Time to move on...

[oliveralways]

Hello All:

I am working in a 20 bed ER at a community hospital that stays steady with the typical cough, n/v, etc complaints and a good number of traumas and other emergent patients.

I started about 3 months ago after a 7 week orientation (with only 3 years of med-surg experience). I am concerned b/c I don't think that I have been adequately trained and oriented to the position. Honestly, I feel as though I'm a new grad. I have learned that nursing on the floor is VERY different than nursing in the ED.

I'm concerned for several reasons:

1. I was asked to triage after my 2nd day off orientation. However, my preceptor told me that the triage nurse needs to have about 6 months of ED experience. In this hospital, there is only one nurse and a tech in the triage area.

2. In a recent event, I received a patient from EMS for AMS, when I got the patient in the room, in less than 5 minutes, the patient seized and it was just me and EMS. At the exact same time we got two other traumas, so there were no other nurses available to help. We got a doctor in the room immediately, moved the patient to a trauma room, intubated and flew the patient out. However, the worst feeling was I had no idea what to do for those first few minutes. The worst part was while I was in the room, the doctor repeatedly requested that he needed a nurse in the room, when I'm standing there looking at him and he knows I'm a nurse. I'm concerned b/c I didn't know what to do in the situation for this patient and the doctor repeatedly called for another nurse.

Since I have been working, I've been reading ED material, I attempt to help and be present in other nurse's trauma so that I can learn. However, what can I do to better prepare myself or is it hopeless? I'm concerned for my patient's safety and also for my license.

3. My other concern is that the majority of the seasoned nurses are leaving and all that is left if new experienced ED nurses and travelers.

Any advice??

Thanks

[PostOpPrincess, BSN, RN]

You're going to lose your license if you stay there without adequate training.

When the doctor asked for a nurse, he probably meant someone who was experienced.

You're been thrown to the wolves. Step back, realign, and get proper training.

Now.

[fungez]

Yeah, ER is very different from m/s. Not harder, just different. But it's a very high liability issue, especially in triage. There was an incident in my hometown where a triage nurse left a person in the waiting room for an hour and a half, then about a minute after he was roomed he keeled over with a giant heart attack. And that triage nurse, who was probably very competent and probably had no bed for this patient, had her name splashed all over the newspaper as a codefendent in a multimillion dollar lawsuit. Fun times, huh? If you don't feel competent for triage yet, tell them no. I HATED triage and quit soon after they started making me do it. I was expected to assess walkups, take vital signs, watch the waiting room, check in new patients....ALL AT ONCE. All because they were too cheap to hire tech help.

[NickB]

Question is, how do you go about getting more training? If your hospital only offered you the 7 weeks, what do you do to get more training and where do you get if from? Doesn't sound like your hospital is set up to give you more. I can't think going back to med/surg will do much more to get you ready as you have already spent 3 years there.

[oliveralways]

I've thought about ways to get more training, however, as I said the experienced nurses are leaving. The nurse that oriented me was not a good teacher and the orientation was not very defined. What is the average orientation for ER nurses (new grads, experienced ED nurse, or nurses coming with no ICU or ED experience)?

[swimrn80]

Definitely sounds like you got shorted on your orientation. It is easy to feel overwhelmed when you get a new pt who is critical. I always just go back to the ABC's and once you have those checked off then vitals, line/labs and such. Sometimes docs get anxious/overwhelmed also and may come in the room barking out orders/freaking out. If you want to feel more competent with trauma see if you can get signed up for TNCC. It helps you learn a expanded ABCD ect.. list so you make sure that you covered everything. Also teaches about diff types of trauma. I think you would do fine with the exp you have so far. As far as triage goes I would try to stay out of that area if you can. It can mean a horrible shift for anyone Also you have been a nurse for 3 yrs, so just remember that you have nursing exp, you are just are just learning a different type of nursing- but the med/surg skills you have are useful. Hope things work out for you. Sounds like you want to be in the ER.

[caeRn]

YUck. when i started at my current place of employment my orientation was horrible. I am in Float Pool. My previous experience was ICU. Once starting this job i had 2 yes 2 12 hr shifts to each unit:

ER, PEDS, ICU, CVICU, PACU, ONC, IMU, CVSD,MED-SURg, ORTH-NEuro, Womens services, and IV therapy

I was new to the Hospital as well so i didnt even know where the bathrooms were yet. I would get off elevator and feel disoriented like where am i what floor etc etc

They throw us to the wolves and see who can handle it.

8 people oriented for float pool with me out of those ate 3 of us still there. eeeks!!!

[Willow Moonsidhe]

Study, study and study some more. I went straight to trauma as a new grad 25 years ago. It was tough but if you make it; you can do any type of nursing you want to. The doctors are some of your best teachers. Ask if you don't know; most of them would rather teach than you just stand there. It is an amazing world of nursing that is so different. Have fun and know you have what it takes but you have to trust your gut a lot and know that the information is in your head. Just my 2 cents worth.

~Willow

[Lunah, MSN, RN]

I've thought about ways to get more training, however, as I said the experienced nurses are leaving. The nurse that oriented me was not a good teacher and the orientation was not very defined. What is the average orientation for ER nurses (new grads, experienced ED nurse, or nurses coming with no ICU or ED experience)?

Orientation for a new grad is probably going to be different than orientation for an experienced, non-ED nurse. My orientation as a new grad was about 14 weeks, plus a fellowship (classroom/online instruction) during that time period. Another RN had worked on an ortho floor, and her orientation was about 6 weeks. She did very well and transitioned nicely into her role as an ED RN. Another RN came from another ED, and his orientation was about 3 weeks -- he really just needed time to learn our policies/procedures/flow and to get used to the electronic charting software, because he's already a fabulous ED nurse, great with patients.

In our ED, RNs must have at least 6 months of experience before going to triage, and they actually prefer a year.

ED nursing is very different from the floor, from what I've been told ... I've only worked in the ED. But never doubt that you have a solid foundation, with your 3 years of experience. It sounds like you just need confidence in developing a more systematic approach to your patients. TNCC would definitely be a great course for you!

Good luck, and keep us posted!

[kimmie4476, ASN, RN]

I too am just starting orientation for the ER at the hospital where I've worked Med/Surg for about 3 years. They are just now revamping the ER orientation, it used to be that you spent 1 year on the floor and then HAD to orient in the ER (usually for only a few days then you were on your own..and by on your own I mean you are the ONLY nurse in the ER..thank God they are changing this!)

Anyways, our new orientation will consist of PROCEDURES and the amount you do before coming off orientation. Since I'm only orientating 1 day every other week, (I'm still full time on med/surg) it may be a year before I fufill all of the procedures they want done, but I think this is a great way to train and decide when orientation is done. When I do train, the other nurse lets me do everything like I'm the primary nurse, but is available for help when I get in trouble. It sounds as though you didn't recieve enough orientation because before you are on your own, you need to know exactly what to do in those situations because the patient's life depends on it.

Remember, when you don't know what to do, go through the ABC's, look at your P&P's in your down time, know your protocols, and another thing I do is imagine a scenario, then go through what I'd do, so that when it happens, I've already got it down in my head (I used to do this a lot as a correctional officer "I walk on the yard and find an inmate down from unknown reasons" )

[canoehead, BSN, RN]

Before you give up on the ER take TNCC and ACLS so you will know what to do in critical situations. Seriously, they will break it down, and you just go through your list automatically, by the time you've run the list your brain will have turned back on.

It was kind of rude when the doc was asking for a nurse with you right there. An experienced ER doc can usually walk you through what he needs, enough to keep the patient alive, anyway. Once you have been there a while the docs will know and trust you more. Ask them lots of questions. It shows you are thinking through your care, and it makes them feel smart. :)