New ER RN- Normal to feel this way?

FL_Nurse92 · Nov 19, 2016

I am also new to the ER, I have 3 more weeks of orientation. Previously I was on a progressive care unit (ICU step down) for about a year and a half. Our ER nurse to patient ratio is 1:3-1:4. I couldn't imagine having 6 patients at a time to be honest.

nursebabyxoxo · Nov 19, 2016

I am also new to the ER, I have 3 more weeks of orientation. Previously I was on a progressive care unit (ICU step down) for about a year and a half. Our ER nurse to patient ratio is 1:3-1:4. I couldn't imagine having 6 patients at a time to be honest.

what state do you live in?

FL_Nurse92 · Nov 19, 2016

Florida

Buyer beware, BSN · Nov 25, 2016

ERs are notorious for having strong personalities. I learned a long time ago that I had to go outside myself and see the motivation and personality behind it. Otherwise I'd be #butthurt all of the time. I would take her good constructive feedback for what it is, change what you need to to grow, and learn from the process.
I'm an outgoing and strong personality, but I do not bark like some of my cohorts do. I just learned to go with the flow. I also know exactly when I have to bark. And I will. If I get to that point, you better pay attention.
Everyone has different approaches and learning styles. I caution against throwing the bullying phrase around. It's trite and unnecessary a majority of the time.
Hang in there. Be happy you're getting oriented to the ED. I've been in my for 5 years or so now, with NO orientation. Plenty of strong personalities and yet I grew in spite of the negativity.
It might get harder before it gets easier. But push through it and learn. Growing pains, and all that.

Yes, barking is just another way of saying I'm losing my marbles and because YOU pose no return threat BOW WOW.

She needs to lighten up, take a deep breath. You all sound busy.

Let me guess: Miami, Orlando, Tampa Jackson?

mrk_RN · Nov 26, 2016

I have been in the medical field for over 20 years the last 10+ as a nurse - 2 in ICU, 4 ER, 4 in management and just returned to ER as a staff RN. I have

First of all comparing ER to the floor is like apples and soccer balls....no where near each other. Trauma center makes the comparison like chocolate and a pile of poop!!! I love ER & critical care. You have to have a thick skin to make it in these areas. I'm sorry you feel your friend is not being very nice but when a life is on the like I need to know I can trust you at my side, coddling & sugar coating isn't going to benefit you when that GSW, MVA or mass casualties arrive and all hands are needed on deck to save a life. If you were expecting Grays Anatomy you might want to take a moment and rethink your decision to go to the ER. It is the hardest job you will ever love....or you will decide nursing isn't for you. I have worked with nurses who can't tell their @** from a hole in the ground in the ER and let me tell you, I will NOT take even my worst enemy to the ER they work in. Trust yourself, don't take it personal and treat every patient as if they were your family member.

The greatest thing about nursing is...if this unit doesn't work ok there are countless others all of which need a great nurse!!!!

nutella, MSN, RN · Nov 26, 2016

I think what you experience is "normal" nowadays.

Even though you are not a new grad - you are a new nurse in the ER and it is a steep learning curve.

Try to cruise with the flow.

Be respectful to coworkers and patients, positive attitude, desire to learn new things.

If your preceptor is always like that it means that the place accepts incivility and such behavior and most likely it is seen as "ok" and "will toughen you up" and "if you can not get through this you won't survive the ER - it shows you are resilient".

You are still in orientation - it is a "culture shock" but also seem to question your own capabilities and how your self-perception and self-worth fits in. You were the "star student" so to speak at your old place but this is a new place and a different "game" - you will need to accept that you are starting from scratch in a lot of ways and that you will have to proof yourself (again). There is a certain humility that goes with such transitions as you realize that you certainly know something but not everything and that you are out of your comfort zone. It is mostly a matter of adjusting to this new situation and making the best out of it.

If you are not willing to sacrifice your "comfort" and "status" or if you feel that this level of stress and anxiety is something that you do not wish to go through at this time in your life it might be better to go back to a job that fits those priorities.

If you think you will like the ER and this is what you want to do for some while and you can live with the fact that it will take some time to adjust and you are starting "from scratch" you probably want to go with the flow and see how things are in a couple of months. It is best not to take stuff personal in a high stress environment like the ER - there is no way you will survive in that place with the typical ER population, high intensity, stressed other professionals, if you are thin skinned and take stuff personal. There will a time when you will be saying something that is not so ideal in such an environment and chances are they will cut you a slack as well...

TheCommuter, BSN, RN · Nov 26, 2016

Moved to the Emergency Nursing forum.

Lev, MSN, RN, NP · Nov 27, 2016

Yes, a 6-7 ratio is very high. I don't know how I would manage with that ratio. Do your patients board for hours in the ED? Our ratio is is 1:4 in the main ED and up to 7-8 in fast track (4s-5s with occasional soft 3s). It is normal to feel completely overwhelmed and like a new grad all over again. I too was a very strong med-surg nurse who transferred to the ED. In the ED it is a whole new territory, especially in a trauma center. I don't work in a trauma center but work in a very high volume, high acuity ED, also the "busiest in the state." If any one has every watched that show Code Black - that is our waiting room on an almost daily basis - very crowded. We call the waiting room "the jungle." I have been the in the ED for almost two years and I am still not 100% comfortable. As long as your preceptor is not discussing every little mistake with management I would just put up with her. As long as she doesn't criticize you in front of patients.

nursebabyxoxo · Jan 6, 2017

Yes a 6-7 ratio is very high. I don't know how I would manage with that ratio. Do your patients board for hours in the ED? Our ratio is is 1:4 in the main ED and up to 7-8 in fast track (4s-5s with occasional soft 3s). It is normal to feel completely overwhelmed and like a new grad all over again. I too was a very strong med-surg nurse who transferred to the ED. In the ED it is a whole new territory, especially in a trauma center. I don't work in a trauma center but work in a very high volume, high acuity ED, also the "busiest in the state." If any one has every watched that show Code Black - that is our waiting room on an almost daily basis - very crowded. We call the waiting room "the jungle." I have been the in the ED for almost two years and I am still not 100% comfortable. As long as your preceptor is not discussing every little mistake with management I would just put up with her. As long as she doesn't criticize you in front of patients.[/quote']
Sometimes we are adequately staffed and when we are we have 5-6 patients. Most times though we are either short staffed or have so many holds in the ER that we end up having 7-8 patients. There was one night nurses had 8 patients and this included one cardiac arrest, a stroke code, a post trauma, 2 icus holds who were intubated and 3 other ER patients (YIKES). I just don't get how ICU floors can have max 2 patients and in the ER it is okay to have 5 critical patients on top of 3 other patients. On orientation I have been able to juggle my 5-6 patients but i have not experienced a lot of critical critical things that people have experienced (like a fresh intubation). My preceptor was a great teacher but is the type of person that would pick fights with family members and talk down to people just because it makes her feel powerful. There was this one day a tech went out of her way to draw labs for patient and she was mad saying how she already did it and how he should open his ears and not have add. (which i took offense because i struggle with add). I liked her criticism but her tone of voice and the way she said it was in the worst way and I felt like she didn't understand what I meant half the time. For example: an ALS patient came in with hypoglycemia and she said what interventions would you do. I always think beyond the box so i said I would put an IV in blah blah and she was like "you wouldn't check the blood sugar? what did you learn in nursing school then?" And she would like yell it in front of all the staff. It was embarrassing having everyone stop talking and staring at me while she raised her voice at me. Stuff like that. Obviously i would check the blood sugar if the blood sugar was low. I just thought she wanted to know what else I would do beyond that.
There was also a time a staff member told me she did everything for one of my patients. I had no idea she did until she told me. and my preceptor overheard and said to me "what did i tell you about getting help from other people? i told you numerous times not to get help! you need to learn on your own".
There was also a patient who asked for a sanitary napkin. I did not know what a sanitary napkin was. And my preceptor says "how do you not know what a sanitary napkin is.. it is a pad" and I was like "why can't they just say pad or a sanitary pad" and she said "it doesn't matter. that is a word for a pad. you should know what that is."
I constantly felt stupid.

nursebabyxoxo · Jan 6, 2017

ERs are notorious for having strong personalities. I learned a long time ago that I had to go outside myself and see the motivation and personality behind it. Otherwise I'd be #butthurt all of the time. I would take her good constructive feedback for what it is, change what you need to to grow, and learn from the process.
I'm an outgoing and strong personality, but I do not bark like some of my cohorts do. I just learned to go with the flow. I also know exactly when I have to bark. And I will. If I get to that point, you better pay attention.
Everyone has different approaches and learning styles. I caution against throwing the bullying phrase around. It's trite and unnecessary a majority of the time.
Hang in there. Be happy you're getting oriented to the ED. I've been in my for 5 years or so now, with NO orientation. Plenty of strong personalities and yet I grew in spite of the negativity.
It might get harder before it gets easier. But push through it and learn. Growing pains, and all that.

Ever since I started the nursing career I developed a hard core. That's why I was always charge nurse. I knew how to deal with complaints and rapid responses. I had confidence because I was comfortable. In the ER I still have thick skin and am good at not showing how I truly feel, but deep down inside when I am overwhelmed I feel hopeless. There was one time though I went to the bathroom to cry just because I was too overwhelmed. I had a STEMI and a stroke code and a post trauma, a moderate sedation, a blood transfusion etc and the doctors were trying to rush me because they get paid per patient. After the breakdown I felt better. I know in the beginning, it is hard. I keep trying to tell myself things may get better. I want to have that confidence back that I used to have on my old floor. Once I get comfortable I know I will.

My last preceptor was a bully though. She called me obese all the time and asked me why I wore my eye make up the way I did. She told me i wasn't smart enough to be a nurse and my old manager said that i was going to be the weakest nurse on the floor. She even counted how many times I went to the bathroom and went to my manager and reported my every move. There was a day she copied my hairstyle and the way my eye makeup was even though she criticized it. When i asked her about it she said she wanted to know what it was like to put up being me. who does that. My educator even wasn't willing to change my preceptor and it was by far the worst 3 months of my life.

Lev, MSN, RN, NP · Jan 6, 2017

Sometimes we are adequately staffed and when we are we have 5-6 patients. Most times though we are either short staffed or have so many holds in the ER that we end up having 7-8 patients. There was one night nurses had 8 patients and this included one cardiac arrest, a stroke code, a post trauma, 2 icus holds who were intubated and 3 other ER patients (YIKES). I just don't get how ICU floors can have max 2 patients and in the ER it is okay to have 5 critical patients on top of 3 other patients. On orientation I have been able to juggle my 5-6 patients but i have not experienced a lot of critical critical things that people have experienced (like a fresh intubation). My preceptor was a great teacher but is the type of person that would pick fights with family members and talk down to people just because it makes her feel powerful. There was this one day a tech went out of her way to draw labs for patient and she was mad saying how she already did it and how he should open his ears and not have add. (which i took offense because i struggle with add). I liked her criticism but her tone of voice and the way she said it was in the worst way and I felt like she didn't understand what I meant half the time. For example: an ALS patient came in with hypoglycemia and she said what interventions would you do. I always think beyond the box so i said I would put an IV in blah blah and she was like "you wouldn't check the blood sugar? what did you learn in nursing school then?" And she would like yell it in front of all the staff. It was embarrassing having everyone stop talking and staring at me while she raised her voice at me. Stuff like that. Obviously i would check the blood sugar if the blood sugar was low. I just thought she wanted to know what else I would do beyond that.
There was also a time a staff member told me she did everything for one of my patients. I had no idea she did until she told me. and my preceptor overheard and said to me "what did i tell you about getting help from other people? i told you numerous times not to get help! you need to learn on your own".
There was also a patient who asked for a sanitary napkin. I did not know what a sanitary napkin was. And my preceptor says "how do you not know what a sanitary napkin is.. it is a pad" and I was like "why can't they just say pad or a sanitary pad" and she said "it doesn't matter. that is a word for a pad. you should know what that is."
I constantly felt stupid.

I think she is just mean. That is beyond just a strong personality. Wow, one nurse had all those patient? Your ratio is very high and there are better places to work. Ratios tend to vary with geographic area. It is ok to ask for help but you do want to be capable of doing things without the tech because there may not be a tech one day.