In ER for final preceptorship

Trauma Columnist · Jun 3, 2007

Hi Miss Mora and good luck (IMHO the ER is the ONLY place to work - lol).

Objectives:

1. Observe triage and be able to choose which patient goes first (who's the sickest). On the NCLEX, prioritization questions are common.

2. Begin to develop solid assessment skills. Practice as much as you can: listen to everyone's breath sounds. If you get a congenital heart baby, listen closely - it will be very different than the norm.

3. Realize that in the ER, you will develop skills that span the lifespan from neonates to geriatrics. Pay attention to what the nurse is doing as in the order of things and what she is assessing.

4. Realize that you are responsible for your own learning experience. If you are paired with a nurse who isn't explaining things or is not open to questions, ask to be with someone else.

5. Enjoy the experience.

Take care and good luck.

abundantjoy07, RN · Jun 3, 2007

I did my preceptorship in the ER in April 07. It was a good oppourtunity and experience. I'm now looking for a job in the ER because of it.

We had to list clinical objectives as well along with other sheets of "busy work" to turn into our teachers. I couldn't tell you what I listed...but you do learn a lot. And you are able to do things that you might not have done before. It really seemed like all of the paperwork for school quickly became irrelevant due to the fast pace of the ER (at times). I mean the patients that come in are so random and diverse in their ages and primary complaints. Really every day is different and you can't predict what you will see during the shift.

I'd just make a list as you go (if you can). Write down the things you do and see during your time there and if your shift is a nice group of people, take time to learn from every one and not just the nurses. I learned so much about collaborative care from techs and physicians as well as the nurses.

If anything, look in your textbooks on emergency nursing and form some objectives based on ideas in your book that you feel are applicable to you and build on it from there as you work and spend more time in the ER.

Good luck!

swatch007 · Jun 3, 2007

Hi Miss Mora and good luck (IMHO the ER is the ONLY place to work - lol).
Objectives:
1. Observe triage and be able to choose which patient goes first (who's the sickest). On the NCLEX, prioritization questions are common.
2. Begin to develop solid assessment skills. Practice as much as you can: listen to everyone's breath sounds. If you get a congenital heart baby, listen closely - it will be very different than the norm.
3. Realize that in the ER, you will develop skills that span the lifespan from neonates to geriatrics. Pay attention to what the nurse is doing as in the order of things and what she is assessing.
4. Realize that you are responsible for your own learning experience. If you are paired with a nurse who isn't explaining things or is not open to questions, ask to be with someone else.
5. Enjoy the experience.
Take care and good luck.

I couldn't say better, so Miss Mora. Go, make a copy of TraumaRus's advice and read it everyday to remind yourself.

Wish you all the best!

Jen2 · Jun 3, 2007

You got some excellent advice already. I will add a few.

1. Believe it or not and dare I say, (sshh! don't tell anyone). Every once in a while there will be down time in the ED. Ususally between 3:00am-8:00am depending on what time you are orienting. This is the time the nurses will be "venting". You will be introduced to a sick twisted sense of humor and will probably cringe. It's O.K. the nurses are only mildly psychotic.

2. During the occasional down time ask questions, stock rooms (the only way to find out where anything is in the ED in my opinion), discuss cases, ask your preceptor to quiz you.

3. When things get crazy, don't expect your preceptor to stop and explain everything to you. I myself will tell students, "Put your running shoes on and stay close behind me, I'll explain later.) Make sure you take mental notes and then ask questions when things start to settle down.

4. Being in triage is a great experience. This is one aspect of nursing that even many nurses don't understand. Unless you are an ED nurse and regularly do triage you cannot fully understand ER nursing. Even our critical care float people that are awesome nurses and great resources have no clue what goes on out there. This is probably the most important role in the ED. This is where you learn to assess a patient by how they look. Too many new nurses are going to the ICU's etc. and being taught to read monitors and calculate numbers. A good triage nurse will watch a patient get out of the car and call the charge nurse to find out where they can put the patient before they even make it to the desk to sign in. When I tell people what I do they are like, "Oh my you get those patietns right off the Helicoptor how exciting." I always say that it's not the ones in the helicoptor that worry me. It's the ones that drive themself to the ED.

5. You will use a little of everything you learned in nursing school. Be prepared to remember your Psych rotation and keep yourself safe. Just because someones chart says that they are there for "abdominal pain" does not mean that they are not psych. Always look for signs of agitation/escalating behavior. It only takes once to be cornered in a room with the door shut to never let your gard down again.

6. Finally you are in a very good place before you take state boards. I exterened in the ED before my boards, and found myself pulling from the experience the whole time I was taking that test. Have fun and enjoy. Post about your experience.

HM2VikingRN, RN · Jun 3, 2007

Keep us posted. I would like to do ER for my synthesis rotation. (synthesis is our final clinical rotation at my school.)

Miss Mora · Jun 3, 2007

Thanks so much, everyone for the posts. I will definately take all the advice into account!! Yes, I am very excited, but also very nervous about this last placement, because up to now, I do not feel very "competent" in that I have not experienced a great deal of diversity, or even had the chance to do many skill-based tasks (NGs, IV starts, cathethers etc....).!!