ER Orientation - what you should be doing....

[traumaRUs]

First, your ER should have a standardized length of orientation and it should definitely be more for the new grad RN. An orientation of 6-16 weeks is the norm, depending on your particular ER, number of visits and trauma level. Some things you want to accomplish while on orientation:

1. Notice the climate of the ER? Is this a fast-paced, 75,000 visits/year level one trauma center with 30 nurses on duty at all times or is it a community based ER with 23,000 visits/year and all traumas, AMIs, sick kids are turfed out or is it a rural Critical Access Hospital where there is just one RN on duty in the ER and your help comes in the form of the nursing supervisor?

2. Learn the basics first, then proceed to the more complex tasks. Basic tasks include learning how to operate the computer or learning the charting system, where are supplies kept, do you have the passwords needed to access supplies and meds if an automated system is used.

Familiarize yourself with the lay of the land: where is the charge nurse, do you reach her by cell phone, pager or yelling across the room?

What type of system is used for room assignments? Team or individual approach?

3. Next, every ER has protocols on which to base your care. These are pre-approved treatment modalities for different symptoms. For instance, you have a middle-aged male who presents with CP, you would automatically place the pt on a monitor, provide oxygen at 2L/NC, give ASA 324mg and of course obtain an EKG. There is often a time limit for these interventions.

You won't need to memorize these protocols but as you go thru your orientation, you will start to learn them and they will become second nature.

4. As you get further into your orientation, start to scope out your fellow nurses: who do you admire, get along with exceptionally well or want to emulate?

Approach them to help with mentoring. Your orientation will zoom by and soon you will be on your own and it is imporant to always have someone in your corner.

5. And...finally, relax and enjoy the ride!

[karrncen]

perbd, Sorry things aren't working out. Don't be discouraged. The pace is difficult and some just aren't able to adjust to so many different scenarios that can occur in a shift. You'll find what works for you. Maybe ICU is a better place where you have assigned patients and can concentrate on just those individuals. I'm assuming critical care isn't the issue for you. Not being able to work ED isn't the worst thing. If you recognize it's not for you and continue in it; that's where you'll run into trouble. Good luck.

[dezertrose]

Finding a good floor is important.

[traumaRUs, MSN, APRN]

perbd - Sorry the ER isn't working out. However, just like an6el posted - don't worry about it and just find some place else that does work for you.

[perbd]

Hi,

Thanks for the responses!

I talked to my Nurse Manager and explained my concerns about working in the ED. She was very understanding and asked me where I would prefer to work. I told her the ICU would be my first choice, but I'd be willing to work on the med/surg floor if there were no openings in ICU.

There were no openings in ICU at first, so I was scheduled to start on the med/surg floor. The week before I was to leave the ED and start on med/surg, there was a change in the schedule. The nurse who bid on the job in the ICU changed her mind and went back up to the Med/surg floor. I am now in my second week in the ICU. I love it. It can be intense. We had a code the last night I worked and I had to do chest compressions for the first time. It was sad because the gentleman didn't make it.

I will be off orientation next week. I'm nervous about that, but my preceptors are telling me that I will do fine. I will never be alone. There will always be a more experienced nurse with me. I can go back on orientation if I don't feel comfortable. They will also send me to a critical care course.

It was weird, but I was feeling more comfortable in the ER the last week I was there. I think it was because I knew I was leaving. They may float me down there when we have no patients in the ICU. I think I can handle that.

Anyway, I am happy now. I love the nurses I work with and feel much more comfortable taking care of one or two patients at a time. I have time to review their charts, labs, history etc. and can get to know the patients and their families. I no longer dread going to work.

PABrn, let me know how you make out. I think it is very difficult for a new nurse to handle the chaos in the ED.

Good luck!

:)

[karrncen]

Hi perbd,

Glad to hear you're doing well. ED isn't for everyone and I hope you enjoy your new position.

[nursebarbie2010]

I love ER. I am a new grad, and I will be in a smaller hospital. I am going straight into ED. I worked as an EMT-I for several years before going to nursing school. That is where I thrived and did my specialty preceptorship. The semester of school concentrated on our chosen specialty. We worked the same schedule as our preceptor and were responsible for total care. I also did my preceptorship the hospital where I was hired so I have a 3 month head start on other new grads. I thrive on the fast paced setting of the ER. It can be positive experience. I knew ER was all I wanted to do. Trying different clinical sites and specialties only confirmed it for me.

[perbd]

Sounds like you found your niche! Best of luck to you!

[an6el177]

Perbd,

Glad things worked out for you in ICU. I declined the small hospital b/c there was not orientation/training but rather thrown in. Even though it's a small 150 bed hospital, 5 bed ED, I still wanted formal training as I had not med/surg experience. I was hired into another major hospital (500 bed, 60 bed ED, non-trauma, magnet) with a new grad ED program. It's 16 wks with 16 hr clinical days and 2 x 12 hr shifts that we work with our preceptor each wk. It's a great program with 90% retention of new grads.

My question is to those who have had preceptors or been a preceptor themselves. How were you "trained" to be a preceptor and what are you looking for in your preceptee. What should a preceptee do if its not a good fit? What are your expectations?

I ask b/c I have worked 3 days with 3 different preceptors. The first day with one was easy going and he "didn't do things by the book" so I learned a lot of bad habits as he is a seasoned, long-timer in the ED. However he always prefaced it with, "you don't have to learn it this way" or "you'll find the technique that works for you but this is how I do it." Like I said, easy going but fudged a little in terms of technique. I can go into specifics but you know what I mean.

The 2nd preceptor day was easy-going, meshed well with the preceptor but more legit. The 3rd preceptor was the one I wanted to focus working on skills/techniques with b/c she is the one I'll be with the rest of the 16 wks. She's been in the ED for twenty some years and has precepted many new grads. However, I couldn't get a good read on her if she liked me or not. My 3rd day I had my own patient but that just means 4-5 patients throughout the shift. The last patient was a resp arrest whom needed a level of care that I had never done (i.e, hang propofol, insert corticore foley,

In the end, I went home feeling down on myself and told myself I should not have gotten flustered after each failed IV attempt and that my RN educator said we need to give ourselves room to learn and make mistakes, and grow. I know this but I feel like some preceptors have forgotten this. I have worked as a EMT in ED and am familiar with the settings but we weren't allowed to start IV's, mainly do ECGs, wound care, restock, etc.

I talked to my fellow new grads and they love their preceptors and say its a good fit. I don't want to be the only one where it doesn't work out. Our RN educator told us if it doesn't let them know ASAP and they'll find someone better suited. I am a "make with what you have", "adapt and overcome", don't complain type of person. However, I know in this case I should probably speak up as it may ruin my ED nursing career (I believe I'm met for the ED and don't have tunnel vision or "deer in headlights" new grad syndrome. I react well, ask tons of q's and am eager to learn but please excuse me if I don't know where all the supplies/forms are. However, my preceptor has told me she's fired new grads that didn't work out). I worry about the appearance of what other ED RN's would say as word gets around that my preceptor and I didn't work out (new grads/new transfers gossip) on top of the fact that she's been there 20 yrs and I'd have to work with her in the future. How awkward right?:uhoh21: In the end I know I should B-R-E-A-T-H and get over it and do what's best for me first.

I appreciate any comments/advice from former preceptees and preceptors. Just wanted to generate some discussion and your thoughts on the preceptorship experience. Thanks!

-an6el177

[DougMSNRN]

WOW. What a supportive discussion!

When I completed my undergrad in nursing, I knew I wanted to be specialized as an ANP. So, I went to a hospital that allowed nurses into specialty areas. I did not think I needed to do floor nursing. I was right. Two months after my orientation ended I had a patient on ECMO. IT WAS AWESOME! If you are self-aware about what you want your practice to look like and you have had an excellent orientation, new nurses should not be discouraged from entering the specialty setting.

When I started as a preceptor for my unit, I attended a 16 week class to be in this role. The majority of the class content was communication techniques to correctly communicate to my new nurse feedback that was useful. Most of it was a no-brainier. We also had de-briefings with the unit educator after each week. These were separate from the sessions the new nurse had with the orientee.

Oh, and another thing. I was rewarded on how my new nurse did. If after orientation my nurse was still in the unit after 30 days, I got $1,000. When they hit 90 days, I got another $1,000. When they hit 6 months, I got $3,000. All of us that volunteered for this had our new nurses w/ us for every shift for 3 months.

Doug