tpnurse95

I appreciate the advice. What I'm getting from everyone, is basically I can't do it all on my own so I need to stop trying to do it all on my own. I understand many probably believe the ER is no place for a new grad, but we actually get a lot of new grads on our ER (probably because our hiring manager started out in the ER as a new grad), so she knows its possible. I'm learning so much I can hardly take it all in, which is why I wanted to be in the ER in the first place. But my brain is growing by the day and studying definitely is continued way beyond nursing school. I like the advice "slow is fast"..I have noticed when I feel rushed I hardly ever get an IV, but when I'm not worrying about my other patients or what else I need to do, I can get that IV started. I will keep that in mind.

Thanks so much. Those are some well-needed kind words! I'm going to work on asking for help more often.

Thanks so much for the tips. I think one of my big problems is I'm not delegating and asking for help unless its offered. I just see the other techs and nurses always seem so busy, I hate to take them away from what their already working on. But it never hurts to ask!

I went through a nurse residency program before hand. This included simulations, PALS, TNNC, ACLS, and a week long class on EKGs. Although it expanded my knowledge base tremendously, it didn't prepare me for all the juggling I'd be doing in the ER.

First off, thanks so much for the feedback and the link! I plan on requesting an extra 2 weeks on orientation if I'm not feeling up to par by week 6. My preceptor is great and she does provide helpful tips and tries to help me prioritize but I'm always falling behind. I've voiced to her that I don't feel that I'm progressing fast enough and she doesn't agree nor disagree..just kinda gives me the "I'm listening, I'm here for you nod." I did have some non-clinical prep before through a nurse residency program, and although it prepped me on skills and refreshed my memory on nursing school basics, hands on care and multitasking is a whole new ball game. I think I just need to start asking for more help and be ohkay with accepting the help.

Hello all! So I'm a new grad nurse starting out in the ER. I haven't had any prior experience in the ER,l. I just finished my 4th week of orientation. We are only getting 6 weeks. SIX! From what I've heard that is short for an ER nurse and especially a new grad. I've been juggling 3 patients but I feel like I'm at my max. The ratio there is 4:1 usually. I feel that other nurses are constantly having to come in an assist me with discharges, charting, and skills. It seems impossible to do it all on my own. Not to mention I've been through a dry spell on IVs the past 2 weeks and this has really slowed me down. How does one finish charting, start an IV, draw labs, get a UA, EKG, all in under 20 minutes when meanwhile you are getting an EMS in one room, you need to medicate in another room so they don't seize again, and take care of a disoriented pt who can't sit up straight, vomiting constantly, and no one can get IV on her. On the other hand lab keeps calling you to let you know they need another purple top because it clotted. And CT keeps calling wondering why you don't have an IV..and the doc wants to know what's taking you so long to discharge....HOW DOES ONE ACCOMPLISH SO MANY TASKS AT ONCE!? And I get that we help each other out in the ER, but I never seem to have time to help anyone else. Everyone seems to have to help me and I still always feel behind. I try to prioritize by seeing my patients who enter the room first but it seems that after I'm in the room for a short amount of time, someone asks why I haven't discharge so and so. To me, that's a lower priority then getting an EKG and rapid assessment finished on a new patient but to them they want to hurry and empty the room so they can fill it asap. How can I possibly get to a new pt when I haven't even finished my initial tasks for my new one!? Maybe I'm just slow, I'm not really sure. But I certainly hope I can keep up with this pace of the ER. I want to stay and be accepted. I don't want to be the nurse who drags everyone else down because I can't hold my own. Well that's my rant. I'm done. Any advice would be of the greatest appreciation.

Thank you for your input. It's possible that they were still coming up with his treatment plan. I'm not sure that he will last that long, but I hope they have come up with a solution by now.

According to his MAR, his PRN medications had not been given during the night shift. I agree, it should have been given around the clock. He was receiving Normal Saline IV fluids, but his oral intake of fluids was not very adequate. He slept all day except for when we provided care, but often screamed out in his sleep. No stool softener ordered either, but there was no evidence of a bowel obstruction. I was thinking the lack of output was from lack of mobility and inadequate food intake. He was receiving an antibiotic, I forgot to mention that before. He was living at home with his wife who is 80 years old and his son. Hospice would probably be a good idea, but I didn't see anything that suggest he is going to pass anytime soon, just that he was in bad condition from inadequate care at home. A consult with therapy would have been a good idea as well for positioning. It was difficult to decide how to lay him with his contractured leg and multiple pressure wounds. I'm not sure if he will still be on my floor when I go back this Friday, but I plan on being an advocate for him if someone else has not already done so. I just want to know what I could have done differently or what I can do next time to help him, because no one (except my instructor and I) was giving him proper care and assessment because of the screaming and him being uncooperative.

Limit caffiene several hours before bed, including coffee, chocolate, tea, and medications containing caffiene. Provide a snack that has had cheese or milk before bed time, they contain L-tryptophan which helps to induce and maintain sleep. Ensure the environment is dark and quiet. Sometimes to much silence can cause restlessness, a fan or soft music can sometimes break this silence without adding to much extra stimulation. This is called "white noise." Allow downtime in the evening before bedtime to allow time to wind down. Activities like sowing, knitting, or reading can relax the mind. Some studies show stimulation from a tv or computer can cause difficulty falling asleep, however if this is part of her regular sleep routine it may not be the cause of her insomnia. Administer medications that can interrupt sleep in the early day rather then at night such as steroids and diuretics.

During my last clinical, I had an especially complicated patient that I believe was being under treated for pain. However, are some patients to old for opioid use? 90 year old African American male with a contracture of his right leg. It crossed over his left leg and was fixed at about a 30 degree angle. Uncrossing his legs seemed physically impossible. Unstagable pressure ulcers on his right hip, sacrum, and right heel. Urinary catheter and colostomy bag. Urinary output is dark, amber color. No output in colostomy for 2 days, but bowel sounds were normoactive . Hypertension, hypokalemia, Alzheimer's, and was recently admitted for acute UTI. He has expressive aphasia and is very confused and uncooperative. Suspected bacteremia. Eats about 1/4 to 1/2 of meals, puree diet. Suspected abuse, PSTD, or neglect. Although his wife and son and came to visit him every morning to feed him, he screamed out when anyone touched him. He screams very loudly "please don't hurt me, please don't kill me!" He screams when you touch the stethoscope to his chest, take his bp, and especially if you try to move him he grabs on to the bed rails and we had to pry his fingers apart just to turn him to assess his wounds. If you just talk to him or feed him he is very sweet, tells the nurses thank you and he loves us. Very appreciative. He is on a bets blocker, calcium channel blocker, antidepressent, anticonvuslant, vitamin D, 81 mg aspirin. Xanxax and NSAID PRN. Vitals BP 119/53, HR 74, R: 18, T 97.6, O2 100% So my question is, why isn't he on any other pain medications? Is it because his diastolic his so low or his old age? He literally screams so loudly the whole floor could hear, it made basic care very difficult. What intervention's would you suggest?

During my last clinical, I had an especially complicated patient that I believe was being under treated for pain. However, are some patients to old for opioid use? 90 year old African American male with a contracture of his right leg. It crossed over his left leg and was fixed at about a 30 degree angle. Uncrossing his legs seemed physically impossible. Unstagable pressure ulcers on his right hip, sacrum, and right heel. Urinary catheter and colostomy bag. Urinary output is dark, amber color. No output in colostomy for 2 days. Hypertension, hypokalemia, Alzheimer's, and was recently admitted for acute UTI. He has expressive aphasia and is very confused and uncooperative. Has expressive aphasia. Suspected bacteremia. Eats about 1/4 to 1/2 of meals, puree diet. Suspected abuse, PSTD, or neglect. Although his wife and son and came to visit him every morning to feedd him, he screamed out when anyone touched him. He screams very loudly "please don't hurt me, please don't kill me!" He screams when you touch the stethoscope to his chest, take his bp, and especially if you try to move him he grabs on to the bed rails and we had to pry his fingers apart just to turn him to assess his wounds. If you just talk to him or feed him he is very sweet, tells the nurses thank you and he loves us. Very appreciative. He is on a bets blocker, calcium channel blockerI need to go