is this normal? how can i feel confident and in control again?

Specialties Emergency

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i just started at a very busy, large ED in a very urban area. i have 2.5 years of transplant/nephrology experience where the ratios were 1:3-5. i feel like i was one of the best, most efficient nurses on the unit.

the ED is absolute madness and i'm beginning to crack after just 3 shifts. i'm on orientation for the next 12 or so weeks but i don't know if any amount of training will prepare me for 1:10-15 ratios, angry patients, lack of privacy or sanitation or space. on my last shift i went outside twice to the ambulance bay to cry.

i don't know who any of my patients are because there are so many of them. i don't understand how we're supposed to constantly be priming IV tubing and constituting IV antibiotics and starting tons of IVs and drawing labs on this many patients without going absolutely insane.

any tips or words of wisdom would be SO appreciated.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Those ratios are unsafe. You must be in NYC. I would head back to the previous position, if possible. Just being honest!

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On 8/31/2019 at 6:15 PM, msulliv4 said:

i don't know if any amount of training will prepare me for 1:10-15 ratios, angry patients, lack of privacy or sanitation or space.

Correct.

On 8/31/2019 at 6:15 PM, msulliv4 said:

i don't know who any of my patients are because there are so many of them.

I say cut your losses.

Take care ~

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Cut your losses! Unsafe! Ya i agree you must be in NY! I have 4 pt and 3 when I am the trauma section! get out girl! Not safe or cool

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OMG, I totally feel you. I just got off orientation and am in the SAME boat. I actually just posted about it. I just fell so lost, and feel my pts are unsafe. Our ratios are usually 1:8. However sometimes they do get a little higher, but to be avoided if possible. So most of the time it is 8. I feel I cant remember names, complaints, or anything for that matter. I feel task oriented and I want to be able to do my tasks but know why I am doing them. The nurses that have been there longer then me are great, they know their stuff and I get great support from them. The manager does come and pass out unsafe assignment forms when necessary to try to get us the staffing we need. They all keep saying with time I wont feel so "lost". Its hard to believe but when I look at the nurses around me (many who have been there 2yrs or longer and some right out of school) I feel encouraged, however I dont want to feel as if I am not doing the best for my pts well being than I possibly can. And that's how I feel a lot of the time. One nurse told me to learn 1 new thing a shift to increase my knowledge. I dont know what the answer is.. if its time... courses (which I have taken) or what.. but I have to believe that with time my thinking will evolve and I will have a better time of it... or is this naive of me ? I only started in May... and I feel better now then back on the first day I was on my own... but still feel ....uneducated... maybe?

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On 9/4/2019 at 2:10 AM, Newengland12RN said:

Cut your losses! Unsafe! Ya i agree you must be in NY! I have 4 pt and 3 when I am the trauma section! get out girl! Not safe or cool

yes i am in NYC at one of the best hospitals in the country (doesn't feel prestigious at all when i'm at work). it's hard because i need to be in NYC for personal reasons but NYC is a really difficult place to be a nurse....high performance standards and even higher patient ratios. experience is required for all procedural areas where safe ratios are guaranteed--experience i don't have. it sucks because the solution is working outside of NY, but for the time being, i just can't do that.

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Seriously??? I've worked in two level I ED's. At both places the ratio was 1:4 for general ED patients, 1:6-8 for VERY low acuity fast-track pod, 1:3 for critical care/trauma. If we were drowning they would assign an RN to the hallway, where you might have as many as 8, but that would be working with a tech and the main goal was just finishing triage, getting lines/labs, keeping eyeballs on them, and pulling them into rooms as fast as they opened up. An entire shift with 1:8, I can't imagine, yikes.

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