Advice for ED Nurse on orientation

Specialties Emergency

Published

I've been a med/surg RN for 18 months. I recently moved into the ED. I've been on orientation for just under 2 weeks. I've been in the EDon orientation for a total of 5 days. I had floated to the ED a few times before, but on nights and now I am doing orientation on days which is a different thing. My preceptor says I am doing good.

Today my manager pulled me into her office and said she had some concerns that I was "sitting back too much". I told her that I did do a lot of watching of how things are done, since it's a totally different flow than the floor, obviously. I've been taking 2 patients at a time, I do work ups, labs, put in orders, communicate with the MDs, etc. Right now I try to focus on the patients that I have, so that the things that I need to do become more instinctive. Sometimes this leaves me with time to watch other RNs or Techs, listen to the MDs, and just pay attention in general. I ask lots of questions (as I have been encouraged to do) and if there's something I haven't seen I try to get in on it. However, sometimes with the RNs being overwhelmed with their patient load they can't safely teach me and do what needs to be done, so I sit back and watch.

So here's my question. What would you expect an RN with 18 months of floor experience to be doing at 2 weeks into ED orientation? I don't feel like I got much direction from my manager, so I will be discussing the expectations with the ED educator tomorrow, but I just thought I could get some feedback here as well

TIA. :D

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Specializes in home health, dialysis, others.

I think her expectations are a bit too high. Do you have a plan with the educator, what are her expectations? Try to look busier!!!

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I think her expectations are a bit too high. Do you have a plan with the educator, what are her expectations? Try to look busier!!!

I'm going to talk with the Educator tomorrow and come up with a more specific game plan. When I started they said they wanted me taking 2 patients at a time, which is what I have been doing, so I'm not sure what else is expected.

I mentioned to a co-worker today that I can just make myself look busy, that's easy. But I want to be able to actually learn, kwim? And I learn a lot by observing.

I should also mention this manager is notorious for rushing people off orientation. My friend, who was a floor RN for 10 years, just moved down to the ED. They kicked her off orientation after 2 months even though she told them she didn't feel at all ready, and then when she makes mistakes the manager is upset with her. :uhoh3:

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Specializes in Emergency.

As a new grad I only got 8 weeks orientation in my ED. They tried to get me out after 6 but I asked for extra. In the ED they kind of expect you to move super fast all the time, in every instance. This may be what you're experiencing. It sounds like you may be cautious. Like you said that when the RNs can't safely teach you because they are slammed, you sit back. You may have to embrace being more of a daredevil and doing some self education. It is the ugly, untold side of the ED. Good luck!

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Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr.

you are doing the right thing by requesting extension of your orientation if you do not feel comfortable. do not allow this nurse manager to bully you. they may be short staffed so they want you off of orientation now. i know of one nurse who is not working on my floor yet who has 2.5 years medical surgical experience and 6 months ed experience somewhere else, where the first 6 months is orientation. this particular nurse keeps allowing charge nurses to put her in places she does not belong when she floats to my floor. in fact, she is even upset with the nurse manager for requesting she show competencies, accept additional trainings, and to wait before jumping into the deep end. that nurse will fall on her face because she won't take advice from anyone more experienced. she thinks she is experinced enough!

fyi, the best way to look busy and to learn is to jump in and help other nurses short of having your own load. if you can have your own load, then do so! in fact, i suggest that you take the entire load from your preceptor (assuming you are not working the trauma section) and have your preceptor act as your back up. this way your preceptor can point out what you have missed and talk to you regarding things you need to notice when you are on your own. also i had a check off list of competencies that helped me to focus my "stupid" questions so when i was off of orientation i was not a lost soul rather i am a growing nurse. gl!

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Specializes in Cardiac, ER.

I transfered to ER from a cardiac unit about 3 yrs ago. Our orientation is 16 wks for new to the ER nurses! I think taking 2 pts on your own is great,...try helping out when you can,.ie when an ambulance comes in start the line and get the labs while the other nurse gets report,.place the pt on the monitor,O2 etc and get them out of their clothes. Those are simple things that really help the flow in the department. Sounds like you are on the right track,...best of luck to you!

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Specializes in Cardiac Telemetry, ED.

16 weeks? 6 months?? Where are all you people working that you get that much orientation? I got 6 weeks, and thought that was awesome compared to the 2 weeks I got as a brand new RN on an interventional cardiology floor!

To the OP, I think 2 patients is reasonable, but if your manager is telling you you're hanging back too much, I would suggest checking in with the other nurses around you to see if you need any help. You might also let them know if there is anything you need to practice. When you see other nurses overwhelmed, ask them "What can I do?" Even if it's just doing some vitals or medicating a patient or doing a discharge, you will be an asset to your coworkers if you make yourself available to help.

When I was orienting, the other nurses made me do ABGs and push paralytics. They pushed me into those trauma rooms. Even if I was just inserting a Foley or acting as a scribe, I was helping. That's what your manager *might* be getting at.

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I should clarify. I DO help out. I start lines on people, I pushed Etamadate on a patient that needed to be intubated and assisted with that code, I've helped with pedi patients, I put in foleys... trust me, I help. And keep in mind, I've officially been down there 5 days lol. But I also talk to the MDs, other RNs, Techs, ect about how things are done. And I watch how they do them. If I'm just flying by the seat of my pants all day long I will be a crappy RN. I feel like I need to learn, not just get tossed down there and told "Ok, just do whatever".

I guess I could understand if I had been in the ED for a few weeks, but it's been 5 days.

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Specializes in CEN.

i totally understand what you are going through, i was a paramedic 16 yrs with CC transport and 911 experience. i was hired as a new grad in october and after the basic hospital orientation my ED orientation started in mid november. its a 6 month orientation for new grads here in my hospital. my orientee handbook states i should be handling 3 non critical pts and to do some care for a critical care pt. My preceptor has thrown me to the wolves so to speak, im taking care of up to 5 non critical at once. i must say that i feel overwhelmed sometimes and i have been feeling quite anxious. I feel like a shark always on the move and if i stop someone will say something and i will get in trouble. i think i have even been up to 8 pts at once, even when the established nurses do maybe 3 or 4 and talk and lounge while i am breaking my back working. I understand that they have earned that right but sometimes i am scared S@#$#less and afraid i will hurt a pt.

The culture of nursing is also hard on my psyche, i am an honest and forthright person from dealing with 911 pts and the streets as a way to survive. here in the ER people talk behind your back and then you find out from someone else. i feel like i am not getting an honest assessment of my progress and worried that at the end of my orientation im going to be told that i am horrible and will get fired. I could also use some advice too. they have had me go on the other floors like the icu and peds and L&D. I feel the most comfortable in the ED but i dont know if i belong, thanks for hearing me out too. it sounds like you are doing good and if they have you scheduled to do 2 pts and you are doing well maybe pick up another. my preeptor has me in the habit to pick up pts as soon as they come into the team so i learn to pick up the slack and not be one of those nurses who are lazy. its so hard being the new guy, no one seems to want to help sometimes. my confidence is shot and i think it shows on my face and nurses smell the blood and i feel like they will find a way to get me out the door. what can We do to make this process easier on us without sacrificing pt care?

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Specializes in Cardiac Telemetry, ED.

Okay. I was just going by these statements, which, if they are true, do indicate to me that you may want to consider doing a little less "sitting back and watching" and a little more jumping in.

I told her that I did do a lot of watching of how things are done....Right now I try to focus on the patients that I have, so that the things that I need to do become more instinctive. Sometimes this leaves me with time to watch other RNs or Techs, listen to the MDs, and just pay attention in general.....However, sometimes with the RNs being overwhelmed with their patient load they can't safely teach me and do what needs to be done, so I sit back and watch.

As I said before, I think 2 patients at this stage is reasonable, though I do have one question. You say you floated down there before. What did you do when you floated? Did you take patients?

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Specializes in ED, CTSurg, IVTeam, Oncology.

Forgive me, but allow me to provide an illustration that may help clarify just what many ED managers want; suppose you were in Haiti right now? Do you wait for back up to arrive, or do you immediately jump in and do what you can; what you know how to do, without being asked? In general, that's what they look for. It's a matter of attitude; like "...Sure, I've got my patients, but I'm not too busy right now, so give me another." If I see someone else busy and I'm not, I immediately offer "...what can I help you with?" without being told. In other words if everyone else in the ED has one foot off the ground, then my ass better not be in a chair or chatting it up with a doctor about some meaningless obscure clinical diagnosis.

As for "orientation" before getting started; there's orientation and then there's theater in the round. I've seen more than my share of "RN's from upstairs" get turned right around and sent right back upstairs because they perpetually stand around waiting for someone to tell them what to do. Orientations are just general directions. When someone comes in with acute Chest Pain, I should not have to "orient" or tell the new RN: "...stat EKG, cardiac monitor, baby asa x 2, O2 via NC, large bore cath to the AC, bloods drawn and sent for Cardiac Panel, bedside Troponin I, Type and screen, etc..." This is all in the ED Chest Pain protocol that they should have read and memorized before they had even set foot in the door.

I remember one new transfer, who surprised everyone by frankly admitting that she didn't want to be left out of the loop, so if it "...wasn't too much trouble, could she get a digital copy of the ED policies and protocols to study at home." This was a month before the woman was even due to transfer down. Needless to say, she made a wonderful impression on everyone.

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Specializes in Cardiac Telemetry, ED.
If I'm just flying by the seat of my pants all day long I will be a crappy RN.

What kind of nursing did you anticipate by going to the ED, if not flying by the seat of your pants? :confused:

I don't mean to sound discouraging. Just some food for thought....

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