when will it "click"?

ICURN_NC · Dec 13, 2005

Hey, Shasta-

I work in a MICU where I started as a new grad in July. I had worked in this MICU as an HUC for 2 years before I started as a RN, and before I graduated I spent 8 weeks in the Burn Center doing a 1-1 preceptorship with ICU patients. When I started, I was sure with this experience behind me I would hit the ground running and, altough I was still learning, I felt that I could make a pretty smooth transition.

Well, it's been almost 6 months, and as of 2 nights ago, I still get the feeling that some things aren't "clicking." Now, even while looking @ this, I can say, "Geez, 6 months, come on, you still need time to learn, to organize your shift, etc," but that's certainly not the way it feels when I'm working, and I feel 10 steps behind while my mind is working 10 steps forward, and my notes aren't done, and pt #1 is dropping his pressures and pt #2 is dropping her tidal volumes, and we have a stat scan now, etc. And I feel lucky I have the luxury of only 2 pts max, when you can have so much more in the ER!

Then, there are other nights, (and these are happening more often), when everything does click, and when I leave I know I've done a good job, and I've helped my pts and myself, and I've learned something new to help me with my job next time.

So, at least for me, the "all things coming together" really comes and goes.

But that's what makes it interesting.

Peace, love, and happiness

S

student4ever · Dec 13, 2005

i just finished an 8 hour shift orienting in the er. i just felt like i never got it together today, i could feel my anxiety level rising as things got hectic. i just felt at times like i knew where to start but i couldnt get myself to move fast enough. i just felt discouraged with myself today, is this normal?, will it eventually click for me? . i just want to be able to function well in the er, take good care of my patients. i started working in the er at the beginning of october, during that time I have been in a critical care course for 4 weeks, basic arrythmia for 2 weeks and an ed course for 2 weeks. i have had a total of about 4 weeks hands on in the er. i know i need more orientation time, but i just want to feel more confident...any tips?

Well, I don't know how well I can advise you seeing as I am not a nurse yet, I'm still in school, but I work at a small though very busy ER as a PCT. Are you feeling that things don't "click" because you're not enjoying the kinds of things you're doing, or is it more, will the flow of things ever make sense? If it's the latter, there is hope! ER is a hectic, fast paced environment, and the seasoned ER nurses make it look so easy! Also, in my experience, ER nurses tend to be very no-nonsense, let's get things done and move on, and it's often easy to feel as though they're annoyed when you don't get things right. First thing to keep in mind is that usually, they don't mean anything by their comments/actions etc. They're just so used to being busy, and knowing so many things need done, and they want things done NOW!!! But that doesn't mean that they aren't a great resource or aren't willing to help you understand things! IMHO, you have to be pretty thick skinned and confident to thrive in the ER setting.

On the other hand, if you aren't enjoying the things you're learning to do, and don't enjoy what you see your job becoming, then maybe ER is not for you. Those questions can only be answered by you.

Good luck in your endeavor!!!!

KatieBell · Dec 13, 2005

i just finished an 8 hour shift orienting in the er. i just felt like i never got it together today, i could feel my anxiety level rising as things got hectic. i just felt at times like i knew where to start but i couldnt get myself to move fast enough. i just felt discouraged with myself today, is this normal?, will it eventually click for me? . i just want to be able to function well in the er, take good care of my patients. i started working in the er at the beginning of october, during that time I have been in a critical care course for 4 weeks, basic arrythmia for 2 weeks and an ed course for 2 weeks. i have had a total of about 4 weeks hands on in the er. i know i need more orientation time, but i just want to feel more confident...any tips?

Perfectly Normal. I have now staffed in 5 different Emergency Departments, two small, one medium and 2 bigger than life (75 beds not counting the illegal hallways..) I still get the anxiety feeling when things get serious- like a patient rolled back all grey with a sat of 46%- just makes me on alert. It just takes time. What it really is, is the ability not to let the anxiety get in the way of getting the stuff done,and figuring out what works for you. Unless you are getting a ton of dirty looks from your co-workers, you are doing very very well. Try to read about common treatments for common ailments so you are prepared. If you have your own rooms- you can prepare them with suction/ambu bags (ie make sure the proper stuff is in your rooms)etc and feel more confident etc...Really it just takes time...

ZASHAGALKA, RN · Dec 13, 2005

I am teaching my 16 yr old how to drive. I have to constantly remind him that, with experience, he will learn to be a more confident driver.

When will it click? That is as individual as you are. But nevertheless, it is still a function of time and experience. As long as you are learning every day and every shift, you are on the path to it 'clicking'.

So just hang in there, keep learning and one day, you will realize: hey! it clicks!

~faith,

Timothy.

ckh23, BSN, RN · Dec 14, 2005

It takes time. The more you see and the more experience you get, the more it will make sense. One bit of advice is never stop learning and take advantage of being on orientation. Right now you have the luxury of having a preceptor so if something rolls in that you have never seen or if you want to observe how a code is run you can slip away and get in the room and your preceptor should be able to pick up the slack. Even when your off orientation, if someone comes in with something you have never seen try to get in that room. One of the better parts about working in the ER is that there is always someone there you can ask. Don't feel weird about asking for help, no one expects you to know everything. Goodluck.

Trauma Columnist · Dec 14, 2005

Hi and welcome to the ER. I always tell our new nurses that it takes a year or so to feel completely comfortable in our ER - level one, inner city, very, very busy. So...give yourself a break - ask questions, tell people your needs - no one can do everything all the time!

babynurselsa, RN · Dec 14, 2005

I agree with traumaRus. I think it takes a good solid year to get really comfortable working ER. You kind of need that whole year to get the seasonal cycles of some things. I don't think ANYONE was or would expect you to feel like you knew it all after only 4 weeks actually on the floor.

Hang in there. It will come.