Critical care classes during ED orientation - is this really a thing?

[raindrop]

At my ED job which I’m still new to, I haven’t been given any classes whatsoever. I was already ACLS/BLS, I had to take an online PALS course, but that’s all. It makes me very uncomfortable being in certain situations without much training. For example, we do conscious sedations on adults and kids. I am not the person giving the sedation, but it still makes me a nervous wreck because when the procedure is done, I’m the only one in there as they wake up/recover. Adults are usually fine. But the kids, at night, after getting Ketamine do not wake up very fast and it scares the crap out of me. And then I’ve had patients who have been intubated and are under my care until an ICU room is available. My very first intubated patient, the ED doc asked me an hour later “Why doesn’t the patient have an OG, ALL intubated patients need an OG - well because I didn’t know what an OG is or how to put it in, nevermind that all intubated patients need one.

A friend just started ED in a different city. She said not only is she getting critical care classes, but part of her orientation will be spent in the ICU since she’ll be taking care of ICU patients until a bed is available. This is what I need and want. We are level 1 afterall.

What was your orientation/training like?

[aykaykayk, BSN, RN]

Same here. Started in March, and all the required classes for ED (e.g., ACLS, conscious sedation, PALS, etc.) are canceled d/t Covid. Honestly, I've been learning by trying to jump in on all cool/new cases I haven't seen before, by picking my preceptors' brains, and internet searches.

Regarding intubations and OGT, I've seen a handful of intubations, and at least in my hospital, the docs placed the OGTs during intubations.

Edit: Oh, and we don't take critical care courses at our hospital even though we start and titrate gtt's. However, we do have an ER-specific course (which I haven't taken d/t the rona)

[abbatar, BSN, RN]

Hey!

I started in the ED as my first job and it was a fellowship program. The first 10 weeks was classroom instruction and we got ACLS, PALS, TNCC (we're level 1 trauma also), followed by months of preceptor training. We got to spend 1 day in the SICU as a part of this, and a couple shifts at the children's hospital since we see peds, too.

My training was pretty extensive and I'm very appreciative of it. If I were you, I would speak to your nurse educator and express your concerns. Maybe make a list of things that have gone on in which you do not feel comfortable with and see if they can teach you or have resources. Part of my fellowship included online modules through AACN and one on conscious sedation. I know some are free online and some aren't (maybe your institution would pay for some or reimburse?). I know RNs can insert NG/OG tubes under scope of practice, but at my hospital the providers do it. Again, I would speak to your educator to see what is expected of RNs in your ED and what resources are available. Best of luck to you!

[PeakRN]

In my opinion your ED has not provided adequate training.

All of our new grads must have ACLS, PALS, TNCC, ENPC, NIHSS as well as complete their online ED modules and all of their staged orientation (which would include things like gastric tube placement, sedation management, invasive line management, vasoactive drug titrations, et cetera) before we allow them to come off of orientation.

If my new grads can’t get the appropriate learning opportunities in the ED by the end of their orientation I will send them to one of our adult or pediatric ICUs to get that experience.