First week on my own in ED.... and frustrated

nurse_clown · Aug 23, 2006

[color=dimgray]i think you should let your nurse manager know of your concerns. the fact that they dumped you there and leave you on your own means they recognize your skills. it doesn't mean you are experienced. that comes with time. very few nurses can handle being dumped on. and you shouldn't be dumped on. if you feel like you are taken advantage of, you probably are.

i'm not an er nurse but in our department, there's a huge problem going on down there. the staff turnover rate is very very high. within the last six months, 75 rn's quit. one committed suicide. it's difficult to talk to them down there because they are so stressed out they bite our heads off. i feel very sorry for er nurses because they are truly frontline nurses. they are also human.

i am asking you to take my post seriously and go to your boss and "write it out in crayon." if they use the excuse that there aren't enough nurses then ask for more. you can't be expected to be dumped on just because you have the skills. you have to take care of yourself. please.

i know this sounds very dramatic but the er isn't fun. there doesn't seem to be any time down there for fun.

teeituptom, BSN, RN · Aug 23, 2006

Unlike the nurse clown, I find ER not only challenging but also fun and Ive done ot for almost 2 decades now.Yes ER is tough but its the only way to go.

Now for you, New ED RN, You consistently use 2 phrases, "Dumped On"

" I'm the new guy".. You said your orientation was in the more acute area, Maybe they think you need to get your legs under you in another area. ER isnt always acute care, there is a lot of chronic and minor care issues. While those cases may not seem acute to you, they are to the patient. I work everything from Trauma cases to MI's to N/V/D to minor care and even triage.

give it time and talk to your boss. Learn to consider everything as an educational opportunity.

Medic/Nurse, BSN, RN · Aug 23, 2006

I feel your pain.

I have been at facilities and had the same "sh**" block assignment for 9 days in a row. On the 10th, I'd finally just had enough. In the meantime, some always get the primo "float", "back hall" etc....you get the idea.

But, I had the not critically ill, but acutely on chronic ill for the most part. Needed extensive LOS and lots of "attention" in the ED (and about half needed admission).

I'd look around on my 4-5 patients AND OTHER BLOCKS were having 1,2 or 3 patients and the float nurse filing her nails commenting "I am so bored. I mean how many times can you really check your e-mail and unsigned charts?" I helped relieve her boredom.

One AM in this section, I got a nasty GI bleed (not too many volunteers for poo duty), a elderly AMS, an elderly Pysch (that was in despair, almost needed 1:1) and then a possible stroke that was quite old and mean. My "other" co-workers had in 1 block, a 22yo M "that had a little too much alcohol and felt queasy" & a simple laceration. In the CC block with the newest nurse she had the 26yo "Chest Pain". Sure! EMS rang in and had yet another AMS in a 90 year old, I told the charge that "when everyone else got their confused ratio of patients that equal mine, I'd be glad to take my turn, again."

I then discussed the matter of assignments with the manager. Things did change. I think the fact that she now knew there were "bored" nurses helped a bit.

Talk to the manager. People treat you the way you allow them to. I believe that a sense of treating people fairly contributes to employee retention. Unfair practices erode morale and will send even the best nurses packing!

Good Luck!

JMBM · Aug 23, 2006

I agree with Tom. Whether its the trauma room, the critical area or the urgent care clinic, the ER is the spot for me. One of the reasons is that it forces you to be a jack-of-all-trades. Its not an unusual shift to have an MI, a neutropenic patient, a detoxing drunk, a kid with a sore throat and a baby with diarrhea - all at the same time. What's not to like? That all being said, there are some assignments that are better than others. As to your assignments, there are really only two possibilities - your charge is giving you your particular assignments for a reason or not. Either way, you need to go talk to your charge. If the assignments were not on purpose, your charge will likely be happy to switch things around. If the assignments were purposeful, you need to know what the purpose is. Do you need more experience in this area? Do all newbies get it? It might be a good reason or a bad one. Who knows? The only thing for sure is that if you just stay quiet and stew about it, it'll only get worse.

Jennifer, RN · Aug 25, 2006

I am still fairly new in my ed. I have worked there full time for 1 year. I never complain about my pts unless I am totally overwhelmed. I know that the new deck that I am dealt could be worse than what I am currently taking care of at any particular time. I am thankful for the less acute pts that I am taking care of because, if I have no really sick people, I have time to give excellent care to the less sick people. If I do have a critical or trauma come in, then at least I know that, for the most part, my pts are less acute and less likely to crash (though anything can happen in an ED). As soon as I complain that my pt's aren't critical enough, the charge nurse will give me an acute MI, overdose, acute SOB, and AMS, all received within 30 min of each other (actual assignment given to me), not to mention my 2 other "minor" pts I also had at the time. Don't worry, if you prove yourself to be a good, strong, independent nurse in the ED, you will get more "emergent" pts than you actually have time to take care of.

And breaks are a luxery where I work. Thank goodness for snack machines in the break room.

CritterLover, BSN, RN · Aug 25, 2006

i, too, came to the ed from a critical care background. it can be very difficult to move from a two-patient-critical mindset to a 10-patient-minor-care mindset.

that being said, i have found that the fast-track/minor care patients can be the most challenging to me. it is the assignment most nurses love. to me, it can be the hardest. why? it is all about charting quickly, and getting them back and then out of the ed. most need no actual nursing intervention. they usually need a splint, maybe, or possibly an abx shot, tetorifice shot. many days, it seems like an assembly line. especially since it is the techs in the er that do the splinting (i know i can't do it :chuckle )

when i work there, it is usually only for a 4 hour shift, so i don't even worry about the break issue. i don't need a break for 4 hours. and i spend most of my time typing up d/c instriuctions and work excuses. but, my question would be this: if the patients are non-urgent, why can't you take a break? so what if they wait an extra few minutes for their discharge? as others have posted on this site: a discharged patient is the least critical patient. i'll get to it when i get there. you wait or you go home. i'm hoping you stay to get your d/c instructions, but if you don't, oh well. i refuse to obsess about it. (i obsess about enough as it is).

as to why you are being assigned to that area, it is probably considered to be one of the "easier" areas in your ed. in my ed, the newer nurses get what is preceived to be the "easier" assignment, regardess of what that nurse finds easy/hard. there is a certain assignment in my ed that i absoutely despise, even though it is considered to be "easy." many nurses that i work with love it, even though i hate it. my solution? they are happy to switch with me when i ask. if that doesnt' work for you, you are just going to have to talk to the charge nurse about your needs. it is also possible that they see your great critical care skills, and want to see how you handle the dailly crap that comes in (otherwise known as stuff that should be seen in the md office, but isn't for a variety of reasons, including the mds that say "we don't lace boils in the office, go to the er").

anyway, keep on going. the beauty of the er is that there is a wide variety of stuff that walks through the doors. everything from the gunshot wound to the acute mi to the n/v/d x 30 min.....you have to be able to treat it all.....and be diplomatic of it all. even when i see track marks.....i still smile, put on my gloves, start that iv, and give the diludid......very slow ivp. because that is what my patient deserves.

edited to add: i just don't get the moaning/groaning i see about assignments in the ed. sure, i complained about it when i was in icu, 'cause we'd be stuck with the pita patient for 12 hours (or sometimes, for the whole weekend, in the spirit of "continuity of care"). but in the ed, most rooms are going to turn over at least 3 times in a 12 hour shift. why complain? (unless, of course, you were assigned to the pid room. my ed doesn't have a specific "pelvic exam" room, but if it did, i think i'd get irriated if i got it often:chuckle) otherwise, take it all in stride. the key,though (i swear) is finding out what your collegues like/hate. you'd be surprised at what kind of deals you can make!)

babynurselsa, RN · Aug 25, 2006

Another thing to think about is that you stated you were only on day 4. Remember that while you were on orientation you had a preceptor and were intentionally given teh more critical assignments. Now it is time for you to start to build your knowledge base on your own. Also remember that while you were on orientation and got assigned the more critical patients your coworkers were working this hall.

Just something to think about.

LeahJet, ASN, RN · Aug 25, 2006

The ER I work in sounds simular. They usually end up putting the new grads and the PRN people in the high turnover, less acuity areas. To me, a 10 year ER veteran, that will burn you out quicker than anything. You just continually get slammed and it seems to never end. As a general rule, the "clinic" patients are the most impatient and demanding.

My advice would be to diplomatically but firmly let your grievances be known. Take the chain of command. Do not discuss (bellyache) this with other co-workers. Do not take it directly to your manager.

Over the years, I have just come to work and have not trotted off to the manager every time someone looked at me wrong. They respect this and will more than likely do what they can to please you when or if you ever have to go to them.

mysticalwaters1 · Aug 25, 2006

I know comming from med surg it was a challenge getting used to minor care with such a high turnover, orthopedics, even just common lacs was totally new and then the subacute abd pain/n/v I was more used to but mixed with pelvic cases the entire setup was new. I was kept in minor care section for a good 2 months then another 2 in subacute and our policy was to start those areas as your foundation and get you really good at that. Now you have the critical care skills but is it possible as others stated they were just trying to get you used to that area? Maybe at least ask the charge nurse or manager if that was being done and if something else can be done.

added: actually as Leah Jet mentioned ask the charge nurse politely first why you were scheduled like that and try to work something out. Then if they give you a hard time I'd go to the manager.

NewEDRN · Aug 25, 2006

Thanks for all the replies everyone. Last night, i finally got a different assignment, thank god, though i still had 5 or 6 pts at a time, the turnover was not as bad, and for the first time in weeks, i actually got a lunch. And just to clarify a little, i did mention to one charge nurse tonight how relieved i was to get something different, and luckily she already knew how many days i was in the other area and how busy i was. We had a staff meeting yesturday, and many collegues brought up the suggestion of limitting nurses time to 4 to 8 hrs on that assignment. It's not that the pts are less critical in that area, it is generally an 8 bed assignment, 2 "surg" beds, almost always full work ups, 2 gyn beds, always full work ups with foley and fills, plus have to be in the room with doc for all procedures, do fetal heart tones, etc, 2 ent beds, usually children with full work ups, and 2 hall pts, usually the only ones without full work ups. The problem is, when you have so many pts, all of who need line, labs, procedures, etc, even when they're not overly acute, they're busy as hell, and its' easy to come out of one room and find 3 pts waiting who all need full work up's too, ugg, just thinking about it gets me overwhelmed. I do really like acute care, mostly because i'm so used to it, but love fastrack too, love to get pts in and out in 15 to 20 mins, don['t care how many of them there are. Anyway, still loving being there so far, and am learning a lot, just hope the assignments find some kind of balance.

Bindy, BSN, RN · Aug 27, 2006

Boy, I agree with all the replies here. I have a heavy Cardiac background and have been only working ED for a year and a half. I learned that you either sink or swim. Yes, it is absolutely possible that you are being dumped on but you have to give it more time before you decide, not four days. ED is all about stamina and the ability to assess quickly, then prioritize. It's a lot different then the unit, and it's a lot simular. Give it time, give yourself time and give your team a clear picture that you are able to handle a load. In a few weeks if you see that you continually get dumped on then quietly go to your supervisor and ask to sit down and talk. Hang in there!:penguin: Bindy