Feeling stupid... feel free to give opinions!

Triddin · Jun 5, 2018

You are two days in. Give yourself some time to learn the unit. Of course you don't know what to do. However, in situations such as codes, review what you can do and do that ivs are important. So is charting. Ask people what you can do to help them. Make a list of skills you want to practice and seek out those opportunities. Be kind to yourself and don't imagine that others think you are an idiot. Recognize that you are new, learning a new skill (many infact) and it will take some time to feel familiar with the ward

Don't worry about what people think and focus on your learning.

Triddin · Jun 5, 2018

You are two days in. Give yourself some time to learn the unit. Of course you don't know what to do. However, in situations such as codes, review what you can do and do that ivs are important. So is charting. Ask people what you can do to help them. Make a list of skills you want to practice and seek out those opportunities. Be kind to yourself and don't imagine that others think you are an idiot. Recognize that you are new, learning a new skill (many infact) and it will take some time to feel familiar with the ward

Don't worry about what people think and focus on your learning.

Editorial Team / Moderator · Jun 5, 2018

You are a student. I don't even expect a new grad RN (or a not-ED-experienced RN who is experienced elsewhere) to "get it" and be functional in an ED after two days. We all start in the ED feeling like we have one hand tied behind our backs. Pay attention, keep moving forward, soak up as much info as you can, volunteer for as many hands-on tasks as possible, and you will be miles ahead of many, many new grads when you are done. Good luck!!!

MiladyMalarkey, ASN, BSN · Jun 5, 2018

I'm also finishing my last year in nursing school, May 2019 can't come fast enough.

I'd love the opportunity for an externship like yours but can confidently tell you even if I had that opportunity, I'd feel like the biggest dummy. I think what you're feeling is normal. Nursing school doesn't really prepare us to hit the ground running like we will be doing soon (you're doing now). We have our basic foundation but real life is a bit scarier. It's a kick to our ego, but we are just starting the learning curve. Take heart & learn all you can. Good luck!

Leader25, ASN, BSN, RN · Jun 6, 2018

Whew ,sounds like a rough unit for a new nurse,you can not expect them to teach you everything,they are busy,watch ,observe,make notes,get your nursing procedures book or what ever they use these days and study.Sometimes it is built in to the computer system, like ovid etc.If this is where you want to be,remember you will never be done learning,it is a lifetime commitment.

PiperLambie, MSN, APRN · Jun 7, 2018

I started in the ED via a nurse residency program (with no prior medical experience) after graduation in December, which is not quite the same as a student externship but no so different from my early on days either (aside from the whole "it's my license" thing). I received about 13 weeks of preceptor assigned orientation (residency requirement), where by the end it was expected that I could pretty much handle the four room assignment on my own, with minimal need for the preceptor to intervene. I'd like to share a couple tidbits with you.

First, one of my nurse manager's first statements to me about the ED: "Expect it to take 6 months to a year to start to truly feel comfortable. It takes a while to develop your routine, and to see enough different things that you have some exposure to a wide variety of diseases and treatments. If you leave here after a few years and go to another ED, expect it to take up to six months to feel comfortable in the new environment- even with the experience you already have." You may feel good after the eight weeks, or your head may still be spinning. Either way, if it convinces you that the ED really isn't the dark side, then maybe this is a good fit for you.

Second, while in nursing school, I started one, yes one (1), IV on a human being, and placed a single foley catheter. Within about 30 minutes of my first shift in the ED I had already stuck several people to place IVs (some successfully and others not), and by the end of the day I had done a couple of straight caths- and this is as a full RN. The fact that you have the chance to hone these skills as a student is an amazing opportunity, so take full advantage of it!

Third, whether you want to work in the ED or not, this is a job interview. Even in a town with as much healthcare as mine (Nashville- healthcare capital of the United States), it's amazing how small the nursing community is. These people are the folks you want to be able to ask for letters of recommendation, and that will be asked about you (or maybe even interviewing you if there is a peer interview process) should you apply to this facility. In fact, one of the competing hospitals in my area only hires nurse residents into their ED if they were previously externs in their ED.

Lastly, as has already been advised, soak it all in- a lot will drain right back out, but you'll start to see the routines and rhythms of how things are handled with a STEMI, or a stroke, or a sepsis. Ask questions to clarify things. You might have to jot them down and ask later, but still ask them. If you're curious as to why something a provider is thinking is different from what your textbook might have said, same thing- find a good time and ask. Even as an RN I probably go up to each of the docs I'm sharing patients with at least once a shift and say "well doc, what's your thinking on this one?" if something a little different comes in. They will tell you, because ED providers absolutely 100% rely on their nurses for tons of things. It's something our medical director talks about regularly. Don't be afraid to go after something if someone asks if you want to do it. If you aren't comfortable, make sure that's known- sometimes things can be slowed down enough for it to be a teaching moment, and others you might have to just observe and talk about it after, but next time it should be all you.

ED staff are not quite like anyone else in the hospital. We are (usually) strong, if not Alpha, personalities. With a few exceptions, most ED nurses are not nearly as wordy as I am- especially on this board (what can I say- personality flaw? Yeah maybe it is for them, but we all have at least one). They're not trying to be mean, just efficient. Things are happening, whether it's an ESI level 1 CPR in progress coming off the ambulance, or its an ESI 5 that we are moving out the door as quickly as possible to clean and fill that room. It is close knit- not just the nurses, but the providers as well. The providers are always there, and I have learned just as much from some of the docs as I have from the nurses, but it's not stuffy. We laugh, we joke, we eat a lot of snacks. No, seriously, someone is always bringing us donuts, or candy, or chicken biscuits- it feels excessive some days, not that I don't grab a donut, mind you.

Okay, I know I said 'lastly' two statements ago, but here is the final word: Have Fun! This is a great opportunity that will only help you as you finish school and start your practice. How many of your classmates in August will be able to say that they've watched a full STEMI workup, or stood in CT as a stroke patient's scan comes back with this wild midline shift? Best of luck to you (and don't be too hard on yourself)!

Ruby Vee, BSN · Jun 7, 2018

Background: I'm a BSN student starting my final year (blocks 3 and 4) in August. I will graduate May 2019. I absolutely love nursing and I was given a super great opportunity to be an extern in the ED of a very well known teaching hospital. I work 3 12s for 8 weeks with a dedicated preceptor. I have absolutely no medical experience prior to school.
I started my externship last week and I am completely overwhelmed. I know that the ED is overwhelming in general but I feel discouraged for some reason? The nurses and techs are nice and helpful but I have a feeling they think I'm an idiot. They are shocked when I told them I hadn't done an IV or EKG or indwelling cath on a real person yet. Whenever a stroke code or ambulance comes in, they all jump in to help and I stand there feeling like an idiot. I've only had 2 shifts so far so I'm barely oriented to the unit (where certain supplies are, policies, procedures, names etc) but my preceptor has told me repeatedly "you need to be more assertive. You definitely want to me a good impression here" which made me even MORE nervous! Hah, I'm rambling now but does anyone have any advice/ opinions on how to do this without overstepping?
FYI as externs we are not allowed to pass, hang or push meds in any form but we can do all tech work, assess, document, start IVs, draw blood etc. In my first 2 days, my preceptor has had me start 10+ IVs, caths, EKGs etc already.
thanks a million!

The nurses and techs are nice and helpful. You have NO idea what they're thinking, so why would you conclude that they think you're an idiot? Concentrate on them being nice and helpful. Two days in, you're not going to know much of anything -- but you're there to learn, right?

As for your preceptor -- it's been my experience that students and externs are assigned to the not-quite completely competent but highly confident newer nurse who they're trying to develop. That means that you don't have an experienced preceptor or even an experienced nurse precepting you . . . generally, they're about a year in. I'm sorry -- everyone wants a great preceptor. Great preceptors are made, not born. You may be the person she's learning on.

Your success (or lack of it) reflects on your preceptor, so they're anxious to do a good job. They may not have an idea of what a good preceptor looks like, so they're either trying to remember how their favorite preceptor did it -- or trying NOT to repeat what their least favorite preceptor did. Although it's easier said than done, try not to let the preceptor make you nervous. No doubt she's doing the best she can. Do your best to extract the nuggets of information out of her messages and try to discount the delivery.

As an experienced preceptor, we don't expect newly licensed nurses to know anything, so we certainly don't expect an extern to know anything! We're trying to expose you to as much as we can while getting your help with tech work, blood draws, etc. Sometimes the assignments don't allow much time for teaching, but we try our best. At only two days in, you're not going to feel comfortable. Give it some time!

taylormade26, BSN · Jun 8, 2018

Thank you guys so much for your insight and opinions! I have had a couple more shifts and I am definitely feeling more confident with the basics. I guess my anxiety is normal for any newbie, and I'm just glad to have the opportunity and didn't want to screw it up. Thanks again y'all!!

she244 · Jun 8, 2018

Relax and learn, learn and keep learning. You will come out amazed at all you can do and handle once you feel confident in your skills and abilities. I graduated and started at a large teaching hospital. Unfortunately, I worked 3 shift and usually the people who were admitted to my floor already had IV's and unless I happened to be working when they needed changing I did not get to do it. While in Nursing School, I got to start 1 IV and put 1 Foley catheter in. It was not until I went to the ER that I gained IV skills as well as many more. I loved the learning aspect of what is offered in the ER, but knew when it was time to leave also. I am now a College Health Nurse and those skills I acquired in the ER have helped me so much. I am the only nurse in my area, so I perform a lot of duties for my patients at the request of my providers. IV's, picc line infusions, administer medications, apply splints and cast, pulmonary function testing. 95% of those skills came from working in the ER. Good luck and Best Wishes on this adventure you are on starting your Nursing career.