Struggling ER travel nurse..

[Watkinsrn10]

I have been an ER nurse for over 4 years now. I started out in a level 3 small, low acuity setting then went to a struggling level 2 trying to obtain Level 2 trauma status who finally did and came a long way but either way it was a painful process...and now a travel nurse on my first assignment at a Level 1 teaching hospital. Everyone tells me I do a great job but I consistently feel incompetent. I do really well at making the patient feel comfortable and important and providing for their basic needs and I love doing that but when I start to get 4 super sick, high acuity patients that I am trying to care for, I don't feel like I am doing enough or like I am missing something. I get so task oriented that I forget the small stuff, like starting Heparin on a bilateral PE pt and not realizing that coag studies hadn't even been drawn yet, thank God the nurse signing off with me noticed it. Or having platelets ordered and then total brain fart as to how fast they go in, do I hang it with blood tubing and document like I am giving blood, they are A pos but B pos PLTs were ordered then I get so anxious I have another brain fart and can't remember what Rh types are compatible with one another, so I google it. I never do anything without being sure but still I just feel like I should know this stuff and I never feel like I know enough, I am constantly scared I am going to kill someone.....maybe it is still just because I am in a new environment, I just feel like everyone looks at me as a travel nurse and expects me to know everything. Any suggestions or encouragement would be great. Struggling..

another thing, all I have ever done is ER, maybe I am missing the floor nurse nack for noticing the "not what is right here right now" kind of stuff...

[amzyRN]

It sounds like you are being pretty tough on yourself. I totally understand that too, because I am the same way with myself when I miss things that I think I should have caught. A few days ago, I missed stopping fluids on a CHF patient that had bilateral DVTs and probable PEs. He also had pneumonia with a harsh cough and his BNP was trending down. So I didn't think of questioning the fluids that were going at 75mls/hr on top of the heparin drip. The next nurse I handed off too, caught the worsening respiratory status and the next day the patient had lasix ordered and the fluids were stopped. I felt like I should have caught that mistake. But no one else had caught it either, so I was no worse than the other nurses.

I think it's all a learning process and there's no way to know everything we think we should know at the same level we think we should. Each person is different, capable of making mistakes, learning at different rates and different ways. As long as we try and do our best and learn from our mistakes and don't miss anything major (my manager called that "going rogue"), I think it's okay.

Don't let it drag you down. If other people are telling you you are doing good, believe them. Why would they tell you that if it weren't true? It is good to have a baseline on PTT before starting a heparin drip, but they are often started before a PTT has resulted or possibly has been drawn. It's okay to not know things. Even nurses with 30 years of experience still ask questions. No one knows everything. I think its better to ask questions no matter what people think if one is uncertain rather than being to prideful to an possibly making a mistake. I'd rather be embarrassed than cause harm to someone, so if I'm unsure, I ask and even if that means calling a crabby doctor and they ridicule me for calling them. I am advocating for the patient.

It's hard to be a travel nurse and walk into an unfamiliar setting and be competent. The fact that you are is impressive. On top of that, ER nursing is a very tough specialty.

[Guest219794]

when I start to get 4 super sick, high acuity patients that I am trying to care for, I don't feel like I am doing enough or like I am missing something.

You should be concerned taking care of 4 super sick high acuity pts. Anybody should.

I never do anything without being sure

Good.

I just feel like everyone looks at me as a travel nurse and expects me to know everything.

Not if they have a half a brain. they should expect competence, good judgement, and enough self confidence to ask for help if needed.

Everyone tells me I do a great job

​Probably a reason for that.

[Watkinsrn10]

Thanks so much, that seriously makes me feel better. I think I am being too hard on myself. I just want to do my best and do what is best for the patient, but with 4 level 2 patients, it is definitely tough to keep up with everyone. I am 26, with 4 yrs of experience so yes every day is still a learning experience. Just hoping to never screw up enough to end up in patient harm... :/.. so scary!

[rhine1121]

Don't feel bad. You cannot remember everything. The main thing is, when you give report to the receiving nurse in the floor and you realize you forgot something, just tell them and apologize. I do that and most of them understand.. Mistakes happen and you will learn from it the next time a similar situation occurs.:)