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New Grad ER Nurse...need advice!

Posted

Hi guys,

I am a new grad in a level 1 trauma center ED. I don't think I quite knew what I was getting into when I started, although I did a senior year internship there. I know that new grads in the ER can be controversial but I'm already here, and just trying to do the best that I can.

It's pretty understaffed, and a lot of the staff are cliquey, and seem to gossip/judge one another often. It's a pretty hostile environment. This ER hires new graduates frequently and gives a solid 20 week orientation, which I only have a few weeks left of. I enjoy the variety of patients that we see, and I feel like I'm learning a lot. However, I still feel unprepared to be on my own.

Like last night my preceptor and my patient load included 2 ICU holds for the entire night, along with 3 other patients. I can't imagine what I would do if I had been on my own.

I just feel kind of nervous and like I can't truly trust my co-workers (after hearing the way they talk about each other and other new people).

I guess I'm just asking if this is typical of ERs everywhere and if many new nurses go through this experience at first? Any advice? I just feel like maybe I don't have the personality for this type of environment. Just looking for support!

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

The first year of nursing is really rough, and there aren't many of us here who didn't go through a boatload of doubts, anxieties, fears . . . Me included. I hated nursing, was sure I wasn't cut out for it and was positive that my coworkers didn't like me.

My co-workers didn't like me. I was so anxious and so fearful that I completely lost my sense of humor, was afraid to say anything to anyone and took myself far too seriously. I wasn't likable. But I had a husband to support; I wasn't able to quit. I stuck it out and at the end of my first year, I realized that I was starting to put it all together. There are times when I actually knew what I was doing, situations that I found funny and that even if my co-workers didn't like me, they were some pretty awesome people. And as I got more comfortable and less anxious, I became more likable -- and liked.

We can all find the unlikable in our co-workers; the trick is in finding something to like about them. (Believe me, they can sense your negative feelings about them even if you're sure it's well-hidden.). You don't have to be best friends with your colleagues, but you do have to get along with them, and that is so much easier when you actually LIKE them. So concentrate on what's to like.

I doubt very much that you'll be given the heaviest assignments when you're fresh off orientation; I suspect that the charge nurses will give you assignments that they think you can handle. Or they may give you assignments to develop your skills in a certain area. One thing about ED; you're never actually alone. There is always going to be a senior nurse or a provider around to bounce ideas off of, to ask questions, to help point you in the right direction.

The first year is going to be incredibly difficult. ED is a specialty that takes longer than the usual "2-3 years" to become an independent and competent nurse who can handle everything that rolls through the door while also mentoring a new grad. The only way to get through that first year, though, is to GO through it. It's worth it; it truly is. I probably had one of the more difficult first years of anyone I know; but I got through it and I've had 39 great years in an interesting, challenging career with flexible scheduling and great colleagues since that one miserable year. It was totally worth it.

CrunchRN, ADN, RN

Specializes in Clinical Research, Outpt Women's Health. Has 25 years experience.

After 23 years as a nurse I still feel that way at every new job. It gets better with time.

Ruby Vee,

Thank you so much for the thoughtful response! It is so encouraging to me. It sounds like we were/are in similar situations. I just got married two months ago and while my husband works, my income is primary right now. Great insight to work on finding aspects of my co-workers that I like, I will do that.

I just wish I could feel fully competent immediately since I will be taking care of patients on my own, but i know it'll just take time.

Thanks again for the encouragement, your response was truly helpful! :yes:

Any advice on dealing with those who are critical and harsh while I'm still learning? Obviously constructive criticism is good, it's just the mean/hurtful approach that I struggle with.

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

Ruby Vee,

Thank you so much for the thoughtful response! It is so encouraging to me. It sounds like we were/are in similar situations. I just got married two months ago and while my husband works, my income is primary right now. Great insight to work on finding aspects of my co-workers that I like, I will do that.

I just wish I could feel fully competent immediately since I will be taking care of patients on my own, but i know it'll just take time.

Thanks again for the encouragement, your response was truly helpful! :yes:

Any advice on dealing with those who are critical and harsh while I'm still learning? Obviously constructive criticism is good, it's just the mean/hurtful approach that I struggle with.

Every new grad makes mistakes -- everyone makes mistakes. Dealing constructively with criticism (even when the criticism doesn't feel constructive) is going to be helpful to you for the rest of your career.

Very few people intend to be mean, hurtful or harsh when they give feedback. Some people are just blunt and straightforward. You can actually take it as a compliment when they give you criticism in the straightforward or blunt way they generally communicate. It means they've accepted you and are giving you the compliment of believing that you can take it without any prettifying. Some people are so anxious about the idea of having to give negative feedback of any kind that they just blurt things out without stopping to think how it will sound. Or they become so paralyzed with worrying about how they'll come across that they never get around to giving you the feedback, which is worse. You need to know you screwed up in order to improve.

Some people prettify negative feedback until it isn't negative anymore, and then you really don't understand that you've done something wrong, much less what it is.

Giving feedback is an art, and most people don't have that art perfected. That doesn't mean you cannot learn from them. Simply extract the nugget of information from the feedback and do your best to ignore the delivery. Honestly, people don't mean to be harsh. They're just lousy at giving feedback. That doesn't mean that what they have to say is less valid, it just makes it harder to take. That they talk to you about it at all is great, considering how difficult it is for most people to give feedback that is negative in any way.

Cultivate a reputation for taking negative feedback well, and even those who are most anxious about giving you negative feedback will give it a try. This means that you get the information first hand and earlier than if your colleagues save up a whole list of things and go to the manager with it when they're angry. You have a better chance of correcting your errors before it gets that far.

Given that everyone makes mistakes, negative feedback is a gift that helps you to improve your practice. Thank them for pointing it out to you, and if it seems appropriate, ask them how you can do better. If you think about how scared and anxious the person most likely is about approaching you, you'll be kinder to them and make it easier for them to approach you the next time.

There are a few mean people out there who don't mind giving harsh negative feedback, but most people are just nice people who are wholly uncomfortable with this negative feedback thing.

Sorry I'm rambling. It's 4am and I'm posting instead of sleeping.

NurseHeart&Soul, MSN

Specializes in ED, Critical care, & Education.

Auson16...and every other new grad out there...

I will agree 100% that the first year of nursing is tough. For me that was over 20 years ago, but the memories are vivid like yesterday. I started in the ED as a new grad as well. There were days I came home thinking "I'm so smart. I learned so much in school." Other days I was thinking "What in the heck are they doing letting me care for THAT (critical) patient?" It's a roller coaster for sure!

Ruby Vee gave you some great advice so rather than reiterate the same thing, I'll give you a few thoughts and tips...

1) Be gentle on yourself. Everyone has to start somewhere.

2) Know what you know, and acknowledge what you don't know. The scariest nurses are the one's who don't ask when they don't know how to do something and don't know their resources to figure it out on their own.

3) Kill them with kindness. This method certainly doesn't work for everyone, but there is a lot to say about thanking people for taking a few moments away from their patient load to help you etc... A smile, genuine appreciation, etc...

4) Find a mentor (if you can). Finding an experienced nurse who will be a safety net, who you can discuss challenging cases with etc... is invaluable. Do you have this connection with any of your preceptors?

5) Journal. Journaling when you come home from work is a great way to debrief, let it out, process your emotions, and hopefully help you be more gentle on yourself. You will think years from now you will remember the details of cases you had today. Unless there is something unique about the case you likely won't. Record your thoughts, reflections, what you learned, what made you nervous etc... It will make you a great preceptor and mentor in the years ahead.

6) Join the Emergency Nurses Association. If you attend meetings at a local chapter maybe you can find a mentor there? If anything, an added support network.

7) Keep learning. Attend CQI meetings with the paramedics or flight nurses. Show your interest in being the best you can be. If you join ENA, there are free CEUs that you can attend online.

Enjoy the journey, because before you know it you'll look back and be the nurse with 5, 10, 15, or 20 years experience. I do it all the time, and wonder where did the time go?

Hi! Thank you so much for these thoughts. It means a lot that you took the time to share! I'm sure things will get better over time, it's just tough to see beyond right now!

crossingfingers10

Specializes in Hospice, ER. Has 6 years experience.

Here is my two cents. I did not start in ER as a new grad, but I did start in ER as my first acute care position. It was terrifying and exciting all rolled into one. Based on what I've experienced, the staff in ERs are actually wonderful coworkers but it takes some time to get your footing and get "in" with them, as petty as this sounds. Once you've been around for a while, you'll get more comfortable around them and vice versa. They'll like you. They have to see firsthand that you can work hard, handle your patients, and respond appropriately in urgent situations.

I was beyond intimidated by a majority of my new coworkers in the ER, but within a year I considered them to be a second family. They have my back and I have theirs. I love them so much now that I chose them and a 65 mile commute one-way over a 10 mile commute and new staff.

I also wholeheartedly agree with what another poster said, that you are never truly alone in the ER. Find a couple of nurses who you can bounce ideas off of, ask questions, etc. They'll make a world of difference for you. Think about someone you can approach to ask something as simple as "Anything specific I need to know when giving ... drug?" if you're giving something you haven't given before. Someone who you can grab for help when doing something major for the first time...RSI, tPA, STEMI, etc. In high acuity situations, there are usually at least two nurses present anyway, at least until the patient is stabilized.

I'm not sure how your ER is structured, but I love love love our ER techs/medics. Many of them have been in ER for years and years and are a wealth of knowledge. Utilize their knowledge and respect them. They'll save you more times than you can count, whether its by getting a hard stick or transporting a patient for you.

Lastly, please don't stress that you don't feel "ready." I'd be concerned if you felt totally ready and confident that you can handle anything that comes your way as a new grad ER nurse. However, you will become comfortable with the routine abdominal pains/chest pains and you'll be more and more competent with the non-routine/more emergent stuff as you're exposed to it more. Ask lots of questions, ask for help when you need it, observe your coworkers, jump in to help when it isn't your patient, etc. Use your resources. Take care of yourself on your days off so you don't burn out. Good luck and enjoy this experience!