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?
Guests
Guest
0 Posts
It would not be possible to function effectively in our ED without verbal orders.
You just need tor emember to follow up and get them to drop the order for you.
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.[/quote']
^ THIS!!! Very well written and my thoughts exactly!
As orientees, we don't know what we don't know yet. That is why our preceptors should be teaching/guiding us. Yes, you need independence, but that will come once the preceptor has assessed that you can function appropriately on your own. Even though you are not a brand new nurse, you are new to this specialty. I'd request a formal orientation, so that by the time you are officially on your own, you can do so confidently. Good luck!
I agree with a lot of what stargazer said - specially the bit about being not only a new nurse but new to the ED as well!
Here is my perspective:
As an orientee: I was new to the ER and nursing as well. I have had the good fortune of having great preceptors at my old job (Med-Surg, sometimes Neuro ICU. Did that for a year and half out of school) and my current one in the ED. My ED preceptor was very thorough. Stickler for detail. Chart as soon as you do something and chart often - because you never know when the next code is going to be dumped on your lap. She was in the room every patient room with me, every shift for the entire orientation. She wouldn't always make comments or ask questions while we were in pt. rooms - but she would ALWAYS ask me to 'Ok, you've assessed the patient. Run it by me and tell me your plan of action. What are you anticipating? What are you worried about? What do you anticipate? etc. Sometimes she'd assess pts. or ask them questions while I was doing my own assessment if she felt the pt. was more critical or if I'd made a glaring error. She also passed on tid-bits based on her own experience working in that ER ("If you're pressed for time, you can chart the admit note while giving report" etc.)
Basically she gave me 'room' but made sure she was involved in each pts. care so that nothing was missed and no harm done to the patient or my 'education'.
As a preceptor:
I generally follow the same principle - especially with new-to-the-ED nurses. I draw on my own experience as an orientee to the ED and my preceptor and go from there. I monitor but from a distance. I let my orientees "do their thing" and critique later. I've been fortunate to have had good orientees so far - all of them have seemed 'cut out for the ED'. I'm also a big fan of audio/visual tools (guess the rhythm EKG games etc.) I'm also a fan of directing the orientees to some of our more knowledgable and patient ED docs and encouraging them to ask questions (Why do we give albuetrol, insulin and D50 to patients with hyperkalemia? etc)
In my experience it has been more 'difficult' to orient experienced ED nurses to my unit than fresh nurses.
When I oriented to ED there was a lot of opinions from other nurses about how things should go. I found the bottom line was that once my preceptor determined me to be a safe practitioner, she let me be but was always available. If she is confident that you will ask when you do not know then she will let you fly, finding that shaky balance of giving you independence without you being in over your head. And you also have to recognize as the orientee when you need assistance. Best of luck to you!
Guest
0 Posts
It would not be possible to function effectively in our ED without verbal orders.
You just need tor emember to follow up and get them to drop the order for you.