New Grad ED Interview: Situational

Armygirl7 · Mar 19, 2017

Hi newnurse866!

Good luck on your interview....so stressful!

I had a pretty intense interview for my first ER job too. I had to walk the HR interviewer (who was an RN) through a head to toe assessment, she asked me a lot of questions about drugs (cardiac mostly), and questions about how I would address problems with colleagues, esp. MDs, I think trying to see if I would be afraid to question MD orders etc. It was nerve-wracking. Then I had interviews with the ER manager and the ER educator who both asked me scenario questions. I felt like the questions were more devised to see how I would behave as opposed to whether I knew exactly what to do - I mean they knew I had no ER experience, so what they wanted to measure was how was my critical thinking and mental toughness. I was drenched in sweat after each one (glad I wore a blazer -never took it off till back in my car!).

Just based on your examples--be careful what you say! Heparin is not a clot-busting drug. It is an anti-coagulant, a blood thinner, it prevents new clots from forming and prevents existing clots from growing larger. Calling it a clot-buster is incorrect. Also unless the questioner tells you it is a DVT - (remember we do not diagnose) then your job as the ER RN is to anticipate the required tests and treatments (of course DVT is on your mind, just like it is on the Resident's or Attending's list of "rule outs").

Any ER plan starts with lots and lots of assessment! In the ER the subjective story the pt tells you is vitally important to ruling things out so if I had a pt come in with leg pain I would want to know:

Any recent trauma, strain, injury?

Recent surgeries?

Any recent travel (long time cooped up in bus/car or esp airplane?)

Pregnant?

Smoker?

On birth control or hormones?

Taking any medications?

Any shortness of breath?

Hx of blood clots?

THEN I would thoroughly assess the extremity- and get on to the objective findings.

Is the painful area red, hot, swollen?

Skin intact, dry (maybe it's cellulitis and not a DVT)?

I would anticipate drawing basic blood work (CBC w/diff and CMP) and depending on leg assessment and pt's story and med Hx, maybe PT/INR as well as a D-dimer; place a 20G or larger IV saline lock, and anticipate an order for ultrasound of the extremity (with pt either going off unit for that or the test performed by the Resident at the bedside).

In any scenario that the interviewer presents to you think ASSESSMENT first.

And in a list of drugs I would say less if you aren't sure what exactly a drug is used for - it is in fact more impressive to say, "well I would anticipate Heparin if it was a blood clot," and if the interviewer presses you, "why Heparin?" you can say "because it thins the blood - but before I gave it to the patient I would be sure to look up the drug and be able to explain to the pt exactly how it works..."

Nothing worse than nurses who give cocky incorrect answers because they are nervous or proud. I have now sat on both sides of the interview desk - it is always impressive to me when someone says "Hmmmm I don't want to mis-speak, but here is how I would find the correct answer; or here are the actions I would take before I did XYZ." You never want to say "I don't know," without some follow up of how you would find the answer in practice, but you also don't want to just blurt out an incorrect answer. Safety first!

All that being said there are certain drugs you should be familiar with that we encounter in the ER all the time - this post has a good list and discussion:

Working backwards from this list you can imagine what types of scenarios you might get questioned about by noting what these drugs are used for.

Let's say you have the dreaded tricksy interviewer who is trying to trip you up or make you sweat - they say, "The MD wants to give XYZ for ABC condition," but you don't recognize drug XYZ... so you're not sure -- then SAY that - it shows you are willing to stop and think critically. Saying, "I'm not sure off the top of my head if that's right, so I would want to look it up or have a further discussion with the MD or another RN before proceeding with that order," doesn't make you look dumb because you don't know - it makes you look smart because you are being safe.

And that happens in real life every day in the ER - you're constantly questioning orders, checking dosages and indications, and learning about new drugs or treatments.

So that's my 2 cents! Good luck!

newnurse866 · Mar 21, 2017

Hi! I replied back to your post a while ago but now when I am re-visiting this post, it seems that my reply didn't post! I just wanted to say THANK YOU for such a detailed, informative post. Your post has helped me immensely and I really appreciate all the advice. I'll be sure to look over the cardiac meds and review general assessments as well. Can't tell you how much this helped and how much I appreciate it- THANKS AGAIN :)

contramanda · Mar 28, 2017

I had a worksheet where I was given 7 scenarios and had to prioritize them and list the actions/interventions I would need to implement or expect to implement.

EDNURSE20, BSN · May 6, 2017

Armygrl7 I know this is an oldish post so not sure if you will see this. But thanks so much for the advise, best I've seen on here. I'm graduating in November and will be applying for the new grad programme in August and this has help so much. Was so afraid of being asked something I don't know, but now I feel like I can relax. Safety I know.