Scared about ER clinical rotation

  1. I start my ER clinical rotation on Tuesday and I'm really scared about it. I feel like I don't know enough to be there and I'm just going to make a fool out of myself. I'm a senior nursing student right now. Being in the ER reminds me of being in the ICU/CCU which i absolutely hated. I had an instructor who didn't like me and made me feel like i should be back in kindergarten. I was put on probation for that clinical. So i'm really worried about the ER now. Iwill be doing it in a Trauma 3 center so i won't get anything really gruesome.. they will be sent somewhere else. I have a pda but am i goign to have time to actually use it? It seems kind of faced paced. I will be assigned to a nurse and follow them around all day. I just dont want my nurse to think im an idiot and shouldnt be there either. I still have trouble finding a brachial pulse sometimes. And trying to find a dorsalis pedis, or tibial... i barely ever can find it. I'm sure this will cause me problems during clinical. We aren't even allowed to bring a lot of books and stuff with us because we have a little tiny room to put our stuff in during the day. I just think i wont have enough information taht I'll need. A nurse will ask me what a drug is used for and i'll forget. Can someone give me some encouragement or advice? I'm dreading Tuesday.
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    About luv2shopp85

    Joined: Dec '05; Posts: 609; Likes: 14

    10 Comments

  3. by   analee23
    You'll do fine. Your nurse isn't going to expect you to know everything when you first walk through the door. I work in an ER now, and trust me, I didn't know much when I started (after nursing school and the dreaded boards mind you). Just look up some of the more common drugs and print out a little sheet that you can keep in your pocket, if that makes ya feel better... I can list some of the ones we use commonly in my pediatric ER, but I'm not down with the adult meds. Also, on finding pulses, it comes with time as well, knowing exactly where to feel. Look in your textbooks and they'll have good diagrams on where to find pulses. Finally, don't be afraid to ask questions! There's no such thing as a stupid question and your preceptor will be willing to show you how to do things, no biggie! With foot pulses, if the foot is pink and good cap refill, chances are there's a pulse, so that's a good bet too if you're really struggling... you'll figure it out, just takes time.

    List of common drugs in my ER (remember, I just work peds).

    Rocephin (Ceftriaxone)
    Unasyn
    Bactrim
    Vancomycin
    Zofran
    Phenergan
    Morphine
    Dilaudid
    Fentanyl
    Vicodin
    Percocet
    Toradol
    Lidocaine
    Epinepherine
    Veccuronium
    Succynilcoline
    Etomidate
    Ketamine
    Atropine
    Versed
    Ativan
    Albuterol
    Xopenex
    Prednisone
    Orapred
    Prednisolone
    Racemic Epinepherine
    Solumedrol
    Benadryl
    And the most common of all:
    Tylenol and Advil.... use them ALL the time, most common drug by far

    I kind of divided them up into pseudo groups like antibiotics, pain meds, code drugs (if we're gonna intubate), Sedation medications (for fx reductions and such), and then asthma meds.

    Once again, this is just a brief list. Don't think you need to know all of them, just what group they're in and major side effects. You'll do fine and remember, you don't have to know it all! You're still a student and there to learn!
  4. by   luvdaisy
    I was so nervous when I first started clinical in the ER. I have to say that the nicest nurses were in the ER. I was assigned to one preceptor, who was wonderful, but all of the nurses would come and get me if something more interesting was going on somewhere else. Use this as a great opportunity to start lots of IV's and insert foley catheters. As far as checking pulses, practice on patients who come in. Feel around for it when you are looking for a place to start an IV. The patient will just think you you are trying to find a vein. Dont worry about not knowing about the meds. Your preceptor shouldnt expect you to know all of them. Keep a list of ones you dont know and look them up in your drug book when you have time. You will probaby see a lot of phenergan and pain meds being given. Most of the meds should be pretty basic ones that you will know. The more complicated ones will be started when they get to the floor. I loved my ER rotation. It was by far my favorite. GOOD LUCK!!!
  5. by   SouthernLPN2RN
    This is why I highly recommend a PDA! I am doing my critical care rotation and I bought Pepid's CC program.
  6. by   luv2shopp85
    thanks for all the help everyone! I have a pda too... will this help me as well? I have the nursing constellation from skyscape which includes, Rn clinical notes (its the RN pocket notes but in pda form), davis's drug guide, labs and diagnostic tests, and tabers. Hopefully I get my money's worth out of and it helps me tremendously.
    Last edit by luv2shopp85 on Sep 3, '06
  7. by   kyboyrn
    Hello,

    You'll do fine. I've been a nurse for a year and started out working in the emergency room (still there). It's not a big trauma center or anything, but we stay fairly busy (36000 pts. a year or so). Once you get working there, you'll see that many of the patients aren't as acutely ill as they would like you to believe, but you'll get a good mix of highly acute patients, and patients of, a, ahem, much lower acuity. As far as not seeing the gruesome stuff, it depends on the location of the hospital. For us, we serve a specific area, so unless a patient gets flown directly from a MVC or something, they come to us, we stabilize them, and then they are transported to one of the trauma centers that are within a 60-70 mile radius or so. Still, don't be scared. Emergency care can be overwhelming, but they are not going to feed you to the animals when you first start. ER nurses know that you can't just throw somebody out there. You're not going to be the exclusive caretaker for a patient with chest pain, because in order to administer many drugs and properly monitor those patients, you must be ACLS certified, which I'm guess you probably aren't since you're still in school. You'll be under someone else's supervision, (usually one of the more experienced nurses). It will be okay, just keep working at it. Just remember to pay attention, and if they let you chart, chart well. It's sometimes hard in the fast paced enviroment of the ER, but charting is a reflection of the care you give, and also legally binding, so do your best. Keep your head up, and emergency nursing could be one of the most rewarding nursing experiences you have in school (it was for me, that's why I do what I do).

    RN
    BSN in May
    Starting MSN program (going to be an ARNP) next fall.
  8. by   vamedic4
    luv2shop...Don't psych yourself out over your clinical..it hasn't happened yet!!!! Take a few deep breaths and relax.

    Look over those meds Analee told you about, and any others you have questions about. Refamiliarize yourself with PRIORITY of patients, and if you have questions...ASK!!! Most nurses I know enjoy sharing their knowledge.
    Try not to get discouraged, and if you find yourself not busy - ask the RN you're following if there's something more you could do or if there's anything she recommends that could help you get more out of your ER experience.

    Good luck!! Don't lose faith in yourself. You can do this!!!

    vamedic4
  9. by   justhavefun
    You'll do fine! Just grab a drug book (most er's have them around) or use your pda to look up the drugs. I have worked ER and TRAUMA for 11 years including teaching facilities. I have worked with residents, interns, nursing students, externs, paramedic and emt students and students exploring the medical field. When we ask you what a drug is used for, we expect you to look it up so you learn it. No pressure! We aren't the nursing instructor and remember what it is like being a student so we don't expect a 10 page explanation what its for....just the basics (abx- sulfa based, etc) just so you know what allergies to look for and how your pt might respond to this med. I think you will do fine. We know you are there to learn and we are there to teach you. Enjoy your rotation!! I enjoyed mine so much that I chose it as a career path. I did tele for a year and half and the rest in er.
  10. by   whiskeygirl
    The only thing I have to add to the above is to stay organized. Look forward to all the cool things you could see and do in the ER.
    Good luck.
    And have fun!
    WG
  11. by   Maverick80
    You'll do just fine!!

    I am a junior nursing student. At the school i go to we don't have an option to do an ER rotation. I would absolutely love to have to opportunity that your going to get. I have always had a soft spot in my heart for the craziness of the ED. I however, got a job as a Nurse tech at an area hospital which is a level one Trauma center Emergency Department (we are a 35 soon to be 40 bed and we see over 60,000 patients a year). I love it. We have to take a class to be trauma certified or else we can't touch a trauma patient. New grads don't usually get trauma certified for at least a 1 year or 2, sometimes longer. Not everyday in the ED is crazy like you see on TV, some days it's fairly quiet nothing major, and other days, It's like your watching TV. Like 2 trauma's at 7am, both gunshot wounds (don't ask me why a couple was up at 6am shooting each other) followed by 2 full arrests both within 20 minutes of each other, all in an hour. Those are the crazy days...lol!! Good luck you'll do perfectly fine. I haven't met a nurse yet that would expect you to know everything the first day!!
  12. by   rjflyn
    I work nights so I dont know what my current hospital does. But the two previuos hospitals that allowed nursing students to do clinical in the ER all they were allowed to do was obtain vital signs, do their own assessment and observe. As you were generally only there for one shift. On occasion you might get to drop a foley or more rarely start an IV it was up to the nurse you were assigned on that particular day and if they knew you.

    Rj

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