did i make the wrong choice

[ncoli123]

I need advice:

I am a newer nurse, graduated in May 2009. I had a wonderful opportunity to be the first emergency room extern at a rural critical access emergency room. During this time I was exposed to so many wonderful experiences and had a wonderful preceptor who taught me very well. My externship went great and I was asked to be their first new graduate hire in the ED.

I was to complete 3 months of med/surg orientation followed by 3 months of orientation in the ED. There were no full time openings so I was going to be per diem. I was given the impression that new FT positions open all the time and I would have plenty of hours until then. I turned down a med/surg job at a larger hospital with an established new graduate nurse orientation program.

A couple weeks before I completed my 3-week orientation on med/surg the hospital come out with the fact that they were having financial difficulties. They laid off two med/surg nurses. I spoke with the nursing director and the ED nursing director and was told that there was a chance I would not have any hours.

I was recommended by the a med/surg supervisor to a FT position in the OR. I got the position and started in the OR instead of the ER. I liked the OR but really was disappointed not to be in the ER. After a year a full time position opened in the ED.

Now, I am in the ED ft nights. I had two days orientation on days before going on to nights. The ED nurse director wanted me to complete the month on orientation and then be on my own. She said that my externship counts as well as the fact that I had come over a hand full of times to help when things were busy in the ED and not in the OR.

I just feel sort of lost. On night shifts there are two nurses, a HUC, and a MD (in house, may be asleep though), there is also a nursing supervisor who is responsible for the entire hospital. Due to some advocating from the other nurses she extended my orientation another month. I am just worried I wont get all the experience I need because and be ready to come off orientation in December.

I told her this and she said that most people don't have the experience of the externship, and assured me that we have wonderful night supervisors. Oh, I left out that my orientation is being continued on nights but I will be working 1 day a week 3-11, in which I will be considered a full nurse.

I feel as though I am a good nurse and fit into the ED environment well but I just have so many concerns.I still feel as though I am a new grad...the OR experience is so specialized that as much as I learned there it doesn't transfer over completely. Any opinions?

[walk6miles]

Working nights has many advantages as well as several disadvantages. Let's take a few and work out the good and the bad. First of all, as a new nurse, you have demonstrated an eagerness to learn and broaden your experience. Nights is uniquely made up of screaming train rides through a long tunnel (too many patients without patience and you are the conductor) and long, leisurely strolls around the perimeter to find something/anything stimulating for your brain ( highs and lows). Getting used to sleeping daytime and working nighttime is a one year (for most) torture. Dating, marriage and childcare are some of the tough sideline problems. At the end of the first year, however, you will begin to notice that you have a great deal of autononomous experience - you'll be doing things you never expected. Go forth and help your coworkers and you will be wanted and appreciated.

The financial worries worry me....may I suggest you sign up and make yourself do some work for a good agency in town...don't go crazy and burn out but I never put all my eggs in one basket (sorry, old saying).....if something happens, you will already have someone working FOR you by keeping you employed and the money isn't bad. Hope this helps a bit. Feel free to ask questions.

[brownbook]

Take a deep breath. It is good that you are concerned. You will check and question what you do, that is good.

Your experiences and orientation sound excellent. No one can be 100% sure and ready for everything that comes through an emergency room door.

"Face the worst, believe the best, do the most and leave the rest."

Patients are going to die. You will question and wonder if could you have done some intervention that would have prevented it. Death visits top notch trauma center's and small rural ER's.

Again you sound like an excellent nurse, your preceptors and supervisor see a lot in you, trust their judgment.

[netglow, ASN, RN]

Also feel good that you are getting more orientation than most new grads these days.

[ncoli123]

Thank you guys so much. I came home so stressed this morning. I feel as though I can read and read and read but I really need the practical hands on. One thing I do notice and forgot to mention is that I feel like most of the nurses started in med/surg or even in a much bigger hospital in Boston or NYC. The director really felt that I could come straight into the ER. Partially due to the fact that I had been an LNA since I was 16 in doctors offices and nursing home. I just want to excel at what I do.

[ncoli123]

walk6miles:

what has been your experience with new nurses in the ER?

[canesdukegirl, BSN, RN]

You know that quote by John Lennon: "Life is what happens to you when you are busy making other plans"? I think you may have just gotten a blessing in disguise. OR nursing is what I do, and it is GREAT! Give it a little while, because there is so much to learn. I think you will love the traumas and the learning that you will get while scrubbed in. It's like a free anatomy lesson.

[walk6miles]

Just saw your question. My experience (trauma level 2) has always been positive. ER nurses are different because the "action" is faster. Many of the new nurses had a good handle on cardiac as well as neuro - trauma is a form of nursing unto itself. I once made an uneducated comment to a fellow "older" nurse that one new nurse seemed more worried about an aspect of the patient's condition and not the atrial fib we noted on the monitor. No sooner had the words been said and there she was with a page of orders - I learned to shut my mouth and be a team player.

I love working with most new RN's -I may get into teaching - I think it would mix well. I must say that no matter where they work, the new RNs are eager to learn (they usually cure "I know it all").

You have a wonderful eagerness that serves you well. Ask any questions; feel free to express yourself.:)

[gonzo1, ASN, RN]

It's good that you realize there is a lot you don't know, but every shift in the ER is a learning experience. After 6 years I am still learning every day. So give yourself a break. Learn as much as you can and take advantage of the fact that you are still considered to be new to the unit so you are expected to not know everything. Good luck and enjoy.

[ncoli123]

what would you guys suggest I read and what should I always have on me? Example...I used to have a little pocket book of OB facts that I kept with me during my OB rotation.

[canesdukegirl, BSN, RN]

Just so I am not confused here...you are doing OR, not ER right?

[ncoli123]

no I originally went into the OR, then went just went to ER after year of OR