Orientation for new employees to the ER

[lisa74]

Hello everybody, long time reader but first time poster :-)

From all that I have read here on Allnurses, the majority of you seem to be in the US. From the many posts I have read, orientation periods in the ER over in the US seem to be quite lengthy and also, from what I have read, nurses new to the ER don't seem to be given patient loads/allocations until after about 6 to 8 weeks. I think this is awesome as where I work in Australia, I commenced working in the ER and my orientation consisted of an "education day" where I was orientated to the ER via powerpoint slides. I wasn't even given a tour of the ER and where to find supplies, the treatment room etc. The clinical nurse educator told me that on my first day she would be out on the floor with me supervising me and guiding me.

As it turned out my first day on the ER floor (with no prior ER experience) was nerve-wracking! The educator met me at the 4 bedded bay I had been allocated and there was only 1 patient there when I started my shift. This educator said to me "Now, you only have one patient, you'll soon get more so my advice is to have all of your necessary paperwork at each bed so when you get a new patient you can hit the ground running. Make sure you record your patients' vital signs hourly and make you prioritise. Now, I have to go back to my office because I have things to do." That was my first day in the ER. Half an hour later, I was given a new patient so things were relatively under control. Shortly after my second patient arrived, the in-charge nurse gave me two new patients simultaneously, both having been brought in by ambulance! Needless to say, I struggled that first week and I couldn't believe that the in-charge would do that to me, knowing it was my first day and I'd never worked in the ER. Talk about baptism by fire!

That was nearly 5 months. Things have improved slightly but I still struggle most days because, even though I do get through most of work before the next shift arrives, I've never been educated in how to prioritise in the ER. I know how to prioritise on surgical wards so I have been able to apply it to the ER but it's hard to learn prioritisation where I work because the goal posts move and the rules change, depending on who my in-charge is. All I have ever asked for is guidance and support from my educator, I am willing to learn, but from day 1 she has refused to give me any supernumary days (where I am buddied up with a colleague for several days) to learn the ropes without being smashed. My employer refuses to give me study days and whilst I have said I am willing to pay for a course, they refuse to meet me halfway and even give me days off to attend education for working in the ER.

This whole experience has destroyed my confidence so I am looking for another job. As I said, from all my reading of topics on Allnurses, I'm just amazed at the long orientation periods hospital employees get in America. Australia could certainly learn a thing or two from your orientation procedures.

It's destroyed my confidence so I am currently looking for another job

[lisa74]

Sorry, I forgot to add that I can count on one hand the number of times this "educator" has given me guidance and those few times she has actually come out to the floor when I've been working, she has gone through my charts and criticised me, loudly, in front of all my patients, my fellow nurses and all the ER doctors. Needless to say it was humiliating. I don't mind receiving constructive criticism. Hell, I can even accept criticism when my work is not up to scratch, but this educator could at least have the courtesy to criticise me behind closed doors and help me/advise me on how I can fix it, don't just criticise me in front 60+ people.

[Lunah, MSN, RN]

What a horrible environment. I don't blame you for looking elsewhere! In the meantime, have you sought out any educational materials on your own that might help?

[TrevyRN, BSN, RN]

Ha! My friend and I are new grads that moved to work in a hospital in the rural midwest. As a new grad in an understaffed ER, I had a day of shadowing and then had to hit the ground running. I remember one day a two weeks in when I had a suicidal patient, a chest pain pt, a possible stroke patient (who wound up being a pneumonia, UTI, fever pt), and a person with abdominal pain brought in by ambulance - all in 15 minutes. I was like - UUUUUHHHHH - hopefully that person isn't toooooo suicidal and that isn't a reeeaaal stroke and a reeeeeeaaaal heart attack and that's not like, an aortic aneurysm or something, 'cause... CRAP!

The most important thing is to admit when you're overwhelmed and need help. Even if you wind up leaving the ER or your hospital's education dept blows, learning to ask for help, delegate tasks, and admitting you're overwhelmed are crucial skills in any department. I wish I had practiced that skill earlier on in this chaotic learning experience. If you can't do that in your workplace, then it's a crappy workplace. There are crappy hospitals in any country, state, territory, etc. There are also good ones! I am fortunate to work in a crappy hospital with a crappy education department, but excellent teammates in the ER. Find good teammates. And kudos for going on this board to get support, advice, or just k'vich. :-)

Meanwhile my surgery friend has the worst preceptors. They're like "do a lap choly ... then there's a Whipple procedure you have to do. I'm going to man the phone at the desk, go on facebook, and eat." She was like "Um, how do I do anything surgery related? What's a Whipple? They don't teach that in school. hello... anyone? " *crickets*

Best of luck to you!