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?
This is a GREAT thread. As a brand new grad I was just offered ED days in a level one. I'm both excited and terrified. Reading this thread made me feel like its doable, though very challenging.
This is a GREAT thread. As a brand new grad I was just offered ED days in a level one. I'm both excited and terrified. Reading this thread made me feel like its doable, though very challenging.
I feel compelled to share. I graduated as a RN in August '04, worked as a Echocardiographer for 11 yrs. prior. Started out in Med-surg, did so for 9 months, then landed a job in a underserved area of Phila, ER. Been there for 4 months. Got my ACLS, going for a dysrthymia class in a few weeks. I feel confident and then unconfident. Codes are intimidating. But the crew I work with are team players. We all work together and that seems to be the most important factor. Hang in there.....that's what I tell myself, otherwise you'll never tackle knowing a specialty. I never wanted ER, telemetry seemed more me since I was in Echo land for some time. But it landed on my lap and I took off with it. I tend to have the mentality that whatever happens is for a reason. So I just try to focus on what I need to learn, ask a ton of questions........(and importantly, not caring if someone gives me the " you don't know that?" look) and take it one day at a time. Remember you must be an advocate for yourself too. Best of luck to you! Belinda,"aka" Bindy, Miller
I feel compelled to share. I graduated as a RN in August '04, worked as a Echocardiographer for 11 yrs. prior. Started out in Med-surg, did so for 9 months...
I had worked on a medical floor for 2 years then changed locations and ended up in a small rural hospital. Here, they greeted me with a big hug, telling me how grateful they were to have me, then told me that I would probably be the only RN on duty most of the time and would be in charge of Med/Surg, ICU, OB/Delivery, AND ER. I received ONE week of orientation and was put on my own.
The ER was down stairs and when you went around that corner, you had no idea what would be there to greet you. On my first day[lucky to have another RN on duty] I was sent to the ER to take care of a GSW victim. I went, as told, with a very experienced aide. I dove in, head first, and thanked God for the aide that knew where everything was. We stabilized the patient, then transferred her to a trauma center in the big city.
You guys are very lucky to have that precepter program for which I now am involved as one. In my early years, the slogan was SINK OR SWIM and thank God I could swim! :)
hi... i wont deny that straight away from the ER point of view i have no idea what goes on there as i have never been in that environment
but listen to yourself... you can put down exactly what you are thinking on paper but like so many have said before me i am sure... have you actually told your perceptor or mentor as we call them here in scotland what the hell is going on, i know your not in the ideal situation to say wow slow down where do i start, but there are so many people in that room with the MI for instance who think it is very routine, some of whom may think that you are just in the way, take a step back a deep breath and watch, and when your mentor goes ballistic at you out of earshot of everyone else the next time, tell him where you stand, why you feel you have no job, tell him if you fail he fails as a mentor, tell him that you are not happy with his teaching skills or his clarity in instructions and you need someone more competant,
dont let him put you down... we all have to learn somehow, take a deep breath and pick yourself up, before you know it a couple of years down the line you are going to be a mentor to the newbie on the ward, and hopefully you will have more patience than your own current mentor
:)
NYNewGrad
142 Posts
This is a GREAT thread. As a brand new grad I was just offered ED days in a level one. I'm both excited and terrified. Reading this thread made me feel like its doable, though very challenging.