New to ER

Moving to a new specialty and scope of practice will require an adjustment period. It's just like starting all over. Actually maybe it's worse....I assume you felt comfortable, competent, and knowledgeable in your LTC position. And now you find yourself feeling like you know nothing. It's hard to start over like this. My best advice is breathe. Soak up all of the new information and skills that this new opportunity is presenting. In time, you will begin to feel more confident. Hang in there.

as long as you have a good support system you'll be fine.

Yes, I'm quite confident (and overly comfortable) in the LTC setting and know I'm a good resource there. I'm trying to breathe, hyperventilating even! :) Not really but I am trying to absorb EVERY thing which is also slowing me but that's ok. So yes, feeling ignorant. I'm hanging in there. Thanks so much for the advice!

Long story short, I graduated RN school in September. I've always (since getting my CNA in 2002, LPN in 2006) wanted my RN so I could begin working in the ED. Now that I'm there, I'm terrified!! So I've got 12 yrs on nurse experience but every bit of that is in Long term care. So the ED has been a BIG change. Which I anticipated. But I'm almost reverting. I just completed my 5th shift and I, with tears in my eyes, do not know that this is for me. I'm so paranoid about IV pushes (do NOT do these in LTC), am I pushing too fast, is it really in there, are they allergic, is there air in that line, is this the right med...all while trying to learn a stupid computer system. I'm never going to make it to the trauma rooms, and feel as though I'll never make it through this 1:4 if I'm not confident. Is everyone this nervous starting ED? Am I being silly? I know that its early on, but holy crap. And advice, suggestions, or self reflection is appreciated!

• am I pushing too fast? Maybe. But doing everything slow push is not the anser, because eventually, you won't really be slow, and when there is a drug where it matters, you will cause a problem. Learn your meds.
  
• is it really in there? Where else might it be?
  
• are they allergic? Maybe. Try not to kill anybody. Check the chart, ask the question, and know how to recognize and treat allergic reactions.
  
• is there air in that line? Probably. Gonna have to be a lot to cause a problem.
  
• is this the right med? Same 5 rights as in LTC.
  

You are terrified. Some fear is rational, some is irrational. Being scared of lightning when you are out on a golf course is rational.. Being scared by thunder when you are inside a house is not.

If you truly lack the ability to answer those questions, well, you should be scared. Some people do lack the ability to answer those questions, and should absolutely not work in an ER. (Or anywhere in nursing.)

I suspect that is not the case. It sounds like you are overwhelmed, and focusing on IV meds. If you are working in a good place with a good orientation, nobody expects you to be instantly competent, and there are safeguards to avoid patient harm. If not, quit. An experienced LTC nurse has a lot to offer in an ER, given the patient population. LTC is a foreign world to most of us, and having an expert around is great.

Are you good at LTC? Were you when you started? I am a good ER nurse, but was not when I started. Anybody who thinks they are is not safe. It takes time and experience and mistakes to get good.

I am an ER nurse and would be terrified to work LTC as I lack the skills. Maybe I could learn them. But I could not walk in and do your job safely, and would not work anywhere that did not safely ease me into the position.

And, I'll step out of line and to presume to speak for all experienced ER nurses. We will take a little scared and cautious over over confident any day.

Your reply is exceptionally helpful. I am terrified, which is not a part of my being so it's hard to admit. But these are people and I need to know what I'm doing. I know a lot of it comes with experience. I have an IV med focus (its bad! But getting better) because it's foreign, and answers seem to vary from nurse to nurse. And considering it is the staple of almost every ER visit, I need to feel confident when administering them. I know I can refer to my drug guide for dilutents and push time frames, but no where can I find how much it should be diluted in or how much to give with each push. I find diluting everything (thus far) in 10 cc NS while pushing slowly is creating almost 5 mins for each IV med. Needless to say, reeeeally slowing me down. Could I not just decrease the dilutent (say use 5cc instead) while pushing 1/2 mL to 1mL every 15 to 30 seconds or so? Or should I stick with the 10cc and push the same amount, just more frequently like every 5 seconds? Not being able to find those answers is annoying me to my core.