[fusster]

Hello, I'm in my senior year of nursing school and one of my clinicals this semester is in the ER. Does anyone have tips as to what the best things for me to review would be? It's a fairly rural ER and doesn't generally get major traumas and I'll be seeing pediatric and adult patients. I'd appreciate any help you all can give. Thanks!

[Larry77]

Most ER's have standing orders for presenting complaints (ie chestpain, nausea and vomiting)...would probably be helpful to get a copy of theirs so you could make sure you don't go against what the protocol is (ie giving a n/v patient water to drink).

But I wouldn't worry too much you will be precepting so you shouldn't be thrown to the wolves and should have somebody with you at all times.

Have fun in the ED!

[sarahdeez]

Brush up on chest pain treatments... our protocol is labs, chest xray, 0xygen at 2L, 12 lead ekg, place on 3 lead monitor, 18 guage IV, asa, nitro. we do not normally use morphine unless the nitro is not working as well as we would like.

Be sure you know placement for the 3 lead and 12 lead electrodes.

GI cocktail for when chest pain is GI related, know what pluesy and chest wall pain is - you may see these diagnoses.

Look up nausea meds - reglan, phenergan, compazine, vistaril, zofran, anzimet

ABT for UTI's

How to do a throat culture

This is what most ER's see the very most of.

Definitely get a copy of protocols from the ER while you are there. Jump in there and ask lots of questions. It is easy for nurses to get caught up in doing their job and forget to teach you. Most nurses do not mind being reminded you want to learn. Have fun! ER's a great place to work.

[BSNDec06]

My main recommendation is to be prepared to move fast. My preceptor was difficult to keep up with at times, so I really had to be on my toes!

[noc_owl]

Review physical assessment, IV/Blood draw skills, urine clean catch and catheter skills, and NG tube skills. And bring chocolate to share with everyone, a little sugar never hurts!

[EmerNurse]

Be proactive.

For instance:

If you give 40mg IV of lasix to a CHF exacerbation, offer to put in a foley (if pt needs it), and empty it and let the RN know the output after a while (or when it's full). Don't forget to grab a sample if the patient needs a UA! Never empty a foley until you KNOW you don't need urine out of it - trust me.

Have a peek at the patient's hx, if they're diabetic but being treated for something else, we still need to check their suger. Offer to do it or ask when it needs to be done.

Note when VS were last done - go grab a new set after a couple hours or more often if pt isn't looking great. Never hurts to have 'em.

Note which labs have been ordered, and have come back. Missing the CBC after everything else is back? Ask the nurse - should you call the lab and check on it?

Do you have a patient who needs a full bladder for an ultrasound? Check in with her, make sure she's drinking, and let the nurse know when she has to pee. Don't LET HER PEE!

Did your patient just get brought back from CT or X-ray or whereever? Go put him back on his leads and sat monitor, put his nasal canula back on him and grab a quick check on vitals.

Find out what admit paperwork needs to be done. Can you go do the property checklist with the patient while the nurse does the transfer form (for example)?

While you're going to be with a nurse while you're there, you can do small(er) things on your own while she's busy charting/talking to a doc/dealing with fire rescue/giving report or whatever. It doesn't take 2 people to do everything and you can't be over her shoulder all the time. The trick is, do things you KNOW you can do without permission. Like measuring a foley output, taking VS when it's not been done in a couple hours, checking with your/your nurses' assigned patients to see if they need anything like an extra blanket. Update the nurse if the pt. or family says/does/looks like something new and pertient.

Anything that could be "internal" such as giving food/drink, placing a line/tube into someone, giving a med, drawing a lab, should of course be checked with your nurse.

Does a lot of this sound like "tech work"? Yeah you could say that but very few ERs have enough techs and all your patients need all this stuff done. Who's responsible? The nurse. Period. End of discussion.

The stuff above is only a tiny percent of the things an ER nurse has to think of for his/her patients, but they're all important.

I did my leadership rotation in the ER I now work in. Did nearly 2 years of med-surg after nursing school before coming here. But I always remembered and loved my leadership experience. I learned SO much! If you're proactive on the "little things" that need to be done, your nurse will have more time to walk you through the stuff I know you want to get experience in - placing IVs, foleys, NGs, assessment skills, and all the other exciting stuff!

Do I love the ER - YEP YEP YEP. Good luck!

[JMBM]

Can't really add much to Emernurse's excellent post, except to emphasize the part about being proactive. I can't tell you the number of nursing students I've had who sit at the nursing station, complaining to the other students about how "boring" it is and that they "haven't gotten to do anything exciting" while I am running like crazy assessing, getting VS' and blood sugars, givng meds, etc. The wonderful and fun student is the one who comes along, offers to help, asks questions, grabs VS, gives out blankets, helps clean rooms, and generally keeps her/his eyes and ears open. For that kind of student, I go out of my way to find chances to put in tubes, IVs, get into traumas, etc. Carry a little notepad and jot down conditions, meds, procedures, labs, etc that you run into and don't understand fully. Go home and look them up. (If you don't write them down, they'll get lost in the jumble.) The very fact that you asked what to study shows you'll probably do well. Best of luck.

[fusster]

Thank you so much to everyone who replied! I'm sure these suggestions will help me out a lot.

[RNdudeNNJ]

"if you give 40mg IV of lasix to a CHF exacerbation, offer to put in a foley (if pt needs it), and empty it and let the RN know the output after a while (or when it's full). Don't forget to grab a sample if the patient needs a UA! Never empty a foley until you KNOW you don't need urine out of it - trust me."

Just to add regarding the urine sample, know if you need to do a urine pregnancy test before the patient voids or you empty the foley bag. I know this from experience...LOL :icon_cheesygrin:

[HM2Viking]

I will probably be doing my synthesis rotation in the ER. Thanks for all the ideas of what to be looking for/doing during my synthesis.