I posted this same thing on the ICU page and would love to heare from the ED RNs too.
I'm feeling very discouraged with nursing after only two weeks of clinical. I'm in my 2nd semester of my BSN program. My clinical instructor thinks that I am way better suited for ICU (I'm thinking ED may be better for me) so I'd love to hear what your day is like (in general) in the ED. So far I've been on rehab, which I hear is the least acute it gets, and I'm SOOO bored. I NEED to use my brain more or I'm sure to go mad. I precepted last week and had three patients, was able to do all but pass meds myself (acuchecks, i&o cath, showers, vitals, all the charting, changed the beds) and was still craving more action. I'm thinking that's a bad sign as I'm "supposed" to be overwhelmed and nervous my first real week with multiple patients. We go back to only one patient this week. I'm not sure what I'll be doing the whole time if I was bored with three....
So that got long! =) Please tell me it gets crazy busy in a more cerebral way. So far they act like critical thinking is holding insulin if the bs is 40. The thought of never knowing what is going to happen and needing to "turn it on" in a moments notice sounds like heaven! My passion and interest lies in wanting to figure out what is wrong and then fixing it. Do you think the ED is a good place for that? I've worried lately that I may need to go the M.D. route to fulfill this need of mine but I'm thinking and hoping the ED (if not the ICU) may do the trick.
Read the charts when you have down time. H and P's are always where I start reading along with the admission note. you can start to see how a diagnosis was arrived at and future planning. You'll challenge yourself a lot by looking at more that the big picture.
I work in the 2nd busiest ER in my state 7a-7p weekends. I show up at 0645 head to the time clock then go to the breakroom to get a glass of water. As I walk in I keep a watch out for stretchers in the hallway as this could indicate I am in for a rough day. Once I get back to the nurses station I figure out which assignment I am taking. We are broke down into fasttrack, intermediate, and critical. I almost always work in critical. I think because I am a man and their are less pelvic exams going on over their. We are responsible for four rooms each and a hallway patient if it is really bad. After I take report I like to go look at all my patients and if needed I retake vitals. Figure out what needs to be done and do it as fast as I can.''
Working in the ER is a balancing act between what you know needs to be done to keep people alive and what needs to be done to keep the flow going. Many times an assesment of a new patient is simply walking by the room and if you see somebody looking back at you in a bad mood but breathing w/o distress you know you can make it in there later. Sometimes you may get stuck in a room with a septic patient for an hour and half before you can even try to get caught up. You have people whining about needing their discharge papers and work notes when you are working up a stemi going to the cath lab. Doctors trying to micromanage you when they don't know what your patient load or acuity level is. I am one of the most easy going people you would ever know but in the ER you have to be able to tell a doctore your busy. If you want that patient DCed right now then go do it. Your rooms will be filling faster than is humanly possible to keep up at times and your patients die on a fairly regular basis. Sometimes you just have to realize that you are only one person and you only can do what you can do.
Staffing in the ER is impossible. Some days you have staff tripping over each other looking for stuff to do and others it seems like "What are we going to do if one more critical pt comes in?" There is also the attitude you get from many of the nurses upstairs about taking report. Was this done was that done. Sometimes I feel like a used car salesman just trying to get somebody upstairs.
Your probably asking, what is the good. When you take that patient who comes in from the ambulance or from out front and they are seriously ill and you and the doctors and techs take that patient from unstable to stable and get them upstairs you feel alot of satisfaction. When your team gets that person having a heart attack to the cath lab in less than 30 minutes you feel good.
For me the good outweighs the bad. I couldn't imagine working in any other area of the hospital.
I NEED to use my brain more or I'm sure to go mad.
You sound like me when I was in nursing school. I think that you need to know that (hopefully) it gets better. You start out at the same pace as everyone else, but toward the end of your clinicals, you are moving toward what you've shown your instructors you are capable of. Does that make sense? Constantly being caught up, having your care plans/process papers (whatever your programs calls those book-sized papers) done -- and accurate, helping other students, offering to go with other nurses in to observe procedures or say, insert foleys, start IVs, insert NGs, etc... all that will show your instructor you're getting bored, and are capable of more of a challenge. Spend time with your patients! If you've got everything caught up and you have an extra 20 minutes, sit with one of your patients and work on therapeutic communication. :) Get to know them, their medical history, family history, personal life (the older they are, the more interesting their lives often are)...
A day (night -- 7pm-7am) in the ED? At 7pm, I hit the ground running... get a nurse-to-nurse (report) from a day shift person on their patients so they can go home, go see all of them, quickly reassess, grab a set of vitals, print a strip if they're on a cardiac monitor, complete any orders that are still needing to be done... receive a new patient or two if I'm low on the totem pole. See them, discharge one or more of the ones I took from day shift, and it's a revolving door all night. You say busy, and are mentally challenged (haha.. in a good way!) all night. Maybe "forced to use your brain" is a better way to put it. I am NEVER not busy. Even on the occasional night where we have a few hours of carrying 1-3 easy patients, there are plenty of things to be done -- restocking the rooms and IV cart, CLEANING. If there's down time, I'm constantly running around cleaning cardiac monitor leads, pulse ox cords/attachments, throwing away old BP cuffs and replacing them with clean ones... there is ALWAYS something to do. And just when you think the night is going to be peaceful, you have a full arrest with a 1-2 minute estimated time of arrival. Most often, though, you are constantly doing something and trying to sneak away to breathe (and pee)... not doing as you are now (constantly trying to find something to keep you occupied). :) Might be a good match for you!
Good luck -- if you look there is always something to do. Maybe mention to the lead/charge nurse on the floor you're doing your clinicals on that you would like to be able to observe/help out with anything possible because you're finding yourself with some free time and would like to both (a) learn and (b) help out. They will probably find you things to do or watch! OR... see if your instructor would let you maybe spend half a day observing in surgery or watch some babies being born? Lots of things you could do to make your day go by with a little more hustle and bustle!
thank you rlgiv and alkaleidi, so much! that sounds like the perfect atmosphere for me! we don't ever rotate to ed for school but i'm going to have to find someone to let me come check it out! my clinicals are at a level i trauma center so i'm sure it would be an action packed visit.
does anyone have any recommendations for getting an ed job as close to graduation as possible? from what i've read it seems that they don't often take new grads. is that accurate?
I'm feeling very discouraged with nursing after only two weeks of clinical. I'm in my 2nd semester of my BSN program. My clinical instructor thinks that I am way better suited for ICU
I can't get beyond this part. At 2 weeks of clinical no one knows what nursing work is best for them. Please don't allow yourself to be pigeonholed this early. If you are bored with what is asked of you, as was suggested up thread ask for charts to read or go over pharmacology.
Specializes in Onco, palliative care, PCU, HH, hospice.
You may want to conisder med/surg or telemetry unit as well, because you will get a little bit of everything and utilize practically ever skill and piece of knowledge you learned in NS and then some.
In LTC and rehab units, it may seem easy but in the real world when the nurse can have 20-40 patients you talk about hoppin' to get your work done! Don't worry though you'll be fine, by the time you graduate after you've gone through all your rotations you'll probably have a better idea of what area of nursing will make you happy.
Specializes in Tele, Renal, ICU, CIU, ER, Home Health..
The thing about menial tasks is, they do require tons of critical thinking. You're not just cleaning poop. This patient has been hospitalized. Do they have diarrhea. Did they contract C - diff in the hospital. Are they constipated? Could they be developing an illeus? What is skin integrity like? Any breakdown? Are they are risk? How is their nutritional status? What about their foley caths? Any signs of a UTI? Is intake = output? Any signs of sepsis? How about pulses? Any signs of DVT's? I'm sure any nurse could go on an on about the opportunities for critical thinking, even in a rehab facility. Patients have complications anywhere...not just in ICU or ER. As a student and a new graduate, it's common to be task oriented and if you are able to complete tasks in a timely manner, you think you're doing great. Well you are doing great, but you've got a lot more to learn and you can start now on building those critical thinking skills. Good luck!!
Specializes in Onco, palliative care, PCU, HH, hospice.
Oh okay, that explains the better nurse to patient ratio. However rehab units in skilled nursing facilities generally have the much much heavier patient loads.
It still seems odd for a nurse on a hospital unit to have only 3 patients. Do the nurses do total care? (no aids?). What is the acuity level of the patients? How long are patient stays? Is this a unique facility/unit with better staffing than average? You say the nurse had just 3 patients. Did all of the unit nurses have the same load? What was your patients' nurse doing while you were there since you were doing much of the basic care? Just curious!!
michael79
133 Posts
Read the charts when you have down time. H and P's are always where I start reading along with the admission note. you can start to see how a diagnosis was arrived at and future planning. You'll challenge yourself a lot by looking at more that the big picture.