New Grad-First Day in the ER--Feeling Overwhelmed and Foolish

Specialties Emergency

Published

I was so excited to start as a new grad in the ER. After three days of training (not ER directed, just hospital orientation) and taking two ECG/rhythms classes, I was introduced to the person I'd be with for floor orientation. I was so excited and felt like I would be comfortable with this nurse since she has a fun/outgoing personality. I am so eager to learn and want to be a great nurse. Unfortunately, my first day did NOT go as planned and I feel overwhelmed and completely foolish. I feel like they're already regretting their hiring decision with me.

I did my school preceptorship (64 hours) in the ER back in June and then took NCLEX in August, so I've been out of the clinical setting for about 4 months. Everything that could have possibly gone wrong (with the exception of killing someone) went wrong. Mistake, after mistake, after mistake. Things I was comfortable with as a student.

Here is a summary of my day. During all my experience in clinicals, I never left upset. I was crying the entire way home and cried for a good hour after getting home. I'm so overwhelmed and I feel like I'm letting the department down. I also feel like they just expect me to know how to do everything, and I don't. I just really need to get these feelings out.

1. Foley: My hands were sweating so bad, I couldn't get my sterile gloves on. I finally got them, but it took forever. Then, I was blank on what to do with antiseptic and even blank on what the syringe of lubricant was! I hadn't seen a foley kit since first year (I had done lots of straight caths throughout clinicals--just not foleys). I finally got the catheter in, but I was embarrassed.

2. I couldn't start an IV if my life depended on it! During my preceptorship, I was able to start them and take blood without assistance. It's like I completely forgot how to even do the steps. Plus, the person I'm with does things completely different than the person I precepted with over the summer which is frustrating.

3. Glucometer. Yeah, doesn't get much easier than doing a glucose reading...wrong. She asked me to find out what his blood sugar was and I was so excited, like "finally! something I won't mess up and can look competent at while doing"...While the machine was reading the results, I pulled the strip out (not even thinking!!!!), so of course, got an error message.

4. Went to connect IV tubing to the IV....couldn't figure out why it wouldn't go on...oh yeah, because I forgot to take off the cap. She teased me on this one and I smiled, but I was feeling so stupid.

5. Almost forgot to swab the IV port with alcohol before doing a saline push, but the trainer caught it and tried handing me a alcohol pad...that I dropped on the floor, so she got me a new one.

6. Put like four of the stickers for ECG on incorrectly because I couldn't figure out how to count the intercostal spaces. I've never done these before.

7. Was asked to reconnect a patient to monitoring...forgot to hit start on blood pressure cuff and didn't hook up the leads.

THIS IS ONE DAY!!!!!!! I FEEL SO FOOLISH. It looks even worst seeing it all written out. Any past experience you've had or hope you can share would be so greatly appreciated right now. I hate feeling this way. Plus, I have ACLS training next week and I'm terrified of that as well.

Did I mention I'm 6 months pregnant? Yeah, I'm just a wreck, lol.

Specializes in Operating Room.

Breath! Take a deep breath and try again tomorrow. You have to relax! Anxiety got the best of me during internship. Meditation helps.

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Specializes in Hospice.
Most of us felt like bumbling bumbles for a while. Give yourself a break. You're not going to feel comfortable for a while.

Concentrate on making sound, clinical judgments. If you have common sense, your coworkers/superiors will note that, while realizing that the hands on deftness comes with time and practice.

I agree. Skills can be taught, common sense cannot. I often say "You don't have to know WHAT is wrong, just know that something IS wrong....then ask for help.

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Your post helped me lighten up a bit. Like you I was hired on the floor I interned on and I start it next week. I'm in full panic and wondering "Ok do I still know how to do a BP it's been 2 months." Scared to death haha. But we are brand new and yes you helped me learn that mistakes will happen it's all in learning! We will have to stay tuned!! In the meantime keep your head up!

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Your post helped me lighten up a bit. Like you I was hired on the floor I interned on and I start it next week. I'm in full panic and wondering "Ok do I still know how to do a BP it's been 2 months." Scared to death haha. But we are brand new and yes you helped me learn that mistakes will happen it's all in learning! We will have to stay tuned!! In the meantime keep your head up!

Good luck! I'm glad the post was able to help you out as well. :-)

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Sounds like you did great.

I still can't apply sterile gloves lol

Me, neither! LOL

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Specializes in ER.

You're new and rusty... fun combo, and forgivable and adorable in my opinion! After I graduated, it was almost a year before I got hired and I went straight into ER. I was like "How do I put nasal cannula on again without gouging nostrils out? Been a while!" But, after a few weeks and months you'll get into a groove. There are nurses that have been working for years that are still learning things. Just keep trying new stuff and pushing your boundaries. One nurse said it took 3 years before she felt comfy in the ER.

Trial by fire is tough. Starting in the ER means you've got [email protected]... ovaries of steel ! I started in the ER as a new grad as well and even on days I was down on myself, people in other departments were amazed that I would even try to start in the ER. Some people in other departments would never switch to the ER because they're afraid of the pressure, speed, or intensity.

Moral of the story - you're rad. You'll get the hang of it! Keep at it! We all make mistakes. I still catch docs ordering urine Hcg tests on males and 80 year old ladies all the time. It's funny - doesn't mean they're dumb or bad docs or something. Try to laugh at some of the mistakes.

:-) And wash your hands a lot with soap and water if you get sweaty hands - the sanitizer makes my hands get a film that mixes with my always sweaty hands and I can't even get normal gloves on!

Peace out!

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I'm a new grad as well, 3 days in and let me tell you I am right there with you! Today I even forgot to grab a 2by2 and when i took my pt's iv out i had nothing to put pressure on it, so I improvised and used my other glove! Lol so as long as you can just learn from it, I think we will make it. I still dont know my way around and sometimes I start walking in one direction to turn around and realize I need to go the oppisite way!

We can do this, and I can't wait till these nerves settle a bit. Just know you aren't alone :-)

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Ive been in ER for just over 8 months and let me tell you one thing , IT WILL GET BETTER. Am I still unsure and get nervous, heck yea. Is it getting less, yes, though I dont think it will ever go away all together. Those that think there perfect and never worry about making a mistake are often the ones that are dangerous (at least IMO). My suggestion, just let your preceptor know that you are so excited to have this oppertunity and so nervous that it was a rough couple of days. They probably already know this.

Also a big suggestion, Get EKG class, go do ACLS, and then get TNCC. I just did those and it helps a ton with confidence and also knowledge base. Keep plugging away and dont let it get to you. Like others have stated (and what Ive been told from the pros around me) your probably doing better than you think and as long as you learn from your mistakes you will get it down pat. It takes lots of time to get to a point where ER is "comfortable". Im not there yet but I keep working towards it.

Thats my 2 cents at least.

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Specializes in Emergency.

Welcome to the darkside. We all learned one mistake at a time. As stated above, the key is to learn and grow. Have fun.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

We have all been there....but it will get better. We all have those...I am such an idiot :facepalm: moments....It is harder for a new grad for you are assimilating enormous amounts of information in a fast paced environment.....it will come....((HUGS))

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"I finally got the catheter in, but I was embarrassed."

You got the the catheter in-which is the important thing-good job!!

"Plus, the person I'm with does things completely different than the person I precepted with over the summer which is frustrating."

Think of how great it is to be able to see different people's techniques! You will get better as time goes on-and pick up the best tips from a variety of people as you watch!

"While the machine was reading the results, I pulled the strip out (not even thinking!!!!), so of course, got an error message."

Time wouldn't allow me to tell you how many times I was in a hurry and messed up the gluc machine. The good news is...it only takes seconds to test again!

"...because I forgot to take off the cap. She teased me on this one and I smiled"

Focus on the "I smiled" part and next time don't feel stupid...just laugh! Ok so I might have forgotten to take off caps or even left clamps open and got sprayed before...and some antibiotics smell!!....such is life. Once it happens you don't generally forget for awhile ;)

"but the trainer caught it and tried handing me a alcohol pad...that I dropped on the floor, so she got me a new one."

Pshhh as long is it got caught....and I pick up things off the floor on a daily basis. Tip from experience...just try not to drop a bottle of insulin!

"Put like four of the stickers for ECG on incorrectly because I couldn't figure out how to count the intercostal spaces. I've never done these before."

Well that's understandable! I do ECGs fairly regularly and about the first ten times I was constantly second guessing my lead placement. The good thing is...the machine will tell you if you get a lousy picture!"

"Was asked to reconnect a patient to monitoring...forgot to hit start on blood pressure cuff and didn't hook up the leads."

I imagine this wasn't the first time this has happened...and you will remember next time.

"Did I mention I'm 6 months pregnant?"

Congratulations! How exciting!

Sounds like you are doing great. Every day you work there will be something that you might think was stupid, and it wasn't all that bad. Some days are worse than others...but this day sounded like a usual day! I'd say I do something hilarious about once a shift...the key here is if a patient wasn't harmed...it was a great day. Minor technical things like dropping an alcohol swab is nothing to worry about. Just look out for those insulin bottles! ;)

Good luck on your future shifts!!

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Specializes in General Surgery, NICU.

I have made mistakes which make me feel so foolish and still continue to do so from time to time. The worst is when a stat RN or respiratory therapist discovers my mistake that lead to them being called to the bedside.....:banghead:. I just try to learn from them and continue on....give yourself time - time will give you experience and slowly make things better.

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