Moved to a new ER, now I don't feel like I'm a real ER nurse anymore

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Vent alarm (you may wish to silence due to high pressure):

I went from a small community hospital ER after 8 months to a level 1 Trauma center since it was a closer commute and allowed for greater career growth. My coworkers at the smaller hospital all told me I was a great nurse and would do well there. Most of our patients in the smaller hospital are ESI 3-5's though a lot of our nursing home trainwrecks we classify as 3 that end up being admitted to tele for sepsis.

5 months later in the new place I don't feel like a real ER nurse anymore. The new place is just sensory overload with alarms going everywhere. The moment I turn around when I'm charting on a computer a resident just pops up and takes the computer WHILE I'm sitting down! This happens so many times! The floor nurses there give me so much flak about taking report and are flat out rude to me. As a floor nurse I never gave the ER an attitude about report and even said just send me an SBAR and send them up. Sometimes even taking care of 5 belly achers and one of them being admitted is overwhelming me now. In my other job I could take care of 7 of them with 2 of them admitted with similar acuities.

I feel so overwhelmed there that one of the days I got so busy I felt like I killed a patient. The patient presented SOB and possibly septic so we put her on bipap to help with the respiratory effort and it took an eternity and a half to get IV access. I was getting back from CT scan for a r/o new onset cva then I see a bunch of nurses RUNNING in, I don't remember how but the patient evetually developed a pneumothorax and got a chest tube. Later on the patient coded and the family decided on comfort measures only. During the code however I got so overwhelmed while charting and had to walk out, only for someone else telling me I had to go back in. What also bothers me is that my preceptor beats me to detecting any changes in a patient's status before I can, which worries me if I'm watching my patients enough. I swear on my other job if I had that same patient, I would be monitoring that one extremely aggressively and would have caught the changes/hung the abx within an hour. I'm so busy just doing tasks I feel like I don't have time to learn.

Also there seems to be a personality clash. A coworker told me I'm way too nice and I have to be a bit more assertive. Another coworker I get along with said he was happy that management hired a personality like me since everyone there is all Type-A and gungho while I'm a little more reserved and rather just get work done. I'm surprised I didn't fail out of orientation after that whole fiasco with the septic patient. Now I feel like the nurses there think I'm a terrible nurse and are keeping me in the lower acuity areas.

I've never come across a job so difficult and part of me wanted to work in that hospital since I got out of nursing school since it was close, paid well, allowed for career growth, and had potential for learning opportunities. But now there is a part of me thinking I can't do this and that even nursing is the right career choice for me.

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Specializes in Cardiac.

I think you're probably doing a great job, you just still need time to get used to this newer, higher acuity department. You can't be everywhere at once, if you were with a CVA pt while your septic pt got a pneumo, you can be happy that someone happened to be around and noticed something was wrong. That's why teamwork is important.

I'm sure you'll be great!

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Thank you for reminding me of why I prefer my small community hospital ER!

But seriously, there is no one size fits all response here. Some people say give a new job at least a year before you decide if it's for you or not. I disagree. I think that even just five months in, you know in your gut whether you're going to be happy there. But what you decide to do is completely up to you. It's like pain- completely subjective.

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Specializes in Critical Care; Recovery.

I personally would tough it out for a year or so just because it will look good on your résumé. After that, if things don't improve I might find something else. Perhaps the other hospital will take you back. I personally do not believe a resident or anyone else should be able to take your computer. That may be a time for some assertiveness, but pick your battles. I wish you the best.

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I'm going to tough it out for now. But damn I get so nervous when I go there.

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Specializes in Med-Surg, Emergency, CEN.

When it gets rough, take a giant deep breath and re-prioritize. About the vented pt, it sounds like it wasn't something you did or didn't do but it happened while they were your pt. I'm sure that the provider and RTs are feeling the same way you are about that.

Don't let anyone run roughshod over you whether it be coworkers or floors. You don't have to yell back. Just hang up or walk away and talk to them a minute later when they've composed themselves. ;)

You can still be in the ER and not be a type A personality. It takes a rainbow of people to make sure it works. As you know, the ER is the most teamwork oriented place in the hospital and not all pts can handle the outgoing craziness of type A's. Sometimes a quiet personality is exactly what they need. (I'm a type A and have had to send in calmer/quieter personalities at times.)

Hang in there! It's a new, crazier environment that your previous place. It's almost like you are a new grad all over again. You've already lasted about half a year which says something good in itself.

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Thanks for the encouragement everyone, there was a slight ray of hope the other week. I happen to work in the same hospital as my mother does but she's in a different department. I took care of a patient that ended up going to the OR during his stay and at the PACU the patient started asking the nurses: "Oh do you have a child that works in the ER?" so her coworkers asked my mom to come in and the patient's wife mentioned my name and said: "Oh you have such a nice kid, he's a great nurse in the ER" she gave her a hug and stuff.

It made me feel better about myself.

I wish I knew how to be more assertive though.

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Specializes in Pediatrics, Emergency, Trauma.

I wish I knew how to be more assertive though.

That's going to take more practice; you can reflect on your missteps and alter them; reflect on when a situation arises again how you would do them differently and professionally and go from there...I certainly learned throughout the years to hone how to stand up for myself and be professional while doing it. :yes:

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You will learn assertiveness in due time. Day after day you will find that patients, families, physicians, coworkers....inevitably someone during your day will try and walk all over you. Eventually you will decide when it is enough and learn how to speak up, professionally. It does take time and confidence.

FYI, your old job was not a typical ED. Welcome to the chaos of emergency medicine. You will learn to love it!

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Specializes in Trauma, Teaching.

We actually have computers marked "MD only", and those are the ones they are supposed to use. Stay off the nurses' comps!

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