New ER requesting the reality check

[Valasca]

i am a new rn and will begin my er residency next week (in just a couple dayd. also i have very limited er exp.). i have read through the stickys. my residency is 14 wks long with opportunities to extende per diem. anyway everything seems great on paper and i am really optomistic about working there.

unfortunately, i am also terribly terrified!!!!!!!!!!!!!!!! i cannot believe that people trust me to "be a nurse". to alleivate fears and provide myself a reality check i would like to ask the following of every er nurse:

1. what is the most rewarding thing about being a (new) er nurse?

2. what is the mot difficult thing about being a new er nurse?

3. as a new er nurse; what was the most difficult patient you had to care for and what was their outcome? how did your nursing care contribute the outcome for better or worse.

4. if you could say one thing to a new er rn what would it be?

5. are you willing to support the fledgling new grad? why or why not?

many thanks for any replies!

Valasca

[kellykenny55]

I went into the ER at a level 1 trauma and level 1 stroke center as a GN. It was probably the hardest job that you could start out at but the one you will learn the most at. There have been times where I wanted to cry. It is not an easy job but it is do-able. ASK QUESTIONS if you are not sure. You would rather feel stupid by asking a question for a few minutes rather than potentially harming a patient. If you see another nurse doing something you are unfamiliar with ask what she is doing and if he or she minds explaining. I have been in the ER now for a little over a year and I am just starting to become really comfortable with it. Good Luck:yeah:

[cagumbo]

I'm a month away from finishing up my first year as an ER new grad. It's the hardest job I have ever done. I thought RN school was hard, but actually doing it, is the hardest. I had absolutely no hospital experience before walking in the ER. I can't believe they hired me.

But, you have questions, so here are my answers:

The most rewarding thing is when someone walks out and says, "Thank you." You rarely hear it, but when you do, it makes your day. Or something like, "You're the best nurse I have ever had." Something along those lines. In the crazy world of ER when someone takes the time to thank you, it means a lot. Also when you get a line the first try for someone who is a hard stick. It's where you get to pat yourself on the back.

New ER nurse difficulty is when it's hitting the fan in the ER and you just can't get a line or you need to ask a question and there's no one around who has the time, you feel so hopeless and sometimes a failure. You have to trust your gut and you don't really have a developed one yet. It took me a long time to get over causing someone pain. We go into nursing to help cure, make folks feel better, that kinda thing, but in the ER I'm always poking, prodding, doing something that causes someone pain before the relief can come. Lines hurt, foleys are uncomfortable, NG tubes, well, let's not even go there, broken hips, all that stuff, folks are in pain and we cause them just a little bit more.

Difficult pts come in all shapes, sizes, ages. All my folks have made it so outcomes are they either are dc'd or they go upstairs to a room. Difficult pts are such a suck of all of your efforts. They either didn't get enough or the "right" pain meds, get a drink when they were doing a CT study, you name it. Difficult is difficult but you have to remember we see people at their worst. For the most part, no one really wants to be in the ER. We get paid to be there, the pts really want to be elsewhere.

I'd tell a new grad ER RN that it gets easier. You'll hear it so much it drives you crazy, but I'm happy that some things are now rote where I don't have to think about it, you just do it. Your practice will get better with practice. There's no substitute for doing when it comes to nursing. Keep your eyes open. Keep your ears open. Learn who the good nurses are and watch what they do, how they do it and emulate them.

I'll support any new person in the er if they are an RN, a tech, a registration person, a cafeteria worker, you name it, I'll support them. It's hard as hell being new. New at anything, so I try to give them as much as I can if they need it. Since, the way I figure it, if you can teach them properly the first time, you won't have to keep showing them again and again. And we all need a friendly face. If you help someone, they will remember you.

The ER is hard. You see a lot of a lot of different things. However, it does have its rewards. Good luck. Enjoy the ride. Know that it will take about 18 months before you are comfortable doing what you do. Give yourself a break. Breathe. Take that extra second to call pharmacy when in doubt. That has saved my fanny and some of my docs fannies more times than I care to admit. Docs make errors too. The way I see it is I don't want to be up there on the stand talking to a judge, jury and the family of a harmed pt and say, "Judge, I didn't have that extra minute to call/read/research about this drug/rate/adverse reaction and I harmed the pt for not taking one extra minute." Seriously. Remember that. Take those extra seconds to double check everything until you are comfortable with drugs, procedures, etc. Find your resources. If you need help doing something, turn around and offer to help that other person do what they need doing. Relax. Think. Do. Be who you are yet have fun while you do it. You get to see some amazing things while in the ER. When I need to compose myself, I go to the bathroom and take that extra second to just sit without anyone wanting anything from you. Close the door, lock it and take some deep breaths.

You'll be fine. Good luck.

b

[Lunah, MSN, RN]

For me, the most rewarding thing about being an ED nurse is being able to take care of patients on what is sometimes their worst day ever, and to help them get through it, survive it, feel better, whatever.

The most difficult thing for me is a pediatric code or traumatic death, and seeing the parents' anguish. I'm a very logical, not-so-emotional person in the ER setting (okay, and everywhere else), but seeing loved ones mourn a loss makes me well up, every time. And that's okay.

Most difficult patient --a shaken baby, with several brain bleeds and a skull fracture who was starting to herniate. The baby lived, but will have intense medical needs forever.

To the new ED RNs: it gets better. Not always easier, but after a while you'll realize that you know how to do this!

I support new grads in the ED ... I was one! :) Some people can do it. Not everyone can. Recognize your limitations. There is no shame if the ED ends up not being a good fit for you.

Had a 6 or 7-year-old pediatric pt. with a bad distal humerus fracture yesterday. He came in screaming, "I have two elbows on that arm, why why why???" It felt fabulous to be able to calm him down, keep him calm, get an IV in him, get him pain meds, and get him more comfortable and less anxious about an awful looking arm. After just 1 mg of morphine, he looked at me and said, "Can I hug you?" It was the cutest thing ever. And made my entire day of sweating in a very hot, un-air-conditioned ED worth every second. (We were on generator power due to a bad storm and power outage.) I love what I do. :) (Just prefer it to be a bit cooler ...)

There will be good days and bad days. There will be awful days and slow days, and days where you'd trade your best trauma shears away to anyone for a chance to go to the bathroom just one time. It's the best.

Good luck!!

[TLSpaz, ASN, RN]

LOVE THIS:

"Difficult is difficult but you have to remember we see people at their worst. For the most part, no one really wants to be in the ER. We get paid to be there, the pts really want to be elsewhere."

[Fribblet]

LOVE THIS:

"Difficult is difficult but you have to remember we see people at their worst. For the most part, no one really wants to be in the ER. We get paid to be there, the pts really want to be elsewhere."

Eh, not always true. I see plenty of patients that are there everyday I work, and I see plenty of patients that need a security escort off the property because they don't want to leave.

I also see plenty of people in status dramaticus who love being in the sick role and the attention it garners from hospital staff and family members. I also see lots of people happy to be in the ER because it means a narcotic high.

So, there are plenty of patients who would rather be anywhere else but the ER, but I see A LOT of patients who wouldn't want to be anywhere else. :)

[TLSpaz, ASN, RN]

Eh, not always true. I see plenty of patients that are there everyday I work, and I see plenty of patients that need a security escort off the property because they don't want to leave.

I also see plenty of people in status dramaticus who love being in the sick role and the attention it garners from hospital staff and family members. I also see lots of people happy to be in the ER because it means a narcotic high.

So, there are plenty of patients who would rather be anywhere else but the ER, but I see A LOT of patients who wouldn't want to be anywhere else. :)

status dramaticus:rotfl:

After six years of employment in a Level 1 Trauma center (not current, but not so long ago that I have lost touch), I have seen all of the above of which you speak. (Never heard status dramaticus though! Funny!) I just thought the sentiment was a refreshing reminder (at least to me-not speaking for anyone else) not to be so jaded or cynical. Believe me, I have a hearty supply of jaded and cynical at my disposal...and I don't always like that about myself.