How long of orientation in ER is enough?

neneRN, BSN, RN · Sep 7, 2007

We give 4-6 weeks for new staff, even new nurses. They generally do fine with this...but they do not care for critical patients for several months...we give them time to get used to the flow of the ER on their own and get ACLS, and then they are given a few additional days with an RN caring for our highest acuity pts. Then we test them out in our high acuity rooms on their own, with strong, experienced RNs working nearby and only on days when we have a float RN available to jump in if they get overwhelmed. So they get off orientation fairly quickly, but are gradually eased into caring for the truly sick pts. And they don't touch trauma patients until they've been on the floor for about 6 months and have had TNCC.

the princess · Sep 7, 2007

YOU ARE RIGHT, neneRN...as in, you just hit the nail.....1.5 year ago, i was in the ED, too, and i was precepted just as how you describe it should be...however, i went on disability...when i was cleared, I reapplied to the ED and got in....however, it was in a different facility and it has a different orientation for new hirees in the unit...they orient hirees in the critical areas...i remember being assigned at the less critical areas just 2x, the rest we spent in the critical areas...and on my 7th week, i was asked if i can take care of 4 critical patients...of course, i said no, "i can take care of med-surg and tele patients, though; i feel more comfortable at the less critical areas at this time, and will gradually move my way there when i'm nore comfortable with the pace", i told the DON...well, and the rest is history...i don't want to go back to that stressful, not supportive ED ever again...

mom2michael, MSN, RN, NP · Sep 7, 2007

Brand new RN's get 12-16 weeks and near the end they pretty much just float room to room to gain as much experience as possible and they take (with the help of everyone else not busy) the critical patients when them come in. No team leading codes or traumas until ACLS and TNCC which is around 6-7 months. No high acuity pedi patients until they've had ENPC, PALS and NRP which usually doesn't happen until near the end of the 1st year.

Experienced RN's (even ones with previous ER experience) get about 4-6 weeks. The last few weeks you spend a lot of time floating room to room to get a feel for what is going on.....get the flow down, etc....and after the 6 weeks, it takes months of working before they allow you to team lead a trauma and/or code but you float alot so you can see how they handle those types of situations.

We have pretty decent staffing at this job though - so it allows the charge and the floats to pitch in a help in a crunch so you never feel "alone" for very long.

raynefall · Sep 7, 2007

Brand new nurses have to go through a six month orientation, they spend one day a week in class and the other three days on the floor. Seasoned nurses get about 4-8 weeks.

Toquay · Sep 7, 2007

I got 2 weeks orientation yrs ago when I started in ER and another nurse starting when I did with 23 yrs ER experience got the same LOL. I was told it's best to jump in the fire to learn, kinda a Captain Ron thing "If anything is gonna happen, it's gonna happen out there." I had done floor nursing prior and OMG I was so ready to go back to the floor the first 2 months. I was used to having my "ducks in a row" and in the ER there is no "ducks in a row" something always sends them quacking every which way. ER is a disorganized organization constant reprioritizing. I now like ER very much for this reason and have been there 11 yrs.

Toq

alkaleidi · Sep 7, 2007

The facility I work for is a level II trauma center. Orientation for new grads AND experienced nurses (with or without ER experience) is 90 days. You are paired with a preceptor the entire time and your RN:pt ratio is never more than a single staff nurse's ratio -- 1:4. That means once you as a new RN have worked up to taking all 4 on your own, your preceptor isn't going to have any pts on their own, so that you always have a resource should something happen or should you need help.

And, like most orientations, if you are ready to be on your own before 90 days is up, you are able to be taken off orientation. And, like most orientations SAY, if you are NOT ready, they give you more time. And unlike some facilities, they do honor that and WILL give you more time... LOL!

I think 90 days is a good period of time because you have that comfort of knowing you have that whole time to learn, if you're ready early you are ready early, and if not, you aren't rushed off orientation and taking a load before you are competent to do so.

Good luck!

Uptoherern, RN · Sep 12, 2007

Let's see........I am on my 7th year of "orientation" in the ER (15 yrs nurse total), and am still learning something new every day......... :lol2:

stayseerrn · Sep 13, 2007

First of all, I love the previous post which says that you have had 7 years of ED orientation!!! That is so true. Every single day, without fail, I learn or see something new. And if that didn't happen, then I missed something. So, yeah, learning in the ED never stops.

Okay, there have been studies that ED is one of the higher burn-out areas because a lot of ED orientation programs were of the baptism by fire nature. Now, for new grads, they really need a good 4-6 MONTH program. Learning to work as a nurse is hard enough. If you have to learn in an area which requires you to work fast and think even faster, this creates another level of stress. JEN published an article a couple of years ago about a program which implemented an orientation model based on the Patricia Benner Novice to Expert model with an elongated orientation program, and loss of new hires reduced dramatically.

For experienced nurses, in areas other than ED, orientation on the unit is easily 4 weeks and sometimes up to 8 weeks. Part of that is due to the fact that emergency nursing is a horse of a different color, and it is sometimes an adjustment to dealing with us wild horses.

Experienced ED nurses usually get a couple of weeks, depending on the type of ED they had worked in before. If they did not work at a level I trauma center before, then they would obviously need more time with orientation to trauma. If they worked in an equivalent ED, then obviously they would not need more than a couple of weeks to figure out the specific workings of our ED.

Okay, this is incredibly long. Can you tell that I worked as a clinical educator in an ED?????

Hope this is helpful!