursing colleagues who has been nurse for 35+ years told me that back in the day nurses were supposed to get up and give the doctors their seats. These were also the days when women were discouraged from attending medical school. I think it's an extension of that era, but that is changing. I don't recall any bad interactions from residents though and again, I think that so much of it is about communication.

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Specializes in Mother-Baby Pediatrics.

I loved this string. I am a first year med-surg nurse who wants to try something else eventually. I am planning to shadow in the ED and in L&D this year. I am not enamored with med-surg but I do see how it is developing my skills at assessment and time management. Also learning to communicate with doctors. I would rather do that first in a med surg unit than try to learn all of it in the ed.

I have a question for ED nurses - I am a first year nurse at age 50. Do any of you have experience with new nurses who are older. I worry I wont be fast enough. I am not trying to bag on being older. I am looking for examples of other people my age and level of experience who have done well in the ED.

Thanks

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