clairebearrn

I think regardless of what area we work in, we have our nursing judgement that tells us what to do...We do have a set protocol for CP, sepsis, etc in our ER, but the doctors have to fill them out first and then the orders are put in to the computer and we get the labels and send the blood, get ekgs, etc...but regardless, if I get a CP, the first thing I do is put in my line and draw blood, that is so simple we dont need an order and but I do need MD orders to send the blood....I put in my own orders in the computer, dont wait for the clerks, but since we are a county facility we cant be ordering things left and right due to cost...even though im semi new I know what has to be done for CP (CE, d-dimer, CT chest, ekg, etc)... I havent worked in the north, but loraticus is right about the south, we cantr jump in and order things because then we would be practicing medicine...either way I will take everyones advice...maybe you guys are right and I need more confidence because I always regret going up to the doctors and asking for orders...I get scared when getting critical patients, and hate asking for help most of the time because I think people might think Im dumb ...There is certain people that help and that I trust and other wont, so that is also a problem...it just kills me to know that other nurses who have only been there 4 months are already in trauma, when Ive been there since last september and havent stepped foot in trauma...

I have had BAD days just like yours, we all do, but you handled it...so youre an awesome nurse, its okay to get stressed and emotional about it,just take a second go to the bathroom and get together... but once youre home, Im pretty sure you feel awesome that you were able to do so many things and learn a lot in just one day...wow!!!!!!!

I want to thank everyone for their advice...I really do try my best... Most of our patients, get seen by NPs in triage and labs are done and ekgs....Still, Once I get a new patient, I put in an IV line in every patient(you dont know when they go downhill) and draw labs...check blood sugars and hemacues...in mostly everyone...cp, I order an ekg...etoh, i get the ativan ready and assume they have a head bleed, diabetes, I assume they have dka, someone with a fever, I assume theyre septic and i start the fluids....but we need orders for everything...except emergency situations...i do tell the doctors, "you want to start a nitro gtt, etc" but I dont get it, I dont know what else could be wrong...Ive never gotten written up, like other nurses...there are other nurses in the same boat and we talk about it and have come to the conclusion we arent good enough for trauma...which really sucks...I also work on the tele floors on my days off, so I even get more experience there, but I dont get what Im doing wrong and everyone tells me am doing good...arghhhhhhhhhhh

So, I have been an ER nurse for about 8 months, in a busy county ER...I still feel like am getting the hang of things...but I haven't gotten the confidence I would like...I feel like Im really slow, cuz sometimes I get patient after patients and discharge after discharge and I end up feeling like I missed something by not being able to think 100% regarding a pts dx....its very high paced...I always second guess myself and feel intimidated by some doctors, who can be nonchalant about a HR of 39, Bright red emesis, hgb of 4, etc...I tell them, "can you write me something for pain," and they just stare at me with a blank face...Like yesterday, I had a pt who came in for CP, ekg was normal and no cardiac enzymes had been drawned. the doctor sees the pt, but doesnt order anything...an hours goes by, while am busy with another CP/SOB, and still no new orders....nothing I ask the doctor if the pt can eat, since hes been asking me every 5 minutes...and then the doctor loudly says, "god, dont you know hes a r/o acs and may need a cath...so no he cant eat...." I was so embarrased, but in my head I was like, "you are so stupid, you havent even ordered anything, even cardiac enzymes, a d-dimer, anything, and yet you already plan a cath..." but all i did was walk away.... and then my heart starts racing when i have super critical pts:redbeathe:redbeathe...like I start thinking, "omg, what if he codes, i dont know how to cardiovert, etc, etc..." Ive been noticing that other new grads were allowed to go into trauma bay area (we are a trauma hospital and receive super critical pts, like GSW, cardiac/traumatic arrests, all those tier 2 pts)...before me and they started after me...This really took a blow to my confidence and now I feel really bad, like my nursing skills must suck.....they must if everyone can work trauma, except me... I dont know what to do, other nurses tell me am doing good and that I am very directable, that I focus on what I gotta do and do it...but I dont know why i feel this way...Ive noticed other nurses are so calm and collected, and joke around with the doctors, etc...and then there I am, like I dont fit in...so im frustrated and dont know what to do...I would really appreciate some advice..:cry::cry: THANKS!!!!!!!!!!!:heartbeat

Hi. I am finally off orientation in a busy level 1 er in la! I only got 5 weeks of orientation and I feel like am learning as I'm going along! Today I was just floating around in the ER and just triaging the ambulace pts coming, which are back to back...we are a super busy ER. I got a pt who came in for N/V. The EMT took the vitals, vital signs were stable, the pulse was reading 191 on the vital sign machine, so I decided to check the radial pulse, which was 100 and then 94. I notified the MD ansd charge nurse and they sent the pt to the front waiting area to be completely triaged, instead of placing the pt on a bed inside the 23. the . Thirty minutes later the pt came back to the ER because her pulse was actualy 200! Now I feel so bad and stupid! How did I get a radial pulse of 94 and 100??? I keep thinking back, that I missed this... And I feel that everyday I might have missed something...I've been on my own now for a month and I'm trying my best, but were so busy...the pt turnaround is high!!! I'm running around like a chicken with its head cut off...I love the ER, but I just don't know how to do deal with the feeling like I missed something on a patient or the feeling of being new and that the MDs might think am slow...my preceptor and other nurses say am good and mature and that I just need to be more confident and get used to the high pace... any hope for me???Sorry for the long post, just need some words of of encouragement...thanks!!!!

I completely agree!!! :up: Thanks fellow ER NURSES!!!! I do my best at work regardless of my patients & I want to come home and have a place where I can vent without getting more BS!!!!! sorry, but most of the days ive had pretty bad days, especially as a new nurse!!!!

I completely agree with daytonite. Even though we get vitals q2 to q4 hours in the ER, I always get vitals on my patients when I come on at 0700. Its part of my assessment. I want to know what is going on with my patients at that moment and catch if anything is going on ex. hypotension, tachycardia, etc. I'm going to be assessing them and be in the room so might as well do them.

I'm a brand new ER nurse...only had 5 weeks of orientation in a county ER in Los Angeles...I have already had my dealings with ETOHs, drug seekers, and countless ungrateful patients. I have had up to a total of 11 patients in a day...let me sum up a day in my ER: I get to work and I have 1 patient going to ICU is on a billion drips has pacer pads due to a HR of 40!!!! then next door I have my 90 year old lady with HgB of 4 with cbcs every 2 hours and running blood...then I have the lady who I have already had about 4 times before due to severe pain....who only wants IV dilaudid every 10 minutes and screams in pain....I spend thirty minutes trying to get a line but guess what? she's an IVDA!!! nevertheless I'm assessing her pain and giving her meds....Then I have a DKA who has a glucode of 893 and accuchecks every 30 minutes and running insulin drips...then I finally get an icu bed for my first patient...im calling report...charge nurse decides to pull the patient out for transport and gives me another patient....who has SOB!!!!!! sating 75 and is getting unresponsive, great!!! I'm done calling report, I run to the SOB patient....turns out to be PE!!!! ahhhh.....then my DKA pt decides to have EKG changes....oops HR 30...potassium is now 8....great!!!! so I'm running around...my bladder is ready to pop....and then I have the family member of my anemic old lady yelling at me because I'm insensitive and who is going to report me for not checking on her for an hour...IM SORRY I WAS TRYING TO SAVE MY PTS LIVES !!!! im a brand new er nurse and I'm venting already...yes it sucks when people who are not nurses call us ' mean, inconsiderate, and other bad words...etc' It makes me feel bad because all I'm trying to do is care for patients by being a compassionate and competent nurse!!!! but no one sees that...I know there is some nurses who aren't that great and can be mean...but not everyone is like that...we are busy trying to save lives and may not have the time and energy for therapeutic communication....

I'm sorry! Hugs to you. I wish you the best and keep going with NS! I know she wants this for you and will be proud of you. You will be a great nurse. Like you said, you can't quit. Just take a day and let it all out...if you need to. Best wishes...

Turd, It seemed you were being sarcastic. Nevertheless, Its compassionate that you choose to work with these patients and view them as human beings when other nurses may not. I agree they shouldn't be treated wrongly, they don't choose this way of life.

Laurenh, If you feel like its time to move on, go ahead. Its great that you gave time and energy to these low income patients. I also work at an inner city hospital. I just started and think these hospitas prepare you for anything. Its a great experience.I plan on staying at least 2 years to get good experience. I grew up going to these hospitals so I feel for the patients. They get frustrated for the long times and get sicker and sicker. The average wait time for my hospiyal is 12-24 hours, sometimes 30 just to get a bed in the ER!!!! I think there will always be bad patients who are mean everywhere. I know it is hard to be a nurse with the high turnover. Its not healthy for you or the patients. don't feel bad, you did make a difference. :) If you feel like its stressing you, move on. You're health is what matters. You can't take care of others without taking care of yourself. Good luck and let us know how it goes.

oh bossynurse...LOL!!! I commend you for standing your ground. Its nurses like you who speak up for those who cant...youre a great advocate. Regarding pedophiles, they are ill and should be getting help to prevent any danger to kids. But Turd you're just going down the 'slippery slope.' People who are mentally ill don't choose to be that way and don't deserve to be treated like crap.

congrats bossynurse, I am glad to hear you story...I just hoped other people suffering from addictions could hear it to have hope!!! :) and no addicts are NOT a piece of '@")!' NOWAY!!! who would say that? Shame on those nurses. Were supposed to be advocates and compassionate. I just think some need help...but some don't want it so how are you to help them?? I've tried sometimes to help them and refer them to AA, NA and its hard because they refuse. again., kudos to you!!!

I agree with you sue. Most of the patients seen due to psych problems have a hx of drug or ETOH abuse and vice versa. Now I believe these REALLY need help because they can't quit the drugs on their own.

Really!!!!? Cannabis was the only thing that came up on his tox report. I know people personally that have used weed long term and nothing works for their pain just weed. This patient hadn't had their 'daily' blunt so dilaudid and benadryl gave him that high to make his pain go away. (or that was his explanation after I drilled him with questions) He was a s/p assault so was in pain. Ha, maybe am gullible. still pain is pain right and as nurses we've gotta help them regardless of their history!!! So you just quit like that? (if you don't mind me asking) I knew it wasn't that bad. My friend keeps telling me he has side effects from trying to quit...i knew he was a liar...haha...'what I do for fun' (sorry out of context!)