Struggling

Editorial Team / Moderator · May 6, 2016

Truth is, at this point, I'm so lost I don't even know where to begin.

As I told you, you need to be proactive with this. This is your dream position, remember? Fight for it! Put on the big boy drawers and schedule a meeting with your preceptor and educator or manager, or all of the above. Establish a plan of action with milestones and measurable goals. A few weeks means that there are several shifts pending during which you can improve. You can do this if you get ahead of the issues NOW. Don't wait! Best of luck to you.

MedicFireRN · May 6, 2016

As I told you, you need to be proactive with this. This is your dream position, remember? Fight for it! Put on the big boy drawers and schedule a meeting with your preceptor and educator or manager, or all of the above. Establish a plan of action with milestones and measurable goals. A few weeks means that there are several shifts pending during which you can improve. You can do this if you get ahead of the issues NOW. Don't wait! Best of luck to you.

This is good :)

I'm a new grad in the ER, and though I have prior paramedic experience, I have no problem admitting that there's lots I don't know.

Carry a notebook with you at work. As you come across things that you are unsure of, jot them down to look up after work (or on your next day off). Ask your preceptor. There's lots of things that I have told my preceptor "I haven't done this in a long time (or I've never done this) so can you walk me through it?" or the second time "I know we just did this the other day, but this is the first time I'm doing it independently, will you come in the room and watch me so you can stop me if I start to do something incorrect?". Your preceptor is there to help you; that's the point of precepting.

I recommend these books:

Sheehy's Manual of Emergency Care

Fast Facts for the ER Nurse

Especially fast facts, study by a few complaints/issues each night. This should help you to learn what kind of focused assessment is needed for these patients, along with what kind of typical order sets go with them.

russianbear · May 6, 2016

I'm morbidly obese. Any pants I put on, be they scrub pants, slacks, cargo pants, etx are, by default, big boy pants.

pockunit, ADN, RN · May 7, 2016

I have worked with nurses in the ED who came from a floor, and this is a challenge for them â€” they always want to do a head to toe. There just isn't time for that in the ED, so keep your assessments focused on the triage complaint and anything relevant to it. Sure, if the patient is an admit hold in your ED for any length of time you might be on the hook for a comprehensive assessment based on unit policy, but that comes later.

This is hard. Really hard. Not assessing and documenting and talking with pts like I did on the floor is

a big part of the ED learning curve. It's probably the one area where new grads have an advantage since they haven't spent years refining their practice.

russianbear · May 7, 2016

This is hard. Really hard. Not assessing and documenting and talking with pts like I did on the floor is
a big part of the ED learning curve. It's probably the one area where new grads have an advantage since they haven't spent years refining their practice.

It seems to be a matter of: get admission, look at chief complaint, proceed from there, i.e. Get EKG line and labs if chest pain. Or GI order set, etc. go in, do focused assessment, tasks, get on out.

Kooky Korky, BSN, RN · May 8, 2016

I'm morbidly obese. Any pants I put on, be they scrub pants, slacks, cargo pants, etx are, by default, big boy pants.

Do you think this is a problem for your coworkers and boss, Russian Bear? Has anyone directly or indirectly indicated that your size is a concern?

There is a show called "My 600 Pound Life". It is about people who are morbidly obese and their struggles to learn healthier ways of eating. Most have some form of bariatric surgery and will later have excess skin removed once they reach about 200 pounds.

Relearning food and exercise is a very difficult thing for these dear people to do, but most succeed. The people they live with have to be re-educated so they stop tempting the patients and leading them astray or enabling them.

I am praying for God to help you in this area of your life and in the area of your job success, too. YOU CAN DO IT, Russian Bear!

Take the advice you've received here about going to your Manager to write down measurable, specific goals and a timetable for you so you know specifically what is expected of you. Do it first thing Monday morning.

Guest603994 · May 11, 2016

Guys, I got my dream job and have been loving it. Lo and behold, 45 day review wasn't so hot. I'm behind where they'd like me to believe. I don't know what to do. I want this so bad.
Thibgs like in a trauma not being sure what to do as opposed to seeing what is not being done and just doing it. Efficiency is an issue. Assessment issues. Etc.

I've looked at your previous posts and it would appear that you graduated nursing school last year and entered the ED setting within the last 4 months. To me and any other ED RN, you're a new grad and very very green with emergency and trauma medicine. There's nothing wrong with that as we all start there.

Where are your resources? Who precepted you? Do you have a critical care or ED educator? Find your resources and ask them for feedback, review your patient load at the end of each shift and conduct an AAR (after action review): what you did right, what you did wrong, and what you can do differently next time. I did that with all of my student nurses as well as new nurses to the department. You can always do better and if you're not sure what you could do better with - ask your Charge RN because I'm sure they noticed.

With that said, a few weeks is plenty of time to show your employer how you're willing to grow and learn and NOT give up. Do you have TNCC? CEN? Maybe buy those review books and let your employer know you're making these changes. Have you signed up for EKG study courses? Do you participate in codes and traumas so you learn what to do? Do you offer to start IVs on tough sticks and work as a team member rather than just getting lost in your patient load and spinning out of control? When you work in a team and you show you're willing to help others, they'll be willing to help you too.

I also noticed you've been applying to NP schools - are you sure ED nursing is your dream job? If you focus on beefing up on your knowledge and less time jumping to your next career, I don't see any reason you can't turn this around. Good luck.

russianbear · May 11, 2016

I've looked at your previous posts and it would appear that you graduated nursing school last year and entered the ED setting within the last 4 months. To me and any other ED RN, you're a new grad and very very green with emergency and trauma medicine. There's nothing wrong with that as we all start there.
Where are your resources? Who precepted you? Do you have a critical care or ED educator? Find your resources and ask them for feedback, review your patient load at the end of each shift and conduct an AAR (after action review): what you did right, what you did wrong, and what you can do differently next time. I did that with all of my student nurses as well as new nurses to the department. You can always do better and if you're not sure what you could do better with - ask your Charge RN because I'm sure they noticed.
With that said, a few weeks is plenty of time to show your employer how you're willing to grow and learn and NOT give up. Do you have TNCC? CEN? Maybe buy those review books and let your employer know you're making these changes. Have you signed up for EKG study courses? Do you participate in codes and traumas so you learn what to do? Do you offer to start IVs on tough sticks and work as a team member rather than just getting lost in your patient load and spinning out of control? When you work in a team and you show you're willing to help others, they'll be willing to help you too.
I also noticed you've been applying to NP schools - are you sure ED nursing is your dream job? If you focus on beefing up on your knowledge and less time jumping to your next career, I don't see any reason you can't turn this around. Good luck.

I worked on the floor for six months before getting into the ED, so I would agree that I'm a new grad. I'm very green.

I worked previously on a cardiac floor so I had EKG class then. Yes, I do have TNCC book, Sheehy's, etc. I'm trying to learn. I do ultimately wish to become an NP, but I'd like to stay in the ED once I do that and this ED hires NPs.

LadyFree28, BSN, LPN, RN · May 11, 2016

I worked on the floor for six months before getting into the ED, so I would agree that I'm a new grad. I'm very green.
I worked previously on a cardiac floor so I had EKG class then. Yes, I do have TNCC book, Sheehy's, etc. I'm trying to learn. I do ultimately wish to become an NP, but I'd like to stay in the ED once I do that and this ED hires NPs.

Then you have self studying to do...

Try to do a concert map on pathways to apply how to reposed to ESI 1s and 2s; ask to go into the trauma room more, get an idea on the roles in the trauma room and documentation.

I always jump in the trauma room at anytime when a high risk pt or multiple traumas come in...I try to gain that experience when I am in the most critical zone to apply the knowledge so I can grow professionally.

russianbear · May 11, 2016

Then you have self studying to do...
Try to do a concert map on pathways to apply how to reposed to ESI 1s and 2s; ask to go into the trauma room more, get an idea on the roles in the trauma room and documentation.
I always jump in the trauma room at anytime when a high risk pt or multiple traumas come in...I try to gain that experience when I am in the most critical zone to apply the knowledge so I can grow professionally.

I do. I just fear I won't learn fast enough. I'm working, though. I really am.

russianbear · May 12, 2016

I've looked at your previous posts and it would appear that you graduated nursing school last year and entered the ED setting within the last 4 months. To me and any other ED RN, you're a new grad and very very green with emergency and trauma medicine. There's nothing wrong with that as we all start there.
Where are your resources? Who precepted you? Do you have a critical care or ED educator? Find your resources and ask them for feedback, review your patient load at the end of each shift and conduct an AAR (after action review): what you did right, what you did wrong, and what you can do differently next time. I did that with all of my student nurses as well as new nurses to the department. You can always do better and if you're not sure what you could do better with - ask your Charge RN because I'm sure they noticed.
With that said, a few weeks is plenty of time to show your employer how you're willing to grow and learn and NOT give up. Do you have TNCC? CEN? Maybe buy those review books and let your employer know you're making these changes. Have you signed up for EKG study courses? Do you participate in codes and traumas so you learn what to do? Do you offer to start IVs on tough sticks and work as a team member rather than just getting lost in your patient load and spinning out of control? When you work in a team and you show you're willing to help others, they'll be willing to help you too.
I also noticed you've been applying to NP schools - are you sure ED nursing is your dream job? If you focus on beefing up on your knowledge and less time jumping to your next career, I don't see any reason you can't turn this around. Good luck.

Great advice. Hey are just now starting to give me more of an idea of what is expected of me. PM. I have questions.

Lev, MSN, RN, NP · May 18, 2016

russianbear - How are you doing?