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?
Specializes in Urgent Care NP, Emergency Nursing, Camp Nursing.
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.
i'm a new grad, and when i was interviewing for my new grad ed position, i was told by the unit managers that they prefer training up new grads to the extent that when they get an "experienced" nurse whose background isn't the ed, they're not quite sure what to do with them. my unit's successful experiences tell me, at least, if no one else, that if a specialty unit is consistently unable to train new grads it is the fault of the educator and preceptors on the unit and not the new grads for applying for and being hired onto a specialty unit.
Specializes in Emergency, Critical Care (CEN, CCRN).
I'm going to throw in with TheSquire and hiddencat on this one - new grads can make it in Emergency, but there needs to be a very solid, thorough orientation and training package behind them. 6 weeks of a 1:1 preceptorship and then throwing you to the wolves is just not adequate. (Heck, I'd question whether it's adequate for experienced nurses transitioning from non-critical care environments. I've seen a few med/surg nurses float down to us and promptly burst into flames.)
As I've said elsewhere, my department makes a habit of hiring well-qualified GNs/new RNs, but we put a ton of effort into training and education. We do a 12-week preceptorship, and that can be extended based on trainee needs; our department educator designed a custom "Core Emergency" GN classroom package rather than use the hospital's standard GN residency; we send our trainees off the floor to work one shift each with Respiratory, Peds and Critical Care; and we have a department culture that encourages teamwork and assistance. (The attitude also extends to our MDs, incidentally. You can ask a doc the rationale behind hanging heparin on a known clot, or why it can be OK to leave a stroke patient a little hypertensive, and nine times out of ten they'll sit down and explain it for you.)
As to the OP's post: you got three hot messes dropped on you within a very short time interval. That sucks for anyone, regardless of whether you have three months or thirty years of experience. In that kind of situation, you just go back to basics - do your assessments, get your labs/imaging, hang your meds, check your vitals. That's also a situation where, as AndyLyn said, you shouldn't be at all ashamed to ask for help, either from other nurses or aides/techs. It happens to us too, and our solution is either to pitch in within that team (we staff three RNs and one tech to a team - if the "front" nurse is getting murdered with high-acuity arrivals, the rest of the team will come help) or call a nurse off another, less-busy team to help cover. Then too, there's always the "nuclear option" of calling an internal resus if the patient's condition is truly that critical.
I'd also agree that unless you know and trust the MD in question, his/her opinion of your timeliness probably ought not to carry a whole lot of weight. I ran afoul of it once on orientation, and my preceptor told me that "triage doesn't stop at the door" - in other words, you continue to prioritize based on who needs care most. No amount of MD yelling should make you prioritize a minor laceration over a respiratory distress, for example. If it's a situation where something needs to be done to meet a care pathway, for example blood cultures drawn and antibiotics hung within four hours on a pneumonia patient, if you're really that slammed you can have your tech draw the cultures and another nurse hang the antibiotics while you take care of whatever other disasters might be brewing.
Hang in there, Emmy. Emergency nurses aren't made in six weeks. Keep your head up and keep doing your best work - you'll make it.
Specializes in Emergency, Critical Care Transport.
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.
i disagree. i personally started in the er, and within a year i was working at a level 1 trauma center, where i'm currently still employed and well-respected. i think it depends on the situation. i personally think the patient load she describes receiving would be tough for anyone. when any of us get 3 patients at once (imagine that happening on a med-surge floor!), we ask for help - and usually the team i work with offers it before it's needed. i think that there are people who do very well initially in the er, and it sounds like overall emmy is doing fine.
to tell someone they cannot succeed borders on inflammatory, in my humble opinion. i think that there are people who do very well starting in the ed- like myself, and a few others i know quite well/work with who bypassed the floor and went straight to critical care, either icu or high acuity ed.
in any case, the med-surge first vs. direct er/icu debate can go on ad nauseum.
emmy, sounds like asking for help is the current lesson you're learning. you can't do anything without help. i have seen some of the most experienced, 20+ year awesome stellar amazing knowledgeable rns say "help help!" when receiving critical patients. we all have days when we feel overwhelmed. you just learn how to deal with it, and you do the best you can. in fact, one interview question i had at a facility where i worked was, "you have two patients... [insert critical descriptions of two patients who are tanking and there's one of you]... no help is available. what do you do?" answer? ask for help anyways.
good luck, and great job at starting in the ed. i love every second of it. even when it's hard - and just when you think you've gone through the most difficult thing imaginable, something else comes out of left field. don't get complacent, and keep breathing. and just do your best.
I disagree. I personally started in the ER, and within a year I was working at a Level 1 Trauma center, where I'm currently still employed and well-respected. I think it depends on the situation. I personally think the patient load she describes receiving would be tough for anyone. When any of us get 3 patients at once (imagine that happening on a med-surge floor!), we ask for help - and usually the team I work with offers it before it's needed. I think that there are people who do very well initially in the ER, and it sounds like overall Emmy is doing fine.
Of course there will be those who "make it," but that is often not the case. New nurses often don't know what they don't know. There are at least three newer nurses in my ED who should not be there, and even though they are not safe, they won't be let go because too much money has been spent on training them. So just because they still have a job, they think they have "made it."
I do think there are some new grads who would do well in critical areas as long as they have adequate training and support, but I don't think that the few who would do well justifies having new grads in critical areas since the failure rate is too high, and many who do "make it" are just too unsafe.
To tell someone they cannot succeed borders on inflammatory, in my humble opinion. I think that there are people who do very well starting in the ED- like myself, and a few others I know quite well/work with who bypassed the floor and went straight to critical care, either ICU or high acuity ED.
The OP was not told that she could not succeed under any circumstances. The caveat to not succeeding is "when the bar is set too high."
In any case, the med-surge first vs. direct ER/ICU debate can go on ad nauseum.
Again, newer nurses often don't know what they don't know. I would put you in this category in this case. Wait until you have been in the ED for few years and watch the new grads come and go, then see if you still think new grads should start in critical areas.
Emmy, sounds like asking for help is the current lesson you're learning. You can't do anything without help. I have seen some of the most experienced, 20+ year awesome stellar amazing knowledgeable RNs say "Help help!" when receiving critical patients. We all have days when we feel overwhelmed. You just learn how to deal with it, and you do the best you can. In fact, one interview question I had at a facility where I worked was, "You have two patients... [insert critical descriptions of two patients who are tanking and there's one of you]... no help is available. What do you do?" Answer? ASK FOR HELP ANYWAYS.
Good luck, and great job at starting in the ED. I love every second of it. Even when it's hard - and just when you think you've gone through the most difficult thing imaginable, something else comes out of left field. Don't get complacent, and keep breathing. And just do your best.
I think that if you hadn't gotten your fur up over steelydanfan's response, you may have understood that he was actually being supportive of the OP.
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. 
TheSquire, DNP, APRN, NP
1,290 Posts
i'm a new grad, and when i was interviewing for my new grad ed position, i was told by the unit managers that they prefer training up new grads to the extent that when they get an "experienced" nurse whose background isn't the ed, they're not quite sure what to do with them. my unit's successful experiences tell me, at least, if no one else, that if a specialty unit is consistently unable to train new grads it is the fault of the educator and preceptors on the unit and not the new grads for applying for and being hired onto a specialty unit.