ER Orientation - what you should be doing....

ER orientation - how cool. The day finally arrived for the start of your orientation. However, what should you be learning in orientation? Specialties Emergency Article

ER Orientation - what you should be doing....

First, your ER should have a standardized length of orientation and it should definitely be more for the new grad RN. An orientation of 6-16 weeks is the norm, depending on your particular ER, number of visits and trauma level. Some things you want to accomplish while on orientation:

1. Notice the climate of the ER? Is this a fast-paced, 75,000 visits/year level one trauma center with 30 nurses on duty at all times or is it a community based ER with 23,000 visits/year and all traumas, AMIs, sick kids are turfed out or is it a rural Critical Access Hospital where there is just one RN on duty in the ER and your help comes in the form of the nursing supervisor?

2. Learn the basics first, then proceed to the more complex tasks. Basic tasks include learning how to operate the computer or learning the charting system, where are supplies kept, do you have the passwords needed to access supplies and meds if an automated system is used.

Familiarize yourself with the lay of the land: where is the charge nurse, do you reach her by cell phone, pager or yelling across the room?

What type of system is used for room assignments? Team or individual approach?

3. Next, every ER has protocols on which to base your care. These are pre-approved treatment modalities for different symptoms. For instance, you have a middle-aged male who presents with CP, you would automatically place the pt on a monitor, provide oxygen at 2L/NC, give ASA 324mg and of course obtain an EKG. There is often a time limit for these interventions.

You won't need to memorize these protocols but as you go thru your orientation, you will start to learn them and they will become second nature.

4. As you get further into your orientation, start to scope out your fellow nurses: who do you admire, get along with exceptionally well or want to emulate?

Approach them to help with mentoring. Your orientation will zoom by and soon you will be on your own and it is imporant to always have someone in your corner.

5. And...finally, relax and enjoy the ride!

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traumaRUs

About traumaRUs, MSN, APRN

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I will go anywhere on the country to get ER training. Where I live there are just two hospitals that have 16 week training but it is so hard to get hired on. I have four years experience in med.-surg and am bilingual. Advise?

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I'm not sure where u live but if u r serious about getting er experience go to the big cities. I'm from Southern Cali originally and whether it be San Diego, LA, Riverside, San Bernardino, there are so many hospital that i bet you can get experience. Or move to the New Jersey, New York area. Florida has many hospitals and openings too. If u r really willing to move the openings r out there. good luck

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Specializes in Nephrology, Cardiology, ER, ICU.

I live in central IL and the level one trauma center is hiring in Peoria, IL

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Specializes in ED, Critical care, Community. Derm.

Hi I start my orientation in the ER on 9th March, thanks for the advice. Really looking forward to it. Wish me luck.

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Specializes in CEN.

Many hospitals in the Boston area are hurting for ED nurses and are hiring. but prefer experience. Don't get discouraged. You might want to try taking a critical care course on your own to add to your resume appeal. Good luck!:idea:

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Specializes in None paid. Did internships in ED, Tele.

traumaRUs,

What do you think of a small 150-bed Level II hospital hiring new grads w/o specific orientations? One hospital offered a job as a Triage ER RN but requires I pass the 6wk- ER Nurse Course taught through Flex Ed, Inc. I've worked as an intern and EMT in a Level I trauma center. Just wondering what your thoughts were!

I appreciate your response!

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Specializes in CEN.

I'm thinking I 'd want to avoid ending up as a patient in that ED. I do believe that new nurses need some experience prior to working in critical care areas, and especially as triage nurses. A new nurse needs experience in the nursing process and becoming familiar with decision making in a less acute environment. You need to be comfortable in your nursing role before you tackle such an experience. I'm not saying it can't be done, but is highly stressful and likely to be overwhelming-----especially with just six weeks orientation. My ED has hired new grads and they are on a 6 month orientation and partnered with an experienced ED RN, and still, a number of them left as soon as their first year was over to find positions in other nursing areas. :twocents:

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Specializes in home care, med/surg ICU, ER, Hospice.

I am currently orienting in the ED of a small hospital. The average census per year is 22,000 patients. I have had 5 days of training there so far. I will be on orientation for 3 months. The hospital hired me for the ED, even though I had no med surg experience and hadn't worked as a nurse for 7 years. They had me orient for 2 months on a med/surg floor and 5 weeks in ICU prior to starting me in the ED.

I DO NOT feel ready to be an ER nurse. I thought every day would get better - NOT HAPPENING! Every day makes me feel more incompetent. I was just beginning to feel somewhat confident in the ICU when they put me in the ER. The fast pace and chaos is not for me. Some people tell me to stick it out, that it will get better, but I'm not so sure. I don't want to be a quitter, but I think you have to be more experienced and even a new grad to be a competent ER nurse. I need more experience.

I graduated from nursing school 14 years ago and worked for one client in the home care field from 1998 - 2002. I find it very difficult to remember all of the things I learned in nursing school.

I think I will bid out of the ER as soon as I can.

:uhoh3:

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Specializes in None paid. Did internships in ED, Tele.

perbd,

Sorry you're not orientating to ER well. Its funny because its the fast pace, chaos, and challenges that the ER environment brings that I THRIVE on. Every day is different more or less and with it new experiences and situations to learn from.

I hope you find a floor that is the best fit. Good luck!

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Specializes in home care, med/surg ICU, ER, Hospice.

Thanks an6el177. I'm glad I am in the ED to gain some experience, but I'm afraid I may do something really bad due to my lack of experience. I realize that I am the type of person who likes to have a routine in my life. I'll hang in there for another week, but I think I want out.

I worked for a steel company (not as a nurse) prior to working as a nurse at a hospital and hated my job for the last 5 years. I don't want do to that anymore. I want to love to go to work. Right now, I dread it.

:crying2:

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Hi perbd,

I was just reading through your posts and am having similar feelings- i dread going to work. I started working in the ER in january. I graduated last May from nursing school. My orientation is 6 months on the floor in the er, however, i have been taken off the floor several times for classes, certs, and so on. I have 2 more months in my orientation and everyone is telling me i not doing good enough.

anyway, I was wondering what the continuation to your story is. Are you still in the er? do you enjoy it more?

(i really liked the way they set up your orientation with the 2 months of med-surg; 5 wks of ICU; and then ER. sounds like the amount of time could be changed a little, but i like the thought.)

hope you are enjoying whatever you are doing.

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