HELP I'm falling apart!!!

[longjourneydream]

I am a new grad who was formerly a ER tech/PCA with total of 17 years exerience.

When I joined the ER as a nurse in June of this year, there were high expectations of me.

Into my 12th week, I was let go take on patients on my own.

The ER starts to gets busy Oct- April, and the chaos starts Nov-March.

The pace is now picking up and I am now falling apart.

At one time I was asked to work 4 in a row, and that stressed me out to the max.

I told my supervisor that I was not ready to function as a fast paced, efficient nurse, they had all expected me to do!

One example is:

One charge nurse tells me to sit at computer and get patient d/c'd to floor ASAP, while one client comes in with CP and needs immediate attention, and nursing supervisor yells at me and tells me I need to get this lady taken care of ASAP. I just started to fall apart.

My ABC's went out the window.

Now they are all watching me carefully now, picking me apart, and my nursing supervisor telling me she worrries about me.

She does not want to see me lose my licence.

The plan is to put me with a seasoned nurse I take 4 patients, and she takes 2 combined with me.

She is all over the place, because she is the charge and has a massive responsiblility.

They want her to help me devise my plan of attack, as far as time managment.

I know the basics on what to do for the patients.

CP- EKG,nitro if needed, asa if needed, IV, labs,O2 monitors, chest x-ray, fluids etc...

Belly pain,IV labs, sometimes fluids, sometimes ekg, labs always etc...

SOB, if extreme; bipap ABG,breathing tx, chest x ray, IV EKG Labs

OD- EKG, IV labs, fluids bipap or intubation if extreme

On and on it goes.

If no labs are ordered I try to think of what the problem is then order the appropriate lab, when in doubt CBC and BMP are always right.

All child brearing women with uterus must be Hcg must be done prior to any tx or x-ray.

I just cant seem to focus on what I need to do when there are many things coming at me at once.

I have been told to put all tx and assessment in computer right away as soon as I have triaged assessed, IV and labs.

Our electronic charting is a bear.

We never have enough computers around.

I am falling apart HELP...

Any advise for a new RN in an ugly envirionment?

[bigsyis]

Give the job a good shot. Hopefully, working with the seasoned nurse will help.

If you don't find things improving after a while, ask if you can transfer to another dept, or find another job. ER is too much for many new grads.

I think a big mistake that a lot of new nurses make is to keep trying and trying, and stay on and on in a job that is not right for them and makes them miserable. I know I did this when I started.

If you find that things do not improve, try to find a position where you will feel more comfortable.

I, too, agree with this. Even though you have had many years of exposure and experience in the ER, it was not with the responsibilities of the RN. Your skill set was totally different, and so was your critical thinking. Give yourself a good shot with the experienced Nurse. If it doesn't work out, don't fight it. Go to one of the floors to work until you feel more comfortable. When you do, THEN go back to the ER. It isn't worth shredding yourself for!

[vampireslayer]

I have SOOOO been there! I was a new grad in the ER, and stressed myself sick for months! One thing you never mentioned but I thought might be an issue is the fact that you were a tech. You have skills that the nurses don't, so I wonder if you're doing things that other nurses would request a tech to do for them, just because you know how to do it? Simple things like wound care, splinting, arm slings, crutch training, foleys, NG tubes, our techs do those things. I know some hospitals require the nurse to do some of those things (esp NG's and foleys) but ours doesn't. Doesn't mean the nurses can't do them or don't know how, but those are some of the things we can delegate to a tech, to help keep up our pace. Techs can also draw blood (can't start IVs though, but can draw blood and blood cultures) and at some hospitals techs can do d-sticks (ours can't).

Anyway, my point is maybe you could lighten your task load a little if you sit back and think of things that can be delegated to techs, but that you're still doing on your own?

It will get better, really. And the chest pain had priority over the DC, at least until you get them on a monitor and get IV access in them (had a CPR just yesterday, SOB, just came in, not on the monitor yet, no IV access yet, was talking when she arrived, then crashhhhhh).

You can't do more than one thing at a time, just set your priorities. Sounds like you really do know what you're doing, it just takes time to get the speed up.

VS

[longjourneydream]

Well,

I must say I really have had experience since my orientation with my new preceptor.

Must take the hardest patient's that come through the door, her and I take on 4 to maybe 6. It has been interesting as well as making my adrenaline go through the roof, but this is the only way to learn it.

After Thanksgiving it will start becoming very ugly, but if you can survive season in SW FL then you can survive anything.

My preceptor has 40+ years experience and I call her the "Ever-ready bunny."

She also made me feel better by telling me that this ER is the hardest by far to work at. The acuity level is high, very sick patients.

It will be hard, but will be challenging and good learning environment.

Many supporters behind me...

An amazing bunch of people!

I have SOOOO been there! I was a new grad in the ER, and stressed myself sick for months! One thing you never mentioned but I thought might be an issue is the fact that you were a tech. You have skills that the nurses don't, so I wonder if you're doing things that other nurses would request a tech to do for them, just because you know how to do it? Simple things like wound care, splinting, arm slings, crutch training, foleys, NG tubes, our techs do those things. I know some hospitals require the nurse to do some of those things (esp NG's and foleys) but ours doesn't. Doesn't mean the nurses can't do them or don't know how, but those are some of the things we can delegate to a tech, to help keep up our pace. Techs can also draw blood (can't start IVs though, but can draw blood and blood cultures) and at some hospitals techs can do d-sticks (ours can't).

Anyway, my point is maybe you could lighten your task load a little if you sit back and think of things that can be delegated to techs, but that you're still doing on your own?

It will get better, really. And the chest pain had priority over the DC, at least until you get them on a monitor and get IV access in them (had a CPR just yesterday, SOB, just came in, not on the monitor yet, no IV access yet, was talking when she arrived, then crashhhhhh).

You can't do more than one thing at a time, just set your priorities. Sounds like you really do know what you're doing, it just takes time to get the speed up.

VS

[MAISY, RN-ER, BSN, RN]

Sorry you are having a tough time. ER is a tough place to start, I know..where I started.

Your priorities are to your sickest patients, and you must be able to say "the heck with the discharge, CP is #1" if the charge needs that room, either she or someone else can discharge. I believe charge needs to be told that very line. She will respect you for it.

Not sure what your ratio is, but I agree with other posters-anyone with sob, cp, dizzy, or severe abd pain. Place on monitor, oxygen, iv with rainbow and urine if you can get it. If you have technicians, let them assist or initiate. I don't know if you have to wait for orders, but we don't. I will assume you have standing orders. If you are getting hit with the elderly, like we are being hit in NJ-I can only imagine what you are facing. Everyday has been a battleground here!

Patients are sicker... the way to keep your license is to document, document, document! Their intake acuity is vital to set their baselines (as you know it). Taking report from another nurse-make them tell you the whole picture, have they completed everything-if not, make them. If patient doesn't know about their own health, document that too! We are not mind readers-if the statement is not there, family could always say we were told.

Time management will come. I have seen 20-30+ year veterans crying when feeling overwhelmed! Their responses made me question my abilities in ER. It's been almost 2 years, I am still here. BUT, there are days....

Good luck to you. BREATHE.

Maisy;)

[wonderbee, BSN, RN]

I agree with the poster who suggested that your charge nurse should have listened to you earlier on when you knew what you needed. Unfortunately the reality is that what's done is done. You now have the extra added pressure of knowing you're being watched. That's a terrible message to have to digest all day long, 12 hours a day. It's going to be hard to recover from that and stay in your current position.

Your first experiences as a professional nurse need to be positive ones. I would start shifting my focus to finding that more positive experience somewhere else. The ER is a fast paced environment but it could be oncology or ICU or fill in the blank. Once you know you're being scrutinized and their talking "license" (though why I have no idea), why submit to what amounts to daily torture?

BTW, I know. I've been where you are.

[steelcityrn, RN]

You have invested time already, and its just going to take more. E.R. nurses are becoming rare, its unbelievable autonomy and stress. If you like that dept., and your co-workers, you should probably give it your best and do what it takes. By june, you probably will be totally on your own.

[longjourneydream]

I honestly belive Nov- April are the most hardest months to get through, season in SW FL are gruling, but I belive if I make through these hard times, I will make it through anything.

Given the hardest patients and the best preceptor in the dept is a gift from God, they honestly are paying for me to stay.

Only bad part is I'm not eligible for bonus pay, but I really do not need the need the extra stress at this time.

Yes by April I think I'll be ready and yes I agree June to go completly on my own.

All my co-workers tell me it takes one full year, after being a new grad, to function alone. I belive it...

You have invested time already, and its just going to take more. E.R. nurses are becoming rare, its unbelievable autonomy and stress. If you like that dept., and your co-workers, you should probably give it your best and do what it takes. By june, you probably will be totally on your own.

[travelpat]

There are some days I cn't handle 4 pts. And I have 19 years experience. Other days I can run circles around the other nurses. Don't get caught up in worry. Just do the best you can. Relax. Take a deep breath. Go into the BR for a minute and think what are your prorities. Good luck!!!!!!!!

[Granted Fal]

You've been a tech for 17 years. You are familiar with your environment, take luxury in that. You are learning a new role and you'll get it if you keep trying; Don't give up. Each shift is a learning experience to add to your repertoire. Always prioritize your most critical interventions first. I think your existing knowledge base can be a real asset for you.

[bigsyis]

So, how is it going these days? Better?

[longjourneydream]

Yes bigsis, it is getting better.

I am learning, sometimes the hard way, but I try to make everyday a lesson.

It takes a long time to become a good ER nurse.

I have good preceptors.

Different types, some are better than others.

My biggest problem now, is time managment, and prioritizing,but it is coming along.

I have even thought about looking for a slot on the night shift, where pace at times is slower, to stop and think about what I am doing.

[bigsyis]

I am really glad to hear that things are coming together for you. It sounds like you have a pretty well-thought out "plan of attack" to succeed.

Nights can go either way in the ER-they can be slightly slower, or they can be an absolute meat-grinder because of reduced staffing and the kinds of things folks get into in the dark of night. I have seen new folks to the ER get a good orientation and adaptation to ER Nursing by beginning on nights, though.

Good for you, and I hope you enjoy your holidays!