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

Esme12, ASN, BSN, RN · Oct 3, 2012

The ED is a tough place to begin.........take it easy on yourself. It sounds like you have landed in a great department that is willing to nurture you to sucess. The ED is a different animal at lightening speed. Expect to feel overwhelmed for at least a year. It wil take a good couple years before you even feel like you are going to kill eveyone and you just might know what you are doing!

Allow yourself to be human. ((HUGS))

CrufflerJJ, BSN, RN, EMT-P · Oct 3, 2012

I am a new grad RN working my first nursing job ever in the ED of a community hospital. I have worked 5 12hour shifts so far. My preceptor is amazing and extremely supportive. She says I will be great, she says she can tell on the first day if someone will make it or not. I have been taking 2 patients on my own (with her having full knowledge of what is going on and being there for any questions I have and making sure I don't miss orders, etc). I also help her with her patients. I love it and I am very lucky to have been offered my dream job right out of the gate. It is just so hard. I graduated at the top of my class and am currently in an RN-to-BSN program, but I feel like I forgot everything I learned in nursing school. It is busy all the time and I am struggling to keep up with 2 patients. ...

CONGRATS on landing your "dream job" right out of nursing school! Starting as a new nurse is scary. You start to realize just how your efforts (and your mistakes) might impact your patients.

It's obvious to me that you realize that even though you graduated at the top of your class, you've got a good bit to learn in the ED. Good For You! This is to be expected.

Expect to be stressed. Expect occasional feelings of incompetence. Expect to make mistakes. You'll hopefully learn from all of these. Trust your preceptors. Ask them how you're doing, and on what areas you should focus to get even better.

Enjoy your new job. Best wishes!

SENSUALBLISSINFL, BSN, RN · Oct 4, 2012

....
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.

I love the story and your disclaimer; which I hope you do not mind if I use it...

I also agree with you on using their last names. On my prior job some patients asked me to call them by their first names, I would thank them and then tell them that I am from a culture who emphazises respect - especially when they are older, and using their last names was a way of me passing that along.

One of my biggest flaws is that I am too critical of myself and definitely hard on any mistakes I make. I graduated in April, and though I have prepared for NCLEX, taken certifications and doing an online class right now to enter the BSN in the spring, I feel as if I am forgetting what I have learned, and this worries me tremendously as I have yet to find a job.

I think is fabulous that you were able to get your dream job in your first year, and you appear to work in a unit that has welcomed you with an awesome preceptor, hang in there....it apparently gets better with time.

swiftdr · Oct 4, 2012

Dear Phlebitis,

I am an ER Nurse since February and before that an ICU Nurse and Nurse Educator for 10 years prior to this. In addition, I was a Paramedic from 1988-2010, fulltime Paramedic Educator for 7 years and continue to work as a per diem Federal Disaster RN.

2 observations - 1) you will never know everything about your specialty area and 2)comfort comes in 6 month and 2 year increments in my experience. In my state, new grads can't work in the ER by law unless the hospital can get a waiver from the Department of Health showing no experienced RNs are available. While I don't necessarily agree with this policy, there is a LOT that Nursing School and clinicals didn't teach you that you will be expected to know in the ER. Emergency procedures, ACLS, PALS, TNCC, med-surg problems/care, OB/Gyn problems/care, Peds problems/care, Ortho Problems/care, et cetera ad nauseam.... Plus composure with patients and families in critical situations.

You will slowly develop comfort in the ER but each day I learn something new. In regard to trust and relationship building, this takes time too. If you approach patient care from the standpoint of "what would I want for my loved one in this situation" you will rarely go wrong...

I would suggest to you that you may have too much on your plate with the responsibility of going to school while orienting the ER as a new grad, but the ultimate decision maker of this is you. I can tell you that despite my extensive advanced pre-hospital experience prior to my first job as a new grad, I drove to work nauseated for the first 6 months - worrying about what that shift would bring and if I was up to the task.

I wish you luck in your journey. We are generally our own toughest critics so be gentle to yourself. Learn from mistakes and move on.

Best,

Dana

Esme12, ASN, BSN, RN · Oct 4, 2012

Dear Phlebitis,
I am an ER Nurse since February and before that an ICU Nurse and Nurse Educator for 10 years prior to this. In addition, I was a Paramedic from 1988-2010, fulltime Paramedic Educator for 7 years and continue to work as a per diem Federal Disaster RN.
2 observations - 1) you will never know everything about your specialty area and 2)comfort comes in 6 month and 2 year increments in my experience. In my state, new grads can't work in the ER by law unless the hospital can get a waiver from the Department of Health showing no experienced RNs are available. While I don't necessarily agree with this policy, there is a LOT that Nursing School and clinicals didn't teach you that you will be expected to know in the ER. Emergency procedures, ACLS, PALS, TNCC, med-surg problems/care, OB/Gyn problems/care, Peds problems/care, Ortho Problems/care, et cetera ad nauseam.... Plus composure with patients and families in critical situations.
You will slowly develop comfort in the ER but each day I learn something new. In regard to trust and relationship building, this takes time too. If you approach patient care from the standpoint of "what would I want for my loved one in this situation" you will rarely go wrong...
I would suggest to you that you may have too much on your plate with the responsibility of going to school while orienting the ER as a new grad, but the ultimate decision maker of this is you. I can tell you that despite my extensive advanced pre-hospital experience prior to my first job as a new grad, I drove to work nauseated for the first 6 months - worrying about what that shift would bring and if I was up to the task.
I wish you luck in your journey. We are generally our own toughest critics so be gentle to yourself. Learn from mistakes and move on.
Best,
Dana

Could you find that legislation about new grads not being allowed by law to work in the ED.......I have been involved in emergency Medicine for a LONG time....(34 years) and have done trauma flight as well as Director of a few ED's in that time. I have never seen actual legislation.......you have caught my attention.

swiftdr · Oct 5, 2012

Can't say that I exausted my search efforts, but I could find no such legislation in NY but as many things get passed from one generation to another they morph and gain credibility. I know that my current institution reuires a "12 month" orientation process in the rare cicumstance that they hire a GN. Let me know if you get any supportive info for what I incorrectly stated - Dana [email protected]

Esme12, ASN, BSN, RN · Oct 5, 2012

Man....I looked too.... :up: I thought I was nuts. Historically new grads weren't "allowed" in the ED.......it's too much too soon. You work for a good facility for an orientation process that long......it's set up for the success of the New Grad, a rare finding in this day and age.

phlebitis · Oct 7, 2012

Thank you all for the replies! I was so surprised to log on here today and see that so many nurses had taken the time to offer support. I will try and be more patient with myself and remember that I am a "student" with an RN after my name. I still have 3 months of orientation left so I have a lot of time (sort of) to keep soaking it all in. Thanks for the support guys :)

ecerrn · Oct 7, 2012

Seriously, please do be hard on yourself, that way no one else has to be. Success on your part makes your preceptor look good, no body wants to push the newbie. From your comments I can tell you're going to be an excellent nurse.by the way, eventually you'll be more confident, but the job doesn't get easier...just something to look forward to cause I can tell you will keep setting that bar higher.