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. 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.
I too have felt this way in the ICU. I had a patient that started bleeding out about 7 minutes after I took his vital signs. My split partner knew just what to do and I felt stupid. I thought he would never split with me again. He did the very next night. You have to look at the situations and say to yourself "What did I do right?" and "What did I learn from that?" When things like that happen, don't dwell on what is done wrong but what you did right and what you WILL do next time. We all feel like this!
I felt the same way as you when i started. 1.5 yrs ago. I felt like crap when i left and was dreading coming in. My stomach was always upset. My preceptor was really nice and helped me along the way. Find someone you can trust (hard, i know) and ask them. Nurses of 30 years practice come up to me and ask for my advice on things i find simple. Nurses who ask questions are the best kind in my opinion.
I work at night and it seems like a different environment than the day shift. When i see someone who needs help, i always volunteer to help them. whether its helping inserting an IV or running all the way down to pharmacy/central supply to pick up something they need NOW. I do it. they remember it and will be more willing to help you insert that Ngtube/foley/iv etc when you can't get in it or stop and answer a question for you. I'd wish you the best of luck, but you don't need it. rock on!
ps. look back in a year from your post date, you think you haven't learned anything. it was quite the surprise when i did this.
I just finished my third week off of orientation in the newborn ICU. I feel the same way as you.
I was first admission on our unit yesterday. Luckily it was a transfer from the newborn nursery so the heavy admission stuff was done. There was still stuff specific to our unit to be done though.
I felt like such a dummy. We put the kid, who is term, on a radiant warmer bed which is standard for us (when we get a term kiddo) until we find out how stable or unstable they will be. Well silly me, I warm up the bed like I would if I were getting a 25 weeker. Put the temp probe on the kid and everything! I didn't stop to think that I probably didn't need this until someone stopped me and told me. The temp was 36.8 when I got it and an hour later, after the kid was settled in and all, the temp was 37.7! Oops!!!!!!
I had to hang some IVIG which was new to me so I had to go read about it before I gave it. It is one of those meds that pharmacy delivers to the bedside and I could see that it had been shaken really well because there were lots of tiny bubbles in it. Also during administration, our unit guidelines say we have to have epi at the bedside. I wasn't quite sure where to get it at so I had to ask where it would be. Looking back, I know I knew the answer......it's in the Pyxis of course!!!!!!!!!!
Well when I went to hang it, apparently I didn't get all the bubbles out and close to the end of the infusion, there was a bubble in the line that was pretty darn big! Luckily someone caught it for me while I was out on lunch and turned it off.
Then the day before, one of my kids was starting to show mild signs of respiratory distress. It started retracting. Did I really notice it? Of course not!!!! I felt so terrible that I missed this! Luckily the resident who had this baby was on top of it and no harm was done.
On top off all of this, I am constantly hunting people down and asking them questions. Things that I feel like I should know by now but I don't.
I feel like I am always bugging the doctors when the round by asking them why this and why that? Some days it seems I'm constantly paging them to ask them questions that more seasoned nurses wouldn't have to ask.
I feel dangerous and it's not a good feeling.
Some days I go in wondering if I will have the same pod partner or if I scared them off with all my questions.
Luckily I consistently work with a charge nurse who truly believes in me and has been trying to instill some confidence in me. It really helps me feel better about what I do. I think it's starting to rub off onto me.
I guess the point of all of my rambling is to say that what you are going through is not unique. All of us new nurses just off of orientation are having the same trials and tribulations and you are not alone.
Nursing is tough. There's no getting around that. I feel that as long as we acitvely seek out knowledge and are open to constructive criticism from our coworkers, who at this point know a lot more than we do, we too will get to the level of confidence and knowledge as they are at.
We just have to keep reminding ourselves that Rome was not built in a day and neither was a good nurse.
Definitely sounds like the new grad blues. We all sing that same sad song when we get our first job. It takes a long time to get over it. It takes a year or more for a nurse to become competent. I agree that new grads should not be in the ER, but the fact is you're there already. My question for you the OP is did they give you any type of floor training like a preceptor for 12 weeks. Did they put you through a critical care specialty course w/focus on emergency care? I got these things when I started working on a cardiac tele floor...and I'm getting these things now in the ICU. These are definitely things I suggest any new grad on any type of floor get..and if not offered, request it. You have a right to be trained properly. This is your license..you worked hard for it..you don't want to lose it. If they can't offer you the course and training. Go get it yourself. Take a critical care course...various companies offer them. Find a mentor in the ED. Find a nurse that knows her stuff and whom you trust....work only the days she works for the first couple of months...and pick her brain and model yourself after her. You have to do what you have to do. It's your license, your patients, your conscience. And as far as the docs, don't be afraid to ask them questions. You are the patient's advocate..not to mention they paid all that money for medical school...go ahead and pick their brains for free...most love to explain things b/c they get to show off from my experience. Good luck.:)
I read your message and it touched my heart because I (and everyone else) have been in your exact shoes starting out. I wish it were easier said than done, but the same things that were advised to me I will tell to you. You are starting out in a department with one of the largest learning curves possible (I started out there as well). On top of you being a new nurse, you already have said "what have I gotten myself into" and honestly, take a look around, You are a brand new RN in the EMERGENCY room, now we all know like you say so many things are not emergencies, but still, it's the speed and the need for care and knowledge that is necessitated but will take TIME AND time and time and time to help. I didn't start feeling comfortable with nursing for about 1.5years and since then, I've been fine as far as the feelings you've described. You are doing NOTHING wrong, my preceptor used to tell me as I will tell you, don't be so hard on yourself, you have taken on nursing which is just about the most challenging profession know to man and in this day in time it's only getting harder. Give yourself tons of breaks, you have made a lifetime choice that you want to help others, isn't that such a wonderful selfless act? smile and know that so many are thankful for your efforts. You are not expected to know everything. Rules 1)be safe, 2)always question if in doubt 3) make notes to remind you of things you've learned 4)confide in another nursing friend who can empathize with you 5)have some fun, find some things outside of work to make you smile. Reading your post made me remember what it felt like and if I could do anything to help you feel better, I would, but time will help. Thank you for joining the profession and keep your head up, God will bless you in this job! Email me if you ever need to talk, you should never have to feel alone. We've all been there.
not having read other posts from posters to you, I'll add my 2 cents.
Sometimes (many times) docs (and there are many of them seeing all of your patients) need to be told what you have going on that is a higher priority than their patient. Don't accept "looks" to mean anything. You need to assert yourself and your position. Hanging a bag of NS an hour "late"? Really? I wouldn't even worry about that. It's not the floor. There are no scheduled times for meds. If the patient was septic, then that's a different story. The bladder irrigation you had going on is very time consuming as well, at some point you could have told your charge RN, "hey, I need some help please, I have some tasks that need to be done and I have some patients who cannot wait, I need help, please." That's what they are there for, that is their job. Sometimes they can find a nurse that can do something for you for 5 minutes then get back to their assignment, or they can help you. Sometimes 5 or 10 minutes of help makes all the difference. And let me point out, that just because this doctor is seeing this one patient of yours, they don't know what else you have going on. I had to point this kind of situation out to a doc who had the nerve to continue asking me about discharging a patient (some med complaint, wanting Oxycontin prior to leaving and then going with a script) while I had a septic pt with her HR in the 140's. That patient was clearly my priority, he did say to me "what can I do to help you?" I told him that I had a septic pt with a HR of 145 and that she was my priority at the moment, and as soon as I get to a stable point with her, I can medicate and discharge your patient. I might have come off ******, but I felt it was necessary to point him into the direction of reality, not helping him dispo his patient just to clear his list before he went home. Don't worry, keep on truckin' and ask for help if you have a few high priority things and desperately need help.
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. 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.
Could you imagine what it's like for a new grad that comes into the ER with zero experience. You had a tremendous advantage coming in with an intimate knowledge of the department. There is nothing like having the tech perspective when you move into the nursing role. We have several former techs that went your route and they all survived and have turned out to be great nurses. Some of the best nurses I have had the pleasure to work alongside over the years started as techs. Don't give up ever and always remember tomorrow brings a fresh start and a whole new set of challenges. You know you like the challenges or you would not have stayed on in the ED after graduation. Remember us ER people are different and you must feel at home or you would have been gone as soon as you had the chance.
Specializes in Cardiology, ER, Hospice, Pediatrics.
Just know that what you are feeling is normal. Even after being in the ED for two years days can come along like this. keep your head up and IGNORE the stupid insensitive peeps who have a big red S tattooed on their chest. Their slow off the mark day is coming and you will be cleaning up after them!
These feelings will pass. It might take 6+ months, but they will if you just stick to it. One thing's for sure, you either love or hate the ED, but you don't need to make that decision until you've worked it (as a nurse) for at least a year. Every new grad finds themself in this situation. Just prioritize and when a dr gives you that look, don't be afraid to tell him you have other pts, or in graphic detail what you've been doing for the last hour. Just don't tell him that if you're sitting on your rump and your stuff isn't done. Most ED's you'll find that you can go ahead and start your line once your pt gets to the room and keep that NS close by so that you can hang in in a flash. Put 95% of your pts on the monitor so you have a record of their vs you can go back and record if you have too do it late. You will learn these and many more little tricks that will help you along the way. Don't be afraid to ask for help. I never mind helping someone, especially if they are new either to the dept or nursing altogether. I was told to "be a sponge" and learn from everyone around me. Most nurses don't mind sharing their knowledge with someone who is eager to learn. It's the ones who think they've got it down and know more than the seasoned nurses that become irritating. Oh, and being a new grad to the ED is not as uncommon as you would think. I did it and don't regret one second of it. I had an ICU nurse that had to float to our dept and take pts b/c of a lack of beds the other night, after being next to him for 12 hours, I was so proud to be an ER Nurse! Good luck!
Something else... If you find yourself with some downtime and it's not your lunch, look for another nurse who looks overwhelmed and offer to help them in some way. You will gain the respect of your coworkers as a team player and not one who is just out for yourself or worse, lazy. It will go a long way when you need help...
To everyone with such inspiring words of advice and support: Thank you from the bottom of my fragile heart :redpinkhe. I'm still struggling with some sleeping issues, racing thoughts....but all in all...I have a wonderful supportive staff that wants to see me succeed. You have all been sincere in your opinions and I very much appreciate it. A little late responding though. Since I'm the newbie, I work variable shifts so my sleep/rest/work schedule is a little all over the place. Still having good days/ versus bad days. Nature of the work.
Again, your words are kind and I think I just may sleep through the night tonight. It's been a while. THANK YOU ALL!
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. 
hcox1975, BSN, RN
66 Posts
I too have felt this way in the ICU. I had a patient that started bleeding out about 7 minutes after I took his vital signs. My split partner knew just what to do and I felt stupid. I thought he would never split with me again. He did the very next night. You have to look at the situations and say to yourself "What did I do right?" and "What did I learn from that?" When things like that happen, don't dwell on what is done wrong but what you did right and what you WILL do next time. We all feel like this!