Maybe the work/studying paid off or maybe I just got lucky when the assignment generator was running, but I was fortunate enough to receive the preceptorship assignment I've been hoping for since starting school--the Emergency Department at a large urban hospital (trying to be deliberately vague re:location). I was a -B for a bit, and had my -P for two years (didn't use my ALS skills much, but I did use them...), then when I got out of the AF, I worked across the hall from the ED for a while so I'd consider myself at least moderately familiar with the way the ED runs. However, compared to that previous experience, working there as a nurse is a whole 'nuther animal. To whit, I have some questions about expectations/preparation for my assignment so that I'm useful beyond just being a warm body and observing. In the preceptorship handbook for my school there is a list of tasks we're allowed to do/prohibited from doing so I'm not going to violate those limitations but would like to solicit some opinions, hopefully from nurses who have precepted in the ED about:
1) Is there a single thing a student could do to either (a) totally knock your socks off or (b) get the student booted out of the ED and if so, what is it?
2) What skills/knowledge bits do you expect a student to know COLD instead of having to look them up in a pocket guidebook/phone app?
3) Are there any extra courses, beyond those normally included in a nursing school curriculum, that would be useful for a student to complete? I've done ACLS/PALS and have my eye on ABLSnow! and some of the AHA coursework re: rhythm ID, stroke, etc. but I have a couple more weekends free before preceptorship begins that I'd like to use productively.
I'll probably come up with some more questions later, but I figure these will make for a good start--thanks in advance for the advice/answers.
Last edit by Cohiba on Jul 29, '12
Jul 29, '12
I precept a lot of EMT-B and -P students that come for clinical experience in my ED. Here are some things that always blow me away...
1. ability to perform EKG and anticipate who will need an EKG
.... all SoB except uncomplicated asthma exacerbations
.... pt with cardiac hx
.... overdose/changes in mentation
.... elderly with vertigo/dizziness
2. ability to perform blood draws / IV start
3. ability to perform purposeful rounding.
4. obtain VS prior to hanging IV abx, during infusion if infused over 1+ hours, and after infusion.
5. most importantly TEAM work. If a patient requests something, be the first to jump up and say, "I'll get it!"
TEAM = Together Everyone Achieves More
Jul 29, '12
In my er the externs/preceptorships are there as students with the same restrictions as in clinical rotations.
So it's a learning experience Ask questions, offer to help, learn where supplies are located so you can get things FAST, know when to back off and simply watch, we get a squad - start vitals, have fun with the time. And oh yeah, this is also an extended interview to see if you fit in with us.
Jul 29, '12
Volunteer to help with whatever you can, but not at the neglect of your own pts. Ask questions! You should stop by beforehand and see if there are protocols for workups and study those if you can. You'll soon see trends like every abd pain gets a UA and IV/full labs, culture sore throats, do EKGs on chest pains immediately as in before you take a blood pressure or put them on the monitor (hopefully your ER will have good team work and staff enough for multiple sets of hands to be on the pt). If you will be getting peds pts weigh every single one!Biggest tip I can give you after working in 3 ERs is that TIME is most important! Get urine from the pt on the way to their room from triage, once they get in bed, forget it. 2 hours later you're bringing out catheter threats. Get the urine and blood in the lab ASAP, get admitted pts upstairs ASAP, no ER should ever sit on pts. You'll learn how to be politely firm with pts. Don't feed or water any pts unless you get the ok.Dazzle your instructor by asking pt name/birthdate *constantly* and allergies anytime you so much as flush an IV. Dont feel like a newb by doing this, it is vital to safe pt care and a lot of nurses get lax about it. Make it your habit from the get go.Also make it a habit to put pts in gowns before they know what hit them. Noooooothing more annoying than getting snipped at by a doc because your preceptee started an IV on a pt still in their street clothes. Your preceptor should be right with you but this is the real world and as you advance it is very realistic that your preceptor will say "hey while I'm doing this, go settle our new pt in room X and start a line, draw labs. "Not to generalize the group but don't get disheartened if you have a bad day or feel like you screw up at some point. I've found ER staff is generally quick to bark but also quick to forgive and move on.As for what could get you booted? I've had several students myself and of course been around countless others in the ED. I've seen several get all dazzled by the ER docs and want to sit at their feet loudly asking advice about going to med school, while the preceptor rolls their eyes and gets insulted/annoyed lol, ER docs can be pretty cool but don't be that student. Won't get you booted but definitely will get you an ice cold preceptor.Have fun and pay close attention, this is a great opportunity for you to see if you really want to live life in the pit!
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