New Grad in ER HELP!

mackjazz, BSN, RN · Nov 10, 2010

I was a new grad in the ED also, and it gets easier. Time management skills come with experience, so do assessment skills. Just remember to always prioritize your sickest patients first. If you are very busy and find that you dont have much time to chart, chart what you need to cover your butt and leave the rest for later. For example, if a kid comes in with a head lac this may apply.. "Noted laceration to head, no active bleeding, parents deny LOC, patient is alert and age approp, behaving normally per parents. No obvious signs of abuse." It gets to the point and allows you to then work on other things. I hope the best for you! Stick with it, soon you will be excelling in your position!

JamieN823 · Nov 10, 2010

Thank you so much for your words.. All last night and today I have been in a slump! It's so hard to get out of.. I am only human- I have to realize that.. Sometimes I am too hard on myself and expect to know everything.. when in reality, that will never happen because I will be learning new things everyday. You made me feel better!!! Thank you again! :)

green nurse lpn · Nov 13, 2010

hi emmy i am really impressed that you are working in a high stress environment with very little experience. wow... i have great respect for all of you for that matter. ER is hard stuff and i witnessed this when i was doing my clinical rotation. i would like to be in the er a few years from now since i still have to get my RN hehe...

you all are great in my book! heroes! :) more power to you guys! :bowingpur:bowingpur

Jaguar Boy · Nov 14, 2010

I've really enjoyed reading this thread. I'm about to enter my final semester in school and am waiting to hear if I've been accepted in an ER for my preceptorship placement. It will be so great if it works out. I do want to work in ER once I've graduated even though it'll be tough as nails. Knowing myself, I thrive on near impossible challenge and I'm working ahead at the moment to prepare myself.

JamieN823 · Nov 16, 2010

sounds great! best of luck to you..! it is hard, but as everyone is saying.. in time you will get better.. work in the ER and you can work anywhere =)

mybrowneyedgirl, BSN, RN · Nov 23, 2010

I disagree that you need to work Med/Surg first. I started out new in the ER 6 months ago. I was a nurse extern for over one year on a med/surg floor but I don't think it was vital experience at all. 3 critical patients is a lot for even a well experienced nurse. Ask for help. We have partners and I always am sure to offer help to mine when I can so that I don't feel bad asking for help when I need to. Also, delegate to your techs when you can. Bringing in candy and coffee doesn't hurt either. Be friendly. All nurses have been NEW before.

Also, doctors expect things to be done yesterday. It's not always realistic. I try to give them a head up when I can't get a test done because my patient doesn't need to pee or I can't get an I.V. started yet. They appreciate the heads up. If an elderly can't pee, I'll suggest to the dr. that they order a straight cath so I can get that sample sooner.

Someone had a great suggestion on the folded piece of paper. Vital often, chart abnormals, inform the doctors. It will get better

AndyLyn · Nov 23, 2010

Don't try and be SuperNurse. Ask for help if you need it. Any experienced nurse worth a hoot can tell when a coworker needs help, and knows how to ask for it herself. We never try and work a cardiac patient alone - I've been a nurse for 12 years and have no problem asking someone to help me get all those drips going, extra lines, labwork. It only benefits the patient to have a second set of eyes on them, anyway.

Docs - as lovely as they are - have a skewed concept re:timelines, and procedures. Work as quickly as you can, but don't get shook up if somethings not done as soon as they think it should be. Things take time.

Learn to prioritize. What needs to be done right now? Next? Continually re-shuffle and re-prioritize. Keep notes if you need to about what you did when. Take time to eat and pee.

Cut yourself a little slack. You're learning just as quickly as you can, and the experience only comes with time.

PACNWNURSING · Nov 23, 2010

I just completed my ER Orientation, ER nursing is so different from floor nursing that I do not think you need Med/Surg experience first. The issue I have is that I only had a 6 week orientation with a preceptor and a one day general nursing orientation which was terrible. I think the ER orientation should be at least 12 weeks. Very disappointed that there is still this major disconnect from nursing school and the reality of nursing. Standardized transition programs must be put in place to give new nurses a better chance for success.

lagrl7 · Jan 20, 2011

Is there a way for you to extend the training, maybe talk to your preceptor and work something out.

steelydanfan · Jan 21, 2011

greetings er nurses!
i have been working in the er for 4 months now (new grad) and my orientation period is ending soon. i thought i was doing ok until this week when i was placed in the "cardiac rooms" (which are the rooms that usually have the sickest and most critical pts). every day this week i went home and cried. i am not fast enough. yesterday i worked and i had 3 pts come within a few minutes of each other. i was trying to juggle with charting all the pt's triages, giving meds and keeping an eye on the 2 most critical pt's but it still wasn't fast enough for one of the doctors i worked with. my preceptor has letting work independently for quite some time now but it seems like she has to "bail me out" a lot. i get behind or i don't catch something during triage.
any suggestions on how to become quicker and more efficient?
any tips will be greatly appreciated
emmy,
i am known for saying that new grads do not belong in speciality areas, and i am saying it to you again.
your preceptor has to bail you out alot because you don 't have the experience to do the job! not because you are lacking in some way. however, that is the feedback you wil get in your final review.
you have been swept up in the trap of "we can teach bright new things anything", however they never teach nor support enough to make it possible. 6 months used to be the time frame for experienced, talented floor nurses to be transitioned to icu, and this included 2 months class work as well. you simply cannot succeed when the bar is set too high.
my heart goes out to you.

hiddencatRN, BSN, RN · Jan 22, 2011

I just completed my ER Orientation, ER nursing is so different from floor nursing that I do not think you need Med/Surg experience first. The issue I have is that I only had a 6 week orientation with a preceptor and a one day general nursing orientation which was terrible. I think the ER orientation should be at least 12 weeks. Very disappointed that there is still this major disconnect from nursing school and the reality of nursing. Standardized transition programs must be put in place to give new nurses a better chance for success.

Yikes- 6 weeks? I don't think I'd even feel comfortable with a 6 week orientation on a med surg floor. I'm a new grad in the ED and my orientation is 6 months, and I was told that if I didn't feel comfortable at 6 months I could extend orientation or only be given 4s and 5s for a while. And even though my orientation will be 6 months, there is continued training spread out over the next year and a half.

whyspir · Jan 23, 2011

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.

I wish that was the minimum standard. I got 6 weeks. To be fair, I had 1.5 yrs experience as a Tele nurse prior to that, but it was still rough. I've been in the ER for almost 7 months now (and love every second of it) but I still have days where I feel like I'm completely out of my depth.

And definitely don't bother to count the doctor's opinion of your work. Unless you've worked with that doc for a while and actually have a decent professional relationship with them. Trust the other Nurses opinions first.