New to ER qsts about orienting

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Specializes in ER.

I'm a new nurse. I spent 6 months in med surg and then 6 months in a clinic. I have had to change jobs for various reasons and now I'm in the ER. I've worked just a few shifts so far and I really like my preceptor and I feel I've actually been very independent and have been contributing which I like but it was brought to my attention by someone that they feel my preceptor should be going in with me to every room every time and "training" me. I guess I felt since I am not a brand new grad this is how orientation is done. It has been "see one do one" basically. I'm now concerned. I'm not sure if I should approach my preceptor and ask for more guidance or if I should continue to do what I'm doing.

I feel like on my own I learn from my mistakes and I wouldn't be learning if she was just telling me what to do all the time. I do get help from her or anyone when I don't know how to do something (ex a splint).

Otoh, I have really just been figuring it out as I go and maybe I'm missing valuable orientation time by working as an extra set of hands instead of focusing on learning.

What do you think? What should I do?

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Every action you do is learning. If you have a question or a concern, can you ask your preceptor?

Things are different in the Ed. Repetition repetition repetition.

I guess I'm not sure what you think you're missing out on?

Everyone does things differently. I think, honestly, the most important learning experience is learning how to manage the constant flow and change.

Does your preceptor pop in your rooms?

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Specializes in ER.

My preceptor basically sees other patients and I track her down when I need her. I've liked it that way but maybe I'm not giving good discharge advice or maybe I'm not doing things right (I wouldn't know bc I'm new). No she doesn't pop in my rooms. She gives me full independence.

Yes I can ask her things if I need to I just have to find her first. The issue came up when I almost followed an incorrect verbal order from a dr. Apparently we aren't supposed to take verbal orders except in a code.

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Yes, do not take verbal orders!

What ends up happening is by the time you go get the med and walk around the corner, they change the med or the order.

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Specializes in ER, Addictions, Geriatrics.
Yes, do not take verbal orders!

What ends up happening is by the time you go get the med and walk around the corner, they change the med or the order.

Every. Damn. Time.

Or they forget that they even said it.

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Specializes in ER.

Thanks all. I learned my lesson on that one. I'm just not sure if I need closer monitoring or if winging it will be more useful for me In the end. I may pick up some shifts with another preceptor just to see how that goes and get some extra insight.

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Not only are you a new nurse, you are a new ED nurse. You should not be working independently just yet. In the beginning, you should only take one or two low acuity patients with your preceptor watching over you and giving you feedback as needed. Over time, you take on another patient or two until you are taking on a full load, again, with your preceptor watching over you.

Just for a little perspective, I am an experienced nurse, not new to ED, and when I took my most recent job, I still could not even touch a patient until I had completed a 300 page binder full of check-offs. I got five shifts of orientation, but only because I am experienced. When I was new to the ED, I got six weeks with a preceptor watching over my shoulder.

If they're throwing you to the wolves this soon, it is because they are understaffed. But that is not your problem to solve. You need to practice safely and protect the patients from harm.

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Specializes in Emergency.

I would suggest you discuss the situation with your preceptor and the Director/Clinical Coordinator/Whatever you call the person in charge of the department. This way they both know how much supervision you are getting and are not getting, and can help you to determine what is appropriate for your situation. Obviously you had a situation and at the very least you and your preceptor need to figure out how to make sure something like that doesn't happen again. More likely, your preceptor needs to spend more time with you and less using you as an additional resource.

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There is always benefit, IMO, to having a more experienced nurse in the room when you're doing something just because you're likely to learn something.

I'm >3 years into the ED and I still feel this way... though I rarely have anybody in there with me.

Personally, I'd ask your preceptor to be close by just for feedback... that's why you have a preceptor... it's not that you can't be independent, it's just an opportunity for you to learn from an expert.

It'll end soon enough, take every advantage of it that you can, while you can.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
My preceptor basically sees other patients and I track her down when I need her. I've liked it that way but maybe I'm not giving good discharge advice or maybe I'm not doing things right (I wouldn't know bc I'm new). No she doesn't pop in my rooms. She gives me full independence.

Yes I can ask her things if I need to I just have to find her first. The issue came up when I almost followed an incorrect verbal order from a dr. Apparently we aren't supposed to take verbal orders except in a code.

This is exactly why you should be with a preceptor....a good one. There are nuances to ED nursing that aren't applicable to anywhere else. Documentation is another issue. ED document for reimbursement so your charting should be different. Emergency nursing isn't something that you should "fly by the seat of your pants" There are medical legal aspects that need to be addressed...liability is high. While I am on the subject of liability....get your own .

How does your facility deal with medical legal lab draws? Who draws your legal ETOH levels?

There are many aspect of ED nursing that are unique. While you appreciate being on your own...your preceptor is not doing you a favor. IMHO they are not a good preceptor.

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Specializes in ER.

My preceptor took a lot of time the last two shifts to explain things etc. we weren't slammed and had time to go over things. She's learning how to precept and it is kind of like learning to dance with a new partner. It is an exchange, both people have to move together or it won't work. She's very flexible and open and I think we're working out what we need from each other.

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Specializes in Emergency, Case Management, Informatics.
Yes, do not take verbal orders!

What ends up happening is by the time you go get the med and walk around the corner, they change the med or the order.

Sure, you can take verbal orders. You just enter the VO into the chart before the doc can change it on you. I'm always checking the chart, anticipating orders, and asking for those orders if they're not already given. If I had to work in an ED where I couldn't get a quick VO from the doc (and immediately chart it, like I said), my workflow would come to a grinding halt.

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