New grad ED woes.. advice appreciated

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Hello all! 

I graduated this year and landed my dream job in an ED.

I have not had previous ED experience, but was lucky enough to be hired. I was offered two positions in EDs, and took the one for less money, hoping I would be more comfortable there. Unfortunately my orientation has gone nothing short of unwell.

I am currently on my 3rd month of 4 total. I have not felt welcomed at all. I have had multiple different preceptors (like 5+) and was put in assignments that did not have any acuity.

I finally spoke up and got a lot of acuity and the whole assignment given to me at once. (1:6 ratio here) I was obviously a bit overwhelmed with the drastic change. They ended up telling me 2 weeks ago that they did not know if it was a good fit for me because of time management.

I don’t leave things for the next shift and always keep safety as my #1. I have honestly been so discouraged that I’m unsure if I even want to stay in the ED. If things don’t improve they will help me find another position in the hospital. I’m tempted to start applying elsewhere and start fresh..  worried though because I’ve only been here for a short amount of time and that they will know if I need references checked. 

The job offer I turned down said I could always have a job if I was unhappy with where I chose. I also feel discouraged from even applying to other ED, as I feel like I’m not cut out for it anymore. 

Thank you all for your time

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Specializes in Peds ED.

I think it can’t hurt to apply to that other ED again. Worst case scenario it sounds like you’ll have a job on another unit in your current hospital. 5+ preceptors is a lot when it’s not one or two main ones with subs here and there.

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"They left if that if things don’t improve they will help me findanother position in the hospital. "

This facility is trying to help you succeed. Many facilities would just let you go.

Your orientation was not ideal, but few are. If you are still having problems after 3 months in ER, perhaps some med -surg experience would be beneficial.

 Best wishes, whatever your decision is.

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Specializes in NICU/Mother-Baby/Peds/Mgmt.

I think a big problem here is the 5+ preceptors!  I've had 13 inpatient jobs (military mostly) and I've only ever had one preceptor with a sub VERY occasionally, like no more than 3 or 4 times for the whole preceptorship.  And orientation was 3 months in some places.  I don't think charge nurses realize how important it is, ESPECIALLY for new nurses, to have one consistent person who knows what you've done, what you need, and what you need to improve and how to give that to you.  Whatever you choose to do I would ask how many preceptors you'll have, and stress that you only want one.  Even if their schedule stinks it's worth it to follow them the whole time, imo.  One of my preceptors liked to work weekends so for three months I had 2 or 3 weekends off.  That stunk but I learned a lot from her.  

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Specializes in orthopedic/trauma, Informatics, diabetes.

At my facility, they really try to help and will offer another position. If you like the facility and want to stay, then stay in another area. 

My only issue is the other place might be worse. And if you do move, make sure to give the feedback about having too many preceptors. I work in a large system and they actually are open to constructive feedback. 

Hope you can find your spot!

 

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Thank you all for your responses. I was just deeply upset that they were so critical of me during this meeting but did not offer any positive feedback. I asked for some specific examples of how to improve and they couldn’t offer me any. I felt as though the offer to get placed in another area was more of a threat than a helping hand offer... which is even more upsetting. I feel like 6 (mostly unstable) patients as a new grad is a lot as well in an ED. 

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Mixed thoughts:

16 hours ago, NewGradEDRN said:

was put in assignments that did not have any acuity. I finally spoke up and got a lot of acuity and the whole assignment given to me at once. (1:6 ratio here)

Was this significantly into your orientation, like beyond half-way through?

If so, I would defend yourself. Say that it is probably not appropriate to judge your time management in a full assignment when you've only been working on that for [x] weeks and was previously given only easy patients.

If it was early on that you said this--tough lesson. I would not have. There is a ton for a new grad to learn even if limited to ESI 4s and 5s (and easy 3s). I'm not saying 4s and 5s is what your orientation should consist of, but some length of time is certainly appropriate for you to get fairly comfortable with these and then move up.

Their handling sounds a little punitive with putting you into full heavy assignments after you said something.

It sounds like communication can't have been good most of the way through. And unfortunately it'll be tough to succeed without any suggestions or constructive criticisms or a plan for moving forward.

What you do next is a personal decision. If I believed I was truly treated poorly I'd be inclined to check out the other hospital as I don't react well to people doing their fair share to make a mess of things and then criticizing only me for how it turns out.

 

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Specializes in Tele, ICU, Staff Development.

Just know that you should have been given constructive feedback all along.

It's one thing to say "time mgmnt is a problem" but quite another to say "discharge or transfer your patients within 30" (maybe not a good example, IDK,? I'm not ED). 

With goals and examples, you would at least have had opportunity to improve your performance. Sorry this happened to you. It sounds very unsupportive.

Best wishes

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17 hours ago, JKL33 said:

Mixed thoughts:

Was this significantly into your orientation, like beyond half-way through?

If so, I would defend yourself. Say that it is probably not appropriate to judge your time management in a full assignment when you've only been working on that for [x] weeks and was previously given only easy patients.

If it was early on that you said this--tough lesson. I would not have. There is a ton for a new grad to learn even if limited to ESI 4s and 5s (and easy 3s). I'm not saying 4s and 5s is what your orientation should consist of, but some length of time is certainly appropriate for you to get fairly comfortable with these and then move up.

Their handling sounds a little punitive with putting you into full heavy assignments after you said something.

It sounds like communication can't have been good most of the way through. And unfortunately it'll be tough to succeed without any suggestions or constructive criticisms or a plan for moving forward.

What you do next is a personal decision. If I believed I was truly treated poorly I'd be inclined to check out the other hospital as I don't react well to people doing their fair share to make a mess of things and then criticizing only me for how it turns out.

 

I have only 3 weeks left now, and that’s why it felt even more like a punishment because they basically said if I don’t improve in the next 3 weeks then I would be asked to transfer elsewhere. I honestly should have spoke up about acuity before.. they had me sweeping the floors.. literally.. and I finally said something. 

17 hours ago, Nurse Beth said:

Just know that you should have been given constructive feedback all along.

It's one thing to say "time mgmnt is a problem" but quite another to say "discharge or transfer your patients within 30" (maybe not a good example, IDK,? I'm not ED). 

With goals and examples, you would at least have had opportunity to improve your performance. Sorry this happened to you. It sounds very unsupportive.

Best wishes

They did not paise me on a single aspect, and I know I do have positive ones. They didn’t even give me concrete examples of how to improve when I asked, so I left even more confused and my confidence in the trash. 

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1 hour ago, NewGradEDRN said:

they had me sweeping the floors.. literally.. and I finally said something

I'd be out of there. Just me. Life is too short to put up with utter nonsense.

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The more I have thought about it, the more I want nothing more to be out. I’m submitting some applications today to another hospital. How do I navigate the awkward question of why I’m leaving after only 4 months and how I’ve never even been off orientation ?

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Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.

Just adding my 2 cents.  Sometimes having them offer another position in the hospital is a kindness, BUT sometimes it's a bit of a scheme to fill a crappy position that nobody will take.

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