ED orientation

  1. Just wondering what other ED's are doing for orientation for RN's new to the ED who do not have previous Critical Care experience.
    Does anyone included time in Critical Care as part of ED orientation for these individuals? And, if so, how long?
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  2. 12 Comments

  3. by   CEN35
    Well......initially we were oritenting people, by having them follow someone for 4-8 weeks. During this time as they improve, we give them a littel more independance and bigger load. We have revcently felt, maybe if we had a better orientation program thigs would work out better in the end. Currently, we are in the process of re-evaluating the orientation program all together, and trying to improve it as much as possible.

    Rick
  4. by   ARREST
    Currently in the Ed in whaich I work we are initiating an ED fellowship program. It has been out intention not to hire new grads but with the nursing shortage it is very difficult. We currently are set to have 5 new grads in June. The fellowship will consist of 8 weeks classroom/clinical and then 8 weeks with a primary preceptor. We hope that this will give them a stronger foundation from which to build. We currently have no critical care component to our regular orientation for ED nurses, altogh some of the classroom time for the new grads will be with a critical care fellowship students like those we have in the ED. Hope this helps, if you have any questions please e-mail me.
  5. by   kaycee
    For new nurses or ones with no critical care background we have a short critical care course. Then they shadow a preceptor in the ER for 4 weeks. They have to take ACLS and PALS as soon as possible. We are also trying to improve our orientation program to make the transition to ER easier. WE don't have a big turn over in our ER so we don't hire inexperienced RN's often.
  6. by   spudflake
    I manage a small rural ER. A friend gave me an excellent learning tool which I have just finished using with a new hire. The new hire graduated last May, she worked at a large hosp. in Reno in CIC. She was put through a critical care course then. She spent 6 mos/2days/week going through the lessons/post tests and working with a preceptor. The hardest thing to teach anyone is that old "gut feeling". Only time does that but she has proven to be a valuable employee and very hard worker and very eager to learn. She also has the personality and ability to admit she's still "green". I am very lucky though, my unit is very nurturing and eating the younguns just isn't tolerated!
  7. by   mercRN
    Originally posted by finch
    Just wondering what other ED's are doing for orientation for RN's new to the ED who do not have previous Critical Care experience.
    Does anyone included time in Critical Care as part of ED orientation for these individuals? And, if so, how long?

    I am just finishing up my orientation as a new grad starting in ED. We get 6 months orientation with a preceptor. We have to obtain ACLS, PALS, TNCC by our 1 year anniversary. We have all of the new RN orientation to do like BCRA, IV's, orientation, CLC, etc. There have been times in the last 6-8 wks where I have thought why am I still in orientation and then the next day I am like can I have 6 more months of orientation. My first official day on my own will be Jan 25th and I am scared to death that I will crash and burn. I will make the most of it and will not be afraid to ask questions.
  8. by   traumaRUs
    Our level one trauma center uses the ENA books for ER orientation. New grads get 12 weeks, for others its more individualized.
  9. by   trsnurse
    Our Hospital decided that new grads could go to critical care areas without prior critical care experience (as a charge nurse this is hard on the experienced RN's at times). since this has been implemented it has been trial and error; the only firm decision that we have honored is that new grads get 16 clinical weeks of orientation. Any ACLS,PALS, TNCC etc. is apart from this 16 weeks; but may be done during the 16 week orientation phase. We too have the ENA books for new grad orientation; but they are on a shelf collecting dust. Our new grads complained that it was too much like school; and they didn't like it. I guess they would rather find an experienced resource person. I am not happy about new grads in the E.R. and most of my co-workers feel as I do. I don't have "warm body" syndrome. I think anyone who is not in orientation anymore should be able to triage, work a code, a trauma, or what ever walks, crawls, or is wheeled into the E.R.--just my opinion-not meant to offend.
  10. by   RNin92
    We have a new grad preceptor program that we just revamped about a year ago. It works pretty well.

    It is 6 months long. They have a year to get their ACLS, BTLS, PALS and ECRN. We also put everyone thru a critical care class and TNS. It it pretty rigorous but seems to be working well. It was tough at first because we had so MANY new grads (thank you nursing shortage) that we ran out of preceptors!! It is critical to keep the new ones with one person!!

    We also have them spend time with our techs/EMTs.
  11. by   trsnurse
    Quote from RNin92
    We have a new grad preceptor program that we just revamped about a year ago. It works pretty well.

    It is 6 months long. They have a year to get their ACLS, BTLS, PALS and ECRN. We also put everyone thru a critical care class and TNS. It it pretty rigorous but seems to be working well. It was tough at first because we had so MANY new grads (thank you nursing shortage) that we ran out of preceptors!! It is critical to keep the new ones with one person!!

    We also have them spend time with our techs/EMTs.
    I agree... but not always possible, we try so hard to keep our new grads with their preceptors, but like I said it is not always possible.
  12. by   RNin92
    Quote from trsnurse
    I agree... but not always possible, we try so hard to keep our new grads with their preceptors, but like I said it is not always possible.
    I know...it is tough to get administration to buy in. We are still fighting the battle. Sometimes when we are short...all of a suden our orientees "count" in staffing. I don't know what game the management thinks they are playiing...it's not like WE don;t know that these nurses are still in orientation!!!

    No one is fooled...except maybe their bosses!

    But, for the most part they leave the preceptors/orientees alone.

    I know what you mean though, too about being able to handle anything. My shift it hasn't been too bad...but nocs...let me say that I would say a little prayer every noc that none of my friends or family had to go into the ER at noc. It was kind of a rule...going in...call me!
  13. by   trsnurse
    Quote from RNin92
    I know...it is tough to get administration to buy in. We are still fighting the battle. Sometimes when we are short...all of a suden our orientees "count" in staffing. I don't know what game the management thinks they are playiing...it's not like WE don;t know that these nurses are still in orientation!!!

    No one is fooled...except maybe their bosses!

    But, for the most part they leave the preceptors/orientees alone.

    I know what you mean though, too about being able to handle anything. My shift it hasn't been too bad...but nocs...let me say that I would say a little prayer every noc that none of my friends or family had to go into the ER at noc. It was kind of a rule...going in...call me!
    Alright-it says you are from Illinois-BUT I am thinking you work where I do--HA HA -I guess it just goes to show you E.R.'s are the same where ever you go. Our "N" shift is full of IN-EXPERIENCE-SCARES THE SH** OUT OF ME-if a trauma is called prior to my shift ending then I can't bare to leave until I have made sure it's no one I know and love. I may have said this at some point, but I am not a fan of new grads in critical care. I am okay if there is one or maybe two, but man when that is all your director hires, it begins to catch up with you, then it turns into a "babysitting" situation. We are a 34 bed ER and when most of your RN's lack experience, it becomes a scarry situation.
  14. by   RNin92
    Quote from trsnurse
    Alright-it says you are from Illinois-BUT I am thinking you work where I do--HA HA -I guess it just goes to show you E.R.'s are the same where ever you go. Our "N" shift is full of IN-EXPERIENCE-SCARES THE SH** OUT OF ME-if a trauma is called prior to my shift ending then I can't bare to leave until I have made sure it's no one I know and love. I may have said this at some point, but I am not a fan of new grads in critical care. I am okay if there is one or maybe two, but man when that is all your director hires, it begins to catch up with you, then it turns into a "babysitting" situation. We are a 34 bed ER and when most of your RN's lack experience, it becomes a scarry situation.
    I know how you feel!!
    And it isn't the fault of our new grads...although they think so. Most of them are very smart and try so very hard. But my God...it is way sacry sometimes. My background is critical care and I am scared out of my mind sometimes...I cannot imagine how these "kids" are getting thru!!
    But wiht the nursing shortage...what is the answer?
    Plus, they are so many more choices for nurses today that many are leaving the hospital setting...and taking their experience with them!

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