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
I understand your rationale of watching to get a feel for things...but best advice I can give is to learn this line "What can I do to help?"
Every time you're in that situation where you're maybe not sure what to do or are trying to learn how to handle things, say this to the nurse in charge of that patient. Trust me, they'll give you something to do to help! Gets you in there actually doing hands on, getting the experience, and nothing gets you accepted faster by your co-workers than being always willing to pitch in.
What kind of nursing did you anticipate by going to the ED, if not flying by the seat of your pants?
I don't mean to sound discouraging. Just some food for thought....
Oh trust me, I can fly by the seat of my pants just fine. But they aren't paying me as staff to be down there. They are paying me to orient. Now you can toss my into a room with a critical patient and I will know what to do for them, but I won't know the protocol for the ED. I'll know the protocol for the floor. I'm not talking about learning how to take care of a sick patient, trust me. But if my manager expects me to place orders appropriately, know where to get a venti mask or a rapid sequence intubation kit, know that Dr so and so likes his labs one by one while Dr this and that wants his labs once everything is back, then she should expect me to pay attention to those things as they happen to the people around me.
Example, another new RN sent a pedi up the other day with a tech instead of taking the pedi up herself. That is against hospital policy and she got in trouble. But no one told her in orientation that an RN needed to go with a pedi. She never paid attention to it, so it was her own fault.
And no, they did not give me a general orientation of the policies. It's expected that I will learn them as I go. So if I take 10 minutes to ask another RN, MD, or Tech about how something is done so I'm not making stupid and needless mistakes, I'm not sure how that's a bad thing.
Anyway, I spoke with the educator and she saw what I was saying. She agreed, this was my chance to absorb as much as I could and if I was learning by watching then that could be a good thing. I told her I certainly wasn't holding back because I was afraid or cautious. She said she didn't think so, because she had heard plenty about how I work from the floor LOL
But if my manager expects me to place orders appropriately, know where to get a venti mask or a rapid sequence intubation kit, know that Dr so and so likes his labs one by one while Dr this and that wants his labs once everything is back, then she should expect me to pay attention to those things as they happen to the people around me.
Absolutely you should pay attention, and I wouldn't expect someone 5 days into orientation to know all of this. But, there's only so much of that that you can learn by watching those around you. At a certain point, you learn it by experiencing it. There is no way you're going to learn all the different doctor preferences or where every single thing is during your orientation period.
Anyway, you asked for advice, and I was just going on your own words. Sounds like you're doing fine.
I'm curious, you say you used to float there. Did you take patients when you floated?
It sounds to me like you are just plain uncomfortable and intimidated. You have to let go of the need to feel like you know everything. You never will in ER. When pt's are admitted, they at least have a possible diagnosis. Sometimes in ER you have no clue what you are working with. So you are going to have a hard time if you keep this up.
You are an experienced nurse......18 months is good experience. You should never have the time to "sit and watch". You need to focus more on the pts than the staff, And the pts always need something and even when there is nothing more to do........there is pt teaching which can help them from returning unnecessarily to ER. So remember you are treating the whole pt and not waiting for someone to teach you something.....it will come to you in due time. For now do what you know how to do and do what you can for other RNs pts whenever you can within your capabilities. Not every day you will 'get taught"......but every day you 'will learn". It will happen. Just be yourself and know your strengths.
i worked med-sug for a year, then went to the ED. I'm just off orientation (10 weeks). I feel like I have the basics of the ED down but at times I know my mind is spinning i see so many different things down there and while on orientation have been thrown into a med alert and handed the pacer, I took a deep breath and just followed the doctors directions. I could not tell if it was capturing or not, but really that's not my job, it's the doctors, even though other RNs were yelling out "it captured". Everytime there was a med alert the charge nurse would take and throw me in there. I'm still very anixous during them, but not frightened to death. i jumped in or was pushed into every trama and med-alert that came in. Now my problem is getting organzied, I probably run around more than i need to, and i know the nurses are laughing at me, but who cares, at one time they were new too. I noticed that going back to basics is what works best for me, the A B Cs-airway, breathing, circulation....
it's a different world down there, very different from the floor. I never realized how nicely my patients were packaged up for me on the med-surg floor, untill I went to the ED. I don't love all of my co-workers, b/c I know at times I'm being tested by them and their not helping me when they do have the time, but I do have a lot of respect for them b/c of their skills and knowledge. I know one day my head won't keep spinning and I'll be able to antisapate the doctors moves, but right now I understand I am a puppy, trying to run with the Big Dogs!
Thats what I am saying, you just dont feel comfortable and it is obvious to others. Like I said, perform at your best in the things you know. And one thing I will fault you for is seeing something that you didnt understand and then not doing your own self teaching. College really only taught us how to learn. If you didnt understand what to look for when they were pacing, then go home, and search it up, take it step by step and next time at least you will know what you are looking for and why. You may not know every medicine you give, but when you come across a new one, give it if you have to emergently, then look it up and next time you will know. If you do this every day then you will be surprised at how much you will learn. Don't be intimidated, it will come in time. Take it step by step. Focus on patient and not staff and you will do well. I do not know why they are not helping you when they have the time, but that is their ego which is common. You just smile, and know that with or without their help you may one day be more proficient than they are. There is one DR or nurse there that is a teacher at heart and loves to explain things .........search that person out and every now and again pick their brain. Pray every day that God will help you adjust as you are doing his works.
I think 2 patients at this stage, is doing well--but what acuity are they? If you find that you get caught up with 2, then ask for preceptor to give you a 3rd--so you can improve time management and priority setting.
What is the 'normal' pt-nurse assignment there-- 1 to 3, 1 to 4? I find time management one of the most difficult things to teach and one of the more difficult skills to master!
If you're caught up then accompany the physician/practitioner when he/she does their history/physical exam. I learned tons this way and many love to teach as they go.
You should meet weekly with your preceptor and set goals for that week for you to strive for. Then meet at the end of the week to review your status. This way, you can express what you feel you need more exposure to, and your preceptor can tell you where you're at...
Review protocols. Make sure you understand the WHYs of the things you are ordering or doing. That helps drive your education
I remember when I first started in the ED. We were just starting nurse-ordering protocols (this was in 1986 BTW). Abd pain-- ordered CBC. The ED doc once asked me (new kid) Why are you ordering this? To say "Well, that's the protocol" would have been incorrect.
Make sure as you are doing, you know WHY you are doing it...
i see so many different things down there and while on orientation have been thrown into a med alert and handed the pacer, I took a deep breath and just followed the doctors directions. I could not tell if it was capturing or not, but really that's not my job, it's the doctors, even though other RNs were yelling out "it captured". Everytime there was a med alert the charge nurse would take and throw me in there. I'm still very anixous during them, but not frightened to death. i jumped in or was pushed into every trama and med-alert that came in. Now my problem is getting organzied, I probably run around more than i need to, and i know the nurses are laughing at me, but who cares, at one time they were new too. I noticed that going back to basics is what works best for me, the A B Cs-airway, breathing, circulation....
neneRN, BSN, RN
642 Posts
I understand your rationale of watching to get a feel for things...but best advice I can give is to learn this line "What can I do to help?"
Every time you're in that situation where you're maybe not sure what to do or are trying to learn how to handle things, say this to the nurse in charge of that patient. Trust me, they'll give you something to do to help! Gets you in there actually doing hands on, getting the experience, and nothing gets you accepted faster by your co-workers than being always willing to pitch in.