ED training panel interview

Not sure what experience you have before the 2 years in MS, but ED is a very different animal then MS. It is much more task driven and fast paced. You will no longer be be doing full assessments on your patients, but focused assessments. ER is a huge pot of patients (medical, psych, trauma, pediatric, cardiac, neuro, preggo's and toe nail pain) and everyone helps each other. Sure you'll have your assignment but there is always help and you always help others when you can rather than sit down (as there isn't charting to do like on the floor). On the floors, the nurses plan out their shifts and get involved much longer with their patients so finding help isn't always easy. We often give medications, do assessments, draw labs or perform testing on each others patients, not just our own. We take each others patients up to the floor, to x-ray, CT, etc. You also have to always be actively advocating for your patients. Some patients may be too sick to wait for transport (if you have it at your hosp.) to CT so you would just take them and call CT to advocate the need to skip the line, things like that. There are no pre-loaded inpatient orders. 95% of the time when you see the patient, no doctor has yet, so it is your job to decide if they can wait or need to be seen sooner, as well as recommend order and medications (Triage). Determining how to prioritize patients and their treatments is a big one to be asked about. Potential employers want to learn how you navigate this process in a high-pressure environment. Especially at a Level 2, I'm sure you'll have ED residents, so you often will be going up to them and asking for certain medications, explaining what is going on with the patient and asking for meds/interventions to hold them over until a doc has time to see them, or telling them they need to come see a patient immediately. You will have a much closer working relationship with the doctors in ER.

I mention those thing's so you can see where ER nurses and a panel may be coming from that is different than the floor. You should highlight that you are a team player, that you are flexible and have no issue with an environment that is everchanging, fast paced and that requires out of the box critical thinking. They want nurses with clear and caring communication skills, quick decision-making, and good technical skills, so highlight those times in your medsurg career. You will have a lot more autonomy than you did in MS so that will be a transition but they know that. They want to see that you will work through a problem, not just look for someone else to dump it on. You will have a lot of high stress patients/family that you will have to handle and manage.  

Some common behavior/personality questions that I've been asked in ER interviews:

How well do you work under pressure?

What strategies do you use to handle stress while on the job?

Can you describe your communication style when working with other doctors and team members?

Can you tell me about a time you disagreed with a Doctors order? What did you do?

Can you tell me about a time you had to care for a verbally abusive patient, how did you handle it?

Have you taken any training in the last year to improve your nursing knowledge or skills?

Tell me about a time when you felt overwhelmed with your patient-load. How did you handle that situation?

Describe a time when you had a conflict with a supervisor or coworker. How did you manage that situation?

How do you communicate information with individuals who do not have a medical background (ie: patients and family)? 

Can you tell me about a time when you managed an emergency at work?

You are at the pyxis/Omnicell and a nurse you know well calls out of a room of a patient that is actively seizing asking for you to pull versed. This requires an override. What is your course of action? ** I will tell you that this occurs a lot in the ED. We override medications all the time. But in an interview you have to be careful here. Personally I would say, "if protocol allows, id override and immediately advise the charge and attending of the ongoing situation". Ensure you get that order eventually from the attending or resident. Some facilities though have different protocol orders, etc. Everywhere I worked had emergency drug protocol orders (ie. 5mg versed for Sz). 

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As far as clinical questions, I doubt they expect you to know vasoactive drips and medications that you have not had any experience with yet. That said, they could certainly ask you about them anyway to gauge what you may know. I would most certainly review ACLS. I think that is always fair game and every RN in the hospital should know it by memory. I know many MS and Tele units do not require it though. Still, review it because I've personally never had an ER interview where they did not ask about ACLS drugs or the algorithm.

Always be ready for scenario questions during your interview. Your panel is looking for how you make quick decisions and triage patients. This gives them insight into your clinical knowledge and critical thinking skills. It's good to include keywords like task prioritization, patient safety, delegation and focused assessment.

Some common clinical questions that I've been asked in ER interviews:

Tell me about your current RN experiences, what type of patients do you take care of?

Why do you want to make the transition to the ER?

Describe a situation where a patient was not responding to the treatment ordered. What action did you take?

Tell me about a time you dealt with a critical patient. What did you learn? How would you have handled it differently? * In MS, maybe you called a code blue but performed some interventions before the team arrived, or noticed a change in condition before they got critical. Explain what you did, etc.

You have a full assignment but your tasks are under control and no patient is unstable. You notice your coworker is stressed dealing with a very needy family in one room and preforming a workup for a walk-in chest pain patient in another. Her third patient has repeatedly asked for pain medications for a broken wrist but you overheard her remind herself there isn't an order for any yet before she got distracted with the Chest pain patient. What course(s) of action should you or can you do?

You walk past a room and a patient waves you down complaining of chest palpitations. You look at the cardiac monitor and see this rhythm *SVT 210bpm* (the panel can tell you what you see, or I've had interviews where they just showed me a strip), What interventions do you anticipate for this patient if he is stable. What intervention if his BP is 78/40? **this is a common ACLS question. They can switch it up to any rhythm on the algorithm, Vtach with/without a pulse, symptomatic or asymptomatic bradycardia, vfib, etc.

You are in triage assessing a patient complaining of a broken finger. During the initial intake a patient arrives in the lobby complaining of 9/10 chest pain. He appears diaphoretic and distressed. What is your next course of action? *This is a classic prioritization question, clearly the broken finger dude no longer matters so you would ask him to go sit down (can delegate to a tech or another RN) and then assess the CP patient ASAP. You would order and start a chest pain protocol (IV placement, Lab/troponin draw, O2 if needed, 12-lead EKG, Chest x-ray, blood sugar, SL nitro) and advise the doc there is a potential cardiac patient that doesn't look good.

How would you manage these 4 patients under your care: one who visited the emergency department for chest pain, one with sepsis symptoms, one in a mental health crisis, and one with minor cold symptoms? **They just want to see that you recognize these all require very different approaches, and that you may need to ask for help (which is OK). 

Sorry I know its a lot but just be you, explain what you know, what you're eager to know and how you are a flexible team player and all should be good. You will never know all the answers, they will keep asking questions until they trip you up and its OK. If you do not know, never guess. Just say, "You know, I'm not too sure of the answer to that, but I can look it up and get back to you". When I would interview someone, Id ask a very complex clinical question I knew they wouldn't know, and if they just guessed, they were out. I want to hear you don't know but you will find the solution.

I am in your shoes, literally. How did it all work out for you?  <a href="https://Google.com/">Google</a>