question for those who started work in ER...

imanedrn · Jun 8, 2008

Hi,
I am a fourth year student doing my placement in the emergency department. I am a month in and was finally starting to feel that I might be up to the challenge of working in the ER as a new grad. Problem is this... I was placed with a nurse that is not my preceptor today (my preceptor was on desk) and completely had my confidence shot! It's not that I thought I knew everything before today (far from it) but today made me realize that I have been so focused on learning skills and procedures, that I forgot to stop and think about what was happening with each patient. This nurse kept asking me what my impression of each patient was and I had NO idea how to answer! I'm just wondering if this is a normal stage to be at or should I consider other areas of nursing?

Let me start by saying that several of my classmates went right into ED, and they're doing very well.

In your situation, I think you have to take a step back and realize that both of these individuals you've worked with clearly have a different perception of what a student / preceptee needs to be learning. Also, since this was your FIRST day with this other person, and s/he was so focused on things that your preceptor has NOT been, it's only natural that this would come as a dramatic shock to you. Fortunately, this is all part of the learning process.

Also, each person you work with throughout school and your career (whether directly or indirectly) will have a different take on their role / perspective / etc. about every situation. This is usually why students & NGs are paired with a SINGLE preceptor -- because multiple individuals can severely confuse a learner, as you experienced, of course.

Don't let this experience throw you off course, though. If you work with this same individual again, explain that your preceptor does it a different way and ask him/her how their focus on these different aspects made ED nursing work for them. When you're with your preceptor again, explain that nurse X focused on Y items and ask why their way works for them. Just make sure to phrase that in a "I'm trying to understand multiple perspective better" sort of way rather than a negative one, as the NCLEX taught us never to ask "why" questions

If they're both "good" teachers, they should be willing to explain the why's and how's and what's, etc. of their role in the ED. Also, they should be able to solicit feedback on how well they think you're progressing in the ED. However, take each with a grain of salt. Again, since each has such a different perspective, they both probably will have a drastically different response (i.e., some people believe NGs NEVER should start in the ED while others believe NGs are just as capable as learning there as any other specialty).

Good luck and keep remembering that learning will always be (at least!) a tad difficult...

angel337, MSN, RN · Jun 8, 2008

Hi,
I am a fourth year student doing my placement in the emergency department. I am a month in and was finally starting to feel that I might be up to the challenge of working in the ER as a new grad. Problem is this... I was placed with a nurse that is not my preceptor today (my preceptor was on desk) and completely had my confidence shot! It's not that I thought I knew everything before today (far from it) but today made me realize that I have been so focused on learning skills and procedures, that I forgot to stop and think about what was happening with each patient. This nurse kept asking me what my impression of each patient was and I had NO idea how to answer! I'm just wondering if this is a normal stage to be at or should I consider other areas of nursing?

nursing is not just tasks. the biggest part of being a good nurse is using critical thinking and prioritizing. i think it is completely appropriate when a preceptor challenges your critical thinking, because in the long run thats what will save your butt if something goes wrong. not how well you placed an IV. good luck in your career, you will appreciate this preceptor later when you actually become a nurse and are on your own.

mom2michael, MSN, RN, NP · Jun 8, 2008

Some preceptors are good at teaching skills. Other preceptors are good at teaching critical thinking. It's your job to take all the information given to you and figure out how it works for you.

And I also agree, at this stage in the game it's probably good for you to see outside the box and a much bigger picture than just the nursing tasks. So you were unprepared for it one day - doesn't mean you'll be unprepared for it the next time you are there.

You'll do just fine in the ER if that's where you really want to work when you graduate!!!

SecondGenRN · Jun 9, 2008

I just want to say thank you to the people who responded. I made an effort today to use critical thinking with every patient (if only to myself). I think yesterday wasn't so much about not knowing the answers but that

a) I'm a student and not used to people asking my opinion, and

b) This nurse is very experienced and I was somewhat intimidated by her

anyway thanks again for the responses, better I start thinking about this now than at graduation!

edmia, BSN, RN · Jun 9, 2008

I have to tell you that I started straight into the ER and what you are feeling is completely normal.

Although it's ok for your preceptor to challenge you, don't feel like you have to come up with the right answers all the time. Part of her job is to push you a little.

I think it was into my 6th month into the ER work that I was able to fully turn my brain's focus from procedures to be gotten down pat to critical/holistic thinking.

My colleagues have all expressed a similar mind shift from when they started in the ED, even nurses with prior med/surg experience.

The thing with the ED is that the amount of procedures you need to be able to perform is Huge. I think on a med/surg or even critical care setting, the variety of procedures is less and you can get to the critical thinking portion of nursing faster. But the scope of your work in the ED is much broader and so it takes a little longer for that muscle memory of repetitive tasks to set in.

Some things you'll get down faster- ie: lab draws and IVs. But then there are tasks like eye irrigation that you don't do everyday.

It's a long road, but don't despair. It's ok to feel like you're lost at this point. You'll surprise yourself by how much you actually do know after just a few more months.