I NEED ADVICE!

[Mebzone05, BSN]

I have been a nurse for almost 4 years. I have 1 year med surg experience, 1 year obs, and the rest in an ER. We have four zones. One is an urgent care type zone, a medium acuity zone, psych zone, and our critical zone. My first couple of months I pretty much had to beg to get into the critical zone. A year later, I am pretty much in the urgent care or psych zone every shift. I feel completely unprepared anytime I am in the medium acuity or critical zone which only happens once every few months. My skills have gotten worse, my time management is worse, and I am scared to work with high acuity patients at this point. I don't know what to do. I don't know if I'm making any sense, sorry If I'm not clear. I am asked to do things that I've never done, give meds I've never heard of, and be a part of codes when I rarely get any experience in them. It's terrifying. I feel as though I need to start all over. I feel like I wasn't properly trained. I am contemplating leaving nursing all together. I feel like I have absolutely no clue what I'm doing with high acuity patients. I feel like I am a danger to these patients. I almost feel as though I need to redo orientation.

Any advice would be appreciated!

[nursej22, MSN, RN]

Is there a critical care or trauma nurse care course you could take? If nothing else, I would get study guides for those and review. 

[Mebzone05, BSN]

21 minutes ago, nursej22 said:

Is there a critical care or trauma nurse care course you could take? If nothing else, I would get study guides for those and review. 

All I do is study and watch Youtube videos for skills but I don't have any chance to apply anything in real life. I can't retain the information or skill if I can't actually use it in practice. All of this studying has been a huge waste of my time. I'm studying for my CEN right now.

[CharleeFoxtrot, BSN, RN]

Have you asked anyone in charge why you are not being scheduled in the other zones?

[RNNPICU, BSN, RN]

Some EDs will have you train for the higher acuity areas after you have mastered the other area.

I would definitely ask about how to get experience there, as well as see if there is a TNCC course or something similar you can take? Ask your your educators what you can do to up your skills

 

[JKL33]

Talk to your manager and let him/her know you would like to be rotated through all the zones regularly. In few words as possible, let them know of the difficulty that arises when you rarely have contact with (medical) ESIs 1-3 and that you would prefer to be able to operate expertly in those situations. Straight up ask for the opportunity to be reoriented in those areas. Be kind, pleasant and professional but very direct.

That puts the ball in their court and you will have the opportunity to see how they respond. You will make future decisions based upon how they respond.

Something like this: "[pleasantries, etc.]...I'm interested in regularly rotating through all zones. I would enjoy the challenge of learning those areas and want to be able to perform at my best when I am there instead of only being in the other zones occasionally. I'd like it if we could come up with a plan for additional exposure and orientation."

If they come up with excuses right at that meeting, be even more direct (but still pleasant): "This is important to me; I want and need to increase my competence in those areas. I need to ask you to give it some thought and see if there's a way it can be worked out."

If they mention a difficulty that would need to be accommodated, be flexible (such as if you would need to alter your schedule, shift, etc.).

GOOD LUCK!

[Been there,done that, ASN, RN]

" urgent care type zone, a medium acuity zone, psych zone, and our critical zone." I ever never heard of an ER divided like this.  You are expected to function, at random.. in four different areas?? Certainly, your main concern is functioning in the critical zone. Tell your manager you need a specific orientation to that area.

 Good luck, that's a mess.

[Mebzone05, BSN]

23 hours ago, Been there,done that said:

" urgent care type zone, a medium acuity zone, psych zone, and our critical zone." I ever never heard of an ER divided like this.  You are expected to function, at random.. in four different areas?? Certainly, your main concern is functioning in the critical zone. Tell your manager you need a specific orientation to that area.

 Good luck, that's a mess.

Yep. We have no clue what zone we will be in until 5 mins before our shift starts.

[Mebzone05, BSN]

On 4/16/2021 at 2:39 AM, CharleeFoxtrot said:

Have you asked anyone in charge why you are not being scheduled in the other zones?

Well, a part that I left out is that nearly a year of my ER time was on night shift. The problems started once I switched to day shift. I believe that there are simply too many nurses fighting for the critical care zone which is only staffed with two nurses a shift. The senior nurses, and the ones that have been on day shift for longer seem to get special treatment. One of our techs literally refuses to work anywhere besides the critical zone which they likely allow due to our high turnover.

[LibraNurse27, BSN, RN]

Do you like working in the critical zone? If not, maybe you can ask that until you can re-train there and then consistently work there to keep up your skills, that you don't want to be scheduled there. If there are nurses that work there every day maybe they are more likely to accommodate that than accommodate you getting consistent turns there. But if you really want to learn critical care, keep trying, and if not start looking for a new job, maybe in a high acuity ER or an ICU? Good luck and I hope it works out!

[Nunya, BSN]

On 4/17/2021 at 12:16 PM, Mebzone05 said:

Well, a part that I left out is that nearly a year of my ER time was on night shift. The problems started once I switched to day shift. I believe that there are simply too many nurses fighting for the critical care zone which is only staffed with two nurses a shift. The senior nurses, and the ones that have been on day shift for longer seem to get special treatment. One of our techs literally refuses to work anywhere besides the critical zone which they likely allow due to our high turnover.

Yep, that's the problem.  Nurses who have been at hospitals for years/decades get these kinds of perks.  Pretty shortsighted of management to let this happen as eventually they'll quit/get sick and then what happens?  All you can do is ask.  Or get a new job....

[speedynurse, ADN, BSN, RN, EMT-P]

Why not try another ER? There are higher acuity ERs, trauma ERs, pediatric ERs, etc.