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Discussion

ER Orientation/Training Guide

Hey fellow ER nurses,

I am a rather new ER nurse with three years of ER experience but a lot of other type of nursing experience. I have been tasked with improving our orientation guide. It is currently all checklists and policies... so boring stuff. I wanted to add useful information. When I was a tele nurse, our orientation manual included everything tele from cardiac rhythms to drugs to post cath patient care. However, I am struggling to figure out what to put in a training manual for the ER as we see so many different things. Currently my thoughts are to include a section on frequently used meds, charting tips, scavenger hunt of the trauma room, triage tips (our nurses need to know how to possibly triage meds), peds section, and some TNCC info such as ABCs. Is there anything that you have had in an ER orientation guide that was really neat and you would like to share? Or do you have any ideas to how I can fix our orientation manual into more of a training guide? Thanks for any input :)

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    Not sure if relevant, but does your unit use the ENA orientation modules for training? There could be lots of useful stuff in there

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    • Moderator

    I hate to be that stick in the mud, but policies and checklists ARE useful information. At least include information on where to find your policies. Most places would prefer they be accessed online vs. printed out because you can't always ensure that paper copies get updated when the policies change online.

    Some things I've seen in orientation binders: NIH stroke scale. Trauma alert levels and criteria. Some "badge buddies" like pediatric vital sign ranges and calculating GCS. The ESI algorithm and what is considered a lifesaving intervention or medication for a Level 1 ESI (I always encourage people to review that section of the ESI handbook, I think people tend to make 2s out of some 1s because CPR isn't in progress). Sepsis bundle information. Quick math formulas for med calculations. Common meds and rates/dosages (dirty epi drip, etc.). RSI drugs and where they are (in your Pyxis in a kit?). List of phone numbers (CT, xray, ultrasound, MRI, nursing supervisor, ICU, L&D, OR, etc.).

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    • Author

    I definitely agree that policies are necessary but was just looking for items to add to the book. You have provided me with several ideas, thanks for the input :)

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    However, I am struggling to figure out what to put in a training manual for the ER as we see so many different things.

    What other information is being taught/given during the course of orientation, and in what format?

    I ask because if there is no effort to systematically work through an ED training curriculum, then a training manual/guide/binder, with tidbits of informaiton about this and that, is useless.

    If they aren't running orientations that often and/or don't have a curriculum in place, then I recommend using one of the well-respected EN manuals to build something/look at the ENA materials. If nothing else, work through the EN manual/core curriculum, etc., with the orientee. When you do that you will have an idea which 'pearls' should go into a binder i.e. you can include pearls based on system/situation. You can also use the binder for things that are particular to your worksite.

    In any case, my opinion is that every orientee should have written materials in hand that are fairly comprehensive. Not a fan of the task-oriented or "pearl"-based, on-the-fly orientation mode of thinking.

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    We have a skills checklist that new orientees have to get signed off on by the coach... restraints, managing a drip, accucheck machine, etc. I think there are about 20 skills / procedures they have to complete. And by "complete" I mean, at least talk about with the coach. We don't use restraints all the time so that might not be something the orientee sees in his/her orientation period.

    I have said our protocols should be included. We have about 30-35 nurse-driven protocol orders that we can initiate with patients that include labs, EKGs, IVs, etc. I always print them off for my orientee so she can start getting used to starting those.

    I think scavenger hunts are good but we quit using them a few years ago. It wasn't just for the trauma room but for all the most commonly used items in the department. We have about four different store rooms for various items so it was good to get new people in those rooms to look for items.

    Honestly, I wouldn't put too much in the book. I'd make sure the orientee is comfortable looking for the needed info on our webpage which will be much more readily available once he/she is off orientation. A book full of pages, etc is just too much to carry around and you WANT the orientee to be able to carry this book to the desk for the first few weeks. A big ol book will just stay in the car.

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