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In our ER, RNs are not supposed to, however, we have one that does and she says, "Dr. So and So did a great job on that EJ." I tell her, I'm happy he did, and would you please now document just what a great job "he" did with it.

I'm a month away from finishing up my first year as an ER new grad. It's the hardest job I have ever done. I thought RN school was hard, but actually doing it, is the hardest. I had absolutely no hospital experience before walking in the ER. I can't believe they hired me. But, you have questions, so here are my answers: The most rewarding thing is when someone walks out and says, "Thank you." You rarely hear it, but when you do, it makes your day. Or something like, "You're the best nurse I have ever had." Something along those lines. In the crazy world of ER when someone takes the time to thank you, it means a lot. Also when you get a line the first try for someone who is a hard stick. It's where you get to pat yourself on the back. New ER nurse difficulty is when it's hitting the fan in the ER and you just can't get a line or you need to ask a question and there's no one around who has the time, you feel so hopeless and sometimes a failure. You have to trust your gut and you don't really have a developed one yet. It took me a long time to get over causing someone pain. We go into nursing to help cure, make folks feel better, that kinda thing, but in the ER I'm always poking, prodding, doing something that causes someone pain before the relief can come. Lines hurt, foleys are uncomfortable, NG tubes, well, let's not even go there, broken hips, all that stuff, folks are in pain and we cause them just a little bit more. Difficult pts come in all shapes, sizes, ages. All my folks have made it so outcomes are they either are dc'd or they go upstairs to a room. Difficult pts are such a suck of all of your efforts. They either didn't get enough or the "right" pain meds, get a drink when they were doing a CT study, you name it. Difficult is difficult but you have to remember we see people at their worst. For the most part, no one really wants to be in the ER. We get paid to be there, the pts really want to be elsewhere. I'd tell a new grad ER RN that it gets easier. You'll hear it so much it drives you crazy, but I'm happy that some things are now rote where I don't have to think about it, you just do it. Your practice will get better with practice. There's no substitute for doing when it comes to nursing. Keep your eyes open. Keep your ears open. Learn who the good nurses are and watch what they do, how they do it and emulate them. I'll support any new person in the er if they are an RN, a tech, a registration person, a cafeteria worker, you name it, I'll support them. It's hard as hell being new. New at anything, so I try to give them as much as I can if they need it. Since, the way I figure it, if you can teach them properly the first time, you won't have to keep showing them again and again. And we all need a friendly face. If you help someone, they will remember you. The ER is hard. You see a lot of a lot of different things. However, it does have its rewards. Good luck. Enjoy the ride. Know that it will take about 18 months before you are comfortable doing what you do. Give yourself a break. Breathe. Take that extra second to call pharmacy when in doubt. That has saved my fanny and some of my docs fannies more times than I care to admit. Docs make errors too. The way I see it is I don't want to be up there on the stand talking to a judge, jury and the family of a harmed pt and say, "Judge, I didn't have that extra minute to call/read/research about this drug/rate/adverse reaction and I harmed the pt for not taking one extra minute." Seriously. Remember that. Take those extra seconds to double check everything until you are comfortable with drugs, procedures, etc. Find your resources. If you need help doing something, turn around and offer to help that other person do what they need doing. Relax. Think. Do. Be who you are yet have fun while you do it. You get to see some amazing things while in the ER. When I need to compose myself, I go to the bathroom and take that extra second to just sit without anyone wanting anything from you. Close the door, lock it and take some deep breaths. You'll be fine. Good luck. b

Begin a new grad nurse who was hired directly out of school for the ER with no hospital experience, I can totally relate to everything said on this thread, from the newbies to the veterans. It's a helluva ride. We had 6 month training program, combo of class and ER work days during which I had a preceptor. Did I feel ready when it was time to go solo? Nope. Some days now, I am scared to death. I have been doing this since August which means I have had, give or take 100 - 120 days as an RN. That has given me tons of skills. I try to pat myself on the back for what I am successful for; other times, I mentally beat myself up for things I could improve. I would love for honest, objective feedback from anyone. I have asked for it. I ask for pointers and get some. I ask on how to do things better and I hear, "it takes practice, it'll come." No one says anything to my face, yet I know comments are being made about me. It would be nice to have someone show me/tell me/mentor me on how to improve/speed up/document when times are balls to the wall/any other little tricks. It seems the more I'm there and the more they are used to me, the more they will speak up. It's like I have passed some secret test and now they are more willing to share. For which I am extremely grateful. Thanks guys. I know that I'm a good nurse now. Not perfect. I know that I do the best I can. I'm slow. But I'm gaining in everything. I know that I'll become one of those great nurses, if I can hack it knowing that when I go to work, I gotta watch my own back. I gotta be and try that much harder since I'm new. I feel like my fellow RN's don't forget all the times I couldn't get an IV started or couldn't get blood or whatever the skill. Now if I need help, it takes the veterans a couple of sticks too. I'm happy to have a job. I'm happy they hired me. I'm happy to know that I have some friendly faces at work every day. I know that when the student is ready, the teacher appears. All I can do is keep on keeping on. Is there a way to do it better? Sure, make the training longer with stated goals and competencies, have the preceptors go thru training to have know how to teach, put personalities together that mesh, all these ideals that folks just aren't willing to do or flat out can't pay for. It can't be ideal since everyone, every situation is so different. And, heck, it's the ER. We get everything. The learning curve is huge and we all learn or see something new every single day. It's got to be a group effort where everyone pitches in and meets in the middle somewhere. Like someone previously stated, I don't want you to do all my work for me, but if I just got 4 new pts and all of them require IV, blood work, urine, if another RN isn't doing something, then they could pick up a chart and help me out. My pts don't need to sit without care, the docs don't need to wait on blood/urine work needlessly just because it's going to take me longer. One day I'll be able to get the 4 done in a blink of an eye with assessments, but really, why watch and time me without stepping up to help the pts? And, if you are going to help me out, do me a favor and do it right. Please get a last set of vitals if you are discharging my pts. Please note that you gave discharge instrux and chart them out if they are gone. Please document somewhere that the iv was taken out, meds given, urine collected, ekg done. Sometimes, a thank you or a compliment would be much appreciated. Even asking how my day is going would rock my world. I think everyone needs to be appreciated for what they do. So, if you read this, next day at work, just thank someone for doing what they do. Cause sometimes, that's all you need is a smile, a nice thought and to know there is a reason for doing what you do, whether new or old. Sorry this rambled, but it sums up my first 9 months of nursing.

I hear you and I sympathize/empathize with you. I, too, came to being an rn later, 2nd or 3rd career. I wanted to do something that mattered, something where I made a difference. Some days I know I do, other days I do the best I can and, in some patients, it will never matter what you do, it will never be enough. I'm now seeing why my preceptor seemed "cold" sometimes. I thought it was her. Come to find out, it wasn't her or her personality, it's just seeing the same "back pain" or "drama queen" or "demanding ahole" or "never satisified pt" that suck the life out of you. It's hard to turn around and then be the caring, thoughtful person you are. And like the above poster said, it's hard because you care so much. It's also reality time. I'm a new nurse, been working for 8 - 9 months. I am finding out that nurses do eat their young, docs don't always prescribe appropriately - let me tell you about what my doc was going to do for a 9 yo kid before I called pharmacy twice on her - your feet freaking hurt after 12+ hours, the equipment absolutely sucks - why can't I get a thermometer to take a temp, rectal or otherwise in less than 30 seconds? Why am I always so tired? I have to work 5 out of 6 days? Really? Really!?!? and there's always something more to be done. Always! It's those times when it all goes to hell that I give in to the universe, smile and just laugh off all the crap. Cause, really, we get to see some pretty cool stuff being a nurse. We do have patients that love us and truly appreciate us. I can't tell you the number of times someone has said to me, You are the best nurse I have ever had. That, my friend, can make your day. I do have fellow nurses that can say the right thing, talk me down or even literally give me a pat on the back right when I need it. I do laugh at work with my pts and not at them. I can help someone overcome their brand new dx. There's a lot of little stuff that I can do that can make a huge difference in the lives of my pt. I can bring that 80 year old 80 pound woman 3 warm blankets. That just made her day! I might not can stop her rectal bleed, but by gosh, I can make her warmer. So part of it is being scared, since we know enough to know what we don't know. We had an idea of what kind of nurse we wanted to be, but reality sets in. It's not the ideal Florence Nightengale. It's not a movie set or Grey's Anatomy. It's real life. It sux and it's great all at the same time. We deal with poop, blood, pee, snot, and pus. Nice! We knew that coming in. It's a privilege to be a nurse. A few days, I wish to be somewhere other than the hospital. But, then I sit back and thank the heavens that I have a job. Most of my classmates I graduated with in May 09 do not have jobs. I'm getting experience. I'm getting courage. I'm getting wicked good skills. I keep improving every single day. The days get better and the challenges get harder. It's hump time for us. We've been out of school 9 months and we're seeing what it's like to really nurse. We don't have that magical year under our belts. Seriously, think where you're nursing skills and time management will be in 3 months. We still have a long road before we have those skills that we want so bad. But we have to show up, we have to try, we have to be willing participants in our own future and in our careers. We can't stop trying yet since we haven't even come close to scaling that mountain. It's hard. It's a slog. But there is joy in it and you have to thrive off the joy and not from the bitterness. But, again, you do the best you can do with what you have where you are. The only thing you can control is yourself, your attitude, and the way your perceive your world. I'm not saying you have a crappy attitude, not in the least. I tell friends, the last thing I personally get to decide on on the days I work is where to park my car in the hospital parking lot. The rest of the day, well, that's up to someone else: to the pts that come into the ER, the docs on for that day, my coworkers, my lunch time, everything else is someone else's decision. And how I choose to deal with it all. And for the control freak in me, that's a huge lesson in giving in. I wish you the best of luck in finding peace within and while finding your "nursing" legs. We can do it together. We are going to rock our worlds. And, face it, if you want another position, go out and find it. That's the beauty of nursing, you can find what you want since there are so many options. Good luck, my friend. I hope it gets easier for you. b

According to Yahoo Maps, it's telling me door to door, I moved 2867.25 miles. From SF, CA to SC. It's been a great choice for me and I'm so happy that I'm here.

I work in the ER and I have a ton of reality checks/shocks. But, one of the main ones is death itself. Never saw it in nursing school. Saw a dead body, helped get it ready for the funeral parlor. That was sorta cool. Not my pt, but I got to help this one on their way, so to speak. What I'm talking about is all of us leaving the room after working on someone doing compressions for 20 - 40 minutes, giving them oodles of drugs, intubated, working like crazy folks trying to save them and hearing the doc call it. The pt is flat out dead. It's just weird. One minute they are here, the next minute they aren't. And all the feelings that go with that. Very mixed. So you gotta deal with the death, but you have live pts that need you. You gotta prep the body. You get to go home, this person doesn't. You hear the weeping family. You deal with the nursing supe who needs to make sure the code is coded properly because it's a charge to the family for dying. The room is a wreck since there's boxes and syringes and crap everywhere. It's a war zone for that time you try to save them and then it all goes eerily quiet and it's just weird. Every time.

I graduated in May of '09. Knowing from this site that New Grad jobs were minimal all over the country, I started looking in January of '09. To do that, I decided where I wanted to live since word was out, there were no jobs in our area. Literally, I got out a map of the Southeastern United States. Personally, I wanted the coast. So, for every city on the coast, I searched on the internet to see if they had hospitals. If they did, I found their jobs/career pages to see if they offered a new grad program. If they offered a new grad program, I applied. When I applied, I made sure I had all the proper ppwk, had all my reference letters, had a decent cover letter. If there was a deadline, I made sure I beat it. I created a spreadsheet to track where I had applied, what the city had to offer, if I had heard back in any way, what the specialty of the hospital was in case I actually got a call back I had a quick reference if they wanted to interview me then and there. I kept copies of all my letters so I'd know what I said to who since I was applying everywhere I could. I completely blew one phone interview since I didn't have all this at the ready and I wasn't going to let it happen again. In my head, I had a couple of true life nursing events to tell the HR folks to fit any question they might throw at me if they happened to call to show off my nursing mind/abilities/thinking process. To let them know that eventho I was a student, I would make a great nurse if they'd give me the chance. Some of them would call very early since I lived on the West Coast at the time. I needed these stories in my back pocket so I could answer them properly with or without a cup of coffee in me. I worked at this every weekend until school ended. My goal was to get a job before I graduated. And I did. I moved all the way across the country. I love my new place, my new life. It's my dream job. It's hard work, long hours and you feel like you can always do more. But, it never could have happened if I wouldn't have put all the work into it that I did. It is a hard job finding your first nursing job. These days, if you don't know anyone, you gotta get out there and make your own "luck." It does happen. It's an active, searching process. Because, yes, you can do anything for one year. You can live anywhere for one year. Personally, I'm very happy where I am and want to stay right here. Good luck out there, everyone. Keep trying. You'll rock it.

Our hospital's policy is no visitors under 19 and no s/s of the flu. b

I just did the very same thing. Moved across the country for my dream job. I'm one of the few of my graduating class who is working. It's tough. I'm a new grad so everything is new, everything with work, home, and life. Sometimes I feel that everything is a chore. Which grocery store do I go to? Which restaurant? What's the back road? How do these pumps work? Ya'll document like that? Then again, there are those great moments like when I see the tag on my car and say, whoa, I live here? I love the different weather, the different people. I left a big city and moved to a much, much smaller one and I am amazed how friendly people are. They wave. They do things out of the kindness of their hearts. I honestly didn't know people like this were still around. It's very refreshing. It can be lonely. It is what you make it. You'll be fine. Enjoy the job, the place, the newness. All of it is a package that you are ready for or the opportunities wouldn't have presented themselves. It's a journey. Sit back and enjoy the ride and then other times, take that wheel and steer where you want to go. Go rock your new world. Good luck to you. b

Good luck. Have fun. Keep your eyes open. You are a professional. Act that way. Do not hang around with all of your nursing students in the halls and act like there is nothing to do on the floor. If you really have nothing to do, then ask/tell someone you will check to make sure all the rooms have gloves. Stock the IV trays if you have them. See if patients need blankets or pillows. Remove food trays from the rooms, noting how much was eaten. There are always, always one thousand and one things to do. Do not sit still unless that is what you have been told to do. If there's nothing to do, see if you can practice with the pumps or other equipment. Go to an empty room and learn how to control the bed, trays, wheelchairs, tvs, phones. Seriously, knowing the way the basic stuff works is huge. And, really, do you want to figure out how the bedside tray works with their meal on it? Nope, you need to see how to manipulate the equipment without food on it or a pt in the bed. Be prepared, meaning be on time if not early, have done all of your pre-work before you get to the hospital. Be clear on what you can and cannot do. If you can't push drugs yet, then don't. If all you can do is watch, then that's all you get to do. Do not over step your bounds. Volunteer for anything that you can while you are there. If shadowing a nurse, ask her to show you things. Ask him what you can do with their supervision. Any procedure, you'll be nervous, but do it anyway. Good, efficient nurses have done procedures a gazillion times. Now is the time to start. Your hands will be shaking, but use your clinical instructors and have them guide you. Believe me, once you're a nurse on your own with no one to guide you, you'll be glad you were the one who practiced with help. Seriously, volunteer for everything. If you can't volunteer, ask to watch. Sometimes all you need to do is to see it for the first time. The more you see and do, the more confident you'll become. Make sure before you give a pt a glass of water or a juice that they can have it. Always double check with your nurse before you give it. No need to delay a procedure if the pt was to be npo for a test in the AM and you gave them something they shouldn't have had. Docs don't like to hear that. Treat your first patient like gold. It's about the only time you'll have only one patient. Do everything for them. Give them a massage. Wash their face. Ask them what they need. Take the time with them to be that person that makes their stay in the hospital just that much better. To you, they're your first patient, but remember, they are in the hospital and no one really wants to be in the hospital. Relax and have a good time. Remember that you are learning how to be the best that you can be so find out what you need to do to learn. And then go do it. You'll be fine. We need you out there practicing. Enjoy and we'll see you in a couple of years. b

Yes, Charleston gets hurricanes. Most notably Hurricane Hugo 20 years ago. Can't help you with your question of which is better for a family, Charleston vs. Greenville. But I can tell you, as some one that just moved from SF, CA, that SC is a great place to live. Good luck to you.

Joy, I am so sorry for the delay. I was locked out of all nurses for weeks due to a password problem that we finally solved today. I am currently in SC. However, I have a pile of things to give you. I hadn't forgotten you, but I couldn't get in the system to let you know. I am not sure when I'll be back in SF. I will let you know when I am so I can give you notes, books, jacket, etc. Does that work for you? b

Joy, Enjoy your time away. No problem with hooking up. I might have to go to CCSF and get them to rush transcripts next week to SC BON. I will be more than happy to deliver what I have. I'll post tomorrow once I find out what time I'll head to CCSF. b

I'm in the Sunset. We can find somewhere inbetween. I'll hunt down all my notes and other things for you. Earliest for me would be Sunday. Does that work for you? b

Tried to email you yesterday, got a rejection notice. I'm happy to find a place to meet to hand over all my school stuff. I passed the NCLEX, just found out, so I'm happy to hand over notes, jacket, etc. Just let me know a time/place convenient for you. b