Preceptorship in ER

fuega · Nov 16, 2004

It is too bad you have had such a bad experience w/ med/surg. Since I know & work with some outstanding med/surg nurses, I don't want you stereotyping these nurses. I would rather have a staff nurse attempt an IV than call for help the second the first line blow; how else are they are going to learn? I am glad there are nurses who enjoy med/surg because I cannot stand taking care of the same patient for more than 4-6 hours; I truly tip my hat to them. Please give them the respect they deserve. We are all nurses...just different specialities.

I am sorry I did not mean to come of that way. Every hospital that I have worked has had a horrible reputation for the nurses that work in Med/Surg. I have only known a few nurses that work thier butts off. I had to orient in Med/Surg because I was floating between ER & M/S. When one of the gals from ER brought an admit. This patient was a very obese man, that was not ambulatory. She must have sat in the hallway forever waiting for someone to help. I finally saw her and I asked if she needed help, the nurse that I was orienting with got angry because I went to help her. :uhoh21: Hello this ER nurse was so tiny there is no way in hell that she could have transferred that patient herself. I know that the only way you learn is by practice, but does everyone in the whole unit need to attempt to get a line before they call someone else to help wheter it be the ER or lab. I know that there is bad, and lazy nurses everywhere you go. M/S seemed to be the place that I experienced it. Maybe it is because the ratio is high there. I dont know I am sorry though I was not trying to sterotype anyone, this is just my experience. :saint:

thanatos · Nov 18, 2004

I am sorry I did not mean to come of that way. Every hospital that I have worked has had a horrible reputation for the nurses that work in Med/Surg. I have only known a few nurses that work thier butts off. I had to orient in Med/Surg because I was floating between ER & M/S. When one of the gals from ER brought an admit. This patient was a very obese man, that was not ambulatory. She must have sat in the hallway forever waiting for someone to help. I finally saw her and I asked if she needed help, the nurse that I was orienting with got angry because I went to help her. :uhoh21: Hello this ER nurse was so tiny there is no way in hell that she could have transferred that patient herself. I know that the only way you learn is by practice, but does everyone in the whole unit need to attempt to get a line before they call someone else to help wheter it be the ER or lab. I know that there is bad, and lazy nurses everywhere you go. M/S seemed to be the place that I experienced it. Maybe it is because the ratio is high there. I dont know I am sorry though I was not trying to sterotype anyone, this is just my experience.

I do see your point. Again, I'm sorry you've had such a bad experience with med/surg nurses. Where I work, most of them are excellent. Also, I used to work med/surg, and I believe this speciality (and I do believe it is a speciality) is unjustly underappreciated and maligned. IMHO.

crh5 · Nov 19, 2004

It is getting to be the time when I have to decide where I want to do my preceptorship. I really want to do it in the ER or in an ICU. However, I am worried because I know to be a nurse in the ER you really need to know your stuff and since I am a student I am worried that I won't meet expectations. I have people tell me I should do it on a med/surg floor so that I can get more experience, but the way I see the preceptorship is to try something you are interested in and do something you may not get a chance to do right out of school. I want it to be more of a learning experience rather than just getting me used to doing med/surg. I will have plenty of that when I graduate.I take my critical care class next semester, so I don't have much of a good idea about providing care for a critical patient.
I was just wondering from the perspective of a nurse who works in the ER, what are your expectations from someone who preceptors there and do you think it is an appropriate spot for a student? Thanks for your advice.

I am a student who just finished a preceptorship in the ER last week. It sounds as though your goals are very similar to what mine were. In my program, there is no ER clinical rotation, so I knew I wouldn't have the opportunity to experience the ER during school unless I did a preceptorship there. I have to say that it was, BY FAR, the best rotation I've had in terms of learning opportunities. I saw so much, and was able to get my hands on so many things. I think it really was invaluable both in terms of hands on experience, and confidence boosting. The key will be to have a preceptor who has the time and patience for a student. The ER where I did mine was not super-busy so there was time for my preceptor to explain things as we went. Good luck!

ernurseafterall · Jan 8, 2005

Just to set the record straight, the "mentor" who uses one case of a pediatric seizure case where 3 experienced nurses jump in and the new grad takes a recording role- as the "disappearing" from critical cases- is just out and out wrong-she got a very short and narrow glimpse of my work and then passed on to my preceptor... And yes, 10 weeks in-this one was scary-but there were many more where I did jump right in.

My advice to new grads in the ED...don't leave your preceptor during your orientation. if the charge nurse on your shift says she doesn't know where to "put you" and you are with different mentors each night-some willing and some not too thrilled...bad idea...go with your gut too. If it doesn't feel right, it doesn't mean you can't do it...keep going-you may thrive somewhere-another dept another hosp, etc. Don't let any nurse convince you that you don't belong there or are too inexperienced. This same nurse talked right over me when I was doing discharge instructions-actually filling in-making the patient percieve that I had no idea what I was saying.

Make sure when you are hired that periodically your precept. sits and goes over a specific list of skills and progress...these show you both where you are and more helpful then the kind of secondhand info that was passed along ....

Also, do what you have to do with your family in mind...for me finding a part-time(3 shift per week) position worked well for me since caring for small kids and a sick parent. No regrets and running "to " patients in the ER and not running "away" from patients....

I am the educator /preceptor for an ED. I have developed a 12-16 week preceptor program that I used for GNs coming directly to the ED. I still think 6 months med/surg is helpful as it helps the inexperienced nurse begin to develop critical thinking skills, as well as hone necessary skills (foleys, NGs, monitor interpretation, IVs, phlebotomy, etc) that may be needed to be performed VERY quickly. Also ,med/surg will give the inexperienced nurse reinforcement on drug /pharmocology- again not in such a critical and usually chaotic atmosphere. I spent 2 yrs on medsurg/telemetry prior to ED- I worked with monitors, ventilators-etc and still when I went to the ED, wasn't sure I could work there. 24 yrs later, I'm still here and wouldn't work anywhere else. That said, the 2 GNs I precepted, mentored from June to October- 1 quit as soon as she moved from dayshift (with me) to 3-11 w/ a mentor only--she said she couldn't "do it"- seemed at times to "disappear" when the critical pt came her way. The other-who had a 4 yr BS program and worked as a tech in a peds ED is still with us and doing well. If you do decide to go directly to the ED--CHECK OUT their preceptor programs. A dedicated nurse assigned to you as a preceptor/ mentor for 3 months would be an excellent type of scenario. If possible, look for a program that instead of sticking you right into the acute care area--combines didactic review, nursing equipment/procedure review as well as patient care- If possible, ask if the program mentor would be assigned to precept you and maintain their regular assignment at the same time--that could be a recipe for frustration for both you and the mentor-you might want to avoid that situation. Make sure your orientation includes ACLS, PALS training-
The ED is an exciting place to work--no preceptor program will make you an ED nurse-that job is up to you--EDUCATE yourself- even if your facility doesn't pay for seminars- pay for them yourself. Join ENA-
Good luck
Anne

needsmore$ · Jan 8, 2005

ERnurse afterall makes very good points-stability with one preceptor is great-as long as staffing is available. Some nurses, although experienced, are not good mentors -mentoring requires knowledge and people skills. Switching from the training -orientation to the followup mentoring stage can be difficult and many times the new nurse is placed with different nurses. The pros of that are that different nurses have different experiences that they can pass on to others-ie- one way to do something isn't always the ONLY way- just because it works for me doesn't mean it will work for you. The cons of different nurses are as ERnurseafterall stated- some nurses don't mentor well and see it as a "chore", some can be very critical of inexperienced nursing staff. And , unfortunately, there are those who just don't tolerate new staff-maybe see them as a threat to their job ( taking away from time available to pick up as extra $$). Who knows- Also--make sure the job is right for you-in both area of expertise (ER, M/S, NICU-whatever) and schedule- if you can't or don't wish to be fulltime then don't sign up for it- if you want flexibility-make sure that the position has that in place-there is nothing more frustrating than going through an orientation program, then never finishing or leaving right after because of other commitments in your personal life. Frustrating for both you and your ED/hospital orientation program (who sees this as lost money). ER nursing is GREAT, but it is a PART of your life-it needs to fit in with the other parts as well.

Anne

ernurseafterall · Jan 8, 2005

Needsmore money makes excellent points. As for scheduling, sometimes you don't or won't know what lies ahead and what can be handled. So you may have the best of intentions and then need to pull back in various times of your life. For me, I had to learn that lesson the hard way..My second time around I was able to commit solidly to a lighter schedule and then pick up extra shifts for people. Which seems to work well.

Life is too short...so you find "it", make the most from it, learn all you can, and be kind to your patients...and then if there is any time or energy left over, be kind to yourself.

I may have a lot to learn about ER nursing, but at least now, I know how to get there without giving up the other things I love more...

ERnurse afterall makes very good points-stability with one preceptor is great-as long as staffing is available. Some nurses, although experienced, are not good mentors -mentoring requires knowledge and people skills. Switching from the training -orientation to the followup mentoring stage can be difficult and many times the new nurse is placed with different nurses. The pros of that are that different nurses have different experiences that they can pass on to others-ie- one way to do something isn't always the ONLY way- just because it works for me doesn't mean it will work for you. The cons of different nurses are as ERnurseafterall stated- some nurses don't mentor well and see it as a "chore", some can be very critical of inexperienced nursing staff. And , unfortunately, there are those who just don't tolerate new staff-maybe see them as a threat to their job ( taking away from time available to pick up as extra $$). Who knows- Also--make sure the job is right for you-in both area of expertise (ER, M/S, NICU-whatever) and schedule- if you can't or don't wish to be fulltime then don't sign up for it- if you want flexibility-make sure that the position has that in place-there is nothing more frustrating than going through an orientation program, then never finishing or leaving right after because of other commitments in your personal life. Frustrating for both you and your ED/hospital orientation program (who sees this as lost money). ER nursing is GREAT, but it is a PART of your life-it needs to fit in with the other parts as well.
Anne