Starting my ER Preceptor

Having done my preceptorship in the ED I have a couple of thoughts for you.

1. Know when to say "I don't know."

2. Treat every patient as a chance to learn.

3. Be willing to jump into everything you can, and let everyne know you're a student and they hopefully will let you know when cool and interesting things come up (how I got to see A-Lines, fracture reductions, intubations, helicopter loading, transport, exploratory surgery among other things during my stint.)

4. Do try to do everything at once, take it step by step. In other words, don't expect to take a full load of patients on your first day.

5. Have fun, learn lots and enjoy the rotation.

Cheers,

Tom

Well, first off, make sure you find out what the department wants/expects from you. Will you be there to observe or will you be assisting staff with patient care. As a student, don't expect to have complete care of any patient. Don't get your feelings hurt if you are asked to step aside or moved out of the way. Build a good relationship with your preceptor and let them know that you want to observe as much as possible in the 5 weeks you are there so please let you know if there is anything going on that might be of interest to you. Know how to blend into the wall so you can watch and not get in the way of things that are going on. If you find that you are watching something that is making you feel sick, don't be ashamed to step out of the room. The staff has enough to handle without having to pick a student up off the floor. Don't just want to be in on the "good" stuff, also jump in and watch the mundane, boring stuff. You can learn a lot from watching everything that goes on. And one of the most important rules...don't get offended by the banter that is common to ER folks!!! Good luck with your rotation!

Pam

I had a wonderful preceptor when I did my ER time in school - she pushed me, but sheltered me from certain things (violent psychs), and made sure I was in on as many things as possible. The first day, talk with your preceptor. Figure out how you learn best (doing, or seeing first then doing) and where your comfort level is on procedures - esp IV, NG, Foley, assessment. It is going to be her license on the line while you're practicing, so always be mindful of that and don't take on more than you can handle.

Before your first day, I would review my basic assessment skills (have a good head to toe, but know your system specific assessments too....if you have a healthy 25 year old woman with abd pain, you don't have to do grips/pushes/pulls, but do need to know about LMP, urinary sxs, etc.). Get comfortable with ED meds....Zofran, phenergan, compazine, morphine, dilaudid, demerol (we don't give it as a general rule, but some EDs do), benadryl, valium, geodon, zyprexa, percocet, vicodin, toradol, epi, dopamine, dobutamine, norepinephrine, cardizem, nitroglycerin (SL, topical, IV), heparin. This list isn't meant to freak you out, just give you a chance to go back to your med book and refresh your memory. These are just some meds that I've given in the last few shifts.

Just be willing to jump in and participate. And never be offended by the way the RNs and MDs talk. We have a weird way of relating to one another :) And if someone yells "grab the crash cart" hear the unspoken "please" at the end of it. I quickly found that ER people are a different breed!

Enjoy it!

Could not have said it much better myself. be the fly on the wall. Dont let the ER staff scare you away, we can be like that sometimes- goes with the territory. Also with the feeling ill part if someone tells you it has never happened to them then they havent worked there long enough.

RJ

Well, first off, make sure you find out what the department wants/expects from you. Will you be there to observe or will you be assisting staff with patient care. As a student, don't expect to have complete care of any patient. Don't get your feelings hurt if you are asked to step aside or moved out of the way. Build a good relationship with your preceptor and let them know that you want to observe as much as possible in the 5 weeks you are there so please let you know if there is anything going on that might be of interest to you. Know how to blend into the wall so you can watch and not get in the way of things that are going on. If you find that you are watching something that is making you feel sick, don't be ashamed to step out of the room. The staff has enough to handle without having to pick a student up off the floor. Don't just want to be in on the "good" stuff, also jump in and watch the mundane, boring stuff. You can learn a lot from watching everything that goes on. And one of the most important rules...don't get offended by the banter that is common to ER folks!!! Good luck with your rotation!

Pam

You've gotten some great advice from the other writers, so I'll just toss in some odds and ends. Carry a little notepad and jot down conditions, drugs, procedures and other stuff you come into contact with that you don't know/understand. You'll have a nice list to look up when you have a chance. Memorize and use the phrase, "No, I don't know how to do that, but I'd sure like to learn." Absolutely don't ever bluff that you know something you don't. There is an enormous amount of trust being bestowed on you by your preceptor, who is ultimately responsible for your actions. Always look for something to do to help, whether its grabbing a blanket, getting the drugs, or just soothing the patient. Because of the turnover and pace, teamwork is a big thing in most ER's, and someone who pitches in where they can is always valued. Do as many assessments as you can. Anyone can learn how to put in IVs. Its assessment skills and the ability to prioritize from them that makes a great ER nurse. Finally, I'll echo other writers in saying that many ER nurses/docs/techs are .....alittle quirky and proud of it. Look past the strange jokes and the not-hospital-standard appearances and you'll probably find some of the finest people you'll ever get to work with.

Thank you all so much! Its very difficult at times to want to learn and continue your skills and education, but at times feel as if you dont know that much yet especially in something totally different from med surg. pace. I will take all of your advice, any other advice would be great as far as common meds, common injuries, systemic s/s to brush up on. I can not tell you all how appreciative I am of your time and effort in helping a fellow future nurse.

Congratulations on coming this far in nursing school. I myself just finished what we call our "mentorship program" It was incredible!!! I was in the ER for 5 weeks 24 hrs a week. I work as a tech in another hospital ER, so I fit right in with all the quirkiness!! But, it's true what the others say... be ready and willing to jump into anything you are comfortable with. My first day of the mentorship, my nurse and I encountered, a cardiac arrest, respiratory distress, acute lower GI bleed, and a hip fx all within about 45 minutes. The cardiac arrest we got to the cath lab, the respiratory distress got a bi-pap, GI bleed got the NG tube and the hip fx got a foley and pain meds.... and unbelievably all within 45 min - 1 hour.... I loved every second of it!! Enjoy yourself!! Be confident, but BE SAFE!!