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Special ER Clinical Opportunity-Advice for how to prepare.

Emergency   (789 Views 6 Comments)
by Code Caffeine Code Caffeine (Member)

Code Caffeine has <1 years experience and works as a New Graduate RN.

1,612 Visitors; 44 Posts

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Hello,

I'm excited (and kinda terrified) to start a special one-on-one nursing preceptor program in the ER tomorrow as my final clinical! There were limited spots for these clinical oppertunites and I'm lucky to be there. I want to suceed and do well, any tips on what skills I can look over besides Catheter or ECG? Any tips on how I can stand out or go above and beyond?

Thanks!

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Pixie.RN has 18 years experience as a MSN, RN, EMT-P and works as a Infection Preventionist/Nurse Epidemiologist.

266 Likes; 7 Followers; 32 Articles; 125,669 Visitors; 12,837 Posts

That is awesome! I have moved your post to the emergency nursing forum to encourage feedback. There are also a ton of helpful threads in this forum for students in the ED. Best of luck!!

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PiperLambie has 1 years experience and works as a Emergency Department RN.

1 Like; 1,094 Visitors; 33 Posts

Congrats on your selection into this clinical opportunity!

As a new grad ED RN (started Jan 15), I will offer you the advice that I got as a student going to ED clinical, as well as that which I got when I started on my unit. It happens to be the exact same advice, despite coming from a few different people: Be eager, excited, ready to move, and don't say no!

Obviously, if you are not entirely comfortable with something, say IV sticks, don't turn down the opportunity- instead turn it into the chance for your preceptor to show you their tips and tricks. A couple of months in, despite poking a dozen veins per shift and I still grab my preceptor or a co-worker if I am not certain or if I have no luck after a couple of tries.

The thing that drew me to the ED full time after school, aside from a couple of awesome ED instructors during my ED experience, is the fact that there is a constant pace to things, and you get to see lots of different kinds of disease processes: cardiac cases, neuro/stroke cases, GI/GU illness, maybe some trauma, and the rest of it too- so even if you end up not liking the ED, maybe some specialty area will start to tug on you just by seeing these patient presentations.

While the skills practice part is always cool, absorb as much as you can, since the focus of the ED is different from the rest of the hospital. It's a great opportunity to work on your communication skills, and your focused assessment skills, as well as see the variety of patients that visit an ED, and what "sick" can look like. There might be a homerun ischemic stroke patient one moment that is going to get TPA. Right after you will get your version of the patient that comes in with chest pain starting this morning, a bruise on their knee, back pain, and a toothache that has bothered them for five years, and they'll get the full cardiac workup that returns negative and suddenly remember that maybe their chest is sore because their kid kicked them yesterday when they were pushing them on the swing. They'll chuckle, you'll grab the discharge paperwork, and send them home with an NSIAD prescription and a dental referral.

All the best on your opportunity! I hope it's as exciting for you as my student ED experience was for me- we can always use more ED nurses.

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Code Caffeine has <1 years experience and works as a New Graduate RN.

1,612 Visitors; 44 Posts

Thank you! Everyone is very nice so far! Day one I did more new skills than I have in the last 2 years! That alone blows my mind. I am also facisnated with psych which they say they get a lot of in the ER. I feel like it will be the most well rounded experience I can get. And those 12 hour shifts are NO JOKE! I have a brand new appreciation for what it's really like to be nurse!

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74 Likes; 4,823 Visitors; 370 Posts

My best advice is to figure out what you want out of this experience. When I take practicum or capstone students I ask them what they want. I am more than happy to teach skills, but I think that often the best thing students can learn from the ED is how to manage an ED patient, how to recognize the true sick vs not sick patients, and what the priority interventions are (in the keeping patients from dying sense, not making the most of your time sense). Things like getting good at caths (especially on infants or old ladies), placing IVs, et cetera come with time and practice that you will get if you end up working in an ED.

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11 Likes; 2,194 Visitors; 53 Posts

Congratulations! If, after several clinical days you decide that you want to work there eventually, make sure you advertise yourself to the right people. The clinical will be over before you know it.

As far as being a student - be proactive and safely participate in patient care. I absolutely love it when my preceptee is "on top of things" and not too shy to ask questions, for example: "Patient just returned from CT scan, can I recheck vitals?" or "The next step would be to ...?". When you give meds (with RN) make sure you mention why you give the medicine and how it is going to make them fill, check all info, allergies etc. When there is a dying patient, don't get intimidated to come into the room for check on respiratory rate, for example. Practice bedside handoffs before taking a lunch break/ ending your shift. If you are assigned the sickest patients, and your preceptor is a scribe, try to keep track of everything going on AND next possible steps on a sheet of paper. For example: "0925 intubation 25 at the teeth, size 7.5" - next step is to order and call XRay for confirmation. Patient got intubated? Does the doctor want abgs (some do)? The doctor will probably also want OG tube and a urinary catheter (need another XRay for OG tube). BP too low - think fluids, possibly pressors after fluids. Pressors - does the patient need a central line?

Good luck!

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