New ER RN- Normal to feel this way?

[nursebabyxoxo]

I have been a nurse for about a year and a half. I used to work on a geriatric med surg floor on night shift, with 8 patients and we were always short staffed. Definitely was tough, but I was damn good at what I did. Little background story..I was hired as a new grad on that floor and my last manager told me I was going to be the weakest nurse on the floor (this was before she got fired; and my preceptor was also a bully). Needless to say, I came a long way. New manager said I was one of the strongest nurses on the floor- I gained so much confidence and new skills. I was one of the youngest nurses on the floor and I was already charge nurse and a unit representative for excellence and won an award. Definitely shows that anything can be possible!!!!

Now I transferred to the ER which has always been my hopes and dreams. It is in a dangerous inner city and it is a trauma center too. The busiest ER in the state. Our nurse patient ratio is 6-7. We can get up to 3 ICU patients within that load. What is usually a normal nurse patient ratio in the ER? I am in the middle of my orientation and I feel completely lost as if I am a new grad. I feel like I don't know anything. I also have anxiety which i had my whole life but once I feel comfortable with what I do, it goes away. My preceptor is my friend but she has a very very very strong personality in the ER and sometimes talks down to me. She yells at like everyone so everyone knows how she is but no one takes it personally. It kind of brings back memories of my last preceptor on my old floor who bullied me and tried to get me fired. My current preceptor in the ER now though tells me I'm doing well even though she criticizes me with a harsh tone in front of people. I try not to take it personally but sometimes it brings me down. When I approach her about it she says "You know how I am, don't take it personally". I definitely do not have the confidence I had on my last floor since the ER is a whole completely new environment and world. I feel like I do not know anything. Does everyone feel this way during orientation in the ER? Even if I am not a new grad? Will things get better here on out? I try to compare it to my old floor- how I felt that same exact way in the beginning but 10000x worse, however ended up one of the best nurses on the floor, but sometimes it is hard to think that way.

[amzyRN]

Your ED sounds unsafe. Our ratio is 4:1. The stress factor might be contributing to your preceptor's attitude a bit. High stress environments bring out the worst traits in people, unfortunately. When I first started I had a tough preceptor, a little bit of a snarky attitude borderline mean at times but she had a good heart. I bit my tongue a few times because I could tell she was putting effort into precepting me. I eventually left that hospital because if was too unsafe, ratio violations, too many ICU patients at once. I needed to keep my nursing license. No matter how good of a nurse someone is, they won't always be able to do everything on their own. ED is a team oriented environment and that should be the norm. It's not possible to handle 2 or 3 crumping patients at once.

I have about 7 months and still feel like a beginner even though I have 4 years previous experience on tough med/Surg and Tele/cardiac step down floors.

[Ambiguphobia]

I'm just browsing through the comments and lamenting over how nice the ratios are outside of NYC.

My last shift, I started with 18 patients to myself, all level 3s and up. 4s and 5s are sent to fast track/smart rooms with NPs and PAs. This is totally typical, too. The worst ratio I ever had was 1:27, all level 3+.

We get one tech or nursing assistant, and one medical assistant to help between roughly 50 patients. Most of the time the tech/NA gets sent to sit on a 1:1, so we are stuck doing tech work and RN work. It's getting exhausting. But, alas, I love NYC, so I'm stuck with this absurd ratio.

[R8T3D_RN]

I'm still a new nurse 1 yr previous experience before my start in the ED. I was working pacu in a surgery center.

The ER was a whole new ball game. Been out of orientation a month now and trust me it does get better. I too have the same pt load 6-7pts. Some nights we are not staffed well. One night I had 8pts. Idk how I got threw it but you are never alone. You will always be learning and you will never feel 100% which keeps you on your toes. This winter has been insanely busy for our ER.

Once your off orientation if you feel overwhelmed speak up tell your charge nurse. Many times you have pts that become icu while your holding on to other pts as well.

Most importantly take care of your sickest pts first and you can never go wrong! Just keep trying to improve everyday.

Find someone you can talk to to vent about your days. I cried many times during orientation and in my first month alone. I cried on the way to work and sometimes leaving work. It's very stressful and there is a lot of pressure to move quickly. But it will pass and you will start to feel somewhat adequate.

IF IT DOESN'T CHALLENGE YOU IT WONT CHANGE YOU!! HANG IN THERE YOU CAN DO THIS (:

[FlyRN23]

Sorry id quit ! Why so many people ? thats beyond unsafe.. Very unrealistic hear in Florida... Just might as well be in skilled nursing, making more money of course.

[canoehead, BSN, RN]

Yeah, I'd quit too.

I wouldn't be able to tolerate the fear of missing a serious problem. The employees sound horrible. You can't have a decent ER without a great team.

[Guest374845]

Sorry to typify the strong personality stereotype but... if you have more than 5 room-worthy patients in an ED in the United States - and that's pushing it - your institution is retarded and you're retarded for staying there.

"Busiest", NYC, doesn't matter. There's no excuse for that.

[Armygirl7]

I also work in busy NYC ER- we are "supposed" to never have more than 7 pts, but my worst night was 11. And in Fast Track we typically can have 25-30 pts split between 2 nurses.

I have no praise or patience for nurses who are mean or humiliate new nurses - I have precepted many nurses onto our unit and I am firm, VERY firm, but never mean, I am straightforward and no-nonsense but never harsh. I learned best from nurses who treated me that way when I started in the ER so that's who I imitate when I am precepting. I was never made a better nurse - only made anxious and angry - by nurses who feel the need or have the arrogance to think it is their right as an ER nurse to humiliate another professional. I don't care how many years of hard ass experience you have - you're a zero on my list if you power trip on new nurses.

You have to know your sh*t in the ER, you have to be fast and efficient and serious, you have to be up-to-date with the latest EBP, and you also have to ask for help and be open-minded at all times when there is something you don't know. You have to have a thick skin because even though it is unecessary and it is not right, you WILL encounter, every day, a certain percentage of just arrogant, mean, a**hole nurses, docs, techs, managers, pts, and family members. They just exist, you can't let them rattle you. Luckily the greater percentage of people are fair, humble, AND kick-ass at their job too!

So this preceptor is giving you a chance to show your thick skin and also to practice being firm- I would absolutely say to this person directly "I really appreciate all you are teaching me but I cannot tolerate when you yell at me in front of other staff - it is humilaiting and demeaning and I am a registered nurse just like you, if you cannot teach me without crossing that line then maybe I need a new preceptor, but maybe you can learn some new things in this relationship just like I am!"

It's important in the ER to cultivate your friends - know the nurses you can go to and ask for advice or help without being made to feel like an idiot. Offer to help colleagues who you see are overwhelmed. Be the team player that you's want to have on your best team! Speak clearly, and directly to your team, communication is key; closed loop communication is essential in my book, and helps prevent errors.

First year in the ER is hell - no question. Hang in there, it is an awesome place to work.