Feel like quitting

It took me over 6 months to get comfortable in a Level 1. That was with 4 years of ICU experience. ER is a completely different animal. Especially a level 1. I would give it more time. No one expects you to be fast when you start. They just want you to be safe. Since you're still new overall, I would give yourself a chance, try to get knowlege anywhere you can, ask questions (if you have time) read on your own outside of work. :) Good luck to you!

There's probably a huge difference between pt volume also.

I jumped from 3 years in level-none and 1 year in level-4 into an urban level-1... probably took me a year to feel fairly comfortable and, as I close out my second year, feeling very comfortable... not that I've seen it all by any means but I've seen enough variations on the themes to know what to do and -- importantly -- I know *where* things are, *who* people are, and *how* the systems work at this facility.

It can be overwhelming and it will eat you alive if you let it. If nothing else, go back to basics... ABCs, spinal precautions, big-bore lines for traumas, O neg in a pinch... that'll get you through an awful lot.

it was a bit overwhelming ... until I realized I had ... far more resources!

In my level 1, we get it all... but we have the resources... three GSWs simultanously? three sets of trauma docs/nurses standing there waiting

RT? One dedicated FT to our department... several in the hospital...

Pharmacist? One in the department most of the time... and if I need one, anytime...

Attending physicians? Somewhere between 3 and 6 in the department all the time... unless I need other attendings, then... there they are.

Nurses? Pull 'em from neurosurg, burn, cardiothoracic... whatever is critically needed.

MRI? Three of them...

CT? Two in a pinch, four if needed...

Ultrasound? Bedside or not?

Echo? How fast?

The point is, in the big departments, you have abundant resources...

In the little rural hospitals... limited resources... even when the badness hits... and it does...

I started out in a very busy Level 2, and it took probably about a year to feel a semblance of "comfortable". The reason I use quotes here is that comfort in nursing is a relative thing. Changing jobs can be really difficult. Not only are you learning where things are and how things flow, but you're also navigating new relationships with co-workers.

I stuck with my first ER job for 2.5 years, but I knew I didn't like the atmosphere where I worked within six months of taking the job. There were too many personalities and cliques, and too many mean, nasty, and ugly patients. I really didn't like the kind of person I was becoming- hard, jaded, cold, and antisocial. I hated people and resented many of the patients just for being there.

I really like my smaller, lower acuity ER because there aren't as many social relationships to navigate, and since it's a community hospital and not a big regional trauma center, the patient population tends to be local community members who are respectful, polite, and appreciative. I feel like I can actually connect with the patients on a more personal level and even though I do deal with some jerks sometimes, for the most part I really like the people that come in for help, and I don't find myself feeling so callous anymore.

Thanks, guys. I really needed to read all this and know that I wasn't being "wimpy" or overly dramatic. You all kind of legitimized my feelings of insecurity.

You're absolutely right about all the resources. I would drown without them. I've asked if they could extend my orientation a little bit longer and they were really supportive and understanding about it. I'm gonna keep plugging along. At the very least, I'll get some good experience here and maybe have the confidence to know if I can manage this job, I could probably go anywhere in nursing (except pediatric trauma that takes something I don't got!) :)

I've asked if they could extend my orientation a little bit longer and they were really supportive and understanding about it.

That said, neither in my first rural ED gig nor in my present life in the urban trauma center, did I feel ready at the end of orientation.

At some point, you just gotta go for it without the training-wheels of the preceptor being close by. It's intimidating as hades but that's the next step.

As goes the common refrain, "Fake it 'til you make it."

I felt comfortable immediately. I worked in my ER as a tech and knew who to go to. I also know that when **** hits the fan, you usually have people there when you're new. Now that I'm more experienced, I'm definitely left alone much more often, even when I don't want to be! But still after 3 years, I like having nurses around who know cardiac drips and who will be there for critical patients.

THIS!!! Biggest frustration of my ED experience - limited resources!

I'm a new nurse and have been in the ED for a little over 6 months now. I'm pretty comfortable for the most part and we're a super busy inner city trauma level 2 and we're ALWAYS short staffed (typical RN to pt ratio is 1:12)... but I feel like I'm JUST starting to get a little comfortable. In the beginning, I was constantly stressed out. I suffered hair loss, insomnia and when I could sleep, I had nightmares about work. Even though I don't love my ED and would love to transfer to another facility, I will say it's gotten a lot better for me.

After a while you learn to leave the stress at work and wash your hands clean after giving report to the next shift. Remind yourself that it's a job like anything else and just do the best you can while protecting your license. The work NEVER ends... you will never get to the point where you have completed all your work and are surfing the web at the nursing station... that's just not the nature of the ED. You being a little slower but a lot safer is definitely an asset, believe me. It takes all types of nurses to help an ED function, not just adrenalin junkies. I work with plenty of nurses who prefer Fast Track or our observation unit all for different reasons, just like I prefer trauma.

hang in there, it gets better :)

Type1Nurse wrote: "...level 2 and we're ALWAYS short staffed (typical RN to pt ratio is 1:12)..."

1:12??? I really have no idea how you folks do it. I was working in a financially-strapped, busy level 2 and could only hang in there for 6 months before I realized if I don't get out of there, I was going to kill a patient or more likely, myself. I went back to working as a paramedic with my busy 9-1-1 EMS and really could not be happier... I may have three patients at once in the rig, but usually only one needs more than basic level interventions. If anyone is receiving Cardizem, CPAP, or needs to be intubated, I will have only that one patient, lol!

While I don't regret acquiring the massive amount of nursing education and still feel proud about passing both the NCLEX-RN and CEN the first time around, I do feel like a failure as an ED RN. Our ratio was 1:4; not sure if having the AMI, acute CVA, renal, and ventilator-dependent pneumonia patients all at once was the breaking point or not. Many techs were laid off, radiology was a skeleton crew, and a new computer EMR system in place seemed to generate more headaches than cures. Am I scared of returning to nursing? You bet.

I am in no way trying to hijack the original poster's thread, but wanted to say I know how you feel and I also really appreciate reading the replies from others. Is the emergency department supposed to be a place where you test a 12 hour+ bladder, are running so ragged that you may get three quick sips of water in during an entire shift, and develop an interesting set of varicose veins to show off to friends and family? "Time management is the key"... been drummed into my head and was well understood. Too bad the nurse call buttons, pharmacy delays, and admitting docs never heard of that key.

I really have a whole new degree of respect and admiration for emergency department nurses! Those are not easy shoes to fill!