New Grad in the ER looking for a shoulder to cry on

VTBabyNurse · Aug 6, 2007

:balloons:First of all, give yourself credit for finishing nursing school! That is no small feat. I have been a nurse for a year now, and I remember the feeling of being lost once I got into the "real-world". I felt I would never be a "good nurse" if I didn't know everything and do everything perfectly at the exact moment I became an RN. But there is what I have learned...

Give yourself time to really get comfortable with your job, skills, time-management, etc. A year later I feel much better about all of these things, but I know I still don't know everything. Experience and time will give you a greater comfort level on the job.

Try to find someone who can be a good role model to you. Someone you feel comfortable going to with questions, concerns, and to just ask "How am I doing?" and who will give you honest feedback.

I almost started out in the ER but I decided to do mother/baby first. I am sure it is very difficult to be starting a new career in a place that demands quick thinking and acting.

Stick it out, learn from any mistakes you might make, don't beat yourself up over them, and you will start to feel better.

Congrats on the new job and finishing school! Good luck!

Blee O'Myacin, BSN, RN · Aug 6, 2007

I finished nursing school and went to work in the ER in July. While I do feel a little more comfortable each day, I still feel utterly lost. WHAT DID I LEARN over the past two years in school?? I feel like I know nothing. Not trying to whine, but looking for some advice on time-management, signs that a patient is going bad and such, and any other pearl of wisdom. THANKS!

First of all, congrats on graduating and for completing your first month.

School gives you the foundation and the knowledge base - aka - the "why". They give you some of the "how" in the skills that you learned in clinical. The piece that you are talking about takes time to develop. The fact that you have recognized this only one month out of school tells me that you are going to do just fine.

As for when a patient is going to go bad - it's a combination of instinct and practice. Once I got comfortable with concentrating on the patient and not the task - that takes a while - I was able to really look at people and know when something didn't seem right - whether it was a change in the patient's demeanor, an increase in RR, increased sweating, a creepy feeling when I looked at them, or the patient talking about how they are going to die that day - I listen to it all - usually the hair on my arms stand up on end.

Blee

Altra, BSN, RN · Aug 6, 2007

My first few weeks as a new grad in a Level I ER were harrowing, enough that I questioned, "What have I done??"

It gets better. Really.

Nursing school lays a foundation. It teaches you disease processes, physiology,etc. It doesn't teach (in my experience, anyway) that reproducible chest pain is less likely to be cardiac in nature, or much about mechanisms of injury or how to extract this info from an anxious patient/family, or tell you very much about noncompliant patients or drug seekers, or that on a hot, humid August day you're going to see every asthmatic in the surrounding 4 counties..

I hope you have a solid relationship with your preceptor and/or educator, but unless you've heard otherwise, you may be doing just fine for where you are right now.

We're here if you need to vent! Keep on keepin' on ...

Larry in Florida · Aug 6, 2007

:balloons:First of all, give yourself credit for finishing nursing school! That is no small feat. I have been a nurse for a year now, and I remember the feeling of being lost once I got into the "real-world". I felt I would never be a "good nurse" if I didn't know everything and do everything perfectly at the exact moment I became an RN. But there is what I have learned...
Give yourself time to really get comfortable with your job, skills, time-management, etc. A year later I feel much better about all of these things, but I know I still don't know everything. Experience and time will give you a greater comfort level on the job.
Try to find someone who can be a good role model to you. Someone you feel comfortable going to with questions, concerns, and to just ask "How am I doing?" and who will give you honest feedback.
I almost started out in the ER but I decided to do mother/baby first. I am sure it is very difficult to be starting a new career in a place that demands quick thinking and acting.
Stick it out, learn from any mistakes you might make, don't beat yourself up over them, and you will start to feel better.
Congrats on the new job and finishing school! Good luck!

If ya dont have it do ACLS. Make friends with experienced nurse or an MD ( ask for help ya may be surprised).

Larry RN in Fla

Just made RN age 62 ( never to late hey!) run 3miles a day, dance every Friday night. Work corrections and starting new job as pre-op nurse. LIFE is goooood

Crocuta, RN · Aug 7, 2007

What kind of orientation are you recieving as a new grad in the ER? You should be getting some highly focused one on one training with an experienced ER nurse. ER nursing requires a set of skills that you don't learn in school and there's no substitute for a preceptor who can help train you to think like an ER nurse.

Our professional organization, the Emergency Nurses Association has many resources available to help you learn your new role. I'd highly recommend joining the ENA.

For books, I particularly like Emergency Nursing Procedures by Jean Proehl and the bible of ER nursing, Sheehy's Emergency Nursing Principals and Practice. Both are excellent reference books and will help you learn many of the basics. Make them part of your bedtime reading.

The ENA also just released the Emergency Nursing Orientation Online Course. Our facility just made the decision to use this course with our new grads who will be joining us soon. I haven't seen it, but I've heard good things. You could talk to your manager about using this course as a tool to prepare you for your new role.

Good luck, don't give up, and congratulations on getting into ER. Remember, if they didn't see ability in you, they wouldn't have hired you in the first place!

angel337, MSN, RN · Aug 7, 2007

I was a tech in the ED for years before I became a nurse so that helped me alot, but don't be so hard on yourself...the ED can be intimidating until you get used to it. It takes time. just make sure you give safe care and everything else will follow. also use your resources (charge nurse, experienced nurses, docs) when you don't ask questions or are afraid that you will look stupid ..that's when you make mistakes. you'll be fine.

porcelina22 · Aug 7, 2007

Hello! I'm a new grad in the ED too. I started my position on May 21st- 2 days after graduation!

I'm in the same boat. Some days I feel like I participated in a 13-hour long test (and didn't know a single one of the answers).

The things that have helped me the most are a really good preceptor, a department that was excited to have me on board (I'm the first new grad for the entire hospital, ever!), a good orientation- 6 months with a preceptor, ACLS, PALS, TNCC (just passed yesterday!), a good EKG class, and the ENA's orientation course. I'm expected to take at least half of the patients on my own, but I can always count on someone stepping in if I start sinking. Plus, I get to go in on the traumas, codes, and any cool procedures so I can get as much experience as possible!

It will get better! It ahs too! Every ER nurse we see was in our shoes once!

kmoonshine, RN · Aug 7, 2007

1. Don't be afraid to ask lots of questions. If you feel uncomfortable about something, let your preceptor know and insist they help you.

2. Try to watch/get in on all the codes, chest tube and central line insertion, trauma, intubation, etc. Just watch - and then ask to be the one to document after experiencing a couple of scenarios.

3. Listen to that little voice in your head that says something isn't right. I heard that little voice tonight as I took care of a 56-y.o. with c/o dizziness, low BP at Walmart (or so he said), cough, nausea and pain "around his diaphragm and pain in his arms when he coughed". He had a history of 2 MI's, 2 stents, CABG, DVT...list goes on. I did an EKG which was normal, threw in an 18g IV, and put oxygen on. I asked another RN if they would send off a stat troponin, and they said "no way". But that little voice told me "do it", and I sent off a stat troponin anyways. Well, turns out that his troponin was elevated, and he was having a non-STEMI; my point is to trust that voice! And if the thought of doing something comes into your head (ie should I do an EKG?), do it. If you consult with an MD and they say something like "no, they don't need an IV", be sure to chart it.

4. Know your facility protocols.

5. Buddy up with the docs who treat you with respect and learn from them.

6. Document thoroughly.

7. Forgive yourself. The ED has a HUGE learning curve and you won't feel comfortable for a long time...and that is ok and completely normal - it keeps you on your toes.

8. Ask questions ("why did you do this instead of that?"). For example, I had a patient come in by paramedics; the patient said his internal defibrillator went off at home. He was 46 and had a history of MI, DM, was on dialysis - basically he had a whole bunch of things going on. The paramedics put in a 20g IV en route. The first thing I did when he arrived was flush his IV to verify patency while another RN was getting the electrodes on to do an EKG. The RN asked me "why don't you get his blood pressure first?". My response was "well, he's upright and talking - so he's got a blood pressure". The reason I wanted to verify IV patency is because starting an IV in renal patients can be very difficult and I wanted to keep that line open and working. Good thing I did too, because it needed to be secured better, for it was close to being pulled out. Afterwards, I checked his BP and it was fine.

citizensaver · Aug 7, 2007

Thank you all for the support and encouragement. The orientation at my facility is 12-weeks, and they say they will extend it if needed. As far as a preceptor, I am not assigned one particular nurse. The assignment varies from shift-to-shift which kinda sucks in my opinion.

I know it will take time, but I tend to be hard on myself. However, I am learning to give myself a break!!

loricatus · Aug 8, 2007

Right now you are just learning the tasks;and, ED nursing is very task oriented. No, you really didn't learn anything more than the bare basics in school. I didn't even know how to work a pump after I got out of school. Once the tasks become second nature to you (like driving a car or learning to ride a bike), you will be able to let your intuition take over. There will come a day when you felt the shift went easy, even though it was as busy as usual-that's the beginning of what you are looking for (doing it without having to think about what you are doing and why you are doing it).

Good Luck. Sounds like you are going to be one great emergency room nurse. Proud to have you as one of us.

lydlamp · Aug 8, 2007

Thank God I found your questions and answers. I also just graduated from nursing school in May, passed my boards in June and began working in the ED in July. I too was wondering when I won't feel sick to my stomach with worry at the end of the day. I double and triple check everything because I don't want to make a mistake at the expense of another human being. Maybe I sound like a freak, but in school, they repeatedly told us "You only have one license. Be safe. Be safe, be safe." The professor's voices echo through my head as I run back and forth getting meds, checking the order, double checking, taking deep breaths and looking like a deer in headlights. I too, just want to feel a little comfortable. My orientation is approximately 22 weeks, and I know I am just beginning...It's just good to know that I am not alone in feeling the way I feel. I think the new grads/new RN's starting in the ED are cursed with that nursing thing, you know, exceptionally high, high high, expectations. Ha ha. Best of luck to you. You are not alone.