I've been an RN for only 9 months. I spent 1 year as a tech on a gen-surg unit, then transitioned to an RN and worked another 7 months there. While I loved the people I worked with, I hated (or thought I hated) floor nursing and always felt a strong draw to the ER, especially after a few days shadowing there during school.
Two months ago I was hired at a level 2 ER at another hospital, and I was elated. But my excitement has turned to misery as I'm feeling regret and questioning my decision to come here.
I realize I'm still very new, and I'm in my final weeks of a 12-week orientation. However, there has not been one day I haven't come home and cried my eyes out. This hospital is very unorganized, and their charting system is very antiquated (Paragon). I come from a hospital that uses Epic, and things there were organized and state of the art, for the most part. My preceptor will be approached by a doctor (unbeknownst to me) to administer meds, and since they all chart everything after the fact, I'm often finding myself feeling like I'm running around like crazy trying to get things done, having pulled meds or preparing to do something, only to be told by her that she's already done it. So it's just frustrating. She's often telling me to stop doing one thing and start another that has greater priority, yet when I ask her why that is, she just gives me a runaround answer that the other thing just needs to be done stat, so just do it.
I'm very inquisitive by nature, and I also want to learn as much as possible, so I ask a lot of questions. But it seems to annoy my preceptor, as she often responds with "just do this," or "this is what you need to do now, we have no time to question things." I get that it's a busy ER, but if I don't understand why I'm doing something, how will I learn? I've asked to be given a different preceptor thinking perhaps my learning style and her teaching methods don't jive. But I was told she's the best for new grads, so I'm stuck with her.
I get zero feedback on my performance, so I leave work every day feeling like a failure because I'm very hard on myself. It doesn't help that even after 2 months most of the doctors refuse to talk directly to me about my patients and seek her or another RN out to discuss my patients and their orders. I'm told that they need to get used to me...well, what's gonna happen in a few weeks when I'm on my own? Are they going to bypass me then too and seek out a trusted RN to discuss my patients?
Sorry for rambling...I'm just feeling hopeless and just wanted some reassurance that these feelings are normal newbie growing pains because none of the other newer RNs I've talked to have expressed these things themselves (although they're not recent grads like myself). I dread going to work each day, and I am often near tears throughout my shifts. Can anyone relate, or even just tell me that it gets better?? I'm so miserabe. :-(
I know our facility requires a two week notice, regardless of if you're on orientation. Although we will give you an immediate release of you are on orientation because it is of no benefit to have you working on orientation. If a two week notice isn't given, you're an automatic no rehire.
I really hope this works out for you OP. It really sounds like you ended up with a crappy preceptor.
As far as the resume, I think the rule of thumb is anything less than 8-12 weeks doesn't go there. But, I am by no means an expert.
Hi! I am a new grad in the ED as well. It's a busy ED usually short staffed with higher acuity pts. I had a 18 week orientation.
My preceptor also did not want to precept she even told me she was volun-told to precept when I first got hired. I felt like I had to watch her every move to learn something and ask questions for her to teach me anything like I was pulling teeth. She expecting me to know a lot of things I didn't as a new grad. It doesn't sound as bad as it is for you though because occasionally she would give me insightful advice and would answer 70% of my questions.
I have been off orientation for about 14 weeks and I feel like the best thing to do is write things down then look them up after work I also have invested in emergency books to learn more about the specialty. As far as knowing how to operate in the ER I really just try to observe ask questions to other nurses when I am uncertain. Look up policies on this I'm unsure about for better explanations. Think about who is highest risk and what is most important and do the best of your ability. My biggest thing is trying to retain all the knowledge you need to know in the ED.
For a while I was just trying to get through the shifts getting everything done and I really felt like I was going through the motions and it felt like I was forgetting everything I learned in school. It still feels like that sometimes so I try to remind myself what I know and apply it. I do think one day it won't just be going through the motions, it'll really be applying it all together. Hopefully not long from now.
It does get better but it will feel like you are incompetent for a long time. If you really want to do ED, stick it out! Keep learning and observing and eventually you will feel more competent. It will get better.
Pebbles I am sorry to read about your experience. U may well be cut out for emergency nursing but it seems that you are not set up for success currently. I help precept occasionally and I would never treat someone like your preceptor is treating u. The goal should be to build you up not belittle you. I hope something changes for u.
Regarding prioritizing, this is how I look at it. Remember I was also a medsurg nurse before. U should always be triaging. Everything u do is one big constant triage. Say room 30 is ordered Tylenol for a headache, 31 needs toradol for kidney stone. So right now I'm about to get up and get the toradol first, EMS rolls an ashen patient into 32 with chest pain. Well the sickest patient has now changed from one minute ago. Now I need to focus on the chest pain. And it keeps changing all shift long. You always ask yourself whose need is right now the priority?
Its easy to be task oriented from being a medsurg nurse. I know. On the med floor for the most part many tasks could be done in whatever order.
If it does not work out for u in this ER don't give up. U may just be in a poorly run ER. Best of luck.
Specializes in ER - trauma/cardiac/burns. IV start spec.
I spent 9 years, 4 months and 17 days in the ER before a latex allergy ended my career. I finished school on Friday and was in the Er on Monday the next week and never looked back but I thrived in chaos. That is what an Er is, it is organized chaos. While I do not know what Paragon is we charted everything by hand and even that was difficult with up to 9 chest pain patients often by yourself or running 5 trauma bays and sometimes a combination of both. I had almost 2 weeks of orientation before I was on my own. It takes a combination of big picture/little picture to work with that many patients. Big picture how many patients do you have that are a level 1, 11, 111 or 1V? The most acute you jump on first. Big picture.
Does your ER have a "track" where the non acute patients are placed after triage? Do you have bays for the ambulance patients? Or are the patients just shoved everywhere? Do walk in's get triaged and their charts sent back? If on the "fast track" side one good thing to do is to look over each chart before your shift starts to see what is in your rooms, get report from the nurse going off shift. Reassess each patient if it is nothing more than sticking your head into the room and asking how they are. When the physician goes into the rooms be right there to grab the chart for new orders/meds. As each patient is discharged and a new one is brought to the room review complaint, verify complaint hasn't changed and then place chart for the doc. If a patient is say a kidney stone be sure to notify doc that you have one he needs to see quickly. You will pick all this up over time. A pediatric fever is more imperative than the "flu" symptoms as children can crash faster than an adult. The sickle cell patient needs are more important than the 'migraine" patient that is eating a snack and chatting with friends. Ask if the unit has standard protocols for some of the patients.
Familiarize yourself with the acuity rating system of the ER, of course that is mainly for the walk ins and if given a chance listen to any report being called in about an inbound ambulance patient. Look up anything you do not know when you get a moment. My first patient (on my own) was an overdose by pyridium. No one, not even the Doc knew what to do, I got the the medical reference book first and found out first - scared me and him to death.
Have you taken ACLS or PALS? Both are great certifications to have even if you have to do them separate from the hospital. Get there first. Do not let your preceptor be the go between with the patients you are caring for. Sometimes it is as simple as standing by the doc and telling him you have a patient complaining of X and would he like you to do Y. Take the initiative yourself. Once they see that you are capable of seeing the patient needs they will be more receptive to you. I got to the point that I could walk past the doc on duty and tell him (for example) the the patient in rm 11 had a kidney stone and I was starting an IV hanging fluids and was going to start with 1 mg of morphine and he would just sign off and come to the room when he could. You must stand up for yourself when you are sure of something. I had my first burn patient and the doc said do this then changed to do that. He asked why I was doing that and I told him that is what he said to do, he said he did not but even the patient corrected him. When he came back into the room with the fluid rate I had already figured it out and started the drip, after that he always trusted me.
Some preceptors do not like anyone who comes from a floor or unit and some preceptors will go out of their way to knock you down if they feel you may be a threat to them. Read, research, learn your ER's protocols and on your next evaluation ask for specific examples of your weaknesses as perceived by the preceptor but also ask about the things you are doing well on, let them know you are doing somethings right. Show your nurse manager that you are eager and a fast learner. Many time the Doc's go straight to the managers and do not go through the preceptors. It is a lot to learn but it is like the ABC's good assessment skills and being johnny on the spot goes a long way to get you to your goal. You can make yourself cheat sheets on some types of patients, a list of things to look for and of things that need doing.
Bobjohnny
99 Posts
I know our facility requires a two week notice, regardless of if you're on orientation. Although we will give you an immediate release of you are on orientation because it is of no benefit to have you working on orientation. If a two week notice isn't given, you're an automatic no rehire.
I really hope this works out for you OP. It really sounds like you ended up with a crappy preceptor.
As far as the resume, I think the rule of thumb is anything less than 8-12 weeks doesn't go there. But, I am by no means an expert.