ER Rotation

How many of the students get to do an ER rotation during clinicals? We are second year with 1 quarter left til we graduate.

We were told at the beginning that we were not going to be doing a rotation in ER.

But, our instructor went to bat and got us a rotation there. I was there tonight from 6:00 until about 10:00; and I did more and learned more than I have the whole quarter on the Med/Surg floor.

I started 3 IV's, Inserted an NG Tube on a non-responsive overdose patient. Drew blood many times, including one through a PICC line. Did IV pushes, 2 Foley's and a Straight cath. It was an incredible learning experience!!!

The OD started to come around towards the end, and he was very aggressive, we had to put him in 4-points.

The nurse I was shadowing with was wonderful, and she let me do everything!! She was very good about letting me at do everything.

I am so glad I got to go, and we get to go again on Wednesday. I was just wondering how many programs give this experience. It is well worth it. JJ:)

[LydiaGreen]

You started IV's, did IV push meds, and drew blood from a PICC line? Where are you studying? In Ontario, these three actions are outside of a student's scope of practice. We are allowed to administer IV meds (not boluses, must be at least a 50 cc mini bag), we are allowed to maintain and d/c IV's but not start them, and we are allowed to do absolutely nothing with a PICC line. Just wondering why it is allowed in your state/province but not here in Ontario. I understand the danger involved for a rookie performing these actions, but cannot understand why it would be alright for a student in one state/province and not in another.

[LydiaGreen]

Oh, and most importantly, congratulations on a wonderful learning experience! Sounds like you nailed it!

[jjbaby]

We learned all of these skills during our second year and we are allowed to do all of them as students, we do have the RN we are assigned to with us during the skills. But, we are allowed to do all IVP with no restrictions. We start IV's regularly and we do not as a rule do blood draws from a PICC line but, her doctor had it inserted for this reason, because she is a very hard stick for draws. ( She is a cancer patient) So in this case we were allowed to use it for that purpose. We learned all of these skills second year.

I thought this was standard for all RN programs. It is interesting to find out it is different in different programs.

When do you learn to do IV starts? We do these on a regular basis, how are you supoosed to learn to do them? We had to start them on each other when we learned them.

[jjbaby]

By the way I go to school in Ohio.

[BarbPick]

I agree with Lydia, as I usually do.

These things are out of the scope of a nursing student's practice and unless you are with your instructor, you are setting your shadow nurse up for many problems.

Glad you feel like a hot shot, but clinicals are not for learning how to draw bloods from a central line, they are for you to observe and absorbe all you can of sights sounds and smells.

Assisting with 4 point restraints, ok. Start a peripheral IV, under strict supervision only. I saw a student start and IV in an artery. Amazing how the fluid pulsed.

Jesus, what next, Brain surgery?

[neneRN, BSN, RN]

Barbpick, I have to say I disagree with you completely. As a nursing student, I was also allowed to do all of these things. Now as a preceptor for nursing students, I supervise them doing all of these procedures. (I should add that they are in the last semester of nursing school when thay can do all of these things.)

Clinicals are not for just observing, they are also for putting into practice what the student has learned. I have never felt uncomfortable letting a student do a procedure- I stand right by her side to supervise and guide her; but also to take over if a complication should arise.

I would think that most people would agree that it is better to come out of nursing school with as many experiences as possible. These procedures may not be in the nursing student's scope of practice in your area, but in my experience thay have been.

Wouldn't you rather see a new nurse come out of school having performed as many skills as possible under the supervision of an experienced nurse? Or would you rather that nurse graduate having never done these skills, only observed them?

By the way, jjbaby, I'm glad you learned so much; the ER is the place to do it. I'm an ER nurse and I love to have students like you. Good luck!

[BarbPick]

Disagree with me all you please. I spent my 2 years sitting on our board of Nursing.

Perhaps we will see all nice preceptors there, in front of their state board of nursing, explaining why a student is drawing blood out of a Central Venous Cathater with out their state certified instructor at their side, but hey it is your license, I am only a doctoral candidate in Nursing Science.

I only saw a few such cases before us of nurses who allowed people to work out of the individual's scope of practice. Be my guest. BTW, read the whole post, I mentioned a student's scope of practice, Ms Preceptor. Hope you enjoy action taken on your license when something goes wrong. You have just been lucky or...never mind.

[memphispanda, RN]

We also are allowed to do all the mentioned skills with the exception of IV push meds with a preceptor. The preceptor assumes the responsibility for the stuudent. I also had an ER rotation this week. Only got to start 3 IVs and hang a few meds, but it was still interesting!

[perfectbluebuildings, BSN, RN]

I believe in our senior year we work under a preceptor, but I am not sure if there are limitations on what we are allowed to do, stricter than what we can do with our instructors. We ARE allowed to do many of the same skills mentioned above. We each had the opportunity to start an IV (under instructor supervision!) during our first clinical rotation. I believe clinicals including preceptorship are for more than just observing; if a student does not get to practice a basic nursing skill in the low pressure environment of school, it will be much harder when they are out in the real world at their first job. I realize, Barb, that you have a lot more experience with the legalities of the matter, so much of what I say may be off base in that area. However, I do think that students need to be able to learn by doing.

[BarbPick]

Yes Rayrae, you are 100 % correct. What you do with your preceptor is usually within the scope of a students practice. Drawing blood from a Central Line is not. It violates the standards of Practice of the Infusion Nursing Society. You must be licensed to do so. Lpn's are not allowed to draw blood from a central line.

If you really paid attention to what I said, much can be done. And you know who pays? The preceptor who allows the student do practice outside their scope of practice.

I suggest all of you go on line and read the Nurse Practice act of your state instead of trying to argue with me. On this topic a Board of my peers suspended many licenses of Nurses who acted outside of their scope of practice.

GET OVER IT!

[Vsummer1]

Originally posted by BarbPick

I agree with Lydia, as I usually do.

These things are out of the scope of a nursing student's practice and unless you are with your instructor, you are setting your shadow nurse up for many problems.

Glad you feel like a hot shot, but clinicals are not for learning how to draw bloods from a central line, they are for you to observe and absorbe all you can of sights sounds and smells.

Assisting with 4 point restraints, ok. Start a peripheral IV, under strict supervision only. I saw a student start and IV in an artery. Amazing how the fluid pulsed.

Jesus, what next, Brain surgery?

Barb, this is POST NO 4 from you that really sounds condescending. You blast out at students on this board stating how wonderful an instructor YOU are and how we should just READ OUR BOOKS, or in the case of the stethoscope thread, you just blasted out unreasonably.

Clinicals may include absorbing sights, sounds and smells BUT they are most definetely to learn how to nurse under direct supervision. If the nurse I am with is standing there while I do an IV start, it is OKAY. I can push one med only, under supervision, but yes IV push is expected as is PICC line care. I am a hot shot? No -- I am a student who has the opportunities that student's should have to learn in a controlled environment.

I was in ER during my 3rd semester. I can start foley's, NG tubes and IV's under supervision, IF THE NURSE I am shadowing feels comfortable letting me. These skills were taught in the FIRST semester of my program and we are EXPECTED to be able to do them. But then, the nurses that we work with KNOW what our program and the facility allows students to do or not to do, as do I (I would NEVER push morphine for example).

Evidently, your facility shackles students into observing only. And that is okay for YOUR facility, but it would be a FAILURE to NOT do these things in mine.

SO WAY TO GO ON YOUR ER EXPERIENCE. I LOVED MINE TOO!!!