Please share orientation ideas!

[Jaysie1]

I am looking for ideas to improve our orientation program for new hires into the Emergency Department. So far, our staff has a two day corporate orientation, followed by a 3 day hospital-wide clinical orientation for techs and RNs. There are so many skills, specialized equipment, and medications (like t-PA) that are ED-specific and I see that it's difficult for preceptors to find time to cover everything while they have a patient assignment. I would like to have a "Welcome to the ED Skills Day" and am looking for ideas (including a better name!).

Do you have a day (or more) where new hires meet with the unit educator before starting with their preceptor? What topics do you cover? What methods do you use (ie: scavenger hunts, lectures, mock codes, etc)?

I look forward to your responses!

[NickiLaughs, ADN, BSN, RN]

All they did at my current job was a scavenger hunt.

I wish they would have covered what a"heart alert" is. How the stoke process is because we have neuro tele etc. the processes for STEMI. I've asked these questions multiple times and they say, well we have a process but it hardly ever happens....

i would go over flows on the major emergent flow processes. Who responds to codes, who has what roles in codes,etc. that would be incredibly beneficial I think. Hope that helps and you get many useful answers. :)

[Lev, MSN, RN, NP]

Our new hires and nurses new to critical care go to a statewide 2 week critical care course which is held a couple times each year at different hosting hospitals. In addition, the earlier the new grads take ACLS the better.

The essentials:

Basic rhythm course

Setup/function of cardiac monitor

How to use the defibrillator and when to put your patient on pads

Set up art line/CVP

IV class (for those with no IV skills)

Code meds (why and when given) - Post ACLS class

Use of level 1/pressure bags/blood warmer

Therapeutic hypothermia

Delegation in the ED - what and to who can you delegate

Common vasoactive/sedative drips and their titration, RSI meds

Patients going to the OR (what you need to know and do)

Assigning an ESI

Chain of command in the ED - who to ask to do what and when?

Critical thinking

Conscious sedation process and protocols

Assisting with chest tube placement

Assisting with central line placement

How to access a port

[Jaysie1]

Thank you for taking the time to outline these! I am very curious to know what your method of validation is for these areas. I'm also most curious to know what's included under "critical thinking."

Thank you again.

[Lev, MSN, RN, NP]

These are my dream orientation skills. We have validation for some, but not all. Validations in general have a checklist with steps written and you are signed off when you successfully perform each step. For ports, nurses watch a powerpoint and then go over to the cancer center and need to be signed off on 6 accesses and deaccesses. A lot of this can be taught in a sitdown class with a quiz (ESI) or in scenarios. For critical thinking in our competency day we were assigned to one of three patient situations and there was a bed with a dummy and we were expected to know what to do and perform any skills. My patient was the septic patient who needed a norepi drip and art line setup. I think part of critical thinking is knowing who to call when. When to call Charge, when to call Respiratory, when to call the MD etc. Letting each new grad play with a chest tube kit or the fluid warmer and let them set it up can be enough. Critical thinking is also about little things like putting a patient flat if possible when their BP tanks.

Two skills to add: setup of pelvic exam and lab values and what can happen if they're off.

[Jaysie1]

Thank you, Lev

I appreciate your feedback and collaboration.