HELP! New ED RN Off of Orientation Soon

[meghanlyn]

I know there are probably several threads out there on this topic already but I think it'd just be easier for me to start my own in order to be more specific about the advice I'm looking for. I graduated from nursing school in December, passed boards in February and started a new job as an ED RN in February. Just a little background about where I work (not that it matters much for the question I'm asking but just in case anyone is wondering): I work in a decent sized community hospital in an ER that has about 30 beds and 2 trauma bays. Our hospital is a certified stroke center and we also have a fairly new cardiac cath. lab as well.

Anyways, to cut to the chase. Like I mentioned, I started this new position in February as a brand new nurse. I had worked as a nurse intern prior to getting my RN and I fell in love with the ER as an intern. This was pretty much my dream job so I was so happy to start. I knew I'd have a pretty lengthy orientation (16-18 weeks) upon starting since I was fresh out of nursing school and that during this orientation period I'd also be meeting once a week with our department's nurse educator who would review what to do in certain emergent situations and help practice skills that need improvement. I started with one preceptor and was with her for about 1 month or so and our nurse educator and management thought I'd benefit from switching preceptors which has really helped.

I've learned a lot thus far in my orientation period and have come a long way as a new nurse. I now have about 4-5 weeks left of my orientation and just recently I was faced with two of my most emergent/critical patients: one was a STEMI who required an immediate cardiac cath, the other a pneumothorax who had a needle decompression done as well as a chest tube placed. Of course I had my preceptor by my side during both situations but for some reason I seemed to freeze when faced with both emergencies. I couldn't quite prioritize the way I should have in either situation and if it wasn't for my preceptor's guidance I have no clue what would have happened.

Now I'm stuck in a tough place. Both situations were very challenging for me and now I'm beginning to question if I truly am cut out to be an ER nurse especially since I come off orientation in a little over 1 month. Part of me wants to take the easy way out and run away and switch to a different unit but at the same time I'd like to stick it out and push forth and take what I learned from those situations and grow from them. I've made it this far for a reason, right?

I've just been beside myself these past few days because I've never frozen like that before and I'm afraid it might happen again when I'm out on my own. Oh and I forgot to mention that I've already been battling with confidence issues throughout my orientation period thus far (which I think is typical for new nurses just because of the fact that everything is new).

So basically I'm just wondering if anyone else out there felt as though they might not be cut out for the ER when they first started and if anyone did feel that way, what advice to you have to overcome that fear?

Every bit of advice and encouragement is appreciated!

[Emergent, RN]

ER nursing is a team effort. You'll never be totally alone. Once you are off orientation, your co-workers will know that you are new and will be helping you navigate as a new nurse.

Eventually, you'll build confidence and ability.

It takes time to get comfortable. You're a novice and it sounds like you've got a decent team... they're not going to let you drown.

When it's going down, you're going to have people next to you.

And don't be afraid to call for help.

And it really comes down to ABCs.

You'll be fine after you get some seasoning.

[jessRN0]

I started in the Emergency Room back in October. I graduated in May of 2012 and worked inpatient ortho until I got the job in the ER. All through nursing school, I dreamed of becoming an ER nurse and new that's where I ultimately wanted to be. No other place made me feel so in love with the job I chose. Even with my previous experince coming into the ER, I thought I was going to have to give up my dream. The ER was nothing like I thought it would be. I remember coming home after orientation one day and calling my best friend (who is also an ER nurse) and crying because I was so frustrated that this wasn't what I thought and that maybe I didn't belong.

The ER is a tough place to work, especially for a new grad, but there is also so much you can learn/see/do. I gave myself some more time to push through a few rough weeks of orientation, and here I am at the end of May and absolutely LOVING my job. There are still so many things I have to learn though. It never ever ends here.

I have a few suggestions for you..

• Talk to your manager about your preceptor. Having the right fit for a preceptor can make all the difference. You need someone whose personality meshes with yours but will also challenge you and force you to grow by leaps and bounds during your orientation. He/she needs to be completely honest with you, and you have to take the criticism with a grain of salt.
  
• Write down a list of diagnosis, meds, labs, etc that you see frequently. Study those and really try to understand what's going on. (I know...studying sounds like the last thing you want to do, but it really helps to just review some of those things.)
  
• BREATHE. You work in an EMERGENCY room. Things happen fast and you can get overwhelmed easily. Find something that you can consistently rely on to relax you after a rough shift. You'll need it.
  

There are doctors, nurses, techs, etc that are ALWAYS around to help you. Some of them may be rude when you don't know exactly what you're doing, but you have to learn somehow. Learn who you can ask your "stupid" questions to without making you feel like it's a stupid question.

You'll do great!! Welcome to the world of emergency nursing. :)

[zmansc, ASN, RN]

I would suggest you don't start doubting yourself now. Give yourself time, experience, a chance to grow. Being off orientation doesn't mean you can take anything that can be thrown at you and handle it with one arm tied behind your back, it means you can meet the minimal standards for your unit and will continue to grow. And in the ER, as others have mentioned, we work as a team, so if you drew the lucky straw and got the crazy critical pt, then your teammates should be coming to your side. DONT be afraid to ask for help, sometimes the rest of the team doesn't know what you have in that room, let people know when you need help. They will help you, especially if you help them when your slow.

[KnitWitch, ASN, RN]

Stick it out.

I graduated in Dec. '11, passed my boards in Feb '12, started my first ED job in Sept. '12, and transferred to a different ED (for commuting reasons) in Oct. '13. I have spent A LOT of time being the New Kid. In a lot of ways I am still the New Kid.

I'm just now starting to not feel a sick twist of panic when told I'm getting a code into one of my rooms. I'm still a little wobbly on stroke alerts and I've never had to give TPA. Acute MIs throw me into a panic because in my huge hospital I'm still not sure of the fastest path to our cath lab. I'd almost rather an 'unresponsive' with no further info because at least then everyone in the room with me starts off on the same "*** is this?" footing that I do.

But that's the thing -- anytime someone super sick or complex rolls through the door, there are always more people in my room to help me than I have tasks to delegate. All I have to do is call out for something, and it's there. If the doc asks for something that I'm not up on, someone else is on it in a flash. The teamwork in my department is on point, and I couldn't do my job without my coworkers. On the flip side, I try to be there as much as I can for my coworkers, even if it's just as spare hands for tasks, fetch n' carry or interfacing with family members.

I am working with nurses who are "newer" than I am, but who were techs in my hospital for years before becoming RNs. I'm working with RNs who have worked ICU, home care, and every other unit. I'm working with RNs who have worked 20 years of ED and know nothing else. And every now and then we get a patient who presents legitimately ill and no one (RN or doc) knows what else to try. And that makes me feel a little bit better too.

Of course I've made mistakes (nothing makes my stomach drop more than one of those huge inter-office mail envelopes in my work mailbox, signifying that Something Has Happened), and I've tried my best to cop to it when I make a mistake, and to defend myself and my coworkers just as vehemently when the floor or the residents are trying to throw us under a bus.

tl;dr: Stick with it. Stick together. Never be afraid to admit you don't know. Never be afraid to ask for help. Help out when you can. Not knowing is NEVER a crime, but not asking could be. Sometimes NO ONE will know *** is going on. Assess, run your ABCs, confer with your coworkers. You'll find your rhythm. Eventually you'll find yourself answering questions and acting on instinct. Don't rest once you get there -- always try to be better -- but take heart that you're doing it and you HAVE gotten better.

[zmansc, ASN, RN]

Interesting post Knitwhich, reminded me that one of the things I picked up that helped me greatly early on in my ER career was going to TNCC. Not because we get alot of traumas, we almost never get life threatening traumas, they are flown from the scene here. However, when I'm in a situation where I don't know what needs to be done I fall back on my ABCDE.... It works just about every time, and you can never reassess airway, breathing... too often! It also helps to keep me calm when a room is getting a bit out of control, I have made the crew do it on a couple of occasions to bring order back, "Ok, so you've got the airway and breathing, good; I see your working on the second IV and you have fluids hanging...." It's always worked for me.

[nurse2033, MSN, RN]

Get comfortable with being uncomfortable. Being comfortable is not required for you to do your job. There is always a patient that can push the comfort zone of any nurse. Focus on doing your job. I think you have "stage fright". If you focus on the "how" to do your job not the "if" you will be able to, your mind will quiet down and you will be more productive (this concept is from "The Inner Game of Tennis by Timothy Gallwey).

[Racer15, BSN, RN]

It gets easier. I started in the ER as a new grad and it was rough. I thought I was going to be fired at the end of my orientation because I felt I wasn't doing well and my preceptor was forever frustrated with me. A year and a half later and I'm still kickin. I remember being way overwhelmed with my first STEMI. Now it's no big deal and there are always several hands on deck in situations like that to get everything done ASAP so we can ship em off to cath lab. I still feel a little lost in some situations and super overwhelmed some days. It's normal. Never hesitate to ask for help if you need it. You will be fine, just remember your ABCs and remember it takes a new nurse a year to feel somewhat comfortable.

[BrooklynRN11201]

your background is the EXACT SAME as mine. I graduated last June, interned in the ED July/August, got licensed in September and started my first nursing job in the same ED in December. I had the same feelings as you too - it's all 100% normal.

I can honestly say now, looking back, all you need to be successful in the ED is decent "do no harm" nursing skills and a pure and undeniable interest in emergency nursing. you are new, everyone knows you're new. it is ENCOURAGED for you to ask questions, lots and LOTS of questions. I still ask "what are we giving this for?" or my nursing colleagues "what is 'paresthesia' again?" develop a good rapport with people, don't act like a know-it-all and they will always be there to support you.

and now that I'm 6mos into it, I am pretty confident on most days - not cocky but confident and totally certain I'm an ED nurse doing what I love to do.

my point is, it will pass - the feelings you're having are GOOD - give it 6mos and you'll look back thinking "why was I so stressed out?"