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In over my head (long)


Specializes in Emergency.

I am a new grad working in the busiest ED (but not the highest acuity) in the state. I've been off residency for nearly 3 months now, and get assigned the "front" rooms about 1/3 of my shifts. Last night was the first time I had a patient code on me (not arrive cpr in progress, etc).

Home vent patient, large abdominal wound draining MRSA, SOB and with a syncopal episode. Medics gave a worthless history, which was surprising because they seemed to be at her house routinely. On arrival we had a hard time getting the monitor to read her rhythm without a lot of artifact, so I just pulled the crash cart over and hooked her up to it hoping for a better tracing. I got one - it was a wide, bizzare ventricular EKG that I had a hard time identifying. She was worrying me, so I went out to the nurses station and told one of our 20+ year veterans, "Uh, I'm in over my head in room 10. Can you come take a look at her rhythm with me?" We walked in, took a look at the monitor and watched her go asystole in front of our eyes. The rest of was weird. We coded her for awhile, and she'd get a rhythm back and then lose it. She was semi-conscious, too, pushing the hands away who were attempting CPR at times. We ended up pacing her, but she didn't have much of an underlying rhythm.

I run to get help when I start to get the sinking in my stomach that says "uncharted waters". I want to stay in the high acuity rooms because it is the only way I can learn, but at the same time I feel like I am a burden to the other nurses who come and help me out - they have a full assignment too. And unfortunately we don't staff by acuity.

I'm in over my head, but the only way out is up. I have to keep learning to ever get better. What do you think?


Specializes in ER, Occupational Health, Cardiology. Has 24 years experience.

Have you had an EKG course, or at least a course on how to read rhythm strips? If not, get thee into a course ASAP. You are doing the right thing by asking instead of trying to fake your way through things. Please continue to do that, and don't be afraid to ask the MDs either, if you need help with rhythms or something equally important. It is better to look new than look stupid for not asking and having to explain why you didn't after something bad happens! Then, one day, you will realize that the newer folks are beginning to come to you with questions that you can answer! You will never, ever, "know it all," but go to work every day anticipating that you are going to learn at least one thing new and you will never be disappointed!


Has 6 years experience.

I think everyone on here would agree that you did the most prudent thing you could have done given your level of experience/knowledge. And perhaps you did everything that a 30 yr. vet would have done...I dunno. But good for you for getting help. And even gooder (poor grammar purposeful) that you seem to have a very upbeat attitude about the situation.

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 29 years experience.

I think you did the right thing - you knew things were not right but not quite sure what to do with the info you had. Nothing you are describing was wrong. Nor, do I think you are a burden to the other staff.

bill4745, RN

Specializes in ICU, ER. Has 15 years experience.

...it is the only way I can learn, but at the same time I feel like I am a burden to the other nurses who come and help me out

I've been doing this for 14 years, and I still ask other nurses to look at rythym strips, and I certainly would have called for help in your situation.

You did the right thing, you will be a great ER nurse.


Specializes in Acute Hemodialysis, Cardiac, ICU, OR. Has 6 years experience.

I absolutely agree with the previous posters... I wish it was a lesson I had learned earlier: Don't fake what you don't know, and NEVER be afraid to ask for help. If having all these new circumstances and lessons haven't put you off ER, and you still enjoy going to work in your unit, then you have found your 'home' and will indeed be successful there.

Good luck to you and congrats on your new career!:cheers:

scattycarrot, BSN, RN

Specializes in ITU/Emergency. Has 10 years experience.

Sounds like you did all the right things to me! Knowing when to ask for help is vital and illustates safe pratice. You will never know it all and the day you think you do, is the day you should step aside.

Keep doing what you are doing! Good luck!

BrnEyedGirl, BSN, MSN, RN, APRN

Specializes in Cardiac, ER. Has 18 years experience.

Sound like you did everything right!! Never be afraid to ask for help and believe me,..I think all will agree,.I'm never upset when a coworker needs help with a critical pt!! That's what we are there for,.we are a team!!!


Specializes in Emergency.

Thank you all for your encouragement. I'm scheduled to work tonight, so it helps to have kind words to start me off!

this is good news!!!!

that pit in your stomach that made you go out and ask the veteran to help you is (hopefully) the beginning of what will become your best friend- intuition. not every nurse has it, but good ones definitely do! you might dismiss it as a pit in your stomach because you feel inadequate, but take it and nuture it!

like everyone else has said- don't be afraid to ask for help. anyone who critcizes you for that is truly a dangerous person to work with!

good luck. :up:keep it up!:cheers:

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