NotWithoutPB&J

Ok, first a little history: I have been a nurse for approx 1 and 1/2 years. I spent the first year on a step down unit called PCU. I always knew that I would end up in the ED, at least when I felt ready. I have worked in the ED in the past. I spent over 2 years as a EMT/Tech (several years ago) and when I was in nursing school I spent 7 months working as a student RN in the ED that I currently work in and absolutely loved it. I know and understand that the ER is fast paced. I have currently been orienting for the past month and the staff had been wonderful. I try and manage the whole group (4-6 pts depending on the staff and pt load that day) and use my "orientor" only as a back up/resourse person. I only have 1 more week on orientation and feel that I am having a heck of a time finding a rhythem. I feel that I naturally get behind when a critical pt comes in and then I am playing catch up for hours after the critical pt is stabilized and/or transferred. I never really feel that I am keeping on top of my pt's labs and ordered tests. I am getting the medications and IV's in on time but half the time I feel like I am just a robot DOING what is expected of me but not really understanding WHY. I am in no way ready to call it quits...I am very stubborn and don't give up easily. I just want some advice or maybe some words of encouragement on how to not be so hard on myself when things don't flow the way I want them to. I feel that I have had some valuable past experience working the ER before but am discouraged that I am not really "getting it". Some other fairly new ER RN's said that it could take up to a year to really feel like you "get it". But I don't know if I have the patience to wait a whole year for this to happen! Thanks in advance!

Not to undo the "duhness" of my "duh" moment, I did happen to check my pts radial pulse prior to calling the MD (which I found to be faint to nonexistant. Not to mentions, she barely aroused to my sternal rub.) It would have been a great idea to have listened apically, though. Unfortunately I wasn't thinking nursing 101. Maybe I couldn't find her radial pulse because my pulse was bounding so hard? Anyways, we learn from our experiences. I definately won't forget this one. "Treat the patient and not the monitor"!

I had a couple of "duh" moments this week, as well... 1) I was assessing my pt at the beginning of my shift.after listening to lungs,heart,etc. I told her I needed to look at her feet...wouldn't have been a big deal if she wasn't a double amputee...DUH! She got a kick out of it...I didn't find it to be as funny, though. 2) Pt came in new onset a fib. Was titrating Cardizem drip all night to get HR below 100. Hr had been consistently in 120's-160's. RT informed me that they put CPAP on...about 3 minutes later I look at the monitor and see hr of 30's. Pt was difficult to arouse (had given 0.5mg ativan about 1 hour prior). I called md to notify of pt hr and difficulty to arouse after being on cpap. Turned cardizem off, of course. MD came in from home to evaluate pt at midnight only to review ekg strips to see that the tracing wasn't picking up and pt had a hr in 120's not 30's the whole time.Unfortunately I was so busy with another pt, I wasn't told by charge rn that the monitor tech had been calling about poor tracing and inaccurate heart reading.Oh, well...better to error on side of caution, I guess. I just feel bad for the doctor having to come in to see her pt when it ended up being unnecessary.

I am a fairly new grad...received my licence back in February.I have been on my own in a step down unit since the end of March.I know I made the right decision when I changed careers to become a nurse. The diecision was right for me and my family. HOwever, I have an "issue" that I can't seem to resolve on my own and I am beginning to think that it is affecting my personal/family life and maybe even my work to some degree. I am DEATHLY AFRAID of making a mistake and ultimately getting everything taken from me and my family. I feel that I am very particular,cautious,careful when assessing,medicating and treating my patients. I haven't made and major "mistakes" (just your usual...I wish I would have organized my day better or had time to do this or that). I am my own worst critic,so as far as I am concerned, at the end of each shift I dwell on all the things I could have done differently or better. HOw I could have managed my time better,etc... My coworkers are great. I have a very supportive staff that I can rely on to help or run questions by. Anyways, to get to my original question about my paranioa...I think as I get more knowledgable, I get more paranoid. I have signed up for liability insurance but still feel like I need to do more to protect myself, my license, my assets and my family. I have even seriously considered changing all of my assets (home,bank accounts, truck) to my husbands or children's names so if I ever encountered a lawsuit, it would appear like I have nothing worth taking...at least on paper. I even left a message to speak with a lawyer to discuss how to protect myself. He never returned my call and I never followed up with another phone call. I am unable to relax and enjoy this new part of my life. When I am at work, I feel great. I know that I made the right decision but I can't totally let go of my fears and enjoy my new career. How often do nurses get personally sued to the point that they lose everything that they earned? Do I have more liability driving my car? Are my fears normal as a new grad? What can I do to be comfortable with my career so I can relax,learn,grow and enjoy myself? Thank you for listening to me ramble...