Newbie in ER....help!

speedynurse, ADN, BSN, RN, EMT-P · Apr 28, 2021

First - meditech is terrible! I refuse to ever transfer to a better paying hospital system in a town I live in because of meditech! (Although I have heard of better versions).

Second - ER nursing is hard. It was hard for me as a paramedic transitioning to ER nurse and time management and all the skills and critical thinking takes time. I didn’t feel halfway comfortable until at least 6 months in and still asked questions years later.

Third - ask questions! Ask your preceptor his or her flow for time management and understanding acuity levels. I really liked Sheehy’s emergency nursing book. Is there a really nice ER doc or PA or nurse? If so, ask questions at every change you can. The more you ask, the more you know. You won’t know everything - and that’s OK. Everyone that thinks he or she knows everything generally does not ☺️

JKL33 · May 2, 2021

On 4/26/2021 at 7:27 PM, nasr69 said:

I was told my goal by end of first week should be to take 4 patients.

By whom?? That is utterly ridiculous.

How long is your orientation in this (fake) "residency?" Please tell me you did not sign some kind of contract for this privilege.

I would have a "meeting of the minds" talk with them ASAP; not just your preceptor but whomever is overseeing your orientation.

nasr69 · May 2, 2021

It is a residency program and my director goal was that I should be able to handle 4 ER patients by week 1. My first week was 3 strokes and two stemmie and a trama. This is week 4 I can bark take 1 patient and now I’m so nervous and worried I’ll make a mistake because the pace is so fast. I don’t know. I have no prior background in medical field... what would be the best unit for me to try and transfer to?? Any suggestions? I love talking with the patients and want to be a good nurse but im

over my head in the ER. I want to suggest a transfer but to where?
thank you for all the replies. And any suggestions!

clockwork2112 · May 2, 2021

If you're truly overwhelmed and there's nothing they can do to help you, you should probably ask to transfer to a med-surg or tele unit for a year and then take another crack at the ER. You will learn a lot about the basics of everything medical and your time management will be 100% better if you spend that time wisely. Pay attention to who are the best nurses on that new unit and learn everything you can from them and mimic their best behaviors. While there, if there are hospitalists or specialists/surgeons who are friendly, talk to them and learn from them too.

JKL33 · May 5, 2021

@nasr69, what was their orientation plan? They have to have something more detailed if they are going to hire new grads into a busy ED.

This is a disaster unless they have something more intensive in the way of actually teaching you. The only thing I can think to tell you is that you need to let them know immediately that their apparent plan is not going to work for your orientation. They either need to review the plan with you and help you get going in the right direction and provide significant didactic and bedside training, or else you need to ask them to help you find a role within the system that would be more suitable for a novice.

Best of luck ~

TriciaJ, RN · May 5, 2021

Where is your preceptor? Shouldn't you be shadowing your first week? This really sounds like a thrown-in-at-the-deep-end orientation. If they're going to be hiring new grads into the ED, there needs to be way more structure than what you're describing.

I second JKL33 above; you need to have a heart to heart with whomever is responsible for your orientation. If they had a medical floor (ideally no tele) it would be a better start. What on earth are they thinking?

MD married to RN · May 5, 2021

When you say 4 patients, I hope you mean they expect you to have managed 4 separate patients over the course of the entire shift (one at a time). If you meant 4 at the same time at then end of 1 week (3 or 4 shifts), that is crazy.

This hardly sounds like a 'residency.' In the first month of an EM physician's residency (which happens after 4+ years of college, 2 years of intense science/book based med school, and 2 years of clinicals at an average of 80+ hours a week), they are only expected to handle 1 or 2 patients at a time, maybe 8 in a whole shift.

What you are describing sounds dangerous, akin to throwing a new born into a pool to see how well they swim.

Not sure its the ED you work in or your hospital system. If the latter, consider other opportunities.

Good luck.

nasr69 · May 6, 2021

Hello,

Thank you all the replies.... I have transferred to another unit. While I loved the ER and the staff were so supportive I was over my head. I have had 1 shift on the new floor and clearly this is were I need to be and I am happier with it.

Thank you!!

TriciaJ, RN · May 6, 2021

22 minutes ago, nasr69 said:

Hello,

Thank you all the replies.... I have transferred to another unit. While I loved the ER and the staff were so supportive I was over my head. I have had 1 shift on the new floor and clearly this is were I need to be and I am happier with it.

Thank you!!

After what you described your new unit should be a piece of cake. Best to you.

HiddencatBSN, BSN · Jun 24, 2021

On 5/2/2021 at 5:45 AM, nasr69 said:

It is a residency program and my director goal was that I should be able to handle 4 ER patients by week 1. My first week was 3 strokes and two stemmie and a trama. This is week 4 I can bark take 1 patient and now I’m so nervous and worried I’ll make a mistake because the pace is so fast. I don’t know. I have no prior background in medical field... what would be the best unit for me to try and transfer to?? Any suggestions? I love talking with the patients and want to be a good nurse but im

over my head in the ER. I want to suggest a transfer but to where?
thank you for all the replies. And any suggestions!

That's not reasonable at all for a new grad in any acute care specialty. I would transfer to a different hospital because I'd worry any other unit would have similarly bad expectations for a new grad. Even as an experienced nurse managing a full assignment in a week is challenging because policies, "how things are done", locating supplies and figuring out resources in a different place takes time.

I think the only way you'd be able to do this is by cutting a ton of educational corners and learning on a tasking level rather than nursing knowledge and judgment level. Like giving meds without taking the time to look them up and learn dosing and indication and administration concerns, not learning lab implications, etc...