New grad RN in the ED. Am I being hard on myself?

jenfromjersey · Oct 1, 2012

Don't be so hard on yourself. It sounds like you are doing fine and that you have the support that you need in order to be successful there. Don't get caught up in the little nuances of the doctors. That comes in time and right now your focus should be on mastering prioritization and critically thinking about the cases coming in the door as to what will be needed/expected and what to look out for as far as monitoring.

I precept many new nurses and have worked with students as externs who ultimately end up taking jobs in our department. I always tell them to understand that the first year out of school is a learning curve and that what you learned in school may seem unhelpful but it was simply a base upon which to add to. You will learn new things every day. My advice to you is to ask lots of questions. I always learned a lot from the specialists when they would come in to consult on a patient. I would sit with them for a few minutes after they saw the patient and ask questions about the treatment on conditions and what types of concerns they have for my patient. Don't be intimidated. I have found most specialists enjoy teaching despite the fact that many of the nurses I work with are afraid to initiate discussions with them. I figure that if they are too busy to discuss a case or are not in the teaching mood then so be it. Otherwise, I have found that by initating these discussions they tend to view me as a partner in the care of the patient and will actually stop by my station before heading out of the ED to give me a quick "report" on what they think and plan for their patient. It really helps when giving report to the floor as well.

Hang in there!

**NickiLaughs, ADN, BSN, RN** · Oct 2, 2012

Ha, perfectionist mentality like me. I went straight into ICU after graduation and continued my RN to BSN right off the bat. It's hard, but it is possible. Keep in mind you will probably have to review stuff for work on your spare time. It's a huge learning curve, but it sounds like you are doing just fine. My experience with nursing jobs it takes about 6 months to not feel incompetent anywhere at minimum, and probably closer to a year for your first job as a new grad. It's hard now, but it does get better.

phlebitis · Oct 2, 2012

Thanks for the replies. I am a perfectionist and am my own worst critic. I am sensitive and want so much to feel like a good nurse as much as actually being one. I'm scared to make a mistake, but I know that nobody is perfect. I am giving myself a year to at least feel not so stupid even though it will take much longer than that to be truly competent and experienced. I am happy to hear that many have gone through this and came out just fine.

Altra, BSN, RN · Oct 2, 2012

You can take some of the pressure off of yourself if you recognize that you will *NOT* be "a good nurse" aka competent for at least a year. And in the ED, it will take up to 5 years for you to be really at the top of your game.

Hagabel · Oct 2, 2012

Sounds like you are doing fine esp if you have a great preceptor.

Use the monitors but don't rely on them, look at your pts first, On our monitors the resp rate is typically unreliable and I never really use it. If concerned about a patient pop them on the monitor leads or the pulse ox but don't rely on it.

Don't be intimidated by the Drs..their poop does not smell like roses and most ED Drs are really approachable and nice.

After 13 yrs in ICU it took me about 1 yr to feel competent in ED!

Enjoy and be patient with yourself!!!

Guest343211 · Oct 3, 2012

You can take some of the pressure off of yourself if you recognize that you will *NOT* be "a good nurse" aka competent for at least a year. And in the ED, it will take up to 5 years for you to be really at the top of your game.

^ This, and it's more like at least two years full-time to reach independent-competent status, much longer for expert status.

CheesePotato, BSN, RN · Oct 3, 2012

The others have given wonderful words of guidance and advice. It takes time to grow into a specialty, be it ED, Trauma, etc and form that proficiency that allows for that super amazing ninja "I can smell the code coming a mile away" skill to blossom. Be gentle with yourself; you will have good days and bad but know you have support here, if no where else.

Re: addressing the doctors by their first names--

As a rule, I never call a doctor by their first name...regardless of whether or not we are drinking buddies outside of work. First of all, patients look to you as a marker of professionalism in your institution--set a good one. Secondly, it's a personal comfort level issue.

Start out using the formal, "Dr. SpongeBob" and wait for the moment when he looks you in the eye and says, "Please, call me SquarePants." The ball is in your court, first and foremost to either accept or deny the invite of informality, and besides that, it acts as a marker, if you will, of when you know you have "made it" in their personal scope of regard.

Personal crazy story of what not to do:

I was working some crazy night shift blown apart femur car vs. tree, blah blah blah, when I needed to ask a question regarding patient bed placement.

The following is a real dialogue exchange....please do not ever do what I do. I am a grade A idiot and it's a miracle I haven't been fired.

Me: Dr. Anderson, as this patient has a history of some nasty cardiac crap, would you like him to go to CCC or the trauma ICU?

Dr. Anderson: You know, I was just thinkin' about that. Let's send him to CCC in case he goes south. He did have some touchy EKG business down in ED.

Me: Very good, sir.

Dr. Anderson: Oh, and CP?

Me: Sir?

Dr. Anderson: Call me Neo.

Me: Only if you'll call me the future Mrs. Anderson, sir.

:: facepalm :: Some days I have no excuse for myself.

Keep the faith,

~~CP~~

Disclaimer: My computer is having a case of the rage. All spelling errors are purely its fault.

Overwhelmed1026 · Oct 3, 2012

OMG Cheese Potato, that is Hilarious!

Guttercat, ASN, RN · Oct 3, 2012

Dr. Anderson: Call me Neo.
Me: Only if you'll call me the future Mrs. Anderson, sir.

Oh no you di'int!

You did?

Guttercat, ASN, RN · Oct 3, 2012

I was a brand new grad once. My first job was served up on a cardiac/thoracic/neuro ICU combo platter.

It sucked for a while.

Relish (pun intended) these early days, they will serve you well in the future.

LilgirlRN, ADN, RN · Oct 3, 2012

Good! You forgot everything they taught you in nursing school! What they taught you really has nothing to do with what you do in the ER. I am not sure which is better or worse, someone with experience transferring to the ED because we practice a totally different kind of nursing than a med-surg unit does, or a fresh grad, green as grass. I'm thinking that the folks you work with are lucky because they don't have to unteach you things. Sounds like you and your preceptor have a great relationship going, communication is key. I too can pick the good ones from the bad so just continue to do what your precep says and you'll be fine!