Typical Staffing/Orientation for Experienced RN

[KristinWW]

I assume this is normal but I'm seeking input. I'm an experienced RN but coming from an ED with a 1:5 ratio with a triage RN, techs to start IVs, draw bloods, clean rooms.

I'm now in an ED with the same 1:5 ratio, but we do bedside triage, start IVs, draw bloods, clean rooms when no one is available (most of the time). Charge constantly circulates and prompts us to hurry to d/c and take the next pt back to triage in a room. This is a community hospital with an FT area, not a trauma center, but I have been with a different preceptor every shift, and most of them have been too busy to assist me/answer questions at all. I have not been signed off on anything, have only had 1 opportunity to attempt an IV, and I'm supposed to go off orientation after 1 month, which will be the end of this week.

Thoughts?

[CCU BSN RN]

Be your own advocate. Talk to your preceptors and managers. Explain that you know it's really busy, but you feel like you aren't being given the framework to succeed. Ask what you can do to get more experience with these technical skills. A lot of it for me, transitioning to an area where I had to do these things myself for the first time...Try it twice, then ask someone else. If you stick enough needles in people, you'll eventually find veins. Once you start finding them, you'll get better. Ask charge or another RN for harder sticks. Watch them when they're putting in the IV, ask questions.

[KristinWW]

I did take matters into my own hands and asked - 2 different charge nurses said "too busy" and I asked preceptors at the start of each shift to practice on anyone and everyone, but I'm constantly told "things are crazy, not now", and "we've never been this busy before".

[NurseHeart&Soul, MSN]

I did take matters into my own hands and asked - 2 different charge nurses said "too busy" and I asked preceptors at the start of each shift to practice on anyone and everyone, but I'm constantly told "things are crazy, not now", and "we've never been this busy before".

Is there an educator or manager you can discuss your concerns with? If you get a chance to explain where your weaknesses are maybe you can come up with a good solution. Could you be a float nurse for a day of orientation to focus on the skills you've rarely performed? Could you spend a day with a phlebotomist or IV therapist (or even a few hours)?

I have worked in both types of facilities that you describe and I can totally see the challenge you are experiencing. You have a whole new type of ED life, multitasking, prioritizing etc. that you are dealing with. Sounds like you need a plan for your "next shift" so you're on the schedule for your orientation to be "the skills person" or something of the sort. That way the "too busy" line will hopefully be tampered down. Good luck. Way to go being proactive now rather than at the end of orientation.