what makes you a good ER nurse?

baby_gurl0604 · Jul 23, 2008

I have read all of the thoughtful replies to the question, "What traits does a successful emergency room nurse possess?" and I am trying to look critically at my abilities to see if there is any hope for me. Would you say that initially you had your doubts and/or that you felt you were incompetent? I've been in the ED now for six months and feel that I learn several new things each shift, have an excellent rapport with patients, and am generally making progress . . . . at least I thought I was until my manager told me she thought I was struggling and forgetting things I had been told (though I had never been told these things and confirmed this with other new grads in the ED). She went so far as to suggest that I had made a "near miss" medication error only I pull up my own medications and only give medications that I pull up and only after having them checked by another RN. When I asked for specifics she told me that that was not the point. I am most certainly a far cry from being a truly competent ED nurse but didn't think I was so far off. I am rattled now and seem to be making one mistake after another since her little "pep talk." Any advice?

Don't get rattled. I felt the same way when I first got out of orientation. I was very, very unsure of myself, and looking back at some of the mistakes that I made (I accidentally bolused an entire bottle of propofol over 15 minutes instead of Keppra...yeah I cried and almost quit that day) I realize how far I've come.

It sounds to me like your manager is not being very supportive of you. You have only been there for six months! Of course you are going to struggle and make mistakes. Is there anyone else there you can talk to/confide in?

If you truly love ER nursing, my advice would be to not give up, just take one day at a time, that's all you can do. Look at the mistakes you make and learn from them- unfortunately, they can often be the best teachers in life. Like in my case, after making that med error, I became extremely careful with all medication administration and still am to this day. Remember, you are still really, really new at this, and at this point, no one should expect you to perform in the same way a seasoned ER nurse would. Don't be afraid to ask questions or look stupid, either. To me, the nurse who asks the questions is a lot more trustworthy than the one who thinks they know everything. Being a SAFE nurse should be your #1 priority. So keep looking out for your patients, and know that everything else is going to come with time.

And be good to yourself- when you are off, go out and have fun, do other things to take your mind off of work. Enjoy your new career and know that it really does get better- there is a huge learning curve just within the first year as a new nurse, and in a few months, you won't believe how far you've come!

obliviousRN · Jul 23, 2008

What makes a good ER nurse?

The realization that "some dude" will never be caught because he does not exist.

For example: "I was just sitting there minding my own business when some dude walked up and shot me."

Ok seriously - I like the one that someone said above about a sense of humor and a thick skin. ABSOLUTELY! Could not exist in the ER without it. And unfortunatly you have to very quickly rid yourself of the idea that you can "help" everyone that comes in. Some people you just plain cannot help. Period.

LilgirlRN, ADN, RN · Jul 23, 2008

What makes me a good ER nurse..... ADD!!!!!!!! I have a hard time focusing on one thing for too long, so I go and do what needs to be done at that moment and then off to the next one. Things are not boring in the ER, usually. Always something new to see or some new way to treat things we've seen before!

Now I do triage because I've been a nurse for so long that my body is giving out on me. Out here in my lil triage office what makes me good is that I've seen and heard it all because I've been in the ER for 20 years. I can usually spot fakers and am usually good at handling the flow and assigning patients to the appropriate room.

I believe in working as hard as I can, I do my best everyday. Sometimes a smile or just a pat and "hope you feel better" can really help someone feel better. There are so many nurses now who believe that the most important thing about what we do is the pay check, now I'm not saying I'd do this for free, but there are other rewards besides money in the bank.

mtedards1 · Jul 23, 2008

Thank you very much for your reassuring and supportive words. I had no idea how much it would mean to me to have you and another person that replied show such empathy. Things have deteriorated further with my manager and I am starting to get the distinct impression that people are trying to sabotage me. I have also learned of similiar situations occurring with other new grads in the department and other departments in this organization. As horrible as it will look on my resume, I am sincerely concerned about being blamed for a medication error or worse. I don't feel that I can trust this manager or her assistant managers. I have also been called into the office again for vague reprimands . . . never anything specific. Most recently I was told that I could no longer have more than two patients at a time and that I needed to be "debriefed" at the end of every shift at 7 am. This is not my first career so I have a stable work history on my resume and I am depending on that stability to make up for this first fiasco. Consequently, I turned in my notice yesterday evening/morning after having had an interview at another ER and being offered the job the same afternoon. I was bearing up after my manager's first "session," and was able to convince myself that it wasn't me, but now, after several more sessions, I am terrified that there must be some truth to their concerns and that I have now laid a path to screw up at yet another ER instead of getting the fresh start a new hospital would seem to have been. I used to be a veterinary technician at a busy practice. I was responsible for an average of five to seven surgeries everyday in between fifty appointments, any walk-ins, and all emergencies, not to mention those animals already hospitalized. In over ten years I never made a medication error and I was responsible for filling prescriptions as well as administering medications! Surgeries were completed, appointments seen, emergencies responded to, hospitalized patients received their treatments correctly and on time in the midst of all this. The clinic had three busy doctors and an in-house lab in which I ran most of the bloodwork myself. For over a year I was the only technician, after which the clinic hired another. She and I juggled all this and all I ever received from the doctors and office managers and clients were compliments and gratitude. I worked fifteen hour days, six, usually seven days a week, but I was in my element. I loved the fast pace, the frequent medical advances, unusual cases, the unexpected hit-by-car, not to mention the usual "never routine" stuff. I was given raise after raise, though not enough to raise two children on which is why I ultimately chose nursing, and was promoted to head tech aka "only" tech within three months of my starting and I had no prior veterinary experience. While I am aware that being a nurse is not equivalent to being a vet tech, I am not an idiot, got my BSN and RN from an accelerated program in 14 months, and have three kids. I am not trying to blow my own horn, rather I am trying to convince myself that I can't be as incompetent as I am being told . . . or maybe I am? Surely some skills would translate, like multi-tasking, prioritizing - - maybe not delegating (this is my weakness and I readily admit it). Thank you for listening to me whine. There is no one that I can talk to so I am venting on this website - - I apologize. Thanks for your kindness.

frenchfroggyAPRN, MSN, LPN, RN, APRN · Jul 24, 2008

Assertiveness not aggressiveness. being blunt not mean. The wheels are always turning in my head. I work with the doctors to figure out what is going on. I actually go and review the films with the docs. I assess by eyeballing someone from across the room, and then more detailed later. The biggest thing is a sick personality and a twisted sense of humor. I have yet to meet a ER nurse that couldn't put a drunken sailor to shame.

Amen :bow: :bow: :bow: :bow: :bow: :bow: :bow: :bow: :bow: :bow: :bow: :bow: :bow:

frenchfroggyAPRN, MSN, LPN, RN, APRN · Jul 24, 2008

how to do a quick assessment?Lets say in about 3minutes or less?Im new here.Im a nursing student...

Always remember your ABC's ( airway, breathing, circulation), if their screaming "I can't breath", you know they are breathing. You can hear and see someone in respiratory distress, they have a certain look on their face. Usually the sicker they are the quieter they are. Find out their chief complaint and look at that system closely.

TraumaNurseRN · Jul 24, 2008

thank you very much for your reassuring and supportive words. i had no idea how much it would mean to me to have you and another person that replied show such empathy. things have deteriorated further with my manager and i am starting to get the distinct impression that people are trying to sabotage me. i have also learned of similiar situations occurring with other new grads in the department and other departments in this organization. as horrible as it will look on my resume, i am sincerely concerned about being blamed for a medication error or worse. i don't feel that i can trust this manager or her assistant managers. i have also been called into the office again for vague reprimands . . . never anything specific. most recently i was told that i could no longer have more than two patients at a time and that i needed to be "debriefed" at the end of every shift at 7 am. this is not my first career so i have a stable work history on my resume and i am depending on that stability to make up for this first fiasco. consequently, i turned in my notice yesterday evening/morning after having had an interview at another er and being offered the job the same afternoon. i was bearing up after my manager's first "session," and was able to convince myself that it wasn't me, but now, after several more sessions, i am terrified that there must be some truth to their concerns and that i have now laid a path to screw up at yet another er instead of getting the fresh start a new hospital would seem to have been. i used to be a veterinary technician at a busy practice. i was responsible for an average of five to seven surgeries everyday in between fifty appointments, any walk-ins, and all emergencies, not to mention those animals already hospitalized. in over ten years i never made a medication error and i was responsible for filling prescriptions as well as administering medications! surgeries were completed, appointments seen, emergencies responded to, hospitalized patients received their treatments correctly and on time in the midst of all this. the clinic had three busy doctors and an in-house lab in which i ran most of the bloodwork myself. for over a year i was the only technician, after which the clinic hired another. she and i juggled all this and all i ever received from the doctors and office managers and clients were compliments and gratitude. i worked fifteen hour days, six, usually seven days a week, but i was in my element. i loved the fast pace, the frequent medical advances, unusual cases, the unexpected hit-by-car, not to mention the usual "never routine" stuff. i was given raise after raise, though not enough to raise two children on which is why i ultimately chose nursing, and was promoted to head tech aka "only" tech within three months of my starting and i had no prior veterinary experience. while i am aware that being a nurse is not equivalent to being a vet tech, i am not an idiot, got my bsn and rn from an accelerated program in 14 months, and have three kids. i am not trying to blow my own horn, rather i am trying to convince myself that i can't be as incompetent as i am being told . . . or maybe i am? surely some skills would translate, like multi-tasking, prioritizing - - maybe not delegating (this is my weakness and i readily admit it). thank you for listening to me whine. there is no one that i can talk to so i am venting on this website - - i apologize. thanks for your kindness.

i'm glad you moved on. from the sound of your previous posts your manager had some "issues". goodluck in your new position, it's the other ers loss ya know?

dianabay · Jul 27, 2008

I'm so sorry it came to this, but I think you made the right decision.

Try not to let that negative experience shake your confidence; easier said than done- I know! When I went through a similar experience, the nurse manager had me so rattled that I would not have been able to tie my shoelaces without screwing up!!!

From what you said it sounds like you have all the skills you need to be a good ER nurse (and more). I'm convinced!!!!! Now, you just have to be, yes? And even if you did make mistakes (my gosh we all have!) that does not a bad nurse make!!!

I wish you well; please post back, and let us know how everything is going. I would be happy to lend you support...I'm not sure how to exchange email addresses privately on this site......hmmmm..... sincerely, the offer is there, if you'd like someone to talk to, ok?