4th day off of ED orientation...what have I gotten myself into?

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Only posted here a few times. But, now...yes now, more than ever need some support. Sitting alone after a tough shift wondering if I've made the mistake of thinking I was cut out for the ED. Had a tough night. Here's the kicker...not one of my patients were "critical", but each were so time consuming I simply could not keep up. I have a fantastic supporting team, but we are usually short with only 1 tech that is pulled in a million different directions. So as the RN, we usually have to do everything on our own.

I'm constantly saying, "I've never done this, could you help", "Would you mind giving me a hand, I've never done this, "Is this indeed correct dosage", "I can't read these orders, what does this say".....the list goes on and on and on. I try to stay positive, but usually about the 11th hour of my shift, I start wondering if I should come back the next day. I feel so stupid, slow, inadequate and unworthy.

I was an hour late hanging a simple liter of NS on a patient, then had to give Avelox that was bound to drop his BP even more. The doc (BTW, who is so fast, quite non-verbal) gave me a look like that I've never seen him give anyone else before. My heart dropped and I apologized, no harsh words from him, just that look of disappointment. :uhoh3: I didn't feel like explaining to him that I was irrigating 6 liters through the bladder of my other pt and he was bleeding from his member and my 2 other patients were on there call light constantly needing attention as he wouldn't have cared much.

I was the tech in this department for 6 mos, then completed my practicum here, then offered the residency position. I feel like the bar has been set really high for me and I don't feel like I'm cutting it.

BTW, I am aware that many feel new grads don't belong in the ED. But the fact of the matter is, I'm there.

I know I just have to keep moving, keep trucking, keep trying my best. I'm not stupid, I'm slower than most. But I don't have a very thick skin right now. Hypersentive to everything. I never once thought this was going to be a cake walk, but I also would like to get a good nights sleep without dwelling on everything I could have, should have or would have done better.

Blah, blah, blah....new grad blues. :crying2:

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I am replying to this at 3:30am on my unusually quiet shift on a med/surg floor. I have been working as a medical/surgical nurse for a year and a half now. I realize you're working in ED, so I wanted to assure you that even on a med/surg floor, which is less acute than ED or often considered as such, the feelings you are having are perfectly normal as a new grad.

When you stop asking questions and asking for help is when you become a very dangerous kind of nurse. Quickly you will start having the answers you're asking about, especially on the more simple things. You'll be surprised, only a year in when the new graduate nurses start to ask you questions, even more surprised still, that you'll actually have the answers.

And you know what, you're going to **** a few doctors off no matter what you do. Eventually, you'll save their orifice a few times by catching a bum order or drug allergy they missed, and they sing a different tune. Hang in there. It gets better I promise.

I remember several times after a patient dying or coding on the floor, going home and dwelling on every little step I took. I was extremely sensitive to anything the physician said and took everything my colleagues said to heart with out a second thought.

I'd venture to say you're probably not slower than most, you're probably just as slow as we all were starting out. You'll get better! So in your own words keep trucking! Learn to trust yourself and your judgement.

Good luck :)

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Specializes in ER, ICU.

You may feel this way for 6 months or more. As you get more used to the job it will get easier. Don't worry about what docs think, you stay on focus and do your job. You are right to ask questions, yes, it is annoying, but you have to do it. Patient safety is number one- don't leap into the unknown because it is socially awkward to ask a question. I made job aides for myself, (like what is needed for a pelvic exam), so I could be more independant. Eventually you will have a pocketfull of these things and one day you won't need them at all. Hang in there! Your feelings are normal, you just have to tough it out and find your way. Best of luck! Gambatte (keep going).

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Thanks for the replies. Just feeling so inadequate. I actually work in a really great place. Very understanding of the new grad, but it's a small department, yet very busy. I take things very personally. I know what needs to be done, but I sometimes just don't have the time to do it. I'm scared. I'm worried. I'm sensitive. Lastly, I'm ranting.

One thing keeping me going is I have aspirations of one day becoming a preceptor for a new grad and teaching the this new nurse in a safe environment to keep up their morale an sense of worth. Questions is: How the heck am I going to make it to that point? Only time will tell.

Cheers. Thanks for responding. It's all I had on this lonely night :redbeathe

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Good morning!

I can sooo relate to what you are writing about. :p

First, let me say how much I agree with the poster who says that patient care is what matters most. Worry about this and not about what look a physician gives you. Who cares?

If you had 6 MONTHS as a tech in your ER, completed "a practicum" (what is this?) and then accepted a "residency" (again, please explain - would love to hear more about these) there is a legit reason for the department setting a high bar for you.

Our techs are sharp and after I started as a new RN it was over a month before I found out that he was a tech and not a RN!

I am not the worrying type but it took 8 months before I felt like I was swimming on TOP the water and not UNDER it. I even puked numerous times before a shift. :-p

Here are some things that have worked for me (11mo into my ER RN career):

  • I have taken notes on EVERY shift I have worked - orientation, classes, working with preceptor, solo, etc. These includes "lessons learned" and it is amazing to see what these lines say.
  • I have researched the correct way of doing complex tasks - what does the official hosp policy say vs some of the advice given by experienced nurses. None of the shortcuts I have seen have been a danger to pts but I dont want to start my career taking shortcuts.
  • I read. I started a small library of ER books - lab tests manual, ENA textbook, Emergency Nursing Procedures, even the expensive manual of triage. Add journal subsciptions and ENA membership and I feel I am well beyond my peers in advancing my mental knowledge.
  • I print out the orders sheet for every patient. This serves as a great reminder of what I still may have to do without having to check the computer a million times. Figure out a good way to monitor for add-ons - does your computer spit out printed papers? Does your tech yell over to you that that doc added on a CT with contrast? Etc. Master this and you won't fall behind.
  • The most helpful thing I have done is come to a full and complete realization that I will NEVER be done. The patients and tasks never stop. So, I view my job as just chipping away at the endless routine tasks as I try to be prepared for the life threatening stuff that may appear at any moment.

Care most about the care you are delivering, then your interaction with the patients and finally (if you have any mental faculties left) worry about whether or not your peers think you are a goober.

Have a great day!

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ED is a place where the pace could be slow, then ridiculously fast depending on the shift. As a new grad, I did not wish to start in the ED. It is a department where one truly needs to have their skill sets down, or at least an exceptional fast learner. I am quite surprised the UM would have chosen you for this position.

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no worries mate, by now you have gotten better, i use tarascon pharmacopia and a little pocket notebook for notes, piece of cake, take a paramedic course, got to a trauma education course. i am 40, i work with 62 year old ladies that handle sick sick sick patients all night five nights a week, they do it, you can too! pat RN, BSN, EMT-P, Corpsman USMC. feel free to contact me anytime at [email protected]

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Specializes in med-surg, step-down, ICU/CCU, ED.
Good morning!

I can sooo relate to what you are writing about. :p

First, let me say how much I agree with the poster who says that patient care is what matters most. Worry about this and not about what look a physician gives you. Who cares?

If you had 6 MONTHS as a tech in your ER, completed "a practicum" (what is this?) and then accepted a "residency" (again, please explain - would love to hear more about these) there is a legit reason for the department setting a high bar for you.

Our techs are sharp and after I started as a new RN it was over a month before I found out that he was a tech and not a RN!

I am not the worrying type but it took 8 months before I felt like I was swimming on TOP the water and not UNDER it. I even puked numerous times before a shift. :-p

Here are some things that have worked for me (11mo into my ER RN career):

  • I have taken notes on EVERY shift I have worked - orientation, classes, working with preceptor, solo, etc. These includes "lessons learned" and it is amazing to see what these lines say.
  • I have researched the correct way of doing complex tasks - what does the official hosp policy say vs some of the advice given by experienced nurses. None of the shortcuts I have seen have been a danger to pts but I dont want to start my career taking shortcuts.
  • I read. I started a small library of ER books - lab tests manual, ENA textbook, Emergency Nursing Procedures, even the expensive manual of triage. Add journal subsciptions and ENA membership and I feel I am well beyond my peers in advancing my mental knowledge.
  • I print out the orders sheet for every patient. This serves as a great reminder of what I still may have to do without having to check the computer a million times. Figure out a good way to monitor for add-ons - does your computer spit out printed papers? Does your tech yell over to you that that doc added on a CT with contrast? Etc. Master this and you won't fall behind.
  • The most helpful thing I have done is come to a full and complete realization that I will NEVER be done. The patients and tasks never stop. So, I view my job as just chipping away at the endless routine tasks as I try to be prepared for the life threatening stuff that may appear at any moment.

Care most about the care you are delivering, then your interaction with the patients and finally (if you have any mental faculties left) worry about whether or not your peers think you are a goober.

Have a great day!

Wow that is some awesome advice you just gave. I'm going to use that for myself at my new job, and I am an experienced nurse. Thanks much!!!!

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Specializes in Emergency Medicine.

You're not in your "comfort zone" yet. You need to get a feel for things.

Don't let it get to you.

Come back after a couple months. Did anyone die? You're fine.

(Oh, and can ANYONE reply w/o quoting the ENTIRE post of someone else??? Nimrods)

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I work in the ER and understand where you are coming from. Don't expect to do everything yourself and you need to get that "being perfect" or trying to be a hero mentality out of your head. If feeling overwhelmed which happens to even seasoned nurses in the ER, just ask for help or let your charge nurse know. No one will look down on you and being a new grad fresh off orientation, your coworkers will perfectly understand. Don't beat yourself up, you are still learning.

ER can get real crazy and chaotic in just minutes and you need to just roll with it and rely on your coworkers. Hang in there, keep a positive attitude, continue learning, ask questions, and be a team player.

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Specializes in med/surg/tele/neuro/rehab/corrections.

I don't think you realize it but you really have gotten a good start. By being a tech in the ER for 6 months and then doing your practicum in that same ER you are more familiar than the new grad who walks in fresh off the street. It will take a while to get more comfortable but that time will come. Perhaps you can't see the light at the end of the tunnel but it's there. :) Most nurses say they are more comfortable after about a year. I'm on med/surg and that's the way it was for me. Good luck. You'll be fine :D

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Specializes in Emergency Dept, ICU.

Don't let it get to you, we all have those days even off orientation. First of all bladder irrigation always sends the rest of your shift to sh*t in my experience. That is one of the most time consuming ED tasks invented.

Secondly I wouldn't worry so much about the NACL fluids but do make sure you keep up with your antibiotics. Depending on the condition of the patient it is the standard of care to hang those as soon as you can. (i.e. PNA pts must have them w/i 4 hours of admission to the ER)

I'm sure you are doing fine don't let a shift or two steer you off.

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