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

[bridgecasey]

I recently made a similar post in the emergency nursing topic, but realized this might be more appropriate to post here. I’m a new grad without solid nursing mentorship and I'm desperate for some advice:

I have been in a trauma level 1 ER for under a year (about 4 months on orientation/four months off). Proud of myself for making it this far and I’ve learned so much in a short period of time, but between high acuity and poor patient nurse ratios (sometimes 4:1 + up to two hallway patients and holding ICU patients for whole shifts) and a pretty constant threat of violence from patients/some close run ins I’m already pretty traumatized by this experience.

I’m afraid of doing harm and I feel like this environment is setting me up for failure. I have some new grad coworkers who I feel (or at least perceive) are doing better than I am and there are experienced nurses leaving the ER in high numbers. (To paint a picture: I was recently in a pod during a busy/high acuity night on a 4:1 ratio with a new grad nurse I started with and another nurse new to the ER who had just come off orientation.) There are also ongoing issues with management and leadership that has been confirmed by nurses that have been there for many years.

I've been performing well all things considered but I don’t think ER nursing is for me and I'm regretting my decision to work here. I've been thinking this over in depth since January. I want to leave before the year mark and it feels like career suicide but I don’t know if I can stick this out any longer. Has anyone had a similar experience or any advice for dealing with an employment gap or how to look for a new job in a new area with less than a year of experience?

[guest464345]

Sorry to hear it's so stressful.

I started as a new grad in an ED much like the one you describe. Also like you, I basically felt, "meh, I barely manage to be OK-ish, but other people catch on and fit in better." I worked in another area of nursing, then decided to try a different ED to figure out my problem: was it the first ED specifically, EDs generally, or hospitals generally? Or me, generally?

The second ED I liked much more - I fit in, I felt more confident, I liked the people. The vibe (grubby but lovable county hospital vs Fancypants University) fit me better, even though it was just as busy and high-acuity. I surprised myself by doing well. For the first time I could see my imperfection, but I could also see myself improving, and I could imagine myself becoming a pretty decent ED RN.

Eventually, though, I realized I'd be happier in a community setting. I was still happy to have the experience of the second ED, and to realize I wasn't deficient after all.....just mismatched ? .

Whatever you do, the period between 6 months and a year is hard. It's annoying to have people keep telling you that things will start to "click" and become less scary, but it's true. If you truly must know what other jobs you might get....investigate! Ask around, apply and see if you get interviews. You don't have to jump into the first thing that comes up, either. Think about what you're seeking, not just what you want to escape. Kinda shop around a little - it's easier when you aren't worried about making rent.

You will look back on this one day from a place of more security and confidence. Good luck!

[mdsRN2005, ASN, BSN, RN]

I’ve worked ER for almost a decade and can tell you for a fact it’s not for everybody! If you truly feel in your gut that it’s not for you, try something that’s a more controlled setting like ICU, Tele, med surg, etc. Not to say these units aren’t busy, but it’s more of an “organized chaos” as opposed to the ER, which is very much “disorganized chaos” lol

HOWEVER... it sounds like you’re in a badly run ER. A 4:1 ratio is very difficult in the ER on a busy day, even for an experienced nurse but especially for a new grad. 4:1 plus hallway patients is definitely too much! (It also tells me a lot when you say the experienced nurses are leaving). Also having started as a new grad in the ER myself (midsize level 3) I can only imagine how overwhelming it would’ve been to start in a large level 1. If you have honestly enjoyed ER but just feel overwhelmed in your current position, look for a job in a smaller ER that’s a lower level trauma center (not to say you won’t get train wrecks bc you will but you won’t be getting as many bad ones transferred in). Avoid the really tiny hospitals though, as the ER will be tiny and you may be one of only two or three nurses, which is also not ideal for a new grad. Medium size level 2 or 3 should be better. Ask a lot of questions about ratios and staffing when you interview, and tour the ER if possible. Should give you a few clues. Hope this helps! Keep us posted!