New Grad in ER HELP!

Asystole RN · Oct 28, 2010

Never base your job performance based upon a Docs expectations...

You had 3 patients dropped on your lap at the same time, two of which were critical, sounds like a busy day for even Florence herself. What does your preceptor, the RN who knows what a RN does, say?

ER is a very difficult starting unit for most new RNs. Many have suggested a minimum of 8 months to 1 year of orientation is a more prudent training schedule.

Flight64 · Oct 28, 2010

EmmyRN,

Don't worry. In time you will get "faster". Unfortunately, being faster does not mean better. Doctors are just humans with a little more education. They deserve no more respect than the fireman or teacher. Unfortunately, your problem lies with nursing administration that allows someone so new to take 3 new admits in a critical care unit. Here's a few secrets. Attention to detail and time management. Get your stuff together before the shift. Don't wait until 15-20 minutes after your start. Ensure that your charting is accurate and complete and NEVER allow anyone to chart for you. Line out ANY open space after chart checks to keep those with less integrity from falsifying charting after you leave. Chart as you go, don't wait until the end of the shift. Give great nursing reports and expect them from others. Never-I mean NEVER, feel scared of calling a doctors after hours. They are in charge of the patient and if you have to wake them up so be it. If they do not want to be awakened then they should be in a different career. Continue your education and become the nurse manager so you can replace those who are less qualified and make the difference. Do not be afraid to ask others for help. Assert yourself and be positive. Never unionize. Stay away from unit gossip. Remember-always stick to your ideals and never become the "lazy" nurse.

JTworoger · Oct 28, 2010

I understand your frustrations, I worked in the ER for 3 years...

I really think its mean to hire new grad nurses in a critical care area... I honestly believe all new grads need at least 6 months to a year on a Medical-Surgical unit and here is why: Nurses that have medical-surgical experience under their belt have very good time management skills because they have to handle a large patient loads from the beginning and they learn how to manage that over a course of just a few months... the patients on the floor are of course acute and can change to critical really fast so you have kept on your toes. Its all about setting up routines that work for you, and I believe medical-surgical nursing teaches people that.

When you work in the ER as a new grad and your preceptor is busy, sometimes you lose track of exactly what your suppose to be doing and why. Plus, sometimes it is complete chaos in the ER on certain days. When you are constantly being thrown in something that is new for you, you get nervous and frustrated and sometimes you can't do your job as effectively.

The most main thing to do in an ER is learn to breath and everything will be ok. Use your nursing judgement and in time you will develope time management skills on your own. Also, charting is very important... and I know that most nurses want to chart what happen right then and there, no exception... however in a busy ER sometimes its really hard to do that, so keep a notepad in your pocket and right really good notes. You can also come back to your charting when all your patient-care is done.

As for Doctor's that is another job will you learn to deal with once you get more experience under your belt. The doctors in the ER want things done yesterday, and sometimes that not best option for you, the nurse, or the patient. Take your time, do you job effectively, and breath... these three things will help you in the long run... don't let the ER burn you out like it does most nurses.

kxvc · Oct 28, 2010

Speed comes with time. Focus on accuracy. Remember it will take you longer to fix a mistake than to just do it right the first time. Many of the posters have great information. I also started out in ER with a 12week orientation. Some days I felt I was flying by the seat of my pants. It took time, but the docs learned to trust my skills/judgment.

I always find it helpful to carry around as many saline flushes as will fit in my back pocket and some blunt tip needles to pull up meds at a moment's notice. Delegation is key. Don't feel like you're inconveniencing anyone. We are all there to work.

GM2RN · Oct 28, 2010

Hi Emmy

I agree with much of what has already been said. Understand that nursing is hard, especially in the ER. Only those nurses who have been doing it for many years make it look easy. You need to give yourself at least a year to start to feel like things are falling into place.

I've been a nurse for almost 4 years and in the ER for 18 months, and I still occassionally have moments when I feel overwhelmed. When this happens, I take a moment to take a few deep breaths and tell myself to focus, then prioitize in my head what needs to be done first, and then do them as calmly and as quickly as I safely can.

Also don't expect that you should be able to take care of 2-3 critical patients by yourself at the same time. Experienced nurses need help in that situation, and you should expect to get help when that happens.

We have teams of up to 5 patients where I work, even with the rooms for the most critical paitents, and the charge nurse and other less busy nurses are expected to help when the acuity level of the patients is high.

At the very least, one or more nurses, depending on how critical the patient is when he/she first gets there, will help get the initial stuff done, like getting pt triaged, ekg, line and labs, etc. This is the way the ER is expected to operate in my experience. If that's not what happens where you are, you may want to reconsider working in that ER.

You may also need to work on being more assertive when it comes to getting help from other nurses and unlicensed staff. Once again, you should EXPECT to get help when you have multiple critical patients at once. Your patients lives and your license are on the line, so it's your responsibility to get help when you need it if it isn't being volunteered. When your preceptor is no longer at your side and you have a critical patient, and no other nurses are close at hand, it's even perfectly ok to drag the butts of those demanding docs into the room to help.

Charting as you go may work if you have paper charting, but not computer charting. And even with paper charting it can't always be done right away. You can keep a small notebook in your pocket if that works for you, but personally, I don't like having to flip through it to find the right page, and I find the pages too flimsy.

At the beginning of my shift, I take a blank piece of standard sized paper and fold it into quarters. I leave it folded and use this to jot down room number, pt first name, complaint, anything that needs to be done like a med or VS, and any critical labs. I know this sounds like a lot of stuff for a small piece of paper, but it really isn't. This fits nicely in my pocket and gives me something to jot notes and times on so I can remember what to chart when I get back to my computer. If I use up one piece of paper like that during the shift I just get another one.

It sounds like you are doing fine so far. Look back to the beginning of your orientation to see how far you have come and I'll bet you will see some real growth. Just allow yourself some time to get the speed you lack right now.

PACNWNURSING · Oct 28, 2010

I wish I had a preceptor for 4 months!!! I have a 6 week precptorship..

Lizzie21 · Oct 29, 2010

My advice for you would be to tell your preceptor to help you out when you get crazy like that. Being a new grad is hard and it will take a while for you to find a routine. I'm a new grad as well and I still feel like the world is going to crash on me and i'm still in orientation. Just because this doctor is getting upset at you for not being quick enough, remember to place the patient's safety first. You don't want to rush through things and make mistakes. I hope it gets better!

TheEmmyRN · Oct 29, 2010

Thank you for all of your suggestions.

My preceptor is usually very helpful and supportive and all the RNs say that I'm doing a great job and I am catching on well.

The main problem lies with lack of ED tech support. While working the front "critical" rooms all of the techs are suppost to work the assignment but since no one is specifically assigned NO ONE does the assignment. Even when I ask for something they are "too busy" to help. I've talked to my Preceptor about it and she completely agrees that it is a problem. I don't usually get behind when assigned to the regular rooms but with the "unassigned tech rooms" it is a common occurrance. I don't mind starting my own IV, pulling labs or doing my own EKGs but I can't be at everywhere at once. Most of the Techs are very good and supportive (as long they are assigned to my rooms) but there are a couple that give me trouble every time I ask them to do something. I know Delagating is essential for the ED.

Any suggestions on delegating to support staff?

TheEmmyRN

GM2RN · Oct 30, 2010

It's the way of things to experience some of what you are talking about whenever you are new to a facility, unit, whatever. They are feeling you out. Be patient, be kind, help them when you can, remain professional even while you make it clear that you need them to do something for you. Eventually they will learn to trust you and they will become more cooperative...as much as they are going to anyway. Just as with any other group, you will always have those who will try to do the least work. But if you do as I suggest, you should get as much cooperation as you can from all of them.

Janedough · Oct 31, 2010

Dear Emmy!

im also a new grad and i have cried more times in the 4 months that i have been the the ER then my entire life!

I have had a bunch of bad days in a row!

im off orientation and i think the nurses and doctors around me forget that.

Im still learning and always will be. I have learned that i only can do what i can do with the 2 hands that i have and go as fast as i can that allows me to be safe.

I too was in the "cardiac" rooms and i had 2 very sick people (one of them i had placed pacer pads ready to go!!) and 3 admits from the shift prior that i knew nothing about! plopped on my lap! i wanted to turn around and go home!

Instead i did one thing at a time and tried to get it all done before my new onset afib or something else came in through the door!

My advice to you is grab the bull by the horns and run with it! speak up and say "this is too much i need help!" get the nursing sup to send in a hand or tell your preceptor to give you and hand and that you need a second to recollect and prioritize your care.

I wish you the best because i know how hard this is and it will be for a while. Your not alone :)

JamieN823 · Nov 10, 2010

I am reading all these posts and I know exactly what you are talking about... I too am a new grad in the ER and I'm feeling pretty down... It is so fast paced and you think you are ahead until you're getting 2-3 more patients at once... Assessing your patients, lining and labbing, listening over head in case a dr calls back for admitting orders, safely medicating and monitoring your pt, starting a blood transfusion and much more is a tough job for anyone... It gets so overwhelming... I cried all night last night- I just felt so lost and slow... I've only been on orientation for a month.. which is going by fast.. and I'm just lost and feeling like I'm worthless...Everyone is saying I will pick up and speed comes with time... and that everyone feels lost.. but I just feel so alone... It's rough...