Feeling like a failure in ER nursing

[ERnurseH]

For the past 2 years I worked at a very slow post-op unit. I recently was hired in a busy pediatric ER in May 2018. I am nearing the end of my 3 month ER orientation. I just feel stupid, anxious and depressed. I really love the work, but I just have a feeling that some of the nurses don't like me. I was working with a preceptor where I feel as though our learning/teaching styles just don't match up. There are a lot of Type A personalities in the ER, while I am pretty laid back and open to other's opinions of doing things. For example, early in my orientation, I would be taught how to do a skill by a preceptor, to then be scolded by a different preceptor down the road for doing it the other preceptor's way. Its just a lot to handle when I am trying to learn.

I think maybe Im just overthinking and getting inside my head.

What can I do to overcome these feelings? I feel confident with the patients with a lower acuity, but the critical patients leave me feeling like a failure. I get hard on myself when I make a mistake, even a really small one.

Thanks for the help,

NurseH

[PeakRN]

I've worked in EDs that have great and less than ideal cultures.

If a task is being performed safely and effectively then there isn't a need to scold someone for different techniques. I'm always learning a new trick for various tasks, in fact I recently learned a great trick about NG placement from one of our new adult ED Docs that I'd never seen before despite working in the ED/EMS for over a decade and has substantially quickened my NG placement and made it more tolerable for patients. That being said I've also been less than thrilled with new hires in the Peds ED who touch a site after cleaning it, and I know which of our other nurses told them them that it is okay. I would say that most of our skills will have many different techniques that can be safe and effective and not everybody needs to do it the same way.

I think that starting in a Peds ED can be one of the most difficult environments. Not only do you get the unique flow of the ED but also the very protective nature of pediatric critical care nurses (and pediatric nurses in general).

[ERnurseH]

Hi! Thanks for your response!

I ended up just making a stupid mistake while working recently.

I was going to draw labs off an IV line and thought I could empty saline syringes to use the syringe to draw up the labs.

For some reason my mind never made the connection that there could be trace amounts of saline in the syringe that could alter the labs.

One of the nurses who is orienting me said she was concerned about this.

I feel bad about it. But at least someone stepped in before it happened.

i don't know how to respond to my preceptor in this situation. I just feel stupid.

[amzyRN]

Try not to take anything personally, let it roll off your back. It takes practice. Next time with your lab draw off an existing line just waste into a tube or syringe first to minimize contamination with saline. A stupid mistake would be if you put a patient at risk, like not notifying the doctor because you were nervous or giving a med you were unfamiliar with or not asking a question because you were worried you'd look stupid. Everyone started where you were now and there will be small mistakes along the way which is expected. As long as you're not putting your ego before patient safety, you are doing just fine. It takes a while to get proficient.

I have almost 2 years and still feel like a novice at times, so much to learn, so many skills unrefined...I would not assume people don't like you and would try not to care too much about this. I would use this experience as a stepping stone if you don't like the environment or the people try to get at least a year or 2 then get out of there. Don't let people think you are weak either because they may walk all over you. Be humble while setting boundaries. Show you are a team player by helping other people out if they are swamped, thank people for showing you things and be respectful of patients and coworkers. Showing respect does not mean allowing people to walk all over you.

[guest769224]

in fact I recently learned a great trick about NG placement from one of our new adult ED Docs that I'd never seen before despite working in the ED/EMS for over a decade and has substantially quickened my NG placement and made it more tolerable for patients.

Sorry to hijack the thread OP, but I am curious what this new NG placement trick is! Willing to share? I'd love to learn a more effective and quick way.

[Lunah, MSN, RN]

A stupid mistake would be if you put a patient at risk

Drawing a specimen incorrectly absolutely can put a patient at risk, whether it is diluted or contaminated with leftover saline or whatever. What if treatment is initiated based on those results? That is a huge patient safety issue.

[PeakRN]

This is specifically for the plastic salem sumps but rather than warming up the tube in hot water you just stretch it out. This makes removes the curves from the packaging and makes it more pliable without making it slippery.