Feeling Dreadfully Slow in the ER

[NotWithoutPB&J]

Ok, first a little history:

I have been a nurse for approx 1 and 1/2 years. I spent the first year on a step down unit called PCU. I always knew that I would end up in the ED, at least when I felt ready. I have worked in the ED in the past. I spent over 2 years as a EMT/Tech (several years ago) and when I was in nursing school I spent 7 months working as a student RN in the ED that I currently work in and absolutely loved it.

I know and understand that the ER is fast paced. I have currently been orienting for the past month and the staff had been wonderful. I try and manage the whole group (4-6 pts depending on the staff and pt load that day) and use my "orientor" only as a back up/resourse person.

I only have 1 more week on orientation and feel that I am having a heck of a time finding a rhythem. I feel that I naturally get behind when a critical pt comes in and then I am playing catch up for hours after the critical pt is stabilized and/or transferred. I never really feel that I am keeping on top of my pt's labs and ordered tests. I am getting the medications and IV's in on time but half the time I feel like I am just a robot DOING what is expected of me but not really understanding WHY.

I am in no way ready to call it quits...I am very stubborn and don't give up easily. I just want some advice or maybe some words of encouragement on how to not be so hard on myself when things don't flow the way I want them to. I feel that I have had some valuable past experience working the ER before but am discouraged that I am not really "getting it". Some other fairly new ER RN's said that it could take up to a year to really feel like you "get it". But I don't know if I have the patience to wait a whole year for this to happen!

Thanks in advance!

[MIA-RN]

I find that too, like you, I am more task-oriented at times. I think that's part of the 'nature of the beast' of the ED. Sometimes you just have to do what there is to do and keep on going. Its normal to get your critical patient stablilzed first, and then deal with the already stable ones. Don't feel like you're behind.

I have found that there are a few things in the ED that are really emergent, and those get tended to first (ABC's etc) but that a lot of the stuff turns out to be urgent but not as emergent. I try to think like that when I prioritize--which is the most urgent, which is the least. I also delegate to the techs a lot. I can't help it some days. Other days, I try to do as much as I can and ask less of them.

Can you pair up with someone? Sometimes it helps to share assignements, You might have twice as many patients but there are two of you to help each other out. Just a thought. It really does get easier!