Help! New grad ER nurse, leaving before year mark?

Editorial Team / Moderator · Mar 19, 2019

Have you considered looking for a position on an inpatient floor elsewhere in the hospital? That would probably have the least impact on your resume/work history because you'd stay with the same employer. The down side is that your ratios probably won't be much better. I have to be honest, I feel like 4:1 is pretty doable with teamwork in a pod (do you even have a tech?), but I am saying this with 14+ years of ER experience so that probably isn't fair (plus I started off as a new grad in an ER where we had a standard 5-bed assignment, so I am warped; it wasn't ideal, but we had amazing teamwork). I know it can be daunting when you are the most experienced RN in your pod! You are just four short months away from that year of experience and if you can hang in there, it will be beneficial. If not, where else do you see yourself? Are there other ERs in your area that have a lower acuity? It's tough for new grads to start in a Level 1, they are often a meat grinder/safety net/rough place.

Serhilda, ADN, RN · Mar 19, 2019

In your case, I'd try transferring to a different unit before resigning. I had new grad friends of mine leave dialysis or home health positions in less than a year and have no problem finding a job in psych or med surg in a small hospital. It'll set you back for sure, but it wouldn't be the end. This can also depend on your location and how saturated your area is with new grads.

WiseAtHart · Mar 19, 2019

I TOTALLY feel you! I am about 6 months into ER nursing. I was a progressive care nurse before that. I don't like it the environment in my ER either. I have 4:1 ratio as well, which is a little crazy. I can handle it but man I work my butt off the ENTIRE shift. I NEVER get a 30 minute lunch break. I just eat at my desk if I have time. One of the big problems is our techs - a few are AMAZING but half the time the ones I work with are just sitting on their rear ends. I like to work hard and get things done but they just complain about having to do anything - if I am working hard then my tech should be too...I'm too nice to say anything tho haha! I am close with one of the techs and she told me that one of the techs I worked with the other day complained about me to her because I actually ask her to help with things - WOW!!!! We are supposed to have a tech with every nurse but that never happens. Almost every nurse I work with complains about working where I work which makes it even harder to work there.

Not to mention the on call!!!!! I totally get needing an on call person but my ER uses it for staffing basically which I don't think is fair (I'm actutally gonna post about it after this haha). But I talk to nurses at other places and it sounds like the same ordeal.

I really do love ER nursing but I just wish it could be staffed well enough! I just don't understand why my department doesn't try to hire more people?? They don't even say they are trying to hire!

SORRY thats my rant ?...I am with the others, I would stay within your hospital. I am moving to another state soon due to my husband being military so luckily I don't actually have to quit. On the other hand tho you can probably get a job anywhere just because there is such a nursing shortage! Inpatient is having the same pt for the entire 12 hrs which really is not bad. I like when I get holds down in the ER sometimes. Depending on acuity of the floor you would decide you have to chart a full head to toe assessment multiple times during the shift, doing intake and output, giving meds many times throughout the shift, having to page the doctor for everything and waiting for them to call back. But it is nice getting to develop a relationship with the patient. Let me know if you have any more questions, I can help as best I can!

JKL33 · Mar 19, 2019

Hello bridgecasey,

Although a 4:1 ratio is doable depending on the specifics, being the one with the most experience in the pod @ 4 months post-orientation is frightening and IMVHO is really not okay. The ED was so fun (seriously) when there was a good mix of experience levels including some experts who had pretty much seen it all. But, that and everything else has changed about the ED. I don't think your feelings about the situation are unreasonable.

That said, I think you should continue to think this through. Here's some more food for thought:

18 hours ago, bridgecasey said:
I’m afraid of doing harm and I feel like this environment is setting me up for failure.

Your current stage of professional development is likely "advanced beginner." You are in a major transition stage. All of that is good/fine/normal. The problem is, it's a transition that naturally produces some feelings of insecurity or worry/anxiety - even when the situation is relatively stable (the new grad is progressing as expected, the patient assignments are not wildly outrageous, etc., etc.). Generally speaking (from my observations), newer nurses who have these concerns may feel very uncertain, very concerned, etc., but they are actually the ones who are learning safely. They know someone can get hurt if they aren't careful, and they know there is a lot they don't know. Therefore they are actually more safe, as newer nurses successfully progressing along a normal continuum, than what they feel inside.

18 hours ago, bridgecasey said:
I have some new grad coworkers who I feel (or at least perceive) are doing better than I am

Unless you know of difficulties (areas where you aren't meeting standards for a newer nurse) or are being counseled about problems you're having, consider the idea that these coworkers may look a little more confident than what you feel inside. And that is not an accurate way to judge your own performance (or theirs, for that matter ?).

18 hours ago, bridgecasey said:
I've been performing well all things considered

I believe this, just based on what you've written. Your thoughts and concerns are well put together and are not abnormal. When you don't have a lot of support you just don't know how you're doing or where things stand and everything feels completely up in the air and scary.

Well....so what should you do?

Obviously we can't tell you what to do, but I would suggest that with a few continued precautions you can safely continue to finish out your year here. No matter what you decide, I suggest that you maintain a very low threshold for asking for help and asking questions. I suggest also that when things seem scary, perform the basics as you were taught. Always use the 5 Rights, for example. Use good assessment skills. Communicate carefully and pleasantly.

The biggest problem I see in what you have written is a relative lack of support. That is indeed a problem. Are there any ways you can reach out? There should be an educator. In addition, utilize the expertise of any shift supervisor or house admin or more experienced ED nurse you may have on your shifts. Call pharmacy w/ all med questions. Use every resource available to you. Ask for feedback (educator, manager, etc.) so that you can continue to improve and as a means of getting a little reassurance now and then.

What do you think about this?

Take care ~

?

Mandy2016, BSN · Apr 1, 2019

THIS SOUNDS SO MUCH LIKE MY HOSPITAL IT'S SCARY. Our high turnover rate (due to being underpaid) has led to chronic understaffing, which makes them hire new grads like crazy. I was brand new when I started and after orientation it was the worst flu season California had seen in YEARS. Just like WiseAtHart, none of us had a lunch break for months, we always had a full patient load, and our overflow chairs were more dangerous than useful.

Something that always stuck with me was when other RNs I worked with (including my preceptor) told me, "if you can make it here, you can make it anywhere," and that was the truth.

As time went on, I became a stronger nurse. Critical thinking and time management take time to build, don't be too hard on yourself. If you have the option of picking your schedule, I would try to see what days the more experienced nurses work and try to get those days. At least you'll be able to pick their brains and they'll be there to help when something critical goes down.

As far as violence goes, I would notify the charge RN and security immediately. If nothing else, they can stand by and watch your back if these people escalate. The security guards I work with regularly try to deescalate these types of patients. If they continue to be violent, it's either discharge, AMA, or restraints. Document everything, I mean every single word they say, all the ***** and the gestures. That way, you cover your *** and every other medical professional reading the chart will be warned about what kind of person they're dealing with.

DO NOT tolerate patients who try to hurt you. I know many nurses will say it's just part of the job and you'll learn to deal with it- but that's total bs. Do no harm, but take no ***!

No one can blame you for leaving if you do, but I encourage you to keep going. Coming from someone who started as a new grad in this environment and a preceptor to many other new nurses, I promise we all feel this way in the beginning. Remember, the end goal of the ER is to prevent death or permanent disability. If you keep your patients alive and prevent them from degrading, you have done your job and shouldn't feel like you are less than worthy for your unit. Will all of your patients be happy, pain free, and not hungry? Hardly ever, but that does not mean you are a bad nurse. The fact that you care, hesitate, and realize the dangers shows you have the core potential to be a great ER nurse. Don't give up

eacue · Aug 7, 2019

I didn't read any of the other posts but I did med surge for 6 months right out of school, got placed on suicide watch by my wife, transferred to the ER and its been paradise since. It is YOUR career and YOUR life, you tried ER, you don't like it then bounce with no regrets. I would youtube different departments and you will see Rn's that have made videos about how ICU vs ER vs Floor vs CM vs flight and the list goes on and on. that may help, best on luck.