Clinical placement in ED

[AusSRN]

Hi!

Sorry if this is under the wrong topic.

I am a final year, last ever clinical placement, two weeks in the Emergency Department. Which I am loving so far!

However, I would like to ask Emergency nurses (and others) opinion on this:

Our facilitators have told us we are not to go into a resus. It doesn't matter if you are allocated there, you cannot be involved or even observe.

I can understand that these can be chaotic, and sometimes confronting. But I don't feel at this level, about to be an RN that we need to be this sheltered or bubble wrapped.

The rational is that it isn't a great learning environment for student; totally get that but it would be great to see if I can clinically think why something is happening.

Another reason, which I also agree upon is that if that were you or your family member you wouldn't want an audience.

What are your opinions, Students in resus or not?

Thanks in advance. :)

[Kuriin, BSN, RN]

Uh...you are BLS prepared and (hopefully) ACLS prepared. You should be experiencing codes as much as you can. In my preceptorship, I was lucky (unfortunately) to be part of 2-3 codes/shift.

[PeakRN]

We absolutely allow students in codes, you are not an "audience" you are learning how to be a medical professional. We do limit students to performing compressions only (by the way this goes for EMS students, nursing students, medical students, and internal medicine residents) however they are certainly allowed in the room. They are then a part of our debriefing and depending on the situation will participate in postmortem care.

I wouldn't want a student to just go from code to code because there is so much else to learn in the ED, but codes are certainly part of it.

[JKL33]

Very unfortunate! That's terrible. What a terrible position for the school to hold - that it isn't a good learning environment. Just being present is an experience in itself that is very worthwhile for anyone about to become a nurse.

Often instructors will respond to be there with the student. There's absolutely no reason you can't participate to a reasonable extent, and at the very, very least, be there with your instructor observing.

Make sure to give feedback about this at the appropriate juncture.

[DayDreamin ER CRNP]

Just to be clear.... are you talking about a full / respiratory arrest or are you talking about a trauma? We always allow students into codes and welcome them and put them to work doing compressions. Performing compressions on a human is vastly different than compression the CPR dummy.

Level 1 traumas are another story. The rooms just cannot accommodate too many extra people in a L1 and it can just get way to chaotic.

If you are being told that you can't go into a code, I disagree with that. Call me insensitive but it's not like you are gonna kill 'em. I think codes are an excellent opportunity to teach and experience a lot at one time.

[Lunah, MSN, RN]

What are your opinions, Students in resus or not?

Trauma resus or just a regular code? Definitely in a code - as long as you have BLS, come in and do some chest compressions! We had a PA student in our Army ER and I suggested he take a turn with the compressions, and he tried to decline ... until our attending told him to get up there. He was traumatized and left early. I felt bad for him, but then again I didn't - reality is a harsh slap sometimes.

In our trauma activations, I don't want students in the room - but because we just don't have the room in our trauma bays at the moment, and every person in that room is an expert in their role, so it's not something we can hand off to a student. If the trauma bays were larger or had an observation area, I'd be all for it. This is how students learn!

Is it really a matter of "shielding" you guys from reality, or is it a logistical reason?

[HermioneG, BSN, RN]

From my senior capstone experience, we were not only allowed but encouraged to get involved in traumas and codes as long as we buddied up with a nurse. I was told to keep back only one time and that was during a pediatric GSW, and in that case I was allowed to observe from the back.

Being in the thick of it, doing compressions, feeling for a pulse during pulse checks, inserting an OG and listening with the stethoscope, pushing meds, inserting an IV during a trauma or code, or stepping back and standing by the doctor or practicing documentation with the lead nurse we so valuable as a student. They helped me practice working under pressure, zeroing in on a task while remaining aware, or stepping back and looking at the big picture. With that being said, there was always an unspoken understanding that if things got too chaotic we were expected to step out without having to be asked.

I'm sorry that you're not able to experience these things right now. You'll have chances to in the future once you're a nurse, but I agree that as a student you should be allowed to as much as possible.. Best wishes with everything. You sound eager to learn and that will take you far in nursing!

[amzyRN]

That sucks. Resus (and Trauma) are what make the ED unique. You'll learn more skills than you would on the floor, but if they aren't letting you in codes, I'd try to get a different placement (if possible).

[That Guy, BSN, RN, EMT-B]

Man I was on a code team with my preceptor when I was a student. I got good at compressions. And I learned real fast what makes a good code and what makes a bad one from being able to witness many of them.

[KrCmommy522, BSN, RN]

At my school we didn't technically do a rotation in the ER. When I did my 8 week rotation on the tele unit, we had one day where the instructor would choose one of us to go to the ER. So we got one day there. But, I did get to experience codes during my practicum on the step-down unit. Students were allowed to participate, but if you weren't doing anything useful it was a given that you should be back, out of the way. You could stand somewhere where you could watch, just not be in the way.