Pre-Grad placement

joanna73, BSN, RN · Feb 20, 2014

Make sure you review your ABC's, your patho, electrolyes, vital signs. Go to the library and look for a good trauma/ emergency nursing text to learn some of the basics. Also review your head to toe assessment, cardiac, respiratory and neuro assessments.

The ER is very busy. It's a good idea to prepare before your first shift. Good luck!

Fiona59 · Feb 20, 2014

Every emerg treat their LPNs differently. Your placement their demonstrates your instructors confidence in you. Follow your preceptor and don't be afraid to ask questions on the role of an LPN. Know your baseline vital and have an idea of critical lab values. Ask if you will be required to start IVs and push IV meds.

Your interpersonal skills will also be vital.

Trevor_Canada · Feb 20, 2014

This is kinda off-topic but pre-grad placement=where you are gonna find a job eh? in most cases?

relaxingbath · Feb 20, 2014

Thank you Fiona and Joanna for the advice, I had an old school teacher in my first semester and she drilled me on my CBCs, electrolytes and my assessments, so I feel pretty confident when it comes to them. CPR on the other hand scares me even though I have completed the certifications many times now I have not put it into practice.

Trevor finding a job is a challenge to every new graduate, I have however heard reassuring things from previous years graduates from my college that they are finding jobs relatively quickly. It is also being preached to us on a regular basis that hospitals are replacing more and more RNs with RPN so we should find it easier to find work. I firmly believe that on some wards I've seen they have gone too far removing all but one RN so if a patient becomes acute there isn't the support there to deal with the situation.

I am hoping there will be training on starting IVs and IV push meds as up to this point we have not been allowed, feel sorry for my preceptor as I already have one hundred and one questions for her. I just need to finish my last day on maternity tomorrow, continue reading up on ER procedures during reading week and start pre-grad the first week of March.

xokw, BSN, RN · Feb 23, 2014

I recently completed my 12 week pregrad placement in the ER before graduating from my PN program so I can probably offer you some sound advice based on my experience! My list is not entirely skill related, but these are some of the big lessons I took away from my 450 hours in the ER :)

1) First and foremost, make a point of getting around the unit to offer a helping hand where needed whenever possible. Nurses will remember you (especially during pregrad when the floor isn't always crawling with other students) and if they see your desire to learn they will seek you out for every opportunity possible.

2) Do not be afraid to ask questions, and don't feel limited to only asking your preceptor. The ER is an excellent unit to work on if you want to experience working as a part of the interprofessional team. There are a ton of doctors, residents, RNs, RPNs, social workers, OT/PT, RT, dietitians etc., and we can all stand to learn a little bit about what the other does in terms of a client's plan of care. Ask ask ask.

3) Practice giving a thorough but concise report, as even seasoned nurses can find report to be a nerve-wracking experience (based on some posts I've read on AN). A large majority of patients in the hospital have come through the ER before being admitted to their respective floors, and as the one who has provided their care, the nurses on the other floors will be looking to you for report. If time permits, explain you are a student and ask for feedback on your report after you have given it. Every bit helps.

4) Don't be disappointed if the ER is not always as action packed as you thought. Don't get me wrong, there will be crazy days and you will see and learn tons, but be prepared for the other side of things as well. A lot of the people coming to the ER present with influenza, gastro (WAY more BM than I expected), minor ailments, cuts and scrapes, asthma/COPD, mental health clients, palliative from long-term care, etc., and as an RPN/PN student you will be providing care for these more stable patients.

5) IV therapy - IVs are everywhere in the ER, know your solutions, your calculations, and what your facility will actually allow you to do as a student. It's a great place to get a ton of practice with tasks things like priming lines, disconnects, bag changes, etc.

6) As I mentioned before, be prepared to work with A LOT of patients experiencing asthma/COPD exacerbations. Very common in the ER and it would be beneficial to brush up on your oxygen therapy and nebulizer treatments.

7) Read up on the Canadian Triage and Acuity Scale (CTAS). This is what it all comes down to in the ER and it will show initiative if you already have some background knowledge when your preceptor brings it up.

8 ) Lab values. Lucky for us, most times the parameters are included with the results (at least that has been my experience) but it's good to refresh your memory about what they all mean. I kept a lab diagnostic book in my bag and it was a great resource.

9) IM injections. Because of all those cuts and scrapes I mentioned the Tetorifice/Diptheria shot is given pretty frequently.

10) Catheterization is a pretty common procedure in the ER. I had never inserted one in anything other than a mannequin before being in the ER but felt pretty comfortable with it by graduation.

11) There is not a lot of focus on mental health in the PN program in comparison with how many people are suffering from mental health issues in the real world. It is a shame. Brush up on the Mental Health Act and the different forms that are in place under the Act (involuntary admission, etc.). Not only will you (probably) see a wide variety of mental health issues but also individuals suffering from a downright failure to thrive. In the early days of my placement I provided care for an elderly gentlemen who arrived in the ER wearing clothes covered in mold, severely malnourished and unkempt, using a broken shovel as a cane, living alone with severe dementia... It was eye opening and certainly not the last client I cared for who was living in these conditions. It broke my heart. The ER can be an emotional environment and can cause even the most composed and experienced nurses to come unravelled at times.

Sorry this was so long, I can't say enough positive things about the experience I had! I could go on and on! I hope you get to learn and experience as much as I did :)

relaxingbath · Feb 25, 2014

Thanks xokw for such detailed advice, where did you do your ER placement? Mohawk's Pre-grad is only 7 weeks 280 hours so its not as much as you did.

Picked up a range of books to read up on the various assessments and procedures carried out in the ER a lot of the material covered i'm comfortable with however there are holes in my knowledge that I will try to fill in before starting. As a PN student did you learn to start IVs and pull bloods during Pre-grad? Did they do any extra training specific to the ER before you started?

Thanks again for all the information and the positive feed back.

xokw, BSN, RN · Feb 25, 2014

I did my pregrad from Jan - April last year in Brantford General.

You probably won't be doing any IV starts or blood pulls as a student. These skills aren't taught in the program and pretty much anywhere you are hired after graduation makes you take a training course through the actual facility you work in (RPN and RN alike). Also, many hospitals have a team specifically that do IVs and venipuncture for the whole hospital. So, in my experience, basically any lab work that was ordered was drawn by lab staff (through a new poke, not through the IV). The floor nurses would start their own IVs sometimes but if it was too busy, a hard stick etc., the nurses would just call the IV team.

I know the policies and procedures are quite similar at a few hospitals based on my own experiences and the experience of friends who are scattered throughout the area. I can't speak for all though but it has been pretty consistent from hospital to hospital.

Fiona59 · Feb 25, 2014

We lost our IV teams about 12 years ago!

In Alberta ERs the nurses do it all. They are trying to sneak lab draws into the floor nurses duties, I believe the ICUs so their own.

Enjoy them while you have them.

xokw, BSN, RN · Feb 25, 2014

I have never had the luxury of an IV team at my job, maybe a good thing!

relaxingbath · Feb 25, 2014

Brantford does have an IV start team (one of the anesthetist likes the challenge of difficult starts) but the nurses i've done previous placements with take it personally if they are unable to get a line started so they are almost never called. My last two placements have been in Brantford (surgical and Maternity) and really enjoyed my time there even being a male student on the maternity ward. My ER pre-grad is in Joseph Brant so i'm sure things will be a little different from having the Meditech system I've become used to.

Fiona I have heard the same in Ontario that they are trying to get the floor nurses to take on more roles however there are still lab teams that draw all the bloods that I am aware of.

relaxingbath · Mar 7, 2014

So I've survived my first two shifts! My preceptor is amazing and I'm working in the Emergency Minor Assessment and Treatment department. I am hoping that my preceptor will be able to arrange for training on drawing blood and 12 lead ECG as that happens frequently there and would really allow me to help with some of the work load. Thanks for all the advice and support it helped me a great deal in preparing for starting.