New ER Nurse , Feel SO stupid

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Hi everyone,

I know this topic has been introduced before, but I need some guidance if possible. I work in a community ER. Previously I have only worked in Post Partum for about 6 yrs. I have always wanted to work in ER. And surprisingly I got this job in May. My orientation was 12 weeks. August was was my first month on my own. I am usually in a district with a 8 patients. Mostly level 3 with a few 2s mixed in. And pain, chest pain, SOB. Not to mention sometimes our frequent fliers that I have already come to know and recognize. Anyway, my problem is that I run around doing all my tasks...and have little time to look at labs or results, not to mention the fact that I feel this is important so I can learn values and what they mean. I have been reading and trying to grasp emergency medicine books to change my mentality. Obviously, there are big changes I need to make when it comes to my ER pts. I LOVE it. But feel I am failing my pts as well as myself because when I am asked questions I dont always know the answers (and cant wait to get to my phone to google what the hell might possibly be going on). Yesterday I had 10(!) Pts. I felt as if I was drowning (other exp nurses said the same thing, so I kept pushing ahead), but I guess what I am really asking is what is the best way to become more knowledgeable about the care I am giving. Is it just a matter of time? My mngr keeps telling me I am doing g fine and these things will come with time and it can take at least a yr to feel "comfortable". She tells me at this stage to just be able to recognize when and if my pt is about to crap out. Everyone keeps saying the rest will come in time. Is this true. What can I do to facilitate this happening. I am willing to do anything. I really like ER nursing but hate feeling like I am the stupidest person in the room

Thank you !

JJ

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Specializes in ER.

10 pts is INSANE. I don’t have anything to offer on how to manage that many. Just do the best you can. The ER is really task-oriented. The more you see, do and hear about the more you understand and can anticipate. Good luck!

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So then is my thinking wrong in that I am trying to understand each disease process? Lol this is part of my confusion and apprehension I suppose. What is it I should be focusing on in order to "think like an ER nurse rather then a floor nurse" which is what I have told. As a new ER RN, what should I be focusing on. I cant formulate my real question into coherent thoguhts... sigh. Lab values , meds, disease process , symptoms, etc all sound important. What's the best way to look at things and become as knowledgeable as possible so I dont feel like a dunce..? I just feel like EVERYONE knows so much more then me..which is an good thing because I go to them to learn... but I cant retain everything.. where's the best place to start. What are the must knows.. ?

Thanks !

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Specializes in Adult and pediatric emergency and critical care.

8 patients is unsafe, I wouldn't work in any ED that thinks that even a veteran emergency nurses can provide safe care for that assignment.

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Specializes in MedSurg, Clinic, ER.
On ‎9‎/‎5‎/‎2019 at 7:58 PM, CTFD_RN said:

10 pts is INSANE. I don’t have anything to offer on how to manage that many. Just do the best you can. The ER is really task-oriented. The more you see, do and hear about the more you understand and can anticipate. Good luck!

On ‎9‎/‎5‎/‎2019 at 8:41 PM, PeakRN said:

8 patients is unsafe, I wouldn't work in any ED that thinks that even a veteran emergency nurses can provide safe care for that assignment.

Just an idea but I think that OP is saying 10 patients over the course of a shift, not all at once. Forgive me if I'm wrong, but this isn't that bad for a bigger ER... less than 1 per hour average.

To the OP, it just takes time. I (and many other nurses) have been in your shoes... as your manager said, work on recognizing when your patient is going "bad" and take it day by day. It's normal to feel overwhelmed in the midst of chaos. Maybe keep a notebook handy and jot down things you want to read up on during down time or off hours. (s/s for example) And you can always answer questions with "I don't know but I'll go find out and return with that information." Hang in there... and welcome to the roller coaster ride. :)

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Thanks , so long as someone doesn't have a magic answer that is eluding me I feel like I am doing ok then.

Also I WISH it was 10 a shift it most certainly was 10 at a time. For that day and some others. Usually it is 1:8.

And yes.. I am in NY since that seems to be the comment when people see that ratio.. it it's pretty much the same wherever you go so I can't just leave the job. My only saving grace is I do love it and feel like a true nurse finally.

Thanks for everyone's info it is much appreciated.

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Specializes in MedSurg, Clinic, ER.
8 minutes ago, jjaye said:

Thanks , so long as someone doesn't have a magic answer that is eluding me I feel like I am doing ok then.

Also I WISH it was 10 a shift it most certainly was 10 at a time. For that day and some others. Usually it is 1:8.

And yes.. I am in NY since that seems to be the comment when people see that ratio.. it it's pretty much the same wherever you go so I can't just leave the job. My only saving grace is I do love it and feel like a true nurse finally.

Thanks for everyone's info it is much appreciated.

Oh goodness that is indeed a crazy ratio. I’m sorry. Hang in there. Time will make it easier.

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Specializes in Emergency/Trauma Nurse.

Ten patients is too many! I’ve got a few years experience as an ED nurse and we get 3 patients. There are times it’s so busy I feel rushed and time crunched. I’m pretty sure if we had ten patients each and every nurse in my department would quit. (Not saying you should do that). My only suggestion is to MAKE TIME to go over those results. Also, get yourself some form of standard organization going on. All patients may end up waiting longer but I have a feeling your dept isn’t going to notice. With ten patients, no one has the time to criticize you!

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Specializes in Emergency/Trauma Nurse.

My other small piece of advice is to focus on the truly emergent patients. Most people in an ED on an average day are not at risk of dying, but some are- focus on those. Good luck to you!

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Thanks, that makes sense. I will definatley begin to look at results and focus more on my sickest pts. Makes sense and I feel I will learn more that way. One of my problems has been to rush and get all the tasks done that I dont feel like I have time to do anything else. But the longer I am there the more I am realizing that if I dont take the time to look at labs then I am not doing anyone any favors. Thanks for the info, it's been encouraging. Yesterday I had 6 so it was much more manageable. Those are the days where I need to hone my skills and I am hoping they become more second nature as time goes on. When I do have 8 or 10 pts I tend to feel lost because everyone has orders at the same time. And if course everyone comes to the ER thinking they will be helped, diagnosed and out the door all in 45 mns. I need to Thicken my skin and let these people know gently but firmly that isnt how it works. Also, when I am at the mercy of a couple docs that are real jerks.. it's difficult to tell them what I need. I need a course in assertiveness also. Sigh. SO MUCH TO LEARN.

Thanks everyone!

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Specializes in ED.

Are you working in Albany area? I worked there for a few years and 8-10 patients at a time was the norm... BUT the average LOS was also like 6 hours so people just waited and waited. The place I worked was full of travelers (what a surprise! they had high turn over...)

My advice, is to know that that ratio is not normal, and not safe. Get a little experiance and get out.

Focus on your sickest patients first and know that tasks can wait for non-emergent patients.

You aren't expected to know every detail of every disease; just the emergent ones! Your specialty is EMERGENCY medicine.

I felt like when I was there I was mostly doing tasks and not doing justice to my patients.. So I left as soon as I could!

Good luck!

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