Help! In over my head?

hkellerman · Jul 24, 2012

I started in the ER as a new Grad and felt lost, I have a new job now and feel lost. I didnt last long in the ER partly due to some differences in personalities as well as some other personal stuff. The first thing I would do and should have done is go to my supervisor and let them know how you feel. I think everything will come with time, as far as looking for something not as fast paced, I am now doing something not as fast paced and still feel like im lost. On day ten you should be still watching anyways. Just watch what they do and make mental notes. It sucks not being taught and being in such a high stress situation. I felt like I was expected to know everything, and when I made a mistake or didnt know something I was made to feel stupid or like I didnt belong there. It's a tough place to start but in any place its going to be hard at first. Ive been at my new place about 2 months, and Im still scared.

please give me your advice. I'm on my 10th day of orientation in the E.R. as a new nurse. I'm feeling like there's very little support or guidance available to me because the person training me, and most all the other nurses are so busy trying to get their patients stable and out of the ER that they don't have time to teach me.
Maybe I'm just not a fast enough learner or I will never be able to juggle four patients and provide good care while charting at the speed of light ? Should I stick it out or throw in the towel and look for a job that isn't as fast paced as the emergency room?

brainkandy87 · Jul 24, 2012

Well I hate to break it to you, but the onus to learn is on you and in the ER, you learn by watching, doing, and asking questions. You're only on your 10th day of orientation. That's not very long. You shouldn't be waiting for someone to make time for you because, in the ER, that doesn't happen. You need to be asking questions, volunteering for procedures, doing whatever you can to get into the chaos of the ER. There are always procedures and interventions being done in the ER. Don't twiddle your thumbs waiting for your preceptor to come and explain a procedure to you. If you see some patient is getting so and so done or needs so and so done, go find that patient's nurse and get your foot in their door. Volunteer to do it with their assistance. Ask to watch them do it. Ask questions. While no one is going to stop and make time for you to give you a mini course on this or that, there will always be a nurse that will assist you with a procedure or intervention, talk you through it, and/or give advice on something. Bounce questions off everyone. That's how you learn in the ER. Be able to speak up and get answers. Not only are you learning valuable information, but you're creating a much safer environment for your patients.

julianne.00 · Jul 24, 2012

Hey docomo! Don't throw any towels around just yet. Your 10th day of orientation isn't too far in. The ER is a crazy place indeed. I do agree with brainkandy though, you've gotta roll up your sleeves and dive in. Give your current preceptors a bit longer, maybe another week or so. I would definitely spread the word every shift that you want to do things-- caths, iv's, help with art lines, intubations, cardiac arrests, stroke alerts, etc. The more of these you watch and participate in, the better off you'll be when you get OFF orientation. Just keep asking questions-- you can never have too many! Stick to your preceptor like a fungus, man. Wherever they go (except to the bathroom, shoulder there be time). Watch them assess, see how they prioritize, ask questions about documentation,etc. If after a week or so longer trying to do this, if you still feel like you aren't clicking with your preceptor, talk to your clinical educator (or... whoever deals with these things in your ER) about maybe switching preceptors. It's not a biggie, some people click better than others, and your current preceptor should understand! Good luck!

**canoehead, BSN, RN** · Jul 24, 2012

Feeling overwhelmed at 10 days into orientation sounds just about right to me, whenther you're brand new or have 20 years in. JMO, if your're not overwhelmed at that point you're way overconfident. Keep asking questions, even if it's busy, even if it's a stupid questions, that makes you safe.

emtb2rn, BSN, RN, EMT-B · Jul 24, 2012

Agree with last 3 posters. Dive in, ask questions. Nothing scarier than new grad who has no questions. Hang in there. Seek knowledge.

docomo · Jul 24, 2012

Thanks to everyone for their feedback. I loved your tip julianne.00 about spreading the word so people will think of coming to get me if they are doing an uncommon procedure or have an interesting case.

RNRichi · Jul 25, 2012

I just came off of orientation and totally understand where you are coming from. I also agree with all that have given you advice so far. If I can add one thing, don't just ask to be let in on the uncommon things. Sometimes being able to see the different ways nurses do the same procedure can be very helpful. I took note of the way one nurse prepped for intubations, because her way made more sense in my mind than they way my preceptor did it. Also during a pediatric code, there was a nurse that showed my preceptor a faster way to draw up the epi into those tiny syringes. Don't limit yourself just to the things you haven't seen before. Stick close to your preceptor, you will start to anticipate the supplies you will need, etc. One of my nicer co-workers made me a cheat sheet of the different conditions that commonly present and the nursing interventions. The ones that are still not second nature to me, I put on index cards,punched a hole and put a ring thru them, and I keep it in my pocket when I'm working. It alleviates me having to ask the same question day in/day out. I wish you the best, hang in there!

lindzrae · Jul 26, 2012

I worked med/surg for 2 years before diving into the ER. I honestly think going to the ER as a new grad would be super tough and I would never want to do it. However, you are already there. Taking a step backwards would be having little faith in yourself. ER is a LOT to know. You will have days where you are scared to death, you will have traumas, you will have codes, you will have things you have never seen. It is part of the environment. You will learn every day, and remember, YOU ARE NEVER ALONE! Keep the senior nurses on your good side, DO NOT be afraid to ASK questions, even to the docs! Have faith in yourself and work hard. It is a tough road but it is possible

Good luck!

froggy0381 · Jul 27, 2012

Give it more time. I'm also new to the ED and about 3 weeks into orientation. I'm still frequently feeling lost but trying my best to dive in and learn. I've been told by many that it will take a good 6 months before you are truely comfortable in the ED. Hang in there and if need be, ask to work with a different preceptor. It may just take a different personality to help you through. Good Luck!

ecerrn · Jul 27, 2012

Yeah, that's tough, the er is a hard place to start out in, I'd hate to do that to anyone, still, you're there now so make the most of it. Tail your preceptor, figure out what's going on, ask questions, offer to do or ask what to do next....try to anticipate. Can you handle one or two patients on your own? Don't try to take on four at once. How long can you precept?