[travelcrazyRN]

Hi,

I just started a new job in the ED 2 days ago. I had been a adult floor nurse (med/surg, tele, cvu, psu) for 5 years before that but I don't have any previous ER/ICU experience. I just wanted a change. This is a 40+bed ER in a big city, but not a trauma center. They still get backboard/c-collar patients and codes from EMS. They don't have a specific PEDS ER but 25-30% are pediatric patients. What kind of orientation should I be getting? I have ACLS, I will take PALS next week. These are the only classes required. I want TNCC. Are there any other classes I should be taking? Any recommendations for classes that may not be necessary but still helpful? Right now I'm working with a preceptor. How long should I expect to have a preceptor? So far I have had 90% CP patients, one broken hip, and a few legal hold patients. No peds or ortho patients yet (my weakness). I triage my own EMS patients (they go straight to a bed). Are triage nurses supposed to have special education? I know it has only been two days, but I am feeling very overwhelmed, yet still happy for the change. I am excited to get up and go to work the next day. It seems harder to manage these 4 patients over 6-7 floor patients, especially when one of the 4 is critical. The charge nurse makes the bed assignments but sometimes they will give you 3 EMS within 5 minutes. I have been told you can end up with 4 critical patients. Right now that just seems like it is impossible even for the most experienced ED nurse. It is hard coming from knowing a job well to not knowing much at all. Everyone I work with is friendly, knowledgeable, and team players, but I don't know what the standards of orientation should be compared to the rest of the US. I plan on giving my self plenty of time to become acclimated but I still feel like I should be more comfortable with 5 years of previous experience. They have not set a specific amount of orientation. I was told a new grad is on a 4/mo plan with a preceptor and other new hires with experience just want to know where the bathroom is. I'm not afraid to jump in a learn quickly I just want to know what a reasonable amount of time would be even for a quick learner and what classes or seminars would benefit me the most. I'm the type that wants to know the job inside and out. Hope it wasn't too long . Thanks to anyone that replies with an answer.

[travelcrazyRN]

it won't let me edit-but I wanted to add that I have read the sticky notes and am in the process of reading all the links attached.

[bluesky]

You know I am also orienting to the ED. My previous experience is 4 yrs ICU. I have been orienting for about 3 weeks (only 2 shifts a week, though). For me the whole taking care of more patients than I'm used to.. and fast... is my biggest challenge. My preceptor and my ED educator both have stated that learning about the populations I don't know (peds, psych, ortho) is the main goal. My preceptor is an agency nurse and she ROCKS! Whenever I get a little antsy about my performance, she simply tells me in this setting if anyone has an issue with you, they will let you know! Unlike the ICU where RNs are on a mission to tear their newbies apart, I am feeling great love where I am. That said, the critical thinking and assessment skills I learned in critical care are very helpful. But have similar skills from your floor experience. For now, I am just enjoying having a preceptor who actually cares about my learning. When I was an ICU agency nurse at a new hospital, I got at most an hour or two to learn a whole new unit before I started to work. It sucked!

[northshore08]

In my experience, successful precepting of new ED nurses (no matter how many years you have been a nurse) has involved 1:1 orientation for at least 6 weeks using ENA orientation materials and close guidance. After the 6 weeks, the orientation loosens up for you to take the assignment with your preceptor at your side. 4 months is a nice orientation. Now here is what I would do if I were you.

1. Get online to www.ena.org and find their online orientation program, if you are not already using it. If your employer will not supply this for you, join the ENA (to lower the cost of their products) and buy it for yourself.

2. Never be afraid to ask your co-workers about things you are unsure of. When a new co-worker asks me a question, I have never felt that I wasted my time sharing knowledge or skills. You will know who is good to ask and who to avoid.

3. Use your downtime at work (if you have any) to get into your rooms or the trauma/resus rooms and learn all the stuff that is there. Do the same thing for infant warmers/bassinets, rarely used equipment, etc. You will be surprised to know that many of your coworkers are unsure about these things as well and you will have a short little inservice right there in the trauma room. If you don't know how it works, open it up and look at it and get someone to show you, or read the directions. (The next time some doc calls for that whatever thing, you may be the only one around that knows how to use it!)

4. When you get an EMS patient, the introductory charting is called triage, but it's not really triage. That pt already is in your bed. You should not be doing triage in the waiting area for at least a year. There are triage courses, but don't worry about going there yet...(there are several different ways triage is categorized.)

5. Classes, hmmmm---I would add ENPC to the mix. PALS is nice, but you need the further pediatric assessment taught in that class. According to your ED description, most peds you will see are awake and looking at you, thank goodness! The ENPC class has great information about the little sweeties, and helps you treat and triage them effectively.

Stay strong. One of the biggest hurdles is learning good teamwork. Yes, when you discharge three of your rooms in a row on a busy day, rest assured you will be bombed by whatever rolls in the door. But you are not alone, and when you have time, help others who just got bombed, too!! Good luck to you in your transition!
Cindy

[deeDawntee]

I have just started an ED position about 5 months ago and am also continuing to work as an ICU nurse as well. There is SO much to learn in the ED that even after 5 months there is a great deal that I have never seen. I think the best precepting will prepare you to deal with the flow and with the quickness of which you are expected to do things. Hopefully you have a supportive group of coworkers who will help you when you run into things you have never seen. There is a lot of reading you can do that can certainly be a huge help, but for me, until I have actually done something a few times do I really feel that I know it.

The best advice is that you have to be willing to get in there and not know everything. Know your resources and never be afraid to ask for help. Remember the ABC's and everything else will follow!! Your assessment is quick...if they are talking to you, they have an airway and are breathing (unless of course they are in distress)...but you get my meaning... concentrate on the presenting problem and what, in the pt's eyes, makes this visit an "emergency".

Good luck!

[Anagray]

I was also a floor nurse and while floor experience always comes in handy, ER is a completely different environment and a different mind frame. In our ER we have many standing protocols and a nurse really needs to be sure that she is using the right one, because it may be an hour before MD rolls in.
It is probably unsafe to assume that you should function on your own just because you have 5 years of experience. Our new grads get a year of orinentation/mentoring.

Please be careful, don't let anyone push you into something you are not ready for.
I wish you all the best!

Nat