Practicum in the ER

I have worked with many nursing students doing their final practicum in the ED -- they universally are appreciative of the experience for the high volume/variety of exposure to patients and immersion in skills. The experience goes a long way toward easing the transition as a new grad.

It will also demonstrate clearly for you either 1. I love the ED! or 2. I never, ever want to work in this setting again! There's no right nor wrong in either conclusion.

Your life experience will likely be a plus, but ... right now, throw out any preconceived ideas you may have about people based on race, ethnicity, socioeconomic status, education level, or any other categorization. What you will encounter in just about any ED will cut across all those lines.

Observe all security measures that are in place - do not circumvent them for any patient/visitor, no matter what the situation.

Realize that patients/visitors deal with whatever the crisis is that has brought them to the ED in the context of all their pre-existing baggage - financial constraints, family dynamics, etc.

Be prepared to be flexible: you may have (with your preceptor) formulated a plan of attack to provide *the most excellent nursing care* ... that will get thrown out the window in a split second when the situation changes. A new patient, a seizure, a change in cardiac rhythm, your patient or another nurse's who becomes combative, and on and on and on ...

Good luck -- keep us updated on how things are going! :)

I'll give you some very practical advice:

1) Watch for sharps... the docs try very hard to manage their sharps but I still find them laying about at times... generally because something urgent and emergent popped up before they disposed of their sharps. If you see things piled up, assumed there's a sharp hiding under there. If there are piles of OR towels after a chest tube, use Kelly clamps to shake them out one by one. I've never been poked but I'm paranoid of sharps.

2) Don't trust patients... they will hit, bite, and scratch (kick and headbutt, too) -- often without warning... Be mindful of their "end-effectors" (which term derives from robotics but describes the situation perfectly, IMO).

3) If something hits the floor, clean it or throw it away. ER floors are nasty... and it drives me crazy how often I see monitor leads hit the ground, or even pillows... or Yankaurs

4) In a trauma, when you start cutting clothing, be mindful of what's underneath... anatomy or monitor cables...

5) When in doubt, wear a gown and a face shield... better to have them on and need to remove them than to not have one on when you needed it.

6) Make sure you know the code status for every patient, their NPO status, and their spinal precaution status... oft times it's obvious but it's not always so certain.

7) Don't stand around... there is *always* work to be done.

8) Invest some time exploring the stock areas so that you know where to find things in a pinch.

9) Never, ever clear an alarm without checking in with the primary nurse.

10) Keep gloves in your pocket... you can't always get to the dispenser so quickly as you need to get them on your hands.

11) Ergonomics... you're a bit older than am I so you're probably already acutely aware of protecting your fragile core and joints but be mindful... generally speaking, the ergonomics in a hospital suck.

12) Don't be afraid to spread your wings and fly.