Scared about mentorship in the ED/ER

Quest5, BSN, MSN, RN · Oct 31, 2014

A mentor ship in the ED can be a fantastic opportunity to work on assessment skills, to use non-medication comfort measures and to participate in interventions with a wide range of patients in a comparatively short time. Be prepared to be on your feet the entire period, so show up well rested and no yawns, or complaints. Have all the necessary paperwork available for your mentor.

Technology is great but any personal cell phone use is inappropriate; HIPPA regulations can be a challenge in an ED, so if you see people you know at all, respect their privacy without exception. No names, no photos, no recordings, no matter how spectacular or news-worthy. Try to act as a professional at all times.

The schedule in many EDs is usually unpredictable but there are some generalities. Some days and times are usually busy, so if you're worried, try to arrange to start on a less active time but remember, chances are you will need to follow your mentor's schedule, one that may have been set a month or more ago. If you have contact information, try to call your preceptor before your first shift to confirm what is expected of you and some minor administrative details, like whether you will have a secure place for your things, meal breaks, etc. If you are allowed to do so, ask to visit the ED in advance or to arrive early, just as you would to get a clinical assignment during other semesters, to find who is who and out where everything is located, including the small things like bedpans, urinals, linen, portable ECG, crash carts, etc. Should your first hours be hectic you will feel less lost if you have a clue where to find things and who does what. Until you really have a sense of what is expected of you, stay out of the way during emergent care of critically ill patients. Don't take it personally if you are spoken to sharply in the heat of a moment. The ED can be highly stressful even for experienced staff.

Asking questions will be expected, but pick your time and place. Especially if the ED has curtained cubicles, remember that sound carries, so be cautious about discussing anything where you may be overheard. Patients in the ED are often frightened so simple things, even a warm blanket or a pillow, if you can find one, mean a lot. Don't offer false reassurances and don't assume that a patient wants you to discuss anything about anything with anyone, family included.

Make the most of the many learning aspects available in an ED, including triage, urgent care, pediatric emergencies, communication with inbound ambulances, cardiac/ respiratory emergencies, etc. The variety can be amazing. In the unlikely event that things are slow for more than 15 min., resist the temptation to sit down. If there is nothing you'd like to discuss with your preceptor, volunteer for tasks. Simple things like ensuring all cubicles are ready for patients, including the code/ trauma rooms is a chance to become more at ease in the ED. Checking supplies on code/ crash carts will teach you the variety of supplies required rapidly. Learn to use the equipment, especially portable ECG and cardiac monitoring; even if you have some experience with these, there are always opportunities to become more adept.

Stay awake, attentive, and professional. It is acceptable to be anxious, but not to be frozen with fear. When in doubt ask if you can assist. If confronted with the horrific, keep control of your emotions and your face by remembering that the patients/ family/ friends are far more scared than you and are watching to see their worst fears confirmed! Should you feel faint or about to vomit, get out of the patient care area or anywhere you might obstruct movement. Of course, if you must leave the unit, let someone know and come back without delay.

Lastly, bring your sense of humor. ED humor is sometimes a little off-beat but it cuts the stressors to manageable size. Don't consider telling any stories or jokes to your class mates later, as chances are they will seem inappropriate or unfunny.

You may feel you are there purely by chance, but that is rarely so. You are nearing the end of your entry-level education so you have the knowledge to be successful during this mentorship. Make the most of the experience. It may lead you to a career in the ED, or not, but at the very least it will give you greater confidence in your abilities and skills. 'Best wishes for a great time!

(By the way, my senior practicum in the ED some years ago led to my selection as one of only two new RNs in the department's first new grad program. I felt empowered, confident and blessed that I had that experience my final semester.)

classicdame, MSN, EdD · Oct 31, 2014

ER can be fun because it is fast-paced and you can see lots of patients in a shorter period of time. You will want to focus on your assessment skills and what they need NOW.

righteousjenn · Oct 31, 2014

A mentor ship in the ED can be a fantastic opportunity to work on assessment skills, to use non-medication comfort measures and to participate in interventions with a wide range of patients in a comparatively short time. Be prepared to be on your feet the entire period, so show up well rested and no yawns, or complaints. Have all the necessary paperwork available for your mentor.
Technology is great but any personal cell phone use is inappropriate; HIPPA regulations can be a challenge in an ED, so if you see people you know at all, respect their privacy without exception. No names, no photos, no recordings, no matter how spectacular or news-worthy. Try to act as a professional at all times.
The schedule in many EDs is usually unpredictable but there are some generalities. Some days and times are usually busy, so if you're worried, try to arrange to start on a less active time but remember, chances are you will need to follow your mentor's schedule, one that may have been set a month or more ago. If you have contact information, try to call your preceptor before your first shift to confirm what is expected of you and some minor administrative details, like whether you will have a secure place for your things, meal breaks, etc. If you are allowed to do so, ask to visit the ED in advance or to arrive early, just as you would to get a clinical assignment during other semesters, to find who is who and out where everything is located, including the small things like bedpans, urinals, linen, portable ECG, crash carts, etc. Should your first hours be hectic you will feel less lost if you have a clue where to find things and who does what. Until you really have a sense of what is expected of you, stay out of the way during emergent care of critically ill patients. Don't take it personally if you are spoken to sharply in the heat of a moment. The ED can be highly stressful even for experienced staff.
Asking questions will be expected, but pick your time and place. Especially if the ED has curtained cubicles, remember that sound carries, so be cautious about discussing anything where you may be overheard. Patients in the ED are often frightened so simple things, even a warm blanket or a pillow, if you can find one, mean a lot. Don't offer false reassurances and don't assume that a patient wants you to discuss anything about anything with anyone, family included.
Make the most of the many learning aspects available in an ED, including triage, urgent care, pediatric emergencies, communication with inbound ambulances, cardiac/ respiratory emergencies, etc. The variety can be amazing. In the unlikely event that things are slow for more than 15 min., resist the temptation to sit down. If there is nothing you'd like to discuss with your preceptor, volunteer for tasks. Simple things like ensuring all cubicles are ready for patients, including the code/ trauma rooms is a chance to become more at ease in the ED. Checking supplies on code/ crash carts will teach you the variety of supplies required rapidly. Learn to use the equipment, especially portable ECG and cardiac monitoring; even if you have some experience with these, there are always opportunities to become more adept.
Stay awake, attentive, and professional. It is acceptable to be anxious, but not to be frozen with fear. When in doubt ask if you can assist. If confronted with the horrific, keep control of your emotions and your face by remembering that the patients/ family/ friends are far more scared than you and are watching to see their worst fears confirmed! Should you feel faint or about to vomit, get out of the patient care area or anywhere you might obstruct movement. Of course, if you must leave the unit, let someone know and come back without delay.
Lastly, bring your sense of humor. ED humor is sometimes a little off-beat but it cuts the stressors to manageable size. Don't consider telling any stories or jokes to your class mates later, as chances are they will seem inappropriate or unfunny.
You may feel you are there purely by chance, but that is rarely so. You are nearing the end of your entry-level education so you have the knowledge to be successful during this mentorship. Make the most of the experience. It may lead you to a career in the ED, or not, but at the very least it will give you greater confidence in your abilities and skills. 'Best wishes for a great time!
(By the way, my senior practicum in the ED some years ago led to my selection as one of only two new RNs in the department's first new grad program. I felt empowered, confident and blessed that I had that experience my final semester.)

Thank you for this! I start nursing school in January and there's really no doubt in my mind that I want to be in the ED when I graduate. I hope to get an opportunity that OP was presented with and yourself as it would help me secure my foot in an ED door.

I can't wait

SoaringOwl · Nov 1, 2014

I only had 2 ED days in nursing school, and they were surprisingly dull, especially for a trauma center! The issues were lots of simple stuff that they could have gone to a clinic to take care of, but of course they didn't have insurance, so that's what the ED's for these days. Colds, flus, something hurts, blah, blah, blah. I didn't think I'd like ED, but it was a great experience. Go in with an open mind, and remember your preceptor will guide you. No one expects you to have the instincts to know what to do right now. That's why you're a student. :yes:

springchick1, ADN, RN · Nov 1, 2014

I ended up in the ICU and dreaded it. I had zero critical care experience and was scared of the extremely sick patients. I finished my 90 hours last weekend and I loved everything about my experience. I was able to preform more skills during my preceptorship than I did during the rest of my clinical experiences combined. I did IVs, foleys, blood draws, teach care, vent care etc etc. The first day is the scariest just because you don't really know the unit and you aren't familiar with the staff. It WILL get better. Good luck!!