New ER Nurse - Feel Like Quitting Job

[xxMichelleJxx]

Hi everyone. I recently started a position as a Staff Nurse in a ER in October. I graduated with my ASN in May 2015 and obtained my RN license in July 2015. Before starting in October in the ER, I worked from July 20-September 28 as a RN in a LTC facility. This ER is my first hospital job. I worked in a nursing home for two years before becoming a RN (worked as a LPN). I didn't really like LTC and wanted to work in a hospital really bad. I was so excited when I got the job. I was a fairly new RN, I only have my associates (I live in NYC and it's so hard to get a hospital job without a BSN) so I considered myself to be very lucky.

So even though I have prior nursing home experience the hospital is like a whole new world to me. I started orientation during the first week of October. We were in the classroom part of orientation until the end of October. Then we were on the floor with a preceptor from November to the 1st week of December. We were told we were going to receive 3 months orientation. This never happened. I was hired for over night (7:15p-7:45a). Our orientation was only in days. When we transitioned to nights to continue our orientation, we didn't receive any. Our first night we were put alone. They gave us 1-2 rooms and said if we had any questions to ask another nurse. Then the next day we were completely on our own with our own assignment. And it has been like this ever since. We were still supposed to be on orientation but I believe they cut it short because they are so short staffed. Our head nurses or the director of the Ed who hired us never once told us we were being let off orientation early. We were never asked how we were doing. We were never even evaluated to see our status. I was so frustrated but I went along with it. I didn't complain or anything. But now I have gotten to a point where I get so overwhelmed. The other day I came on shift and was assigned 4 rooms. I had a ICU patient along with 6 other patients of varying ESI levels. I was so stressed out. I had to hang propofol for my pt and then I had all my other pts to worry about. And the triage nurses kept triaging more pts to me despite the fact that I already had a icu pt. In our Ed there is no set nurse-pt ratio or set number of rooms. But I think it's so unfair and unsafe. On regular icu units, the ratio is 1:2. From what I heard if we have a icu pt, we are only supposed to have 2 other stable Ed pts and that's it. But that's not happening here. The head nurse was aware of the whole situation and didn't do anything. I started crying at work and felt so embarrassed. The next day at work was no better. I again had a icu pt with 5 other pts and I kept getting more pts triaged to me. So now I don't know. I am honestly terrified of going back to work and see what awaits me. I have work tonight and am already saddened just by thinking about it. I want to quit. I know I just started and I am not even 3 months into this new job. What should I do? Also this is a city hospital. I'm afraid I might be burning bridges with all the other hospitals it is affiliated with. What should I do? Is this normal? How are things in your ED? And tips or advice would be really appreciated

[R8T3D_RN]

I say if you are absolutely miserable then start looking for a new job.

I work in a er now and have been for 4 months now and I absolutely hate it. I dread going to work. I'm applying to new jobs. Why should I be miserable in a job I hate if I know Im eventually going to leave. I used to work in ambulatory surgery center and loved it. I'm trying to go back to that. But good luck to you and to whatever you decide.

[TMGRN70]

I find many of these comments to be unsupportive: "Suck it up, buttercup". Her question is old, so she may have grown to love it by now, or left the environment entirely. But honestly, the ER is not for everyone.

I am not a new nurse. However, not too long ago I took my first ER position. I do not love it. I, too, was thrown into the deep end on day one. This seems to be the common method of training in the ER. While it did help me get on my feet quickly, which I know is the point, it really does lead to a feeling of insecurity. The staff working around you pretty much looks at you like you are an idiot because you don't automatically know what to do, what's the protocol, etc.

Now that I've grown past that point of insecurities, and know I can do my job confidently, I'm still not sure if it's for me. Why? For the same reasons the original poster noted above. I feel unsafe. I worry every day that my license is in jeopardy. It is not uncommon for me to have an ICU patient circling the drain while on a drip (that the ICU won't take because they need a second CAT scan, or a central line, or something else that can actually be done in ICU but I digress), another patient in respiratory distress, another with a walk-in clinic boo boo, a psych patient throwing feces while in a Soma bed, and a detox patient screaming obscenities & spitting at staff while in four-point restraints - all while waiting for my 6th or 7th patient to arrive. Add to this the regular and increasing environment in emergency rooms (during my 8 hour shift last night, we had to call security six times), and there is less time giving actual care, and the majority of time spent working with a CYA mindset.

Rather than denigrating the original poster for not feeling like the ER is for her, perhaps we should be questioning why, as a group, we are accepting these abhorrent and dangerous conditions as the norm.

[PeeWeeQ, ADN, RN, EMT-B]

I'm not a nurse (yet), but, I have worked in the medical field for a long time, particularly in Emergency and Prehospital care. I was a combat medic in the military and I had to learn to be several things very quickly:

1. Assertive--both for myself and as an advocate for patients. Sometimes those are one in the same.

2. Organized--someone suggested using sticky notes. I use whatever note-taking material is available.

3. Knowledgeable and thorough--I created and used a "priority of care" algorithm for myself, miniaturized it to note card size, and had it laminated. I referred to it whenever I felt like I was forgetting something. You're going to forget things if you don't find a way to remember. Recognize this early on and invent ways to help yourself. If other people laugh, who cares? You do what you have to do.

4. Look out for yourself--Learn to take a minute here and there and reevaluate all of your patients, trends, and interventions, and adjust as needed. Take your time and ASK FOR HELP WHEN YOU NEED IT. Fast is great, but is worthless if you are fast and WRONG. Even have someone come along behind you and give your patients a once-over from their perspective.

5. Learn to take criticism--yup, it sucks, but it will help you grow. The more you take the easier it is to take.

6. It is NOT for everyone--I have had to take infantry line medics and move them out of the field and into a more controlled environment because they couldn't handle it. I've had medics ask for me to move them themselves. No shame in it at all. Know yourself and your limitations.

Hang in there! I really do hope it all works out for you!

[Granuaile, ASN, RN]

I find many of these comments to be unsupportive: "Suck it up, buttercup". Her question is old, so she may have grown to love it by now, or left the environment entirely. But honestly, the ER is not for everyone.

I am not a new nurse. However, not too long ago I took my first ER position. I do not love it. I, too, was thrown into the deep end on day one. This seems to be the common method of training in the ER. While it did help me get on my feet quickly, which I know is the point, it really does lead to a feeling of insecurity. The staff working around you pretty much looks at you like you are an idiot because you don't automatically know what to do, what's the protocol, etc.

Now that I've grown past that point of insecurities, and know I can do my job confidently, I'm still not sure if it's for me. Why? For the same reasons the original poster noted above. I feel unsafe. I worry every day that my license is in jeopardy. It is not uncommon for me to have an ICU patient circling the drain while on a drip (that the ICU won't take because they need a second CAT scan, or a central line, or something else that can actually be done in ICU but I digress), another patient in respiratory distress, another with a walk-in clinic boo boo, a psych patient throwing feces while in a Soma bed, and a detox patient screaming obscenities & spitting at staff while in four-point restraints - all while waiting for my 6th or 7th patient to arrive. Add to this the regular and increasing environment in emergency rooms (during my 8 hour shift last night, we had to call security six times), and there is less time giving actual care, and the majority of time spent working with a CYA mindset.

Rather than denigrating the original poster for not feeling like the ER is for her, perhaps we should be questioning why, as a group, we are accepting these abhorrent and dangerous conditions as the norm.

I know the OP is from awhile ago, but the topic interests me as I'll be starting a full-time ED position soon. Reading some of the replies, I agree, there are quite a few that don't seem very supportive. Working in NYC in an ED and regularly having an ICU pt plus up to 8 other patients, to any sane person, sounds down right dangerous, and 3 months in, I would imagine any nurse except one with tons of urban ED experience would be overwhelmed, and understandably so. I hope this nurse found her power and made a decision that is both empowering for her and strengthening for her practice as a nurse.

[bgxyrnf, MSN, RN]

Now that I've grown past that point of insecurities, and know I can do my job confidently, I'm still not sure if it's for me. Why? For the same reasons the original poster noted above. I feel unsafe. I worry every day that my license is in jeopardy. It is not uncommon for me to have an ICU patient circling the drain while on a drip (that the ICU won't take because they need a second CAT scan, or a central line, or something else that can actually be done in ICU but I digress), another patient in respiratory distress, another with a walk-in clinic boo boo, a psych patient throwing feces while in a Soma bed, and a detox patient screaming obscenities & spitting at staff while in four-point restraints - all while waiting for my 6th or 7th patient to arrive. Add to this the regular and increasing environment in emergency rooms (during my 8 hour shift last night, we had to call security six times), and there is less time giving actual care, and the majority of time spent working with a CYA mindset.

It sounds like your hospital is suffering seriously from not having state-mandated ratios. An unstable ICU patient should be singled and certainly no more than 2:1.

I'm not sure which I prefer more about California nursing, the excellent compensation or the state-mandated ratios... the latter, I think... especially since I might one day be that patient who needs nursing care.