ED Nursing

While it's good to get experience doing IV's, blood draws, foleys, etc... those are just skills. Much depends upon the amount of time you spend in the ED during your practicum. At least for a little bit, spend some time getting the feel of the flow of events for a patient from triage to discharge. Nurses do a LOT of coordination of the various departments as they do various services for (and to) patients.

When I receive a patient from an ambulance, I do the triage, (often) get the 12-lead going, coordinate with lab to get their samples done (sometimes it's off my IV start), administering initial meds and prioritizing them, having x-ray do their studies (at bedside or in their suite or doing a CT study), and so on. Since it's the ED, all those orders are sent out all at once and the folks I work with are VERY responsive... so it's up to ME to coordinate all those activities because they (inevitably) show up all at the same time.

It goes on from there.

Since I'm a working nurse, I don't get to shadow those other services, though I have to know about them and (kind of) how they do things. I would suggest taking a day (if you have one) and just use part of that day to shadow various services that visit a patient in the ED. Go to the lab and get shown around. See how they find out about orders. Follow a patient to CT or to ultrasound. Follow the techs for an hour. See what they do and how they contribute to patient care. I wouldn't do this on your first day. That day should be spent working with your preceptor, doing things along with him or her so that you start to get an idea about what your preceptor does and how they're done. Then do the shadowing for a couple of hours and take short notes so you know what to ask your preceptor about and further concentrate on things you want to learn and learn about!

When I receive a patient from an ambulance, I do the triage, (often) get the 12-lead going, coordinate with lab to get their samples done (sometimes it's off my IV start),

You don't do your own blood draws? And lab is allowed to touch the IV access???

When I worked in the ED, if I started the IV, I would draw blood off the IV start for the lab.

Otherwise lab would come up and draw blood for labs. Our lab techs did not touch any IV access, but the nurse would for them if needed (like a lab draw off a PICC or central line, or IV start).

I think you should seek a "big picture" approach. As critical patients present themselves in your workflow for the first week or two, you're actually better off at the foot of the bed with one of the physicians; glean which rabbit holes they're trying to go down to differentiate pathologies, coordinating multiple resources (RT, x-ray, labs, ekg, meds/pharmacy, consult, bedside FAST or echo), etc. Once you can see the well-oiled machine from a distance, THEN become a part of it.

I think a lot of new nurses insert themselves into a task in those situations and lose perspective.

It's all about assessment. That is why you need a year in our ER before you can do triage. see if you can spend some time with the nurse doing triage and then see if you can figure out what is going on with that patient in the few minutes of triage and decide what priority level each patient is. Try and discuss what things the triage nurse noticed that made them make the patient a higher or lower priority than what you predicted. It is often subtle cues that a good RN picks up on that says something more serious is going on with this patient.