New Grad RN: Should I hang in there or leave?

[Smnthvolger, BSN]

I’m a new grad nurse who finished school during the pandemic. I don’t have hospital experience and I was lucky enough to land a new grad position in the ER in a community hospital a month after licensure. Three people are in my new grad cohort and it’s a couple months of orientation. It’s a little community hospital ER with a lot of psych patients as well as medical, ratio 4-1... and they want to hold me back on orientation for a month, and if it doesn’t work out transfer to medsurg.

The experience has been difficult. My preceptor is very sweet but has been there for years and started as an LVN. Most people have been an RN longer than I have, even the other new grads. I’m assigned a different preceptor every shift and I feel like I’ve been thrown to the wolves for most of the orientation period - most people that works with me just let me make a bunch of mistakes all shift, don’t watch over me and notify me of my poor patient care at the end of the shift. Another new grad and myself made a med error because nobody was supervising either of us and trained us wrong in terms of co-signing high risk medications. I cried. I feel like they had too much confidence in me and threw me in without supervision too soon and now I’m left to be judged and perform poor patient care, while getting looks of disappointment and them stating that I should be ready to be on my own by now... but I’m not. Btw, there’s NO new grad classes to help brush up on nursing topics, policies and procedures. 

I feel like I’m drowning and the loser of the unit. I also feel like I should have started in home health or something to get my feet wet. 

Any advice? What should I do?

[Daisy4RN]

It is hard to be a new grad anywhere so first I would say you need to cut yourself some slack. It doesn't sound like you have had the best orientation but I would not quit just yet. I would stay and finish the extended orientation but have a meeting with the manager, educator (who ever is the appropriate person in your ER) and diplomatically explain your concerns and what would help you succeed, and mention that you really wish to remain in the ER (assuming you do). They are obviously willing to work with you bc they did extend and also said they could place you on med-surg, that is a plus. What ever they decide at the end of the orientation I would accept and give it a try. don't let the fact that you feel that others are doing better than you make you feel like a loser. We all learn at different paces and they also have different experiences than you. Focus on your learning and don't worry about them. If you havent already I would also talk to your preceptor about what you need and let them know how much it means to you to stay there.

Starting in HH as a new grad would be no walk in the park either. It would be very difficult to start there with no experience and nobody readily available to ask questions. Plus it is rarely a job you can just clock out and be done. 

Good luck!

[hppygr8ful, ASN, RN, EMT-I]

I really think you should stick it out for that first year of experience. So what if they step you back to med-surg? You might not be ready for a specialty like ER just yet. At least they are going to give you a chance at something different. With the right attitude Med-surge can help you build a strong skill set in assessment and bed side care.

[SmilingBluEyes]

Hang in there and try to stick it out. Don't let anyone get to you; don't take things personally. I know it's hard, as we all have been where you are. I had a horrible first year in nursing. The other nurses were so mean to me. But I stuck it out, learned what I could from them and  helped them when I could. Eventually things got better. Glad I did not run away.

Home health is not for new nurses with no experience. I would wait at least a year before you try that.

I wish you the best.

 

[registerednutrn, BSN, RN]

I say stick it out.   But ask for a meeting with you manager and educator and request that you have only one preceptor (since you had several you may know one that works well with you).  Request a daily update from your preceptor on how you are progressing and where you need to show more improvement making sure to get guidance on how to improve. And please don’t look at being moved to med/surg as a step back because it is not it is just different.  There are many ER nurses that can not handle med/surg but rock the ER. And remember not every area of nursing is for every nurse.  You got this.  

[bitter_betsy, BSN]

So I actually had clinical up to my last semester. I ended up getting a job in an ER residency and I'm coming up on my year.  There are SO many things that are difficult about starting in an ER.  It isn't impossible but it surely isn't easy either.  There is SO much to learn about how to be a nurse.  You have to learn to work the Pyxis and fix it when you do something stupid - like close the drawer before taking out the medicine or taking out the medicine to count it and shutting the drawer while still holding all the medicine. You know - really dumb newbie errors.  It happens daily.  Then you have to learn to chart.  That's an experience on its own. Then you have to learn who to call when labs don't show up - except first you have to learn what is what when doing what so you know that something is missing to begin with.  Then there is that whole delivering patients up to the floor once they get a bed and figuring out how to give report - because each floor expects report differently and guess what - there are rules for giving report too.  You have a crap ton of stuff to learn and haven't even actually started on real nursing stuff yet because that is a whole different ball game.

Step 1. Ask for 1 preceptor who is willing to work with you closely to help develop your skills.  You didn't learn them in school, so you need to learn them now.

Step 2. Take time to learn the steps of WHAT to be an ER nurse.  Documentation, pyxis, phone calls, etc.  Not patient care - but the things the hospital expects you to know in order to provide care.

Step 3. Time management.  I was a server for a long time and thought I had it figure out - nope. Not the same and not even close.  The biggest help for me is to try to get in the room prior to the doc to speak with the patient (assuming that I'm not the one triaging them).  If I can't, then I go in when the doc is in there.  Does this waste time ??? Not for me.  I can get the majority of my questions answered for documentation without me asking them and I can get an idea of what orders are going to be placed so I can start getting my stuff together.  When the doc leaves, I have the person pee in a cup - because they almost always want that while I'm getting IV stuff together.  By the time I pull that, their orders are in, I can grab their meds and then meet the person to get their IV and blood.  Its easier to have them get up before I hook them up to monitors and start fluids.

Step 4. Give yourself grace.  The ER is hard. Med Surg does not teach you how to be an ER nurse.  It may help with nursing skills but its completely different.  I don't have a clue how to give a bed bath according to hospital procedures - I know how I did it in nursing school but its not the same.  I don't keep patients long enough to give them a toothbrush.  I also am stingy with water and food.  You are in the ER - until all your test results are back you can't eat or drink.  This really makes the patients who come in for a pregnancy test angry... but its an emergency room and we never know when people will get shipped off to surgery.

Start every day new. Learn from yesterday. You eventually get comfortable.  I don't know when because after a year - I'm not there yet - but I'm more comfortable every day.  

Finally - don't stop studying. There is so much to learn it can be overwhelming. Pick a topic and study a little.  Study like snacking - a little bit at a time.

[JKL33]

Random stuff:

5 hours ago, Smnthvolger said:

it’s a couple months of orientation

That is not enough for a new grad in the ED unless maybe something like a staged program where you just learn fast track stuff then back to orientation for higher acuity patients.

5 hours ago, Smnthvolger said:

I’m assigned a different preceptor every shift

Speak with the manager or educator about this. See if there is an experienced nurse whose schedule you could follow for this next month. Bonus if it's someone who's actually interested in orienting a new grad.

5 hours ago, Smnthvolger said:

most people that works with me just let me make a bunch of mistakes all shift

Now this...I'm not sure exactly what you mean by it, maybe you're being hard on yourself or maybe you're actually making bona fide errors. If it's the latter, that isn't good. Nursing school does provide the basics that should allow you to operate with a modicum of safety if nothing else. It also should have encouraged you to operate in a proactively professional manner if/when you need help. There's nothing stopping you from approaching your assigned nurse for the day and stating what you are about to do and reviewing your planned steps with that person, for example.

[I am not excusing their failure to actually precept you, by the way, I'm just saying that you also need to do your part].

Get a basic ED book such as this one; also available on amazon. Study.

If they think you should try med-surg, there is plenty to learn there, too, and you will need many of the same interpersonal and other skills. Just keep trying hard and learning and you'll be okay.

??

[Been there,done that, ASN, RN]

New grads do not belong in home health, you would be the only set of eyes on the patient, without adequate assessment skills.

If you want to remain in ER , accept the additional month. But take control of your orientation. Ask preceptors each and every time you are unsure.

If you end up in med-surg.. that could be the orientation you need.

Good luck.

[Smnthvolger, BSN]

On 5/21/2021 at 6:49 PM, registerednutrn said:

I say stick it out.   But ask for a meeting with you manager and educator and request that you have only one preceptor (since you had several you may know one that works well with you).  Request a daily update from your preceptor on how you are progressing and where you need to show more improvement making sure to get guidance on how to improve. And please don’t look at being moved to med/surg as a step back because it is not it is just different.  There are many ER nurses that can not handle med/surg but rock the ER. And remember not every area of nursing is for every nurse.  You got this.  

I have definitely asked for more time with a single preceptor. My primary preceptor just always gets flexed and takes advantage... last shift she didn’t even tell me she was gonna leave and was like “this person is gonna watch you now”. Well I’ll leering towards the end on this unit and “this” person doesn’t know where I need to be or what I need to learn still! I don’t need a babysitter, I need a preceptor! I specifically asked for a single person to guide me and my manager made so many excuses but big picture is it’s a staffing issue and I honestly feel like not a lot of people want to take the time to teach new grads. 

[Smnthvolger, BSN]

On 5/21/2021 at 8:26 PM, JKL33 said:

Random stuff:

That is not enough for a new grad in the ED unless maybe something like a staged program where you just learn fast track stuff then back to orientation for higher acuity patients.

Speak with the manager or educator about this. See if there is an experienced nurse whose schedule you could follow for this next month. Bonus if it's someone who's actually interested in orienting a new grad.

Now this...I'm not sure exactly what you mean by it, maybe you're being hard on yourself or maybe you're actually making bona fide errors. If it's the latter, that isn't good. Nursing school does provide the basics that should allow you to operate with a modicum of safety if nothing else. It also should have encouraged you to operate in a proactively professional manner if/when you need help. There's nothing stopping you from approaching your assigned nurse for the day and stating what you are about to do and reviewing your planned steps with that person, for example.

[I am not excusing their failure to actually precept you, by the way, I'm just saying that you also need to do your part].

Get a basic ED book such as this one; also available on amazon. Study.

If they think you should try med-surg, there is plenty to learn there, too, and you will need many of the same interpersonal and other skills. Just keep trying hard and learning and you'll be okay.

??

So my school did teach me the basics of patient safety for sure. I feel like I did well in school and easily passed NCLEX. What I didn’t get was hands on because of the pandemic and being in an accelerated BSN program. I also feel like my hospital is so all over the place and if you don’t have prior healthcare experience you’re thrown to the wolves. My coworkers keep on saying “it was so hard starting nursing in a pandemic”, and I’m sure it was, but what about us who had to do skills lab online? We have the book smarts but I honestly am so lost on the floor now, especially without solid preceptorship. 
also, I did request solid preceptorship... a lot of excuses came my way. It’s not good to now have someone watch your progress per shift... there’s a lot of different opinions and expectations without an idea of a starting point and how they’ve progressed as a nurse I think 

[BSN-to-MSN, ADN, BSN, RN]

On 5/21/2021 at 4:22 PM, Smnthvolger said:

Another new grad and myself made a med error because nobody was supervising either of us and trained us wrong in terms of co-signing high risk medications.

Take the responsibility of making an error, don't blame others, but learn from it. What are you going to do differently to avoid it next time?

Request to follow one nurse's schedule, to have one (max 2) preceptors.

ER is fast paced, and training there will be difficult for any new grad, give yourself some slack.

Study, study, study at home. Review cases and rationales.

[Nurse Beth, MSN]

Great advice from all.

You are not being given actionable constructive feedback. Ask for specifics.

For example, if your educator or manager says your problem is time management, ask "What specifically would my performance look like if I improved my time management?"

I hope you'll read the article below for more tips ?