Last Semester In Nursing School, ER Preceptorship

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What are the most important skills to brush up on before my first day?

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Specializes in ER, Trauma.

Rapid assesment skills. Remember you'll be treating a patient without a diagnosis. Continuously reasess priorities in everything you're doing. ER's are chaotic by nature, and for your own safety, never, ever say the word "quiet" in the ER or the staff will blame all that goes wrong on you. Call it "the Q word." Some people thrive on the ER atmosphere, most don't.

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Specializes in ER, IICU, PCU, PACU, EMS.

Yes, never say the "Q" word or you'll be blamed for the chaos that follows.

Along with the quick physical assessment, brush up on your verbal assessment skills/ questions to ask the patient based on his/her chief complaint. Sometimes the diagnosis will be completely different than what the patient describes. That is why it is important to review the signs/symptoms of major diagnoses.

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Specializes in Trauma/ED.

Don't do anything that you are uncomfortable with and get as many IV starts as you can...ask questions but try not to bug everyone--mostly your preceptor. Try to see as much as possible but for God's sake stay out of the way! :-)

Oh and HAVE FUN!!!

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Specializes in ER, ICU, Flight.

I am preceptor for students and nurses new to the ER. I have been giving my students this handout before thier rotation to help get them ready:

Items to Review

Skills

Whether you have done a lot of IV starts or none at all, don't worry!! Learning is what the rotation is for! I just want you to be familiar with the procedures so you know how to measure the NG tube before we place it. Don't be nervous about skills, there will be ample opportunities to practice in a safe environment. Review these skills:

IV starts

Venipucture

NG tube placement

OG tube placement (with a ventilated patient)

EKG lead placement

3 lead (red, white, black)

12 lead placement

Foley catheter placement

Straight catheter placement

ABG collection

Medications:

Remember, just a few important points about each. Why would it be used it in the ER?:

Morphine

Ativan (lorazepam)

Epinephrine

Haldol (haloperidol)

Benadryl (diphenhydramine)

Solumedral

Metoprolol (Lopressor)

Nitroglycerine

Versed (midazolam)

Albuterol

Magnesium (what type of dysrhythmia is it used to treat?)

Zofran (ondonstrone)

Phenergan (promethazine)

Cardizem (diltizem)

Dilaudid (hydromorphone)

Compazine

Protonix

Xanax (alprazolam)

Valium (diazepam)

Pepcid

Lidocaine

Amiadorone

Adenosine

Atropine

Dopamine

Propofal (diprivan)

Normal Saline

Dexamethasone (decadron)

Heparin

Lovenox

Vicodin

Percocet

Tordal (ketoralac)

Ancef

Rocephin (ceftriaxone)

Activate Charcoal

What drug do you use to reverse opioid overdose?

What drugs on this list are narcs?

What drug do you use to reverse benzodiazepine overdose?

What drugs on this list are benzos?

Systems Review

Keep pathos short, I mean 10 words or less!!! Think about assessment!! You will be doing a lot of focused system assessments while in the ER.

Cardiac:

Common signs of an MI

Remember MONA??

What is Troponin? What does it mean if it’s elevated?

Be familiar with the following rhythms:

Atrial fibrillation

What does supraventricular tachycardia (SVT) mean?

Normal Sinus Rhythm

Ventricular Tachycardia

Ventricular Fibrillation

Sinus Tachycardia

Cardiovascular:

What is shock?

What are the four (major) types of shock?

What is anaphylaxis?

Renal:

How do the kidneys regulate BP? (no long patho, just the big picture in 10 words or less)

Common signs of a kidney stone

Hepatic:

How does the liver effect clotting (in 10 words or less!)

GI/ Abdomen:

Common signs of appendicitis

Common signs of cholecystitis

Endocrine:

What is DKA? What are the common sign and symptoms?

Neuro:

Common signs of a stroke

Differences in treatment of hematic stroke vs ischemic stroke

Common signs of herniation

What is involved in a nuero assessment?

What is a Glasgow Coma Score?

Respiratory:

Common signs of pneumonia

Common signs upper respiratory tract infection

Croup, RSV, bronchitis, pharyngitis (we see a LOT of these!)

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Specializes in HH, Med/surg- liver & kidney transplant, ortho, ++.

Mesa

LOVE your post. I am a new grad in LTC but really want to get to the ER some day. This is FANTASTIC. I think it would be beneficial to everyone, not just ER nurses. I see a lot of my residents on quite a few of the drugs mentioned. Thanks so much.

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Mesa, thought it's been a while back since you've posted that post... THANK YOU! I've been trying to collect bits and pieces on the internet about emerg diagnoses and medications to review in preparation for my final preceptorship. I have done some research but it is definitely not as succinct as yours. The post really helps me focus on what's important for me to know right now. Thanks again!

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