I am a new grad in a and ER residency program. I just completed my first week on the floor with my preceptor and I feel overwhelmed and underprepared. My preceptor is great, but sometimes she moves a little too fast for me because I'm still trying to sort everything in my head - especially documenting because I learned 2 other charting systems in nursing school and I know zero about this one. Our time on the floor is 12 weeks in total (unless we need just a bit more assistance and then we continue in 2 week increments) , we have class every week as a cohort and homework. The problem is - there is so much I need to know right now. Some of it I know, but I want it written down so that I don't make mistakes. For example - I know the basics for IM injections BUT I need to know how much I can put where - NOW - for each age group (for example how I split up a rabies vaccine for a baby). I won't have time to look it up when I need it, so I need it available now in my "brain book". Pinterest sucks anymore because there are so many dead links and advertisements that its nearly impossible to find anything good. I have spent a good portion of my day trying to find a resource that I could purchase when I should have just spent the day looking it up and writing it down - but I was trying to save time and use resources already developed.
I would appreciate any resources that you can send my way (they don't have to be ER specific either). I want to spend my time wisely and learn. I'm so frustrated following links to articles on shoes, gossip and facebook instead of how long to push Benadryl over or what meds I can push together.
@HiddencatBSN do you have an outline for what you use for your preceptees? I feel like maybe I could use some overall direction to realistically keep me on task if I find myself in the weeds again. I've thought about purchasing the CEN online module but only because our residency coordinator told us that by the time we finish we should have all the knowledge to pass the CEN while my preceptor keeps saying that I should be preparing for the TNCC because it will give me the best overall knowledge. I just want to do well and succeed with as few tears as possible this first year. Yesterday at home, I spent the majority of the day watching videos on IVs. I feel like we didn't get nearly enough teaching on the subject - like where to even find a vein other than the ac. Today was spent on IM stuff.
Sheey's has 2 books:
Manual of Emergency Care and Emergency Nursing Principles and Practice. Both are 7th edition. I don't mind buying both, but which one should I start with?
I don’t have a formal outline. The orientees have an orientation book from our educator and we have a checklist of tasks/assessments they get signed off on as we go along. I always cover the Pediatric Assessment Triangle with my orientees (I’m peds ED) and I talk through CIAMPEDS which ENA doesn’t use anymore but which I like for peds specific triage because it focuses on things I want to know about my peds patients. And we talk through things as they happen.
I wouldn’t study for the CEN specifically- I took the CPEN after several years of experience and I didn’t find studying for it to be very helpful to my practice.
I think the principles Sheehy is the more comprehensive one. I would work through that. As far as the tons of protocols, I would make a list of the most high risk ones based on complaint and start there- knowing that for a chest pain complaint you need that EKG, on the monitor, IV with labs, what the meds are for a STEMI and your cath procedure will help you speed up your order reading because you’ll be seeing orders you expect.
As a preceptor, there are times I step in to speed things up because of patient condition or because our volume is so high we can’t afford to take time for my orientee’s speed, but I communicate that and try to have them focus on a couple of the patients rather than just drag them along behind me. And when there’s a ton of stuff I still look up (our double bag insulin protocol for DKA is cumbersome and I don’t do it enough to have it memorized so always print the policy and check things off as I go through it) I wouldn’t expect an orientee to have everything memorized as well. It’s much more important to know how to look things up, know when you need to look things up, than to have every bit of minutiae memorized. Not only because of the volume of things there are to know but also because things change, med formulations and concentrations might be different than usual, etc.
HiddencatBSN, BSN
594 Posts
I don’t have a formal outline. The orientees have an orientation book from our educator and we have a checklist of tasks/assessments they get signed off on as we go along. I always cover the Pediatric Assessment Triangle with my orientees (I’m peds ED) and I talk through CIAMPEDS which ENA doesn’t use anymore but which I like for peds specific triage because it focuses on things I want to know about my peds patients. And we talk through things as they happen.
I wouldn’t study for the CEN specifically- I took the CPEN after several years of experience and I didn’t find studying for it to be very helpful to my practice.
I think the principles Sheehy is the more comprehensive one. I would work through that. As far as the tons of protocols, I would make a list of the most high risk ones based on complaint and start there- knowing that for a chest pain complaint you need that EKG, on the monitor, IV with labs, what the meds are for a STEMI and your cath procedure will help you speed up your order reading because you’ll be seeing orders you expect.
As a preceptor, there are times I step in to speed things up because of patient condition or because our volume is so high we can’t afford to take time for my orientee’s speed, but I communicate that and try to have them focus on a couple of the patients rather than just drag them along behind me. And when there’s a ton of stuff I still look up (our double bag insulin protocol for DKA is cumbersome and I don’t do it enough to have it memorized so always print the policy and check things off as I go through it) I wouldn’t expect an orientee to have everything memorized as well. It’s much more important to know how to look things up, know when you need to look things up, than to have every bit of minutiae memorized. Not only because of the volume of things there are to know but also because things change, med formulations and concentrations might be different than usual, etc.