Published Jun 6, 2016
survivor1970
1 Post
I worked as an OR nurse for 13 years. I graduated nursing school and went straight to the operating room. A few months ago I decided I wanted a change. I'm 40 years old. I lost so many nursing basics in the OR that I learned in school. I decided I wanted to be an ER nurse. The ER is very eager to get nurses. I talked to the ER manager and told him I lost a lot of RN skills but wanted to be an ER nurse and we set a date for me to start. He said he'd accommodate me to facilitate my learning and getting my skills back up to par. I have bought several books and look up everything. I started 6 weeks ago in ED on a Saturday. The manager tried to put me on the fulltime schedule after 4 weeks. I have not done a complete assessment, blood draw, given meds, even had a team of patients, etc since nursing school. I thought I was catching on quickly and relearning things I was taught but actually didn't do in OR, but at that 4 week mark I was told I was falling way behind. Mind you I was only working 2 twelve hour shifts a week for the 4 weeks and the 3rd 12 hr was modules, educator training, or class. I was doing 2 rooms by myself at this point and helping doing other rooms to gain skills back. It was really disappointing to me. I am like a new nurse. For the past two weeks I was sent to the floor but I do not think it did me any justice besides getting comfortable with the IV pumps. Things are done a lot differently in ER. I am somewhat anxious now because I am a "seasoned rn" and I have 4 more weeks to prove myself. I'm getting 12 weeks total to relearn everything and learn what I hadn't before. 4 weeks more....is it possible? I have the drive even at my age. My preceptor is great. She thought me going to the floor was a waste of 2 weeks. I love the ER. Fast paced, never know whats coming through the doors. Any suggestions? Our max is 4 rooms per team. I can do 3 right now.
Lunah, MSN, RN
14 Articles; 13,773 Posts
I thought I was catching on quickly and relearning things I was taught but actually didn't do in OR, but at that 4 week mark I was told I was falling way behind. Mind you I was only working 2 twelve hour shifts a week for the 4 weeks and the 3rd 12 hr was modules, educator training, or class. I was doing 2 rooms by myself at this point and helping doing other rooms to gain skills back. It was really disappointing to me. I am like a new nurse. For the past two weeks I was sent to the floor but I do not think it did me any justice besides getting comfortable with the IV pumps. Things are done a lot differently in ER. I am somewhat anxious now because I am a "seasoned rn" and I have 4 more weeks to prove myself. I'm getting 12 weeks total to relearn everything and learn what I hadn't before. 4 weeks more....is it possible? I have the drive even at my age. My preceptor is great. She thought me going to the floor was a waste of 2 weeks. I love the ER. Fast paced, never know whats coming through the doors. Any suggestions? Our max is 4 rooms per team. I can do 3 right now.
As a new grad I had 12 weeks total of ED orientation, with two of those days each week doing a didactic portion of an ED nursing fellowship. When I oriented to a level 1, I got 9 shifts of orientation. Nine, that's it. Your orientation sounds rather generous on the surface. But any "seasoned RN" who comes to the ED is going to feel like a green new grad. It's just the nature of things. I have seen it with nurses who come to the ED from the ICU, med/surg, ortho, you name it. Some catch on, some away run screaming.
If you are falling behind, please do not wait to discuss an improvement plan with your preceptor. Do it as soon as possible, and develop measurable goals/milestones. What those are I cannot say because I am not you, or your preceptor. But it sounds like you are close to being "there," if you can handle three patients. What is it that is taking your time and preventing you from taking a full load? Where can you maximize your time? Are there things you can delegate? Do you just need to practice charting more quickly, maybe look at any charting macros shortcuts your EMR might have? Are your assessments too broad rather than focused? Don't do a head-to-toe on everyone! Some things just come with practice, like being able to start an IV or get an EKG done quickly. Do you have techs who help with some of these things?
Best of luck!!
amzyRN
1,142 Posts
Both new grads and experienced non ER nurses get 8 to 12 weeks at my hospital. They try to get us off by week 8 but some people ask for more time. I'm a non ER nurse and have worked on very challenging units and this is by far is the toughest thing I've done. The turn over is exhausting. I got 16 patients in a 12 hour period. I would have my patients put in the hallway for new higher acuity patients to come in. I'm in week 6 and am taking 4 patients with help from my preceptor who is working with me making sure I'm prioritizing correctly and also helping with higher acuity patients making sure that their needs are met.
You should try to take all the patients and have your preceptor help you with care so that you can get used to having 4 then move up with the acuity. I was told that by week 5 taking 4 patients was expected while working in parallel with my preceptor since some things will be new to me like pediatric patients and ICUs. But at least doing all the charting and major interventions for 4 patients by week 5 will allow you to move up the acuity and then be ready to be on your own.
What I do when I work with my preceptor is share my thought process with them and they guide me to come up with a plan. There should always be a plan and even though the ER is very chaotic there are logical steps to take in each scenario. For example, Chest pain gets an EKG first, stroke symptoms gets a CT scan as the first priority. Abdominal pain needs a urine sample and an IV if they are vomiting. Fever with tachycardia and any signs of severe sepsis gets blood cultures, fluids and a broad spectrum abx. If you think it's severe sepsis, two large bore IVs... If you have multiple patients who are high acuity, then prioritize by ABCs, whoever will die the fastest gets the priority.
I think you will be okay if you challenge yourself now so that in 2 weeks your preceptor can be mostly hands off, then you will be really ready to be on your own.
ArrowRN, BSN, RN
4 Articles; 1,153 Posts
Im a med-surg floor nurse, I have floated to our ER before, its a level 1 trauma center. You not necessarily need to do thing quicker, just smarter. First thing you mentioned was "complete assessments"...thats for med surg on the floor in the ER you should be doing rapid head to toe and FOCUSED assessments. Like 30seconds. You should be concerned about are they breathing, airway clear? Any gross bleeding...no? if all good, then you done with that pt and move on. If they all talking and walking then next is pain meds....your last priority is regularly scheduled meds....again i'm not an ER nurse, but seems like they were teaching you how to be a med surg floor nurse than an ER nurse, its way different mind sets.