ER Orientation - Anyone like to share theirs?

jaimealmostRN · Mar 30, 2005

I can only tell you about #1. I'm a new grad starting in the ER. For the past three weeks (and for two more) I have been on a Med-Surg floor learning the pyxis, documentation, the computer system, pt-oriented stuff that a new grad may not know yet... HIPAA for instance. After that, I'll go down to our ER where I'll begin in Minor Care then work my way up to the Emergent section...at some point I'll float over to Peds for a few weeks (were only required to float there in a real emergency, mass call outs,etc, so very rarely). I hope this helps, I can tell you more in the next few weeks and months. Good luck.

needsmore$ · Mar 30, 2005

From a prior post:

For GNs: My director took me off clinical for 3 weeks- During that time- I made GN notebooks- sectiioned off by systems--(a great source was wild iris .com) cardiac , resp GYN, trauma, abd, etc. Every morning we reviewed a section--didactically--reviewing assessments, history taking, diseases, etc. After "lecture-classroom" I had equipment out that pertained to the systems we were reviewing-also including facility policies as well. We reviewed techniques- (foleys, long spine boards, splinting, Ngs, blood admin, etc). Usually -after lunch -we started pt care- (hopefully from the beginning of their treatment as opposed to taking over). We started initially with the medsurg level- 1 pt each. Their goals were assessments, histories, documentation (we have a computer documentation system which isn't always userfriendly) .With the low pt ratio- they went in with the physician during their exams. As they comfortable in the ED routine- We started higher acuity type pts- Since I did not have a clinical assignment, it left me free to pick the type of pt's, and the areas of ED I wanted to focus on.When they were taught IV, phlebotomy- they added those skills. I gave them "homework"- specific drugs to investigate, or disease processes to review with me the next day. They took ACLS and PALS when the courses were available. I also reviewed cardiac rhythms-starting with recognizing NSR (great CD program- Essentials of Cardiac Rhythm Recognition by Williams and Wilkins) that we used.

Also look at ENA orientation modules that are now available. We will be using these to supplement our departmental education for nurses already working in the department

Also-supplement with ACLS, PALS, TNCC and/or ENPC .

Hrtnurse14 · Mar 30, 2005

I am currently starting to orient in a level II er. I am an experienced tele RN and the other orientee is a new grad. We are using the ENA modules. We spend 1/2 day in a class room type setting going thru didactic and the other half we have spent in the e.d. I am told we will switch in another week to working on the floor for a day with our preceptor getting patients in and practicing our skills, spending time with the PCT's and secretary's and docs. Then alternately spending time in didactic with the ENA modules along with time to discuss our floor experiences. The ENA modules seem very well planned. Going from the hx of ER nursing, federal and state legal aspects, policy and procedure, review of the systems, meds, doses, titrations, and more. It helps that we have a dedicated preceptor until we get onto our shifts. Then we will be assigned an experienced RN to continue precepting for several weeks. The new grad has been orienting on the floor since december and I just started this week. They estimate my orientation to be about 2 months, but will adjusted to my comfort level etc if needed.

Hope this helps. We are the first orientees being "properly oriented" in a long time and I am really enjoying it.

Mary Ann

ER Nurse :) :)

Trauma Columnist · Mar 30, 2005

Level one trauma center 710 beds:

New grad - up to 16 weeks with ENA modules, CPR, ACLS, PALS or ENPC, TNCC. Lots of one on one classroom to review pathophys, etc. Post orientation test that must be passed.

New ER RN, but experienced RN - up to 12 weeks with the same as above criteria.

Experienced level one trauma RN - individual, but not less than 8 weeks EVER and same above criteria.

ER2Ed · Mar 30, 2005

Thank you for the replies - please keep them coming.

The ENA modules sound like a great idea - could anyone direct me to where I could obtain them - I did a little searching on the ENA website but didn't have any luck. Thanks.

erjulie · Mar 31, 2005

ENA modules are on the ENA website (http://www.ena.org) under the marketplace link, then click on educational stuff. However, they only offer the replacement modules, and you can't purchase them unless the institutiion has bought the program. What I did is find a hospital in the area who uses them, and went to see them there, to se if the program was worth it. The program looks great, but the problem with it in our ER is that it requires a lot of classroom time, and the ER is too busy and not enough orientees at one time to make it work well. Ideally, you'd have a staff preceptor that can work with the orientee(s) off the floor, and there's the rub with us. Can't get anyone off the floor! The administration has not committed to the ER as of yet, and therefore can't get the time committment we need. It's really a shame, because there is a level of knowledge that is afforded in the didactic that you can't get on the floor. I'm the clinical educator in the ER, and believe me, it's hard to just keep up with the certifications, etc. Good luck! New grads get 6 months with a preceptor. New to the ER but experienced nurses get minimum of 8-12 weeks, and weekly reviews wuith the clin spec and manager. New to our ER but experienced ER get minimum of 8 weeks, with the same reviews. We have learned that 8 hour shifts are better for the "short-timers", becasue 12s are too long, then too much time in between.

Good luck

jaimealmostRN · Mar 31, 2005

Sorry forgot to add: We have the ENA modules....oops. :)

PennyLane, RN · Mar 31, 2005

1. 3 month orientation with a preceptor. 5 weeks of ER medicine classes--8 hrs/day, 2 days/week plus 1-2 shifts on the floor. We have tests we must complete and competencies to fulfill (IVs, phlebotomy, etc.).

2. Same as above.

3. No classes, just a one month orientation with a preceptor.

ernurseafterall · Mar 31, 2005

Attempting to collect information to revamp our emergency department orientation for new employees. Would anyone care to share what they do for orientation?
We get 4-6 months as a new nurse in the ER. We have a binder full of competencies to work on . Then the ENA modules, we sign them out ourselves. We are expected to do these on our own time. We read them and then have a binder full of case studies and questions to do after, again on our own time. We then have to compile all these for the educator and our assigned preceptor and review our progress or ask any questions. We sign out the modules, say 3-4 at a time because our hospital only purchased one set. It seems to work well and the modules are good. I believe there is about 25 of them. Then we have various competencies we have to do on line to test knowledge, ER meds, safety, etc etc. We have an assigned preceptor for the 4-6 months. Within that period we take a 6 week critical care course with its own modules, ACLS, PALS. The critical care course is 3 days a week for 8 hours a day. This is followed up by a test with an 85 passing grade.
For experienced nurses, its 3 months on the floor.

mommatrauma, RN · Apr 1, 2005

New RN's get 16 weeks, 1st month is spent in classroom, going over policy procedure, equipment, do's don'ts, mandatories, etc...CPR, PALS, ACLS...they spend 1 day a week the first month in ER shadowing their preceptor...get the flow, without overwhelming them...next 12 weeks they spend in ED, with preceptor...they have a competency book...they have to meet weekly with educator and preceptor..for progress reports and set up goals for the next week...if need be their orientation can be extended for 4 weeks after that, its not for you....they do critical care course during their 12 week clinical...and they do TNCC after their 6 month probation is up. They do not go to trauma or triage until they have been in ER at least a year.

Old RN's new to ER...if they were in house 12 weeks with same weekly meetings and goals, no classroom cause they should already know most of the policy and procedure, they may get one or two days just to go over ER P/P their mandatories are usually done before they come....TNCC at 6 month mark..if they were not in house they get 16 weeks with same as new RN's with less time in classroom if they already have their certs, they will get more clinical time the new RN's in that first month. Have to wait one year for trauma and triage.

Old RN's Old to ER new to hospital...1 week classroom for policy procedures and mandatories...then they get 6 weeks orientation in ER. Will go to triage after 6 months and trauma will depend on their past experiences but no sooner than 6 months

None of this is set in stone...we are very flexible in that, if you are very strong and doing well, as a seasoned nurse...you will not have the full 6 weeks orientation...but if you need it is there...Its more of a guide...

needsmore$ · Apr 1, 2005

Since it is GN time again-do any of your EDs have new nurses sign a contract of sorts? It can be common for new people to go to one place-get orientation/training for several months- a critical care course/ACLS/PALS paid for-then quit your ED and go somewhere else for whatever reason? (usually more $$$)

This has happened in our ED on several occasions over the years I have been training. Our ED is out $$$ from training, preceptoring, tuition costs, etc.

If any of you utilize this- let me know how you developed it- protocols- resources , etc.

So- new ED nurses- if you commit---then stick to it. It takes about a year to begin to feel comfortable in the ED setting.

Good luck- ED nursing is great!