Preceptorship in ER

SybLee · Nov 13, 2004

Francine:

I have worked in an ER for the last 3 years. During nursing school, I wanted to end up in the ER but knew that the med/surg path was a necessary step. However, I agree that you will get plenty of M/S experience soon enough, and a little taste of the ER could help you see another side of nursing.--- A side you aren't likely to see without some experience! That was my problem- you usually can't get a job in an ER without ER experience--and you can't get ER experience without a job in the ER!! :chuckle

So, what to do? My advice? Take the preceptorship in the ER! Contrary to popular belief- nurses (most anyway) do not eat their own young. I enjoy having a student and showing them a little bit of the ropes. Nothing exceptional will be expected of you- be eager to learn- ask lots of questions- if they are slow- ask for books to read. Our ER has alot of texts lying around that can be very interesting. Show that you are willing to learn and hopefully you will get paired with someone willing to teach!

Good Luck!!!!!!!!!!!!!!!!!!!

needsmore$ · Nov 13, 2004

I am the educator /preceptor for an ED. I have developed a 12-16 week preceptor program that I used for GNs coming directly to the ED. I still think 6 months med/surg is helpful as it helps the inexperienced nurse begin to develop critical thinking skills, as well as hone necessary skills (foleys, NGs, monitor interpretation, IVs, phlebotomy, etc) that may be needed to be performed VERY quickly. Also ,med/surg will give the inexperienced nurse reinforcement on drug /pharmocology- again not in such a critical and usually chaotic atmosphere. I spent 2 yrs on medsurg/telemetry prior to ED- I worked with monitors, ventilators-etc and still when I went to the ED, wasn't sure I could work there. 24 yrs later, I'm still here and wouldn't work anywhere else. That said, the 2 GNs I precepted, mentored from June to October- 1 quit as soon as she moved from dayshift (with me) to 3-11 w/ a mentor only--she said she couldn't "do it"- seemed at times to "disappear" when the critical pt came her way. The other-who had a 4 yr BS program and worked as a tech in a peds ED is still with us and doing well. If you do decide to go directly to the ED--CHECK OUT their preceptor programs. A dedicated nurse assigned to you as a preceptor/ mentor for 3 months would be an excellent type of scenario. If possible, look for a program that instead of sticking you right into the acute care area--combines didactic review, nursing equipment/procedure review as well as patient care- If possible, ask if the program mentor would be assigned to precept you and maintain their regular assignment at the same time--that could be a recipe for frustration for both you and the mentor-you might want to avoid that situation. Make sure your orientation includes ACLS, PALS training-

The ED is an exciting place to work--no preceptor program will make you an ED nurse-that job is up to you--EDUCATE yourself- even if your facility doesn't pay for seminars- pay for them yourself. Join ENA-

Good luck

Anne

maxinefrancine · Nov 13, 2004

I complete agree with the previous posts, but can offer an alternative solution. When I went through Nursing school (graduating in 2000) I requested a split preceptorship. I had no definate plans where I wanted to start as a nurse, but I was quite sure I did not want to do M/S. I talked with my instructor and together we worked out a plan for me to do half my preceptorship in psch. and the other half with a House Supervisor. Although I chose neither of these as my career, I was extremely pleased with this decision.

I went straight out of nursing school, with NO hospital experience, into a very busy inner city ER. I use the psych aspect almost eveyday, and after the supervisory aspect, I understand the workings of the WHOLE nursing picture alot better.

I also agree with the post about investigating the orientation program of the facility you are interested in working in. I now look back at my inexperience in nursing at the beginning and am amazed at the commitment and thoroughness of Nancy (my mentor) when I began nursing. I do not think that M/S is a necessity if you have the right stuff and are serious about nursing and learning. They covered all the basics in school, and as long as you jump at every opportunity to learn, you CAN go straight into ER, ICU or whatever specialized field you choose.

Good luck, and never be afraid to ask questions!!!:balloons:

Sarah, RNBScN · Nov 13, 2004

I am the educator /preceptor for an ED. I have developed a 12-16 week preceptor program that I used for GNs coming directly to the ED.

==================

Would you mind sharing with me your program mentoringship you have used. I would be willing to share with you in return whatever you have asked or require. Please advise Anne (needsmore$).

Thanks,

Sarah

teeituptom, BSN, RN · Nov 13, 2004

We dont call them preceptors anymore

Here they are called Clinical guides or companions

who ever dreamed that up should be shot

RNin92 · Nov 13, 2004

We dont call them preceptors anymore
Here they are called Clinical guides or companions
who ever dreamed that up should be shot

You know, why is it that we can't just call things as they are???!!??

Medical Records...no no..."Health Information Systems"

guess what people ask for when they call or come in...

Radiology...uh uh...Medical Imaging

as opposed to some other type of imaging??!!??

Secretary...Certified Health Unit Clerks

can you figure out their acronym???

Nursing Assistants...Nurse TECHNICIANS...Unlicensed Assitive Personnel

don't even start me there!!

Housekeeping...Environmental Engineers

?????

The list goes on and on...

And I haven't even begun on the administrative "titles"...but that would be a whole other post!

:rotfl:

fuega · Nov 13, 2004

Hello everyone,

I am an LVN and I am currently taking the LVN-RN transition I will be in the 2nd year in fall (august) I moved to wyoming from california. I was working in the ED in california. I was working in the wound center before that, when I came back from maternity leave there was no position in the wound center, but the director of the ED knew my work ethic and asked if I was interested in doing the fast track. I was so excitied because I was a tech in the ED prioir to working as a nurse. The only job at that hopsital avavilable was in the wound center, so there was my chance to be where I always wanted to be. Anyways, I did not know that you had to have a preceptor, until my friend that just passed boards told me about how she could not find a preceptor. AAAAAAAGGHHHHH. Here I am just thinking that all I need to do is apply and I will get hired. I know that I belong in the ED. I will be finished with school May 2006, I would rather cut off my right arm then work in Med/Surg!!!!!!!!! I have had nothing but horrible exp in Med/Surg. " I've got an idea, lets get off our as$$*s and do some work, Hey if the doctor is standing right there and he wants labs stat, and no one form lab is coming, GET A BUTTERFLY AND DO IT YOUR DAMN SELF!!!!!!!!!!" I love how they always call us to get a line after they have stuck the patient way past the 3 mark. The patient looks like a damn bloody cottonball! If you dont feel comfortable call before you use that patients as a pincushion.

I just cant handle it I hate the floor HATE IT!!! So what I am asking is will I have to do my preceptorship in Med/Surg? I don't really understand how it works can someone explain this to me. :imbar :imbar :imbar

needsmore$ · Nov 13, 2004

I am the educator /preceptor for an ED. I have developed a 12-16 week preceptor program that I used for GNs coming directly to the ED.
==================
Would you mind sharing with me your program mentoringship you have used. I would be willing to share with you in return whatever you have asked or require. Please advise Anne (needsmore$).
Thanks,
Sarah

Sarah- My director took me off clinical for 3 weeks- During that time- I made GN notebooks- sectiioned off by systems--(a great source was wild iris .com) cardiac , resp GYN, trauma, abd, etc. Every morning we reviewed a section--didactically--reviewing assessments, history taking, diseases, etc. After "lecture-classroom" I had equipment out that pertained to the systems we were reviewing-also including facility policies as well. We reviewed techniques- (foleys, long spine boards, splinting, Ngs, blood admin, etc). Usually -after lunch -we started pt care- (hopefully from the beginning of their treatment as opposed to taking over). We started initially with the medsurg level- 1 pt each. Their goals were assessments, histories, documentation (we have a computer documentation system which isn't always userfriendly) .With the low pt ratio- they went in with the physician during their exams. As they comfortable in the ED routine- We started higher acuity type pts- Since I did not have a clinical assignment, it left me free to pick the type of pt's, and the areas of ED I wanted to focus on.When they were taught IV, phlebotomy- they added those skills. I gave them "homework"- specific drugs to investigate, or disease processes to review with me the next day. They took ACLS and PALS when the courses were available. I also reviewed cardiac rhthyms-starting with recognizing NSR (great CD program- Essentials of Cardiac Rhthm Recognition by Williams and Wilkins) that we used.

needsmore$ · Nov 13, 2004

ENA is, or has developed, a modular ER nursing program. I don't know the cost. I tried to mirror my program after theirs. Some other preceptors give a "post orientation" test -like 50 questions,to all staff to show competency- they base their questions from the CEN exam. I am going to incorporate this in my 2005 yearly competencies for all staff as wellAnne

thanatos · Nov 14, 2004

I would rather cut off my right arm then work in Med/Surg!!!!!!!!! I have had nothing but horrible exp in Med/Surg. " I've got an idea, lets get off our as$$*s and do some work, Hey if the doctor is standing right there and he wants labs stat, and no one form lab is coming, GET A BUTTERFLY AND DO IT YOUR DAMN SELF!!!!!!!!!!" I love how they always call us to get a line after they have stuck the patient way past the 3 mark. The patient looks like a damn bloody cottonball! If you dont feel comfortable call before you use that patients as a pincushion.
I just cant handle it I hate the floor HATE IT!!! So what I am asking is will I have to do my preceptorship in Med/Surg? I don't really understand how it works can someone explain this to me. :imbar :imbar :imbar

It is too bad you have had such a bad experience w/ med/surg. Since I know & work with some outstanding med/surg nurses, I don't want you stereotyping these nurses. I would rather have a staff nurse attempt an IV than call for help the second the first line blow; how else are they are going to learn? I am glad there are nurses who enjoy med/surg because I cannot stand taking care of the same patient for more than 4-6 hours; I truly tip my hat to them. Please give them the respect they deserve. We are all nurses...just different specialities.

needsmore$ · Nov 14, 2004

I give medsurg nurses a lot of credit-- I worked there for several years and it was tough--I felt like I lived with these patients-day in, day out. They were discharged only to return in a few days. The nurse-pt ratio is high-and these pt's are often sicker with multiple complicated needs. This also goes with my opinion that Medsurg nursing is a foundation for all other specialties. I have a good rapport with the medsurg nurses probably because "I've walked in their shoes"- I know what they go through--different from the ED, but not necessarily "easier"- not as chaotic, not chock full of constant critical thinking situations like the ED, but certainly not "easier", just different.Anne