I had my ED (Emergency Department) preceptorship during the COVID pandemic, and this was during the time when nurses were mass-quitting, and fed up with everything. ED Preceptorship was the most challenging, yet the most rewarding, clinical I had in nursing school. The ED is for those who are willing to be flexible, able to handle high stress, and open to learning completely new things. Here are some must-know things before you start your ED preceptorship, especially if this is your first time in the ED.
Know Hospital Protocols
During your orientation, they usually go over hospital protocols. This includes emergency protocols, codes, important numbers to call, and so on. Definitely pay attention to the emergency protocols. For example, you want to know what to do when a code grey or silver is called, and where to go. For my hospital, a code grey is a combative person, and a code silver is an armed person.
In the ED, there are also certain protocols for treatments and interventions. For example, my hospital requires that we treat DKA by having an insulin drip and D5 NS running together at the same time, and a strict potassium repeat test every two hours. Get familiar with these protocols in case you get a patient that has a condition that requires specific protocols to be followed!
Study before your first day on the floor
For skills, know how to insert an IV, foley catheter, and NG tube. Know how to get an EKG and how to read it, especially for myocardial infarction. Know how to do a rapid assessment, head-to-toe assessment, and a focused assessment on different parts of the body. Know how to do your NIHSS stroke scale and recognize a stroke (BE FAST acronym). Also, know how to give fluids, and medications through different routes, and how to draw labs with certain tubes.
Things to do on your first day
On your first day, the only thing you should focus on is absorbing everything that is happening. Know where all the supplies are, and where the crash carts are. Understand how the workflow is, and start getting used to the environment. Also, talk to the staff and get to know them! Help out when you can, and learn as much as you can from your preceptor. You should write down things that you do not know and need to study for the next day you are there.
overall message: be friendly, open to criticism, and be proactive
ED nurses need to be proactive and anticipate what orders the doctor will put in. If a patient is presenting with nausea and vomiting, what kind of orders would you anticipate? Some answers can include fluids, nausea medications, labs, or an x-ray and ultrasound. If they do not have IV access, get access as soon as you can in case a patient needs fluids or codes. Being proactive comes a long way, and it can get you a great letter of recommendation from your preceptor.
You will not know everything in the ED. There will be something you have not seen before, and you should ask as many questions as you can to improve your skills for next time. The ED is a fantastic place to learn, and while it is tough being a new grad in the ED, I personally think it is one of the most rewarding nursing careers.