No one else to talk to and just need to vent....

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Specializes in med/surg---long term---pvt duty.

I have 21 years of med/surg--long term care experience and a friend of mine talked me into moving to the ER--I've been there since August 12th and I feel soooo out of place sometimes. I work in a very small hospital where there is only 2-3 nurses on daylight--2 for pt care and 1 triage-if we're lucky and only 2 at night. Orientation is about 6-8 weeks depending on "how you do". Sometimes we get so busy that the girl orienting me is lucky to be able to point me to the right room much less show me anything. And some of the Docs we have are just PCPs that are "filling in" so they don't always know what to do either so the nurses have to "watch" them also....I talked to another nurse today--soo wish I was orienting with her--and she asked..well have you seen this, done this, do you know how to do this?? I said I didn't even KNOW I was suppose to do all of that, much less know to ask about it. She told me to read books etc. but I don't know where to start. I'm afraid that something will come through those doors that I'm going to be totally clueless about and cause someone to die. How do you ever get over that "OMG--what am I doing here" feeling.....

My hubby always says I have a confidence problem...you know this stuff why do you doubt yourself so much??? Maybe one of the reasons is when I first started nursing, the RN orienting me..after about 2 days told me "You'd make a good LPN but but you'll never be more than a halfa**ed RN". :cry: I never realized how much that affected me but every time I run into a problem..that flashes back into my mind even after 21 years.

I know it's only been a few weeks but it's really starting to hit me how much I need to know to work in the ER. They ask me how I feel I'm doing and I really don't know...they are saying I'm doing OK or you'll be fine, it just takes time but I don't want to be "JUST" OK....I want to be a really GOOD ER nurse and when that patient comes in that truly needs you is not the time to say "wait-I need to look it up."

Thanks for reading my rambling..I feel better just "talking" to others who might have a clue as to what I'm going through.....

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Specializes in med/surg---long term---pvt duty.

WOW..sorry..didn't realize how looooong my post was....:imbar

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Specializes in EMS~ ALS.../...Bartending ~ Psych :).

Is it the Patients that you are worried about or the SOPs of the ER that you don't know?

If its the patients, perhaps asking the medics if you can do a couple of ride alongs with them. observe, ask questions after they turn the pt. over to the ER, medics can be great teachers.

If its the SOPs, you will learn them, its only been a couple of weeks.

Good luck to you

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Specializes in ER-Med-Surg-Travel/Contract Nurse.

In my experience, I don't think that you'll ever get over the "OMG, what am I doing here" and you'll never know it all, I have been in the ER for 8 years now, and am still learning and seeing new things, I'm not an expert, I consider myself as the jack of all trades/master of none, maybe it's the ER you're in, sounds like you need to be in a bigger ER where you have more resources and more coworkers to pull information from...

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Specializes in ED, PCU, Addiction, Home Health.

klcrn-

I am in an ER exactly like you have described. Nothing gets in my craw worse than a poor, poor orientation program that leaves us good nurses doubting ourselves instead of being trained!

The only thing that kept me going when I started here was that I had 2 years prior in a BIG ER a few years ago. Our physicians are also not "board certified", they are more like glorified PCP's - and some of them need watching! I think working in this smaller environment is harder than the level I trauma center I was at before.

No matter where you work, you will never feel 100%. I think my own lack of confidence at times is what drives me to look for something new to learn that day, so that way it serves a good purpose. I've had those days that I thought "I can't do this", but that's just my "monkey mind" taking over :imbar

Hang in there - I'm glad you posted what really I think many of us experience!

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Specializes in Emergency; Corrections.

I've been doing this 18 years and still have the occasional crazy shift. But give it time, the more you do it, the easier it gets. I've done alot of time in the tiny 'rural' ER, there are definitely things you do there you won't see in the 55 bed 'city' ED. When things get crazy, everything always seems to work out. I'd recommend 'High Acuity Nursing' as a good book for reference and studying, try Amazon.com.

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Specializes in Trauma, Teaching.

It takes far more than just a few weeks or months to feel comfortable, I've been in ER 13 years and still ask questions. It felt really wierd moving from being the senior nurse on the floor to the rank beginnner all over again, when I first went to the ER.

The TNCC manuel is a good one to read, and take the class when you can. One preceptor went through the ABC-I algorythm with me, and it helped a lot. ACLS is another good one. Remember, the nursing process is still there, its just speeded up on you!

Benner described it really well, novice to expert. Expert in one area still cycles back to novice in a new specialty, but you have all the tools and background to move toward expert far more quickly than a new grad would.

Hang in there!:yeah:

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klcrn~

What a terrible thing for someone to say to you! That was so inappropriate of that nurse! Your obviously very experienced and very knowledgeble! 21 years! omg!

Ive been in the ER for 3 months now. I came from surgery (did almost 4 yrs there)...and everyday I say to myself..omg. What has helped me, is when I get a pt with something Im not to sure about whats going on I ask many many questions to the other nurses and the docs. Then when I go home, I look it up, and try to get that..ohhhh..thats what that is, or why we did that factor going. That seems to help me a lot, because Im ready the next time I get that type of pt. I google, look in my nursing books, acls book etc etc until I understand the rationale behind it all. I also carry a pocket calculator and a drug book on me, there are sooo many meds Im not familiar with. I also have my standing orders cheat sheet in my pocket, like what to do when u get this pt. That will help in starting things off, like do they need an IV, labs, neb tx, asa, ekg, monitor stuff like that b4 the docs see em.

Im at a small hospital as well, and we have 2 docs that dont seem to know what their doing, or what to order. One doc only orders a cardiac panel on every pt that comes in. (our policy is cardiac panel includes all cardiac enzymes, ekg, pcxr, monitor, pulse ox, bp both arms, and our cp protocol sheet) yeah he orders it even on our gyne pts. Go figure.

You are soooo right, there is sooo much to learn! I learn at least one new thing a day! Hang in there, and take advantage of opportunities that come in. If you havent done something or seen something, ask if you can help! Not only will that nurse appreciate your offer of helping her, but its a chance to learn something new. I ask a lot. Sometimes the ER makes me feel like I dont know anything at all. Sometimes I feel like I know a little more than what I did yesterday. I'm not comfortable, in fact I get nervous and worried about what do to and how to do it and how fast to move. I guess all that takes time. I try to absorb everything like a sponge, take it in and remember what we did and why we did it.

We're in the same boat, if you ever need to vent or chat again..do it, I'll listen!

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Specializes in ER, ICU, Neuro, Ortho, Med/Surg, Travele.

We have all been there, some of us are just better at voicing our frustation and even our fears. I have worked ER in South Jersey (400 Pt's on July 4th) OMG! to a very rural hospital in Colorado. None of us no everything and if you come across a nurse who think they do RUN!!

We all should be learning from each other, classes, books and yes even the doctors (if we are luck enough to have them). Our field changes constantly and we have to roll with the punches.

You know the process, some times you have to take a deep breath and believe in yourself. Don't be afraid to ask questions. There is no such thing as a stupid question. I contantly buy books to refresh myself and to challenge myself.

Don't let anyone or anything stand in your way.

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Specializes in ER, telemetry.

I also recommend reading the TNCC book and taking the class. If you are not ACLS certified, you really should work on that as well.

And, if you find that you just are not comfortable in the environment you are working in, find another job. That's the great thing about nursing, there are so many different opportunities for us out there. Good luck!

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Specializes in med/surg---long term---pvt duty.

Thank you so much for the replies. When I posted I had just gotten home after work and was feeling very down and frustrated, just writing it down helped tremendously. And to have so many say they have been through it too was like a (((((BIG HUG))))) that I really needed. I will work on getting the TNCC book you recommended...

I really do feel much better. I have to work 7a-7p today so I'm going to take a deep breathe...let it out slowly...and charge ahead.....................:)

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