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What you teach nurses in an internship program can make or break your chances for success, stresses Hollie Gehring, RN, CEN, ED nurse clinician at Medical Center of Plano (TX).
In the ED’s internship program, classroom lectures are focused on specific emergency situations, says Gehring. "This ensures that nurses obtain the knowledge base needed to make appropriate decisions in the clinical area."
In the ED, decisions often must be made rapidly and independently, says Gehring. "Classroom time provides each nurse with the fundamentals needed to make appropriate clinical decisions in the ED."
Here are summaries of the content of three successful ED nurse internship programs:
At Robert Wood Johnson University Hospital in New Brunswick, NJ, the hospital and ED nursing leadership worked together to develop a weeklong didactic course to prepare the nurses to work in an adult ED, says Kathleen Evanovich Zavotsky, MS, RN, CCRN, CS, CEN, CNS, C, ED clinical nurse specialist. The course content is based on the common problems of the ED patient, such as neurological and abdominal emergencies, as well as the Emergency Nurses Core Curriculum.
"After the curriculum development, we then looked at the clinical piece of the training program," she explains. "We looked very closely at the orientation manual that we had for the ED with the experienced preceptors and made the necessary changes."
For example, a competency checklist for assessing fetal heart tones was added, says Zavotsky. "Being a Level 1 Trauma Center, we were seeing an increase in pregnant trauma patients," she says. "So the preceptors wanted to include this as a basic competency during orientation."
A preceptor workshop was held for experienced nurses to help prepare them for the new nurses. "We estimated that most of the new nurses would need about 10 weeks of clinical orientation in addition to the weeklong didactic session," says Zavotsky.
The first program was offered to five in-house transfer candidates, so issues could be identified and necessary improvements made before outside candidates were contacted. "We then opened the program to outside candidates and advertised through the nursing journals, conferences, and the Internet," Zavotsky reports.
At Medical Center of Plano, the internship is a 13-week course in which 15 eight-hour class days are front-loaded and the rest of the time is spent in clinical applying newly acquired knowledge to specific patient situations, explains Amy Atnip, RN, MSN, director of emergency services.
Each ED manager is responsible for the hiring of general nurses or inexperienced nurses and then reserving a space for them in the internship program. There are identified preceptors at each facility to assist each new hire with their clinical orientation. The process in which clinical orientation is accomplished is up to each individual facility, Atnip explains.
At the end of the 15 class days, a test is given to establish baseline competency coming out of the program and also to identify areas in which the orientee may need special attention at the clinical site, says Atnip. "Some managers have chosen to have the orientee repeat the test at the end of their clinical rotation in hopes to show improvement," she explains.
At Promina Gwinnett Health System, managers at the five EDs in the hospital system select interns, says Sandy Vecellio, RN, BSN, ED clinician at Gwinnett Medical Center in Lawrenceville, GA. "The managers look at their vacancies and then determine how many they can put in each area. This past year, we had six interns in the program, all new graduates."
The 12-week program includes two classes per week and two to three days of clinical to make 40 hours. "In the ED rotation, they have to go through all five EDs. At the end, the decision is made which ER department they will go to, and they have input into this, also," she says.
The classes are specifically geared toward the ED during the last four weeks, covering cardiac emergencies, trauma, shock, and orthopedic emergencies. "The students have a test after each system and must make a score of 80. If they do not make this score, they are given a case study to do on their own and return," says Vecellio.
Nurses cannot fail more than three tests or they are out of the program, says Vecellio. "There are also expectations for the clinical time as far as being on time and not absent, and getting back good evaluations from their preceptors. If we find that at the end of the internship that someone still is not quite ready to be on their own, we can work with them and give them more orientation time up to a point."
For more information on nurse internships, contact:
• Hollie Gehring, RN, CEN, Emergency Department, Medical Center of Plano, 3901 W. 15th St., Plano, TX 75075. Telephone: (972) 519-1505. E-mail: firstname.lastname@example.org.