I am a "brand" new nurse of about 7weeks. I am orienting in the ED, my "dream" unit, and I am feeling like this was a huge mistake.
Nursing is a career change for me, so I have had NO previous medical/health related experience and I think it's really hurting me, so I've been told and I'm also thinking it myself. I was pulled into the educators office on Tuesday and told they were giving me two more weeks on the unit with another preceptor, to see what their opinion was, to see if I was going to make it in the ED. Apparently, I am lacking in skills and some educational areas for the ED. Well, needless to say, I was totally thrown for a loop when I was told this. I felt as though I was coming along pretty well. Also, prior to being hired, by the way they knew I had NO previous health related experience, I would have up to 6 months of precepting if need be, and I was now told it is 8 weeks, but they will allow longer if needed. I thought I was just going to LOSE it when they told me this.
They told me I may be better off working on med/surg for a year to get experience and I could come back to the ED at a later point if I wanted to. Do I look for a positon in this hospital or look elsewhere if I take this route or I am forced to take this route???
I need some advice/suggestions please, on what you all think I should do. I'm feeling like the med/surg might not be a bad idea after all, especially since I have NO previous experience. Most of their "new" nurses have been techs in the department for 5+ years, so they are very comfortable when they transition to their RN positions.
I am an old nurse, working trauma now. Our unit hires new grads too as does the ICU. Back in the not so great olden day, you needed one year of med surg to go into crit care. Let me reassure you that your are not alone. I find that unless the new RN has worked as a "tech" in the unit, their first year is so difficiult. I truely believe there is an esaier transition to crit care from med surg; however, in the end, it works out on most cases.
I have suggested a more formal mentoring program for new RN that continues on after orientation for at least one year. I think each new crit care RN needs a champion or mentor. First to be a sounding board, to help develop organization skills and to help keep the sharks at bay.
You first year there is so much that are assimilating into your practice that you don't even realize that you are learning. Then there is all the new clinical information. All this is very stressful because, school had you thinkiing that you would be able to fly right into your job, and perhaps even be a "change agent" bla, bla, bla. So, that even adds to your stress, becasue your self expectaion arenot being met,
So here a little advice:
1. You worked hard to achieve your RN. Don't let that be unappriciated.
2. Find a mentor with a lot of experience and excellent skills and ASK for support.
3. There will always be jerks, Learn to politely, either shut them off or shut them up. I see many older nurses telling young nurses how to things incorrectly. What you where taught clinically in school is right.
4. Read up on organizational skills and communication skills.
5. Don't let the jeks get your down. This is your career. Trauma is a tough area, you need to be a little tough to work there.
6. Remeber to be kind to new staff when your the experienced RN.
Thanks nursemike!! I have a lot to think about these next few days. Do I just tell them I want out or ride it out at this point??
Hey, Homegirl! (Just noticed your location.)
I don't think either way would be wrong. Would your manager and educator be amicable to letting you try a couple more weeks, then transfer if you still need improvement? At this early stage, you can develop a lot in two weeks. On the other hand, if it looks pretty definite that you're going to need to make the move, nothing wrong with doing it sooner.
I do suggest you try to avoid preconceived notions of what you'll be getting into. Some posts on these boards make med-surg sound like a living hell. That may be true in some facilities, but it isn't universally. You can also get the impression that med-surg is a lot easier than critical care.
There can sometimes be a mentality that "my patients are sicker, so I must be more important/a better nurse than you..." Med-surg is different, but I don't know any area of nursing that isn't challenging (if I did, I'd give serious thought to transfering there!) As I see it, the advantages to med-surg for a new nurse are that they can sometimes afford to give you more time to get acclimated, the skills you'll acquire apply to any area of nursing, and you'll see a lot of variety. Also, while those points may be most true of a true general medicine/general surgery unit, a lot of the same applies to acute care in specialty areas, like ortho or onc. Anywhere that entails a lot of fundamental nursing for a full load of patients. If I get pulled to onc or cardio, I'll see meds and patients I'm not used to, but the general idea is still pretty much the same.
I do like the set-up at my facility, where several floors have step-down subunits, rather than one big stepdown for the whole house. The chance to work some shifts with three more acute patients is a good chance to learn things you don't see as much with regular acuity, but the skills to juggle 5-6 "floor" patients are also important. But, in the early going, the 5-6 regular patients teach you a lot about time-management, priorities, IV sticks and the like.
You make some good points re: benefits of some med-surg units. When I worked a predominantly post-op unit on 12-hr nights, it seemed staff rarely had the same patients from shift to shift... due short patient stays, the varied staffing schedules, the floor layout, and the balancing of patient acuity among staff. And most nurses rarely worked more than two nights in a row anyway, so there wasn't a lot of chance for familiar patients, unfortunately. Also due to the ever changing combination of staff on any particular shift, it took that much longer to get a feel for each other and how to deal with the different personalities, strengths and weaknesses.
Looking back, maybe I'd have done better on a predominantly medical unit. I hated daily receiving patients new to me straight from surgery - groggy, pale, needing Q15 vitals... etc. I much preferred receiving patients in a state where I could talk to them, assess their chief complaints/medical conditions and any other issues.
Well anyway, just thoughts... : )
When I was still in school, a friend in the CT lab advised me to go into critical care, because I'd be wasting my talents on a med-surg unit. It was a nice ego boost at a time I really needed one, but once the cerebral edema went down, I asked myself, "What are my talents?" I decided the only one I was sure of was that I was a good listener, which didn't really seem so relevant if all my patients were sedated and on vents...
But I think there are some advantages over ED, over even ICU. High on the list would be continuity. Most of our patient stays are several days, some even run for several weeks. It's typical to get the same assignment for consecutive nights, so even if the first is rocky, they've lost the element of surprise when you come back. If a routine procedure like a dressing change doesn't get done on your shift, the next shift will pick it up (and you'll do the same for them without complaining, of course!)
Not being general medicine or general surgery (seperate units, at my facility) somewhat limits the variety I see, but only somewhat. I've had patients on trauma service, nephrology, OB, and even peds. We often get kids, usually >6 y.o., on our epilepsy unit, and not long ago they sent us some regular peds (fairly easy ones) when the peds unit was full. I got to show one of my mentors how to set up a chest tube, one night, since I'd had the same pt the night before and had read the instructions (it was kind of an odd set-up, and even standard chest tubes have most of us scratching our heads a little. Unit wide, we might see them twice a year.)
I won't go quite so far as to suggest everyone should have to start out in med-surg, but I do agree with the conventional wisdom that it's probably the best way to develop your skills. If nothing else, the turnover is fairly high, so the experienced nurses are more accustomed to dealing with newbies. Of course, by your second year, you're one of those experienced nurses--it's a little unnerving when the next batch of hapless newbies is coming to you for advice, but if nothing else, you'll know who to ask.
Sage advice and info from this bolded!!
I work med/surg myself, in an ortho/neuro unit, and we get our fair share of admissions from the ER. I personally love the ER admits because it changes stuff up a bit. It gives me the opportunity to do the frontline education to the patient, which I love to do (usually for scheduled surgeries the patient already has already been educated in the doctor's office or in pre-op classes). Not only that, but the pt's are usually fairly stable by the time they get to me - so there's a little less urgency. The odd patient that "goes downhill" every so often is more than enough for me (my coworker just had a patient code last week...i nearly had one myself)!!!
Just keep in mind that if you wish to continue an RN in the ER, if your patient gets admitted your actions and ability to gather the correct data affects everyone down the line...from the RN you hand your patient off to, the physicians the patient is admitted under, to the discharge planners. Everyone is relying on you and your data collection skills, procedure skills, and communication skills to be on point. Not necessarily from a "leaving a mess" standpoint, but from the standpoint of prompt and effective care for the patient. I've seen patients get medically misdiagnosed based on poor assessment skills by RNs down there...nothing major, but it's definitely happened and continues to happen.
And believe me, there are certain RNs down in the ER where I work that I don't even really pay attention to when they call to give report. Mainly because they never really seem to handle of what the heck is going on. To me, it seems like they enjoy the status of being an ER nurse rather than being cut out for the type of work they do. For instance just last week I had a patient admitted for a broken hip. This new nurse, fresh off orientation (I know her personally outside work) says she inserted a foley because the patient didn't pee. I asked her if there was any return. She said, "Oh ...uhhh...yea, like 100 and it was still draining when I left the room..." When the patient came up, there was nothing in the bag, and the bag was completely dry. Not like, "it got emptyed" dry, but literally dry. Not to mention there was no other output charted at all. So she basically lied to me because she didn't know the answer to my question. Indeed, that is an example of completely ineffective data gathering and poor communication. This is not the first time this sort of thing has happened with that particular nurse either. She's down there thinking she's doing a great job, in the meantime we're upstairs left scratching our heads. I'm not comparing her to you, but I think sometimes it is not always apparent where the deficiencies lie.
So don't feel bad if they want to give you some more time with a preceptor. It's not a taint on you, it's probably because they feel like you're a good fit for the job and want to help develop you a bit more! I think if they truely thought you weren't a match they'd be more blunt about it. Just keep in mind that if they are suggesting med-surg it's because they're more experienced than you. They may see deficiencies where you think there are none, just because they've been doing the job a LOT longer than you have and know what it takes. I doubt it is anything personal, it comes down to the ability to provide effective patient care. I'd certainly ask them for a written evaluation of your performance so you can review it at your leisure and make a plan for improvement in the areas that your deficiencies lie.
My 2nd year of school I worked as a tech in the ED for a month, untill they pulled me in the office and said 'it just isn't working out', after nearly 30 minutes of me begging and pleading with them as to what on earth I had done wrong to deserve to be fired... "you just aren't cut out to work in the ER, you'd make a great critical care nurse..." Apparently they just 'know' if you're right for it... I think this is the biggest load of crock I've ever heard. Only I know what is right for me, they just didn't give me an ample oppertunity to prove myself.
To this day they tell me that was the only reason they let me go... devasted me. Threw me into a major depression. Nearly failed my 3rd semester because of it.
The ER have a different breed of nurses. If you don't fit in, they simply move on to someone else.
Its a relief to read these posts. I feel for you. I am in my 7th week orientation, just picked up 6 patients on a med/surg floor and freaking out. I feel like a robot running around pushing meds and pushing paper, no time to care for patients or families, certainly no time to think or get the bigger picture and connect the dots. I have to believe blindly that it gets better with time.
You have to do what is right for you, and nobody can tell you what that is. But, if working in the ED is what you really want, I'd suggest you ride it out, do your very best, and if you're still not cutting it, apply for a transfer to a general medical or med/surg floor. Don't look at it as a failure; any specialty, like the ED, is going to be a very tough place to start for a brand new RN. If it's just too much to start out in a tough place, you are not a failure, you are not alone, and you should not be made to feel that way. There is nothing wrong with needing to get your feet on the ground in a less critical environment first. Later, when you feel more confident and capable, apply for a transfer to the ED.
It's not the end of the world! Just keep your head down and keep plugging away, doing your best.
i am a "brand" new nurse of about 7weeks. i am orienting in the ed, my "dream" unit, and i am feeling like this was a huge mistake.
nursing is a career change for me, so i have had no previous medical/health related experience and i think it's really hurting me, so i've been told and i'm also thinking it myself. i was pulled into the educators office on tuesday and told they were giving me two more weeks on the unit with another preceptor, to see what their opinion was, to see if i was going to make it in the ed. apparently, i am lacking in skills and some educational areas for the ed. what did they expect?? you are a new rn...you aren't going to have the skill set and education of someone who has been in the ed since the dark ages!! i thought that was what a preceptor is for, to guide and teach you the ins and outs of whatever department you are working on.well, needless to say, i was totally thrown for a loop when i was told this. i felt as though i was coming along pretty well. also, prior to being hired, by the way they knew i had no previous health related experience, i would have up to 6 months of precepting if need be, and i was now told it is 8 weeks, but they will allow longer if needed. i thought i was just going to lose it when they told me this.
they told me i may be better off working on med/surg for a year to get experience and i could come back to the ed at a later point if i wanted to. do i look for a positon in this hospital or look elsewhere if i take this route or i am forced to take this route??? you can certainly look in that facility for a med surg position if you otherwise like the facility. med surg for a year is a good idea (please no flames from those who disagree) before transitioning to an er or icu. check in your area for inservices/conferences/seminars on er topics in order to increase your knowledge base.
i need some advice/suggestions please, on what you all think i should do. i'm feeling like the med/surg might not be a bad idea after all, especially since i have no previous experience. most of their "new" nurses have been techs in the department for 5+ years, so they are very comfortable when they transition to their rn positions.
overwhelmed here, please share your thoughts!!
((((((((((((((((((((((((((hugs)))))))))))))))))))))))))))) and good luck!!!
piasugarjersey- Thanks for the wonderful feedback and advice!!! I did have a "great" day on Friday, my preceptor stated that he thought I would definitely work out on the unit, but how long the "uppers" want to give me is another story. This preceptor is a new person for me. He is sooo much better than the person they had me with before. I thought she was good, but after being with this "new" individual for the last couple of days, I can already see changes in myself and how I am thinking (critically) that is, LOL.
I am keeping my fingers crossed, but I have accepted that fact that if they want to move me to med/surg, I will accept that with no problems. I tell myself that it will only help me, not hurt me.
tamz04- best of luck to you. You put it nicely, no time to connect the dots. We know how to do it or understand the concept, but just need a little more time to get there. This is what's killing me.
I had two diff. situations yesterday that I fully understand why something was being done after it was all over and done with, but as new nurses we are not able to think that quickly yet. I hope it comes with experience!!
november551-I hope I don't become one of those nurses, LOL. Actually, after reading your post, I will make sure I do NOT do this to anyone because I would not want it done to me if I were on the receiving end. I too would be mad if someone called me to give report, told me all of this info only to find out that half of it was inaccurate or false. What a shame.
I work in a Level II trauma center, very big hospital compared to what I'm used to from my clinicals in school. The most beds I've ever seen in an ED is 30 plus 2 trauma bays and the hospital now where I'm working has 50 beds. We are expanding and adding another 12 beds to the ED which should be up and running in about 2 months. YIKES!!! But, I now have positive thoughts and if it's meant for me to be there, I will be there; otherwise, I will move to med/surg and accept that with no problems.
piasugarjersey
4 Posts
Hello new Trauma Nurse
I am an old nurse, working trauma now. Our unit hires new grads too as does the ICU. Back in the not so great olden day, you needed one year of med surg to go into crit care. Let me reassure you that your are not alone. I find that unless the new RN has worked as a "tech" in the unit, their first year is so difficiult. I truely believe there is an esaier transition to crit care from med surg; however, in the end, it works out on most cases.
I have suggested a more formal mentoring program for new RN that continues on after orientation for at least one year. I think each new crit care RN needs a champion or mentor. First to be a sounding board, to help develop organization skills and to help keep the sharks at bay.
You first year there is so much that are assimilating into your practice that you don't even realize that you are learning. Then there is all the new clinical information. All this is very stressful because, school had you thinkiing that you would be able to fly right into your job, and perhaps even be a "change agent" bla, bla, bla. So, that even adds to your stress, becasue your self expectaion arenot being met,
So here a little advice:
1. You worked hard to achieve your RN. Don't let that be unappriciated.
2. Find a mentor with a lot of experience and excellent skills and ASK for support.
3. There will always be jerks, Learn to politely, either shut them off or shut them up. I see many older nurses telling young nurses how to things incorrectly. What you where taught clinically in school is right.
4. Read up on organizational skills and communication skills.
5. Don't let the jeks get your down. This is your career. Trauma is a tough area, you need to be a little tough to work there.
6. Remeber to be kind to new staff when your the experienced RN.