Training for ER; Didn't do so hot

[RNEulogy]

I am not exactly a new nurse- I've been working about 3 years in LTC. I was really starting to hate my job, so I went out on a limb and applied for a midnight ER/ Acute care position. My manager gave me a chance and I got the job. Everything was going well for the most part, until I started training at the main hospital ( I work at a critical access hospital and our ER isn't super busy- we send all the lvl 1-2's to the main hospital). Anyway, I just couldn't keep up! I felt like I was sinking; not a shocker considering my *only* background is in LTC. My manager told me on Friday that I just wasn't ready and she recommended I take my old job back- Definitely a blow to my ego, but I must say- I was not having an easy time.

Okay- I understand, I took a leap and it was more than I could handle without any acute care experience... What I found most irritating is that the woman who was training me gave such a bad review to my manager- but when I asked her how I was doing or for feedback- she made it sound like I was improving at an acceptable rate. I even said " I think I'm improving but I'm not sure if it's enough for the ER" she said I was improving at an acceptable level. She told my manager that I had no motivation, didn't look up drugs I didn't know and was tired all the time. I feel like I busted my a$$, frankly. There were times where I sat to chart and had a few brief periods of downtime ( very brief), but I wouldn't say I was unmotivated. In my "down time" I studied EKGs.

I can acknowledge that I was not ready for an ER job- I don't have the fundamentals and I would need to be trained for quite some time. I also believe my idea of "training" and hers were different. I made the mistake of thinking she would be like a teacher to me. I think she sees it as an orientation to the facility and could let me be more independent much faster. I will say, I did not feel comfortable doing some things and say someone had really crappy veins, I would ask her to do the IV so I wouldn't blow the one good vein they had. I did at least attempt starts on most patients, and my last few days I was getting IVs in everyone without help.::sigh:: I wish she just would have been more straight forward and in so far as the drugs I didn't know- there was one that I had never given, an antiarrhythmic and she was quick to explain how it works and showed me how to hang it. I looked it up at home.

I guess I resent how negative my review was, with the lack of motivation being the most painful and her lack of...ugh..I hate to say 'dishonest', because she wasn't...but she gave me the wrong impression on how my performance was. She made it sound like I was doing alright and that a lot of these things would "come in time". I didn't really know what to do without guidance since I've never been exposed to that environment, but I was improving, I was working my a$$ off and yeah- I was tired. I went to bed early, tried to get at least 7 hours of sleep AND I am accustomed to going to bed at 5am, not waking up at that time! (I worked midnights and afternoons; my position was to be midnights)..Maybe she mistook my lack of experience ( and need for guidance) as lack of initiative?

I'm going to apply for some med/surg or cardiac floors...I think that is a more appropriate transition from LTC.. I learned a lot and that will make me a better nurse, but I feel defeated. Most of all, I'm embarrassed that I'm going back to my old job with my tail between my legs. I was so excited to leave. What do you look for regarding improvement, demeanor and assertiveness in a less than experienced candidate? I only trained for three weeks, had I been given another three I think I would have vastly improved- maybe still not enough, though. Idk. >.

[poppycat, ADN, BSN]

In my opinion, three weeks doesn't sound like enough for them to really know anything about you. I think they should have given you the type of orientation they would give a new grad in that environment. It almost sounds like they set you up for failure, knowing you didn't have acute care experience.

I changed specialties from general Peds to NICU when I had 26 years of acute Peds experience. I was very nervous about the change because it's a very different specialty. My manager & the unit educator were very supportive & I received the same 16 week orientation that the new grads were given. I don't think I would have succeeded in NICU if I hadn't gotten that extensive training.

I really don't think you have anything to be embarrassed about returning to your old job. You tried something different & it didn't work out. It's a failure of the people who didn't train you properly.

[oceanblue52]

I agree that it sounds like you were set up to fail. LTC experience is very valuable and you clearly did outside work to get up to speed. It's over and done with, but if you face a similar situation down the road maybe it would help to document what you are doing off the clock and make sure you are reviewing with your manager/preceptor. ER is a very different environment and taking that new grad approach could put you in a more defensive position. Good luck with getting into some Med-Surg positions, I hope they will provide some more support for you. I'm glad you posted your thoughts; it's therapeutic to put it out there and and get feedback, and it also helps people realize they are not alone in uncertainties with starting a new specialty. You did your best and sound very motivated.

[TheCommuter, BSN, RN]

Moved to the Emergency Nursing forum for more responses.

[ohiosam2]

You are being far, FAR to hard on yourself. I was ED nurse for 20 years and now I am an NP in the ED. I have oriented more people that I can possibly remember. Now I orient NP's to the ED. I've done trauma, pediatric ED . . you name it. First of all, three weeks is not enough time to make the judgments they made about you. I do not care for the negative spin that manager placed on you. To tell you to go back to your original job is highly unconstructive and downright unprofessional. Here were are as nurses once again eating our own. The ED is a fast paced environment where you have to think quickly on your feet and make snap decisions. You don't have time to think things through for a long period of time. This is a very difficult thing to do for some people. If you are not used to that high intensity nursing, it is very beneficial to work for on a med/surg or telemetry unit. There you can learn to organize your time and gain more experience in order to move faster. Number two: decided if the ER is really where you want to be. When I started out as a nurse I spent one shift in the ER to find out "if it was for me". A very wise and older physician told me this, "You are either ER or you are not. And there is NO shame in being not." It takes a strong constitution and an ability to work under stress. If this is not you, then don't be ashamed. Not everyone is meant to be there. Number Three: if you really want to work in the ER then don't let anyone on this planet tell you that you can't. You may need to put in some time on an acute care floor or even reading up on skills. But if this is what you want to do, don't let someone else deter you. You can do it with hard work and full dedication. Number Four: there are plenty of ER's! I really don't care for the way this was handled. If you get negative comments and feelings from a place - run the other way! Find another ER at a different hospital. Take it from me, I have worked ER's from California to Ohio. Each one is different and has different management. Some are horrible! Some are the greatest places to work. Find a good one! So if you don't want to go back to your old job - then don't! If you want to do ER - find another one or go to a med surg unit and get some experience and try again. If you think ER is not for you, find something you want to do. Don't let the snap judgments of others get to you. If you are willing to work hard, you can accomplish a lot more than you think you can right now.

[amzyRN]

I got 10 weeks orientation with the option of 12 and I had acute experience. Three weeks isn't enough time. If you love ER, find a job at a place with a better orientation.

[bgxyrnf, MSN, RN]

This story emphasizes something that I think is often underlooked:

Just because you *can* get the job doesn't mean that it's a good idea to *take* the job.

It sounds like you were in over your head. I can understand why you're resentful although I think you might have been a bit naive in expecting her to serve as a teacher. Unless there's money to permit you to remain in an orientation position for the months needed to learn the basics of ED nursing, I don't think there's much chance for you to get it on the fly. You were basically set up to fail.

Keep your head up, keep preparing, and look for another opportunity.

[brewski09]

It sounds like you were in over your head. I can understand why you're resentful although I think you might have been a bit naive in expecting her to serve as a teacher. Unless there's money to permit you to remain in an orientation position for the months needed to learn the basics of ED nursing, I don't think there's much chance for you to get it on the fly. You were basically set up to fail.

Keep your head up, keep preparing, and look for another opportunity.

Isnt that what the ED is saying by hiring someone with no hospital experience? "we will take the time to train you because we realize you don't have the experience necessary to hit the ground running." And I also believe your preceptor is a teacher and mentor. I still ask my preceptor questions and I've been off orientation almost a year already.

[americana419]

That was so nicely worded Sam Ohio. I have been an ER nurse for many years, as well as a hospital supervisor. I believe that anyone who desires to be an ER nurse benefits greatly from experiencing floor nursing, prior to. It prepares a nurse to experience the hospital setting with a smoother transition, especially from LTC. It upsets me to hear the comment of "Go back to your prior job". No, you left for a reason. Apply in the hospital to a Tele or ICU unit, which will increase your skills and create a good foundation for things such as: complex drugs, invasive procedures, and etc. (used quickly and often frequently in the ER).

Moreover, one of the greatest struggles that I found personally with transitioning from tele to ER was understanding how to titrate drugs such as: nitro, cardizem, diprivan, and many others. The ICU is a great unit to learn these skills and I feel that a nurse who has not had ICU prior to ER should be required to take this training. It is human life that depends on this skill. Many times ER is slammed and it is just you, other nurses are busy, and the patient requires this change quickly.

Lastly, remember in the ER you are exposed to every age population, every disease process and it requires time to adjust to this department. So again, I say never go backwards and look in the mirror and tell yourself "no nurse is stupid", it takes so much time, dedication, intelligence to become a nurse. Only move forward and never let anyone discourage you from achieving your dream!!! I am soon interviewing for an ER manager position and my goal is to be the change, set an example for best practice in this department, create a great team, that most importantly, a team that loves their job and feels appreciated. Good luck & remember you can do it!