I'm a new nurse in a level 1 trauma center, and I'm still with my preceptor. He doesn't talk to me during the traumas, he's busy doing his own thing...afterwards he yells at me for having just watched everything going on around me, but not doing anything. I've tried to tell him that I don't know WHAT I'm supposed to be doing, but he says (or yells) YES YOU DO, YOU KNOW WHAT TO DO, YOU JUST DON'T DO IT!!.
So here's the deal: I can handle the chest pains and abd pains and UTIs no problem. I know what to do, what to ask the patient, what to assess. I get them in a gown, put them on a cardiac monitor & pulse ox & O2 if I think they need it, start and IV and draw their blood. It's routine, no big deal. But then when a big trauma comes in, GSW to the head, they're doing CPR, or an unresponsive person, decreased LOC, that EMS is bagging as they come in....stuff like that. The BIG stuff, the ones where the docs and the nurses and the techs are all crowded into the room together, the docs start to intubate...the techs are still doing chest compressions...I just don't know what to do! I really don't! There are so many people in there, by the time I think "oh, I need to get a pulse ox on this guy" someone's already done it. And then I think "I need to get the cardiac monitor leads" someone's done that. And most of them come in with an IV, but in traumas, we always put in a second line...and the CPRs too...but I suck at my IVs still, I'm still missing 90% of them! So I don't do that...then the techs start cutting the clothes off, and I wonder if I"m supposed to be helping do that...my preceptor does. My preceptor's usually running around doing stuff...getting an IV going, or drawing the meds, the Vec or versed or whatever if they're going to intubate. AND I HONESTLY DON'T KNOW WHAT TO DO! Everyone around me is doing stuff, and by the time i think of it, it's done.
Often my preceptor will tell me to "start writing"...so that I can record the times that the intubation occurred, the times of all the meds, etc etc...and later i put it all in our computer charting system. But I want to DO SOMETHING, not just write it down. But I don't know what to do! I really don't!
I have been told "remember your ABCs"...and I KNOW THAT...but when it comes in the door, A-airway and B-breathing, it's covered...they're patent, they're being bagged and sometimes they're already intubated...or the docs are preparing to intubate...so then what? C=circulation...I've kind of decided "ok, I'll be the one to get that first blood pressure" or to check pulses...at least that gives me something to do.
This whole post just sounds so stupid....what I want is for my preceptor to talk me through this stuff, when the pt rolls through the door, I want him to say "ok, because the situation is "x", I'm thinking "y" and I'm going to do "z" first...and the "xx" can wait for now because .... you know? I want him to talk me through what he's thinking, what he's doing first, and why. And what MY role is...versus what the techs are doing and waht the docs are doing and what respiratory is doing. I know they say "A, B, C" but in reality, when there's a whole room full of people, you're really all working on the A's B's and C's all at the same time, not waiting for A, before going to B and C, you know?
Anyway...how do I stop just standing there and watching, and start DOING something? Has anyone ever felt like this?
While I am not a "seasoned pro," I think I am just on the other side of the fence from where you are now. I graduated a little more than a year and a half ago and have been working in a "busy" (level 1, inner city, teaching hospital) ICU since then. I definitely remember being terrified coming into work and having that simultaneous dread/hope of getting a sick patient. You aren't alone in how you're feeling and your fear definitely doesn't mean you are in the wrong place (actually, the couple of new grads that I have known that didn't make it in critical care areas were folks who were either overconfident or didn't know enough to be scared). Some thoughts......
1) When I first started I went to a lot of codes only to find the room PACKED with people (Or was too slow and ended up being the one left to watch all the patients in the section...lol). My solution was to run faster and to not be afraid to worm my way into the action. Being one of the first few in the room makes it easier to find a job. I also recommend being a runner if all of the primary jobs are being done (grabbing supplies, drugs, paging x-ray, etc.), just to be part of the action/team.
2) Recording. I have said the exact same thing as you about recording. However, it is very important and is a great learning tool. When I was being precepted, my preceptor was of the opinion that recording is one of the best places for a new nurse to be during a code because it keeps you involved in the big picture, lets you learn the sequence of events, and keeps you a little removed from the action so you don't get too stressed. It is also something that is rarely done well and when you do a good job at it, you look good (vitals every couple mins, names of folks doing compressions, bagging, giving meds, starting lines, tubing, meds/doses, time procedures started, time finished, # of attempts, rhythyms, etc.).
3) The most impressive person I have ever seen in a code is one of the nurses on my unit that has a lot of ED and ICU experience...surgeons were putting in a subclavian on his pt, dropped his lung and then panicked and completely disengaged as the pt went into PEA. This nurse totally ran the code (started an EJ in about a second, was pushing drugs and making sure everything got done). One of the things this nurse has said to me is that "Codes and traumas aren't rocket science." They are all about algorithims...do things in this order, if A then B, etc. Being calm, but still fast is the challenge and that comes with experience.
4) You haven't had ACLS or TNCC yet?! Your preceptor needs to lighten up a bit then it sounds like to me. These are the classes that teach you about coding someone or taking care of a big trauma pt. If you haven't had them it is very hard to know what to do in these situations. You'll learn alot and have a much better idea of what is going on once you have taken these courses.
5) Having your preceptor give you an assigned task is a great idea. Even if they don't, then just picking something that you are gonna try to do so you have some focus is good (first set of vitals, get the labs, etc). Also, don't be afraid to approach the techs or RT and saying ""hey, i've never done compressions/bagged a pt/confirmed tube placement/etc. would you mind walking me through it on the next code/trauma?" By asking these folks you will show that you are eager to learn, without stepping on toes (ie if the techs "always" do compressions they might feel like it is their domain and if you just try to step in and do them there could be some misunderstandings. also being willing to learn from folks lower on the pay scale than you is both classy and very educational).
6) This doesn't seem to be a weak point for you at all, but I would echo someone else's post and say...learn, learn, learn. Book knowledge doesn't mean that you will necessarily be good in clutch situations, but the more knowledge you have to draw on the more comfortable/effective you will be. Study your ACLS drugs and algorithms, learn about rhythym strips, study a CCRN or CEN review manual, make note cards about lab values, drug doses, etc. Check out check out the software from http://www.madsci.com about codes and traumas...expensive, but pretty educational (you can even download free demos).
Whoo...didn't mean to write that much, hope that at least some of it was useful to you. Just remember that you CAN learn to be good at this. Everyone was green once. Experience and repetition.
I am also a new grad and feel like you sometimes. During codes I like to do chest compressions because I am doing something "easy" and at the same time I can observe everything else that's going on without feeling like I am standing around. I think sometimes there are just too many people in a room and there really isn't anything to do. I have never had someone yell at me for just observing though, sounds like your preceptor is kind of a jerk. I guess I have had docs yell at me for things though. I have learned to not let it get to me, I often get yelled at for things I didn't do, I guess since I am the new kid I am an easy target. I just assume they are stressed out and taking it out in an immature way and chalk it up to them being unable to cope with their emotions like an adult and it makes me feel better. :wink2: Anyway, good luck in getting though this learning process, I am right there with you.
I'm a new nurse in a level 1 trauma center, and I'm still with my preceptor. He doesn't talk to me during the traumas, he's busy doing his own thing...afterwards he yells at me for having just watched everything going on around me, but not doing anything. I've tried to tell him that I don't know WHAT I'm supposed to be doing, but he says (or yells) YES YOU DO, YOU KNOW WHAT TO DO, YOU JUST DON'T DO IT!!.
So here's the deal: I can handle the chest pains and abd pains and UTIs no problem. I know what to do, what to ask the patient, what to assess. I get them in a gown, put them on a cardiac monitor & pulse ox & O2 if I think they need it, start and IV and draw their blood. It's routine, no big deal. But then when a big trauma comes in, GSW to the head, they're doing CPR, or an unresponsive person, decreased LOC, that EMS is bagging as they come in....stuff like that. The BIG stuff, the ones where the docs and the nurses and the techs are all crowded into the room together, the docs start to intubate...the techs are still doing chest compressions...I just don't know what to do! I really don't! There are so many people in there, by the time I think "oh, I need to get a pulse ox on this guy" someone's already done it. And then I think "I need to get the cardiac monitor leads" someone's done that. And most of them come in with an IV, but in traumas, we always put in a second line...and the CPRs too...but I suck at my IVs still, I'm still missing 90% of them! So I don't do that...then the techs start cutting the clothes off, and I wonder if I"m supposed to be helping do that...my preceptor does. My preceptor's usually running around doing stuff...getting an IV going, or drawing the meds, the Vec or versed or whatever if they're going to intubate. AND I HONESTLY DON'T KNOW WHAT TO DO! Everyone around me is doing stuff, and by the time i think of it, it's done.
Often my preceptor will tell me to "start writing"...so that I can record the times that the intubation occurred, the times of all the meds, etc etc...and later i put it all in our computer charting system. But I want to DO SOMETHING, not just write it down. But I don't know what to do! I really don't!
I have been told "remember your ABCs"...and I KNOW THAT...but when it comes in the door, A-airway and B-breathing, it's covered...they're patent, they're being bagged and sometimes they're already intubated...or the docs are preparing to intubate...so then what? C=circulation...I've kind of decided "ok, I'll be the one to get that first blood pressure" or to check pulses...at least that gives me something to do.
This whole post just sounds so stupid....what I want is for my preceptor to talk me through this stuff, when the pt rolls through the door, I want him to say "ok, because the situation is "x", I'm thinking "y" and I'm going to do "z" first...and the "xx" can wait for now because .... you know? I want him to talk me through what he's thinking, what he's doing first, and why. And what MY role is...versus what the techs are doing and waht the docs are doing and what respiratory is doing. I know they say "A, B, C" but in reality, when there's a whole room full of people, you're really all working on the A's B's and C's all at the same time, not waiting for A, before going to B and C, you know?
Anyway...how do I stop just standing there and watching, and start DOING something? Has anyone ever felt like this?
VS
It's impossible to "precept" in a trauma or code, like you would another pt. Time is so valuable and besides stepping back and watching, initially, there isn't time for step by step explanation. Being a new grad in an ED, is very, very difficult/trying, I'm sure. I was a new grad 26 years AGO in a large Med/Surg ICU/CCU which was adults only, and that was quite a learning experience. I have worked quite some time in trauma center ER's and as a flight nurse. Experience and many certifications allow me more of a "comfort zone and knowledge level" to work in that setting. I don't know how many certifications (ACLS, PALS, TNCC, etc) you have yet, but that will help. For those of us who have been in that setting awhile, it's almost like "auto pilot" at times, you have done it so much, you know what you'll need and have to do. Most trauma surgeons I have worked with expect it to flow as much like clockwork, as it should, and there's a lot of people doing things quickly in attempts to save that life. Unfortunately, sometimes new grads these days have a little more difficulty with orientation/precepting because the unit is so busy and understaffed. If you feel it's "too much" for you initially, have you thought about working in a smaller ED or different area, to get some experience under your belt before jumping into the frying pan? Best of luck.
And it sounds like your preceptor needs to remember where he/she started.
personally, I would tell your preceptor to "back off" and "just stand there" during the next trauma.....and you do what he/she does. Let he/she watch and critique after!!!
doesn't your level I have designated "jobs" for primary, and secondary nurses during a trauma?
I am also a new grad in a level I trauma center. I just finished orientation. 2 months ahead of schedule. I was lucky though, my preceptor was wonderful. We spent the first couple of hours stocking the trauma bays, which at the time I thought was very trivial. But when that first good juicy trauma rolled in, I was grabbing things quickly because I had stocked it all. As far as the whole experience, attitude is everything. You managed to graduate, the rest will come. I had a senior nurse tell me to think about everything that could be wrong with my patient before they roll in. And the trauma surgeons, don't mind their yelling half of them are as wet behind the ears as we are. You can only do one thing at a time. I would have atalk with my nurse manager about my preceptor sounds like he just is not a teacher. Good luck.
Thanks for all the helpful replies. I've gotten great advice! I'm feeling a little better now. Got my ACLS book, I take the class in a few weeks, and have been reading through that. I've also gone back through the hospital documentation I was given a long time ago, and sure enough there IS a set list of responsibilities that each person in a trauma is supposed to do! Now, that's for the high level traumas, not the smaller ones, but still, it helps me to see it. I think our hospital tends to blend all those responsibilities, of course, everyone helps out with everything/anything they can, but just seeing on paper what respiratory does, what the techs do, what the primary & secondary nurse does, and all the trauma residents....it makes things more clear. My preceptor also has a lot of experience, so I'm finally realizing that he does things that other nurses don't do...he'll draw ABGs even though respiratory normally does that, he'll help the techs and do a lot of those things, just because he knows how, while other nurses just let the techs do their jobs.
I had a smaller trauma the other day, GSW to the leg & shoulder, and I felt like I handled it pretty well! I actually had to reach AROUND a new tech to start putting leads on the patient because he was standing there doing nothing! Must have been kind of overwhelmed, which of course I can SO relate to! And when I went to put the BP cuff on the guy, I reached around and started putting it on the pt's arm that was farther away from the monitor, of course my preceptor yelled "just put it over there" and I spouted RIGHT BACK "he's got a gun shot wound on this shoulder"...that felt good!
I also have been doing better with my IVs...not great, but better. My problem is that I take a LONG time to find just the right vein (not in a trauma of course, haven't done the IV in a trauma yet, but my regular medical pts), so I need to pick up the pace on that, which I know will happen naturally as I get more & more successful sticks under my belt. Anyway, last week I had a HUGE success with IVs. I got a 19 year old heroin user, and my preceptor was helping me find a site for the IV because I couldnt find one. He finally stuck the guy 3 times and missed all 3 times! He was getting REALLY annoyed (drug users are a sore spot for him, so he gets angry easily when they come in), and he called another nurse on the phone to come help him. Well, he left the room and while he was gone, I worked and worked at a little hand vein, tapping it & tapping it, and I got it! It was only a 22g, but heck, it was in, and I got blood out of it for labs without any problem, so I was happy!
So anyway, baby steps! I only have 3 more shifts to work with my preceptor, then the following week I start working my own shift, which is the opposite end of the week as my preceptor, so I'll only see him if he picks up extra shifts (which he frequently does). I'm not sure I'm ready, and I'm not sure if my preceptor thinks i am either, I'll find out when we have our last evaluation meeting next week.
Thanks everyone, for all your good advice. I have read and reread this thread many times!
I got comfortable with traumas as an EMT. Some places have agreements with different ambulance companies that will allow you to ride along and do stuff. I guarantee that will help if you get to do it. If not, watch what the EMTs do when they come in, eventually they're going to have to leave the patient, so someone will likely have to take over what they're doing. That will help you get more comfortable with everything. Watch what others are doing, too. Just be really observant and get some practice. Preceptors are good at being rude and obnoxious, if nothing else, so don't sweat that.
I'm a new nurse in a level 1 trauma center, and I'm still with my preceptor. He doesn't talk to me during the traumas, he's busy doing his own thing...afterwards he yells at me for having just watched everything going on around me, but not doing anything. I've tried to tell him that I don't know WHAT I'm supposed to be doing, but he says (or yells) YES YOU DO, YOU KNOW WHAT TO DO, YOU JUST DON'T DO IT!!.
One big hurdle for anyone with a soul and/or conscience, who potentially holds someone else's life in their hands is confidence.
Your preceptor yelling at you and ignoring you during opportunities for you to be doing what you are supposed to be doing is no way to build your skills or your confidence.
No professional should be yelling anyway. Ever.
Sit down with your preceptor and his supervisor. If you can't get the guy to teach you and cease the yelling, ask for someone else. He is clearly out of control (yelling isn't appropriate in any setting--not at a child, not at an animal, not at a patient, not at a subordinate). He needs some therapy or some time off or something.
But he doesn't need to be yelling at you. You might find that you have all the confidence in the world if you are coached and supported instead of punished.
Gosh I was reading the different replys and thought everyone had a lot of wonderful advise and the encouragement is just so priceless. But what I really want is to borrow your hubby VS because I would love a willing pin cushion for me to practice on! I have asked several peoples, classmates and family, no one is willing to give me a chance to try to get an IV in when I am in a more relaxed setting. He is a pretty awesome guy! I have 1 more semester to go before I graduate, I have had one opportunity to do an IV and didn't get it. I have always wanted to be in the ED but I thought I wouldn't be able to b/c I would have to know more about that quick response and automatic reaction/action. You make me feel jopeful about myself knowing that it isn't something one just steps into already seasoned. I hope to be there in the near future. Keep smilin
I'm a new nurse in a level 1 trauma center, and I'm still with my preceptor. He doesn't talk to me during the traumas, he's busy doing his own thing...afterwards he yells at me for having just watched everything going on around me, but not doing anything. I've tried to tell him that I don't know WHAT I'm supposed to be doing, but he says (or yells) YES YOU DO, YOU KNOW WHAT TO DO, YOU JUST DON'T DO IT!!.
So here's the deal: I can handle the chest pains and abd pains and UTIs no problem. I know what to do, what to ask the patient, what to assess. I get them in a gown, put them on a cardiac monitor & pulse ox & O2 if I think they need it, start and IV and draw their blood. It's routine, no big deal. But then when a big trauma comes in, GSW to the head, they're doing CPR, or an unresponsive person, decreased LOC, that EMS is bagging as they come in....stuff like that. The BIG stuff, the ones where the docs and the nurses and the techs are all crowded into the room together, the docs start to intubate...the techs are still doing chest compressions...I just don't know what to do! I really don't! There are so many people in there, by the time I think "oh, I need to get a pulse ox on this guy" someone's already done it. And then I think "I need to get the cardiac monitor leads" someone's done that. And most of them come in with an IV, but in traumas, we always put in a second line...and the CPRs too...but I suck at my IVs still, I'm still missing 90% of them! So I don't do that...then the techs start cutting the clothes off, and I wonder if I"m supposed to be helping do that...my preceptor does. My preceptor's usually running around doing stuff...getting an IV going, or drawing the meds, the Vec or versed or whatever if they're going to intubate. AND I HONESTLY DON'T KNOW WHAT TO DO! Everyone around me is doing stuff, and by the time i think of it, it's done.
Often my preceptor will tell me to "start writing"...so that I can record the times that the intubation occurred, the times of all the meds, etc etc...and later i put it all in our computer charting system. But I want to DO SOMETHING, not just write it down. But I don't know what to do! I really don't!
I have been told "remember your ABCs"...and I KNOW THAT...but when it comes in the door, A-airway and B-breathing, it's covered...they're patent, they're being bagged and sometimes they're already intubated...or the docs are preparing to intubate...so then what? C=circulation...I've kind of decided "ok, I'll be the one to get that first blood pressure" or to check pulses...at least that gives me something to do.
This whole post just sounds so stupid....what I want is for my preceptor to talk me through this stuff, when the pt rolls through the door, I want him to say "ok, because the situation is "x", I'm thinking "y" and I'm going to do "z" first...and the "xx" can wait for now because .... you know? I want him to talk me through what he's thinking, what he's doing first, and why. And what MY role is...versus what the techs are doing and waht the docs are doing and what respiratory is doing. I know they say "A, B, C" but in reality, when there's a whole room full of people, you're really all working on the A's B's and C's all at the same time, not waiting for A, before going to B and C, you know?
Anyway...how do I stop just standing there and watching, and start DOING something? Has anyone ever felt like this?
VS, i commend you for choosing to work in an ER environment -- i used to work pediatrics, a mix of med/surg and oncology kids over age 7 usually. i HATED being floated to pedi ER -- it scared the begeesus out of me, even after completing ACLS and the boatload of other courses available to become an acute nurse, as well as becoming a more experienced pedi nurse. there are so many things going on at the same time, the adrenaline is high in the room (as well as the testosterone!), patients are always disappearing on you (lol! like when a well meaning coworker and doc take your pt to the cast room, or Radiology takes the patient to Xray, etc). working on the floor you KNOW where your patients are! then to get a code or trauma on top of that! ultimately i chose hospice, because i liked the pace better. you know the patient is going to die, your job is to make the patient as comfortable as humanly possible and help the family cope. i find it more to my strengths -- but i'm ever so grateful for nurses like you who choose to bring order to such chaos!
teeituptom, BSN, RN
4,283 Posts
Hang in there
after awhile you can walk through most traumas without a thought