What is wrong with me??

[fancee free]

I graduated from nursing about 7 years ago and went into management in LTC and worked there for about 5 years. I just started a new job in Emergency, and am being orientated in Observation. From the get go, I was very honest about my background about the fact that I have little to no experience in nursing skills. Plus I never worked in a acute care setting. I was told that this was not a problem as they would orientate me to these skills.

My orientation feels like a horrible nightmare, and at this point I don't know if I have gone crazy or am needy or what, I am at a total loss.

• I am buddied up with someone different almost everyday of orientation, which is stressful in itself.
  
• I constatly receive contracdicting information, for example some nurses say we need a MD order for lab work, other say we do not.
  
• I have two people telling me to do two different things immediatly because each thing is a priority (one being my buddy, the other the CRN).
  
• I feel like I am running around in circles like a circus freak doing nothing productive and forced into doing one thing when I am in the middle of doing something else.
  
• I am always being told that I missed something (like a MD order, consult etc, etc), however I am not sure how to avoid this. I am so frazzled that I don't even think of asking how this can be avoided and I don't remember anyone telling me how to avoid missing this information.
  
• My buddy will do some of the paper work and patient care without telling me and then expect me do to other paper work, it all seems very random. For example, I have the MD returning my buddies telephone call about my patient, but I cannot figure out why she called the MD in the first place (of course, I am the one answering the call and my buddy is no where to be found and nothing is charted), yet I am blamed for screwing up because I missed faxing a consult. Is this normal?
  
• I want to cry in the middle of the shift.
  
• At the end of the day I feel more stupid and incompetent.
  
• I asked for constructive critizism and was told that I am slow, disorganized and a safety concern. Is this constructive or just critizism?
  
• Am I wrong for asking what some tests are, what some diagnosis mean, or how to provide some simple nursing skills such as giving a bolus of normal saline?
  
• What is the role of the buddy nurse, and should she (or he) posses a level of understanding?
  
• What is a supportive environment, and does it include giving any encourgment?
  
• I feel like everyone has given up on me.
  
• I do not want to ever to return to that place, but I need the money.
  
• Am I being too sensitive?

I use to be confident as a nurse and felt that I had enough "soft" skills to survive, such as assessments and communication skills. I always thought I was a smart nurse and a quick learner. However, any confidence I had went down the toilet very quickly. I am pretty sure I suffered from false confidence and now reality has set in and I am actually an idiot nurse. I no longer know what is normal or not because I am so dazed. Please help.

[Tweety, BSN, RN]

Hang in there.

First of all, there isn't anything wrong with you. It does sound like this might not be the environment for you. I echo the thought of maybe finding a floor where there's a better preceptorship with more consistency. Your concerns are valid and should be brought up when you ask for a more supportive place.

[deeDawntee, RN]

Phew....sounds brutal...but typical. Orientation is commonly like that. They are as disjointed and contradictory as the environment itself. I would definitely sit down with your manager and describe exactly what you have said here. (It won't be much of a surprise, I would bet.) It sounds like every orientation I have had in the hospital setting. You have to be able to roll with the punches, and get what you can from each person. Everybody has their OWN practice and their own way of explaining things. I would try to keep a quick list of things that you need to go over or "debrief" at the end of each shift. Don't try to keep stuff 'in your head' because you will forget, be sure to have a pad of paper in your pocket and jot down a quick note to remind yourself. Ask your manager for time to do this with her or your preceptor.

It will get better and things will start to make sense. The truth is that orientations really suck because of all the reasons you describe. I think an ED is the worst place to get an organized orientation. If this is where you want to work, I KNOW you can do it. Be a strong self-advocate and ask for what you need. It is likely that no one else will do that for you. The truth is that people do want to see you succeed, but leave most of that up to you.

In some ways, you are like a new grad, but in most ways, you are not. You have already proven yourself. Those "nursing skills" that seem so illusive are not that hard, just ask people and don't be ashamed for it! Doing a fluid flush and most other skills are very easy and you can learn them fast. To think you need to start in med surg is not needed, IMHO.

It will all start making sense. Speak up for yourself. If somebody tells you to go do something, but you want to do something else for your education, tell them, "No, I really need to see this, or do this." They will try to use you to get their work done, rather than looking at what you need. Stand up for yourself. They will respect you for it in the long run. Social skills are very different in a fast paced place like the ED. You need to be assertive, even aggressive at times, that is part of the expectation, I would say. Take those "soft skills" and turn them into "hard skills". Be tough!! You can do it.

:yeah:

[wonderbee, BSN, RN]

There's no way to learn when you're this frazzled. Give serious thought to getting out of the ER and moving on to something not quite so fast paced. Have you considered rehab nursing? This is a great specialty for nurses who are light in the task/skills department but can be very rewarding.

[lmc512]

I definitely know that "totally lost" feeling you have. I agree with the other people that you should maybe try to ease back into the hospital setting as opposed to going straight to the ED. I just switched hospitals recently and am also have difficulty getting used to the basically non-existant orientation program they offer. Where I came from regardless of the experience you had, you must go through the same orientation program as the new grads so that you learn how things are done at the particualr hospital. It was also great because you got to meet the other new people starting at the same time so you didn't feel so alone. The program consisted of classes and of course precepting on the unit.

When i switched hospitals I also opted to go to a unit with higher pt acuity and after a few weeks of feeling totally dissapointed in their teaching skills and realizing they had no plan as to how to orient people I transferred within the hospital to the same type of unit I was on.

If you don't feel like you are providing safe care to your pts and it is driving you nuts then take yourself our of that situation.

I think there is an expectation in nursing that one must work with the sickest pts and the most complicated equipment in order to be successful. I am 800% happier taking care of my pts on my "piece of cake" unit as some call it than driving myself and my family nuts on the other unit. It is all abut what makes you happy, and after having been in this same situation 4 weeks ago I can pretty confidently say if you need to post this at all then you need to get the heck out of there!!!

GOOD LUCK!

[Daytonite, BSN, RN]

There is nothing wrong with you, but plenty wrong with the person who hired you. They need to have their head examined. The manager who hired you had no business putting someone with no acute hospital experience in an ER position. You are being taken advantage of, probably because they needed the body. I would seriously consider quitting or ask for another position on a medical or surgical (my first choice) unit where you will do much better. You need to be on a unit where there is more of a regular routine going on--not the chaos of an ER.

[dbihl, BSN, RN]

There is nothing wrong with you, there is something broken with our health care system. The ER's around the country are like this. If you stay, you will get used to the routine and be able to know what is going to happen b4 it does almost. Maybe working nights on a med surg or step down unit would be a good start. Then you could see what a patient should look like when they arrive on the floor. Or what is missing that they could not get don in ER.

[TazziRN, RN]

if new grads with no experience at all can be precepted into an er, then so can someone with 7 yrs of ltc. it's not fair for you guys to tell her that she's out of her element when she hasn't even been given a chance. given a proper preceptorship, with the one on one teaching that she should be getting, she just might surprise the lot of you.

[wonderbee, BSN, RN]

if new grads with no experience at all can be precepted into an er, then so can someone with 7 yrs of ltc. it's not fair for you guys to tell her that she's out of her element when she hasn't even been given a chance. given a proper preceptorship, with the one on one teaching that she should be getting, she just might surprise the lot of you.

oh goodness! i hope the message she is getting is not that she is incapable. rather that she keep her eyes open to the possibilities. not every nurse will find happiness in er, right? we're all a prolific group who genuinely want to help. some of us just see things in a different light. we merely suggest options in light of our own experiences. if that nurse were me, i would examine what i like about er and decide whether it's worth it to continue on the current path. either the path has to change or the destination.

in fact, the ltc experience may be working against her in some ways. the focus of er (treat and street) is polar opposite to ltc. a new grad might have it easier. i have seen new grads make it in er with structured preceptorships. best of luck to op, whatever she decides.

[Djuna]

TazziRN, I completely agree with you. Whilst having some Med/Surg experience is useful, I have see new grads fit into ER very well. A lot of people comment on how chaotic ER is but having worked in the environment for a year now, I can see the organisation within the perceived chaos. All it takes is some decent orientation and preceptorship and a bit of experience and you find yourself feeling more and more confident with your skills and ability to work well in this type of nursing setting.

Hang in there, you might start enjoying the buzz of ER.

[leslie :-D]

a comprehensive orientation with a preceptor who believes/supports you, means everything.

most anyone would excel under those conditions.

leslie

[fancee free]

I would like to thank everyone's input to my situation. Firstly, the orientation leaves alot to be desired. I am more than prepared to work in emerg, but not like this. I did speak to the manager, and we agreed that some experience on the medical unit would be beneficial, so this is what I plan to do.

It is too bad, because I think I would have done well in emerg, but this was getting to the point of crazy. My confidence basically bottomed out, and I really, really do not even want to go back to that place, but I am in desperate need of money. I have applied to other places and pray that I get on board and can leave that place forever. Reading this thread, and others, it is really sad that many nurses get treated like this, because there is no reason for it. We are intelligent individuals who just want to make a positive difference in peoples lives, which is why we went into nursing.

[TazziRN, RN]

oh goodness! i hope the message she is getting is not that she is incapable. rather that she keep her eyes open to the possibilities. not every nurse will find happiness in er, right?

kitty, if you go back and read the threads again, you'll find at least two that imply that she had no business trying to get into the er. one even suggested that she try something like home care. lemme tell ya, as an old er nurse who jumped ship into home care this year, home care is not as simple as i once thought. i got used to having to think on my feet in a rural er, but in the home it can be even harder. home health nurses have to have killer assessment skills, not to mention ingenuity.

you're right, the er is not for everyone.....just like medsurg and other specialties are not for everyone. how is she supposed to find that out, however, if she's not given a chance?

fancee, i saw your last post about your conversation with the nm, and i wish you well. not all ers are like that, i promise.