new RN, first job, having tough time, need advice

Watkinsrn10 · Apr 11, 2014

I know exactly what you mean. It is so difficult when someone who you are trying to help is deliberately being rude to you. I can't wrap my head around it. I don't know if you are a woman of faith, but what gets me through is knowing that Jesus dealt with all types of people and always did so with a heart of love and forgiveness. He even forgave those who were hanging him on the cross. I try to go through my day knowing that I am doing the Lord's work and not my own, and then you get those super sweet patients who truly are sick and who are so thankful to have you as a good nurse that makes it all worthwhile. Another thing that really helps is reading Chicken Soup For the Nurses Soul. It is a good reminder of why we became nurses and gives good stories of times where other nurses have made a difference and you do too every day, it's just those aweful patients that seem to stick out.

Another thing I have learned is don't let them walk all over you or you will get burned out quick. Some people you just can't make happy and that isn't your fault. Others are just abusing the system, and that isn't your fault either. Just provide them good safe care and that is all you are required to do. It isn't McDonald's have it your way, it's do what they need to stabilize them and provide them the care that is required and from there they can just well....suck it up. Lol It is impossible to please everyone

Guest 360983 · Apr 11, 2014

Being a nurse in an inner city ER is difficult in ways only other ER nurses in the inner city can understand.

Look up Hood Nurse's blog. She isn't actively blogging anymore but seeing her stories helped me realize that it wasn't me, it was the situations I was thrown in.

It sounds like part of your anxiety has to do with "sick" patients, which makes me think you don't feel prepared to handle them and you get overwhelmed. Grab a pathophys book, a pharm book, the ENA ER textbook, or Up To Date or Wikipedia and look up everything you don't understand at work.

Finally, learn to set boundaries. "No" is a complete sentence. Talk to coworkers for tips on how they handle difficult situations. When I worked at County, I found prisoners easy to handle. I simply told them they would treat me with the same respect they treated the prison nurses or I would be speaking to their guard, who I knew had the power to make their life very miserable. We were spoiled with a decent group of guards.

I use the "Walmart Rule" of respect. You can do a lot of dumb things at Walmart, but they will kick you out for being disrespectful to the cashier. If you can't call a Walmart employee a **** because she isn't giving you your items for free, you can't call me one for pushing your Dilaudid slowly. If you've been MSE'd already, I will kick you out. If not, I get the charge and the doc involved and we will get you in the fast track for dispo.

edmia, BSN, RN · Apr 12, 2014

You are right outrunningzombies, only those of us who have worked inner city ED know what the OP experiences. It's a different world. A completely different culture to learn to navigate and the rules are just different.

I learned so much from those patients and colleagues -- even the rude ones. I can literally handle anything.

Guest 360983 · Apr 12, 2014

Sorry, misread your comment about trauma vs whiners. So, maybe not the second part of my advice.

I debated adding this earlier but I want to add it now: I started as a new grad in Hood Hospital. I left for Snazzy Suburban hospital after a year and a half, for a mix of reasons including burnout, wanting new experiences, and "grass is greener" idealism. I don't miss being attacked, but I am looking at PRN jobs at Marginally Less Hood Hospital because I miss the trauma and the drama. I'm fortunate to be in a big city where job hopping isn't tough, but don't be afraid to switch, if only to see what it's like on the other side.

Racer15, BSN, RN · Apr 17, 2014

I don't tolerate that crap. Cuss me out? I inform them that until their attitude does a 180 I am not coming back into the room. I don't get paid to get cussed out, aside from my dementia patients. You come to my ER, you follow my rules. I'll bring you warm blankets and fluff your pillow till the cows come home, but cuss me out and threaten me? Game on.

Racer15, BSN, RN · Apr 17, 2014

Is this real life?! No one ever presents to the ER simply because they are drunk or want drugs?! I think that is called utopia.

annaotis · Apr 17, 2014

Emergency medicine has it's downfalls. Those other nurses are "jaded" because they have to be for survival....or it will eat you alive.
I have been called everything under the sun except blonde and white....which is my hair color and race. I have been armed robbed for narcotics. But.... I also had gang members come to my wedding to give me a gift. (let me tell you that caused a sensation). I can rock a baby to sleep and forearm a gang member to the floor.
You appreciate the little things and the rest......You just let it go.
You can't take everything personal. You can't take everything to heart. Celebrate the small victories. Realize defeat. You can't fix stupid. Move on to the next day. This is the life of of an ED nurse.
I actually have a tougher time adjusting to the privileged. They have the money to back up their side of the story. I cared for children with better manners that lived in a box on the street than the ones who went to a private prep school. I broke up a fight in the waiting room at this affluent hospital with a fire extinguisher. I was attacked by a commercial pilot to leave marks on my neck because he waited 10 mins to see a MD for his daughters chin lac.
It is what it is.
((HUGS))

Esme 12 you are my hero. So much experience, so much wisdom, so many funny quotes. Thanks for all your great advice.

Type 1Nurse- you are a better person than me. Couldn't do ER. I am sure you have very special qualities that you bring to that department. Those patients are lucky to have you there. Hang in there!

BrooklynRN11201 · Apr 17, 2014

Well, I am not even sure where to start...
It is evident that you are, indeed very unhappy with your position but remember, as a new grad without any experience at all, you are blessed to have been offered a chance to begin your career. Your perception about the patient population is not appealing! As a professional, you should understand that nobody chooses to visit the ED just because they are drug seekers or drunk as you have classified your patients. I also believe that you knew beforehand the type of hospital you were going to work. You should also know that pain is subjective and you have no right to determine wether they are lying. If patients are cursing...guess what? Suck it up and kill them with kindness. That is unfortunate our patients have not had the same opportunities we have had. Do not discriminate them. I am an ICU nurse, and I have had patients who wanted to kill me, and sometimes make my work miserable. I deal with it easy & breeze!
So, if you're loosing your hair, having nightmares, diarrhea and psoriasis bursts all over, I highly suggest you to look elsewhere. Another RN would snap that position with passion and dedication in a heartbeat!

I think you are missing my point entirely - never did I say ALL my pts are drug or ETOH addicts, but you are very VERY wrong about people not specifically choosing to come to the ED "just because they are drug seekers or drunk" - it happens all the time and I think several people would agree with me on this one. At the end of the night/morning, several people don't want to leave - they want the free bed and sandwich they get at the ER, they don't want to go back to the street or the shelter, many of them are so abusive to the staff, they are escorted out by hospital police.

Now please don't twist my words and deduce that I'm not passionate or dedicated in my job. Despite what it may seem to you, I do not discriminate, and I am kind to my patients. I get the feeling like you think I deserve the abuse. I don't think ANY nurse "deserves" the threats and verbal abuse they sometimes encounter in the ED.

You're right, of course I'm lucky to have this job as a new grad, and I knew exactly what I was getting into, but my specific question was "How do I not care enough to let the stuff get to me but still care enough to provide good care to everyone?" It was not "how do I ignore/block out these patients and survive my shifts?"

Ruby Vee, BSN · Apr 17, 2014

Well, I am not even sure where to start...
It is evident that you are, indeed very unhappy with your position but remember, as a new grad without any experience at all, you are blessed to have been offered a chance to begin your career. Your perception about the patient population is not appealing! As a professional, you should understand that nobody chooses to visit the ED just because they are drug seekers or drunk as you have classified your patients. I also believe that you knew beforehand the type of hospital you were going to work. You should also know that pain is subjective and you have no right to determine wether they are lying. If patients are cursing...guess what? Suck it up and kill them with kindness. That is unfortunate our patients have not had the same opportunities we have had. Do not discriminate them. I am an ICU nurse, and I have had patients who wanted to kill me, and sometimes make my work miserable. I deal with it easy & breeze!
So, if you're loosing your hair, having nightmares, diarrhea and psoriasis bursts all over, I highly suggest you to look elsewhere. Another RN would snap that position with passion and dedication in a heartbeat!

Where to start? I find your post to be smug and belittling. You evidently don't have a clue about the differences between ICU and ER, and worse, I'm not so sure that you deal with entitled or nasty patient's in the ICU "easy and breeze".

Yes, people visit the ED just because they are drunk, drug seekers, have no place to sleep and it's cold out, haven't eaten for days, have a pimple and it's prom night, it's Saturday night and they have nothing else to do, or myriad other frivolous or pathetic but not emergent reasons.

Pain is subjective, but someone who is drug seeking and "lost his clinic card", "got robbed on the way home from the pharmacy with my dilaudid prescription" or insists that their hangnail be treated with IV narcotics require a bit of nursing judgement before medicating.

I am an ICU nurse, too, and believe me we don't see half the nonsense that the ER sees. If you doubt me, spend an evening in the ER waiting room and watch the entertainment.

Ruby Vee, BSN · Apr 17, 2014

I see patients almost every shift that are seeking drugs, many hospital hop and have narcotic contracts or orders to not give narcotics except in a case when surgical intervention is necessary. I also frequently have drunk patients that are just looking for a warm place to sleep and a sandwich to eat while they sober up. I am indifferent to it and as long as they are polite and follow the rules. Pain is subjective but I am sorry if a patient is crying out in pain stating they have 10/10 abdominal pain while you are in the room but chatting on their cell phone and eating chips when you leave, then they are probably lying. I will treat them with respect regardless as long as they do the same but I will also inform the doctor of my observations and chart the same in an objective manner. In the ICU things are different. Every patient you have NEEDS medical care. If they swear or treat you poorly it is probably because they are having a tough time dealing with their illness. They maybe deserve understanding for their bad behavior. Every patient that I see in the ED does not need to be there. Many do obviously but not all and in my experience, most people that are truly ill are not the ones being rude and disrespectful.
The patient I have seen 4 times this month for their left lower quadrant abdominal pain that is demanding dilaudid now, is refusing to use their call bell because they prefer to yell, and will only refer to you as "hey you, come here now". Killing them with kindness does not work, it only makes it worse. Staff that let patients like this walk all over them and be disrespectful set that patient up to continue the bad behavior next time they come in because they know it gets results. There are tactful ways to let patients know how you expect to be treated. I don't care if the patient is rich or poor, I treat them with respect and expect the same in return.
Or what about the patient who overdosed on heroin that came in unresponsive with a weak thready pulse that you gave narcan to who is now cussing you out cause they want to leave now since you wont give them any morphine for their killer headache, telling you that you better get the $&@* over there and talk to the doctor or else. Do you think killing them with kindness is going to help? They don't hear anything you are trying to say. All they know is their high is gone and they feel like crap. That sucks for them it does. But I'm not the one that injected the heroin in them. I am the one that saved their life and I would do it again. I hope they get help. I will try to encourage that even if they don't listen. They will not yell and scream at me or call me names.
I think you were a little harsh to the OP. I don't think she is discriminating. She is describing the harsh reality of the patient population she treats. She needs to decide if she can handle working in that reality because it is tough and not for everyone.

I like your post and agree with much of what you say. But as an ICU nurse, I can assure you that not every ICU patient deserves understanding for their bad behavior. Having difficulty dealing with illness does not entitle you to swear at, threaten, assault or manipulate the nurse. Those truly ill patients that are polite and respectful in the ER can become rude, entitled or assaulting in the ICU. Their families, once the initial shock and fear have worn off, can become even worse.

But yes, the poster you quoted was more than a little harsh to the OP and clearly does not get that she doesn't get it.

BrooklynRN11201 · Apr 17, 2014

OP: There's nothing wrong with being jaded... SO LONG AS YOU GIVE PEOPLE A CHANCE.
I am jaded as all get out and yet I still get many compliments from patients about my excellent care and personable interactions...
I give everybody a chance, every time they present... even if they've been weenies before... but I remain jaded because I see people as they are... and some people are... disrespectful creeps...
But I echo Esme's experience... some of the most trying patients I've had are also the most affluent and powerful... and some of the kindest have been strung out street people with scarred up veins.
Personally, I dig the ED, and I like working at an urban trauma center... all of its warts notwithstanding.
I think you need to decide what you really want and start to toughen up. Not too many softies make it in the churning waters of the ED.

very intelligent and SPOT ON advice, I appreciate it.

to be clear, I do have at least a couple of patients shake my hand on discharge and tell me I was excellent on each shift (which does make it worth it). I do provide personable interactions and very detailed assessments. I do attempt to comfort the patient even if it's an extra rolled up sheet under their legs or sacrum or a cup of water. I've had 4 positive comment cards written about me in the last 5 months, actually. It's just the really difficult patients that irk me, I suppose. But I hear (as this post proves) it's basically the same everywhere. I think it makes sense not to internalize it and to just leave work at work when I go home. It's just tough looking over my shoulder and feeling I need to carry pepper spray with me when I leave the building!

BUT despite this, I do think I belong, particularly in trauma where most of my interest lies. I think I just need to focus on getting certified (will be in early June) and requesting more placement in that area of the ED. I just know I also have to pay my dues in the beginning and sort of prove myself to colleagues in the meantime.

I learned so much from those patients and colleagues -- even the rude ones. I can literally handle anything.

good point, I definitely DEFINITELY feel a little "tougher" a little more "resourceful" and like I have grown thicker skin so far in my first 5 months in the ED

Type 1Nurse- you are a better person than me. Couldn't do ER. I am sure you have very special qualities that you bring to that department. Those patients are lucky to have you there. Hang in there!

oh my gosh, thank you so much!! :)

Yes, people visit the ED just because they are drunk, drug seekers, have no place to sleep and it's cold out, haven't eaten for days, have a pimple and it's prom night, it's Saturday night and they have nothing else to do, or myriad other frivolous or pathetic but not emergent reasons.
Pain is subjective, but someone who is drug seeking and "lost his clinic card", "got robbed on the way home from the pharmacy with my dilaudid prescription" or insists that their hangnail be treated with IV narcotics require a bit of nursing judgement before medicating.
I am an ICU nurse, too, and believe me we don't see half the nonsense that the ER sees. If you doubt me, spend an evening in the ER waiting room and watch the entertainment.

I love you?

Those truly ill patients that are polite and respectful in the ER can become rude, entitled or assaulting in the ICU. Their families, once the initial shock and fear have worn off, can become even worse.
But yes, the poster you quoted was more than a little harsh to the OP and clearly does not get that she doesn't get it.

100% - I often vent to my neighbor who was an ED nurse for 3 years and has been an ICU nurse for 2 years and she says the exact same thing! THE FAMILIES!!! ugh.

Kooky Korky, BSN, RN · Jun 21, 2014

Emergency medicine has it's downfalls. Those other nurses are "jaded" because they have to be for survival....or it will eat you alive.
I have been called everything under the sun except blonde and white....which is my hair color and race. I have been armed robbed for narcotics. But.... I also had gang members come to my wedding to give me a gift. (let me tell you that caused a sensation). I can rock a baby to sleep and forearm a gang member to the floor.
You appreciate the little things and the rest......You just let it go.
You can't take everything personal. You can't take everything to heart. Celebrate the small victories. Realize defeat. You can't fix stupid. Move on to the next day. This is the life of of an ED nurse.
I actually have a tougher time adjusting to the privileged. They have the money to back up their side of the story. I cared for children with better manners that lived in a box on the street than the ones who went to a private prep school. I broke up a fight in the waiting room at this affluent hospital with a fire extinguisher. I was attacked by a commercial pilot to leave marks on my neck because he waited 10 mins to see a MD for his daughters chin lac.
It is what it is.
((HUGS))

That must have been a cool wedding! But, girl, where was Security? You can't go around swinging a fire extinguisher!!!

What was up with that freaking out of control pilot??? Scared I guess, but it just goes to show you - he could probably handle any flying emergency, but when his baby got hurt, he freaked.