Emergency Department Immersion: A Clinical Elective.

Contribution to Emergency Nursing Practice

Nursing schools are attempting to find creative ways to incorporate clinical rotations during the COVID-19 crisis. A creative way to incorporate clinicals is the use of electives in specialty areas.

This article explains how professional relationships between hospital management teams and nursing school faculty can help increase students’ clinical experiences while immersing them into the world of the emergency department.

This elective provided unique opportunities for the students and allowed them to increase their clinical judgment and confidence in their skills. There were numerous opportunities to help the students improve on their career development skills.

Many scholars agree that clinical experiences are the best way to develop deep knowledge of nursing practice. Even though clinical hours are planned in the curriculum, students enjoy additional opportunities to prepare for graduation and career opportunities. This article explains how an elective ED course helped to enhance nursing students’ clinical judgment, interprofessional collaboration skills, and technical nursing skills during the COVID-19 pandemic.

Attempting to obtain clinical experiences during a time of crisis was hard for many nursing schools. Federal and state protective orders shut down many hospitals that students had attended. Students had to adapt and learn through a new environment using video conferencing devices. However, this article focuses on creating an elective in an emergency department made possible by existing professional relationships between the management team and a faculty member from a prominent bachelor of science in nursing program.

Creating a trusting and supportive relationship with the hospital’s management team made it possible for this elective to succeed during a crisis. The faculty members and management shared common ideas, such as a structure for the students during clinical experience, immersion in the emergency department's reality, and focused, high-quality, patient care. During the COVID-19 pandemic, hospitals became understaffed, and the staff was very stressed and tired. However, by allowing the students to participate in this ED elective, they could perform nursing procedures, learn how to communicate with patients and their families, and complete assessments.

The faculty member created an application to learn why students were interested in the course. The students were interviewed by faculty and offered acceptance to the most promising students. At the end of the process, 6 students were enrolled in the course. Students typically have a knowledge deficit in specialty areas, and specialty electives help students strengthen knowledge deficits or focus on clinical interests to prepare for nursing practice. Previous literature has shown that providing additional opportunities strengthens relationships with practice partners, helps with the graduating students’ job placement, and increases students’ clinical judgment. , Nursing electives allow students to explore nursing areas that may not be available during clinical rotations, such as hospice or palliative care, perioperative, rehabilitation, geriatrics, oncology, and global health.

Goals for the Course

The student learning outcomes for this nursing elective focused on students applying their previous knowledge, increasing hands-on skills, reinforcing professional behaviors and core values, and focusing on the safety of the patients and the students. The participating students had completed third-semester courses, and this elective course helped them apply their knowledge to complex situations in the ED setting. The students also focused on delegation, leadership, communication, interprofessional collaboration, and applying evidence-based practice within the health care setting.

Description of Course

The faculty member planned the ED elective course in a 941-bed community hospital. In preparation for ED practice, the faculty member planned the first clinical day in the campus-based Learning Resource and Technology Center to practice using ventilators, hot-line tubing, warming blankets, and defibrillators; the students also reviewed skills with the placement of intravenous catheters and urinary catheters. This experience exposed them to the equipment and skills that they would encounter in the emergency department, allowing them to practice with the equipment in a nonstressful environment. The students used case studies and ED protocols to help them learn to think through common emergent conditions.

Immersion Experience

Students immersed themselves in 10-hour days where they learned how to function in a complex, chaotic ED. They worked and interacted with nurses, physicians, respiratory therapists, radiology technicians, and many others who were part of the health care team. The students completed 90 hours. Students filled out an assessment form on their patients during their clinical and then reflected on their experiences throughout that day. Clinical experiences provided the students with opportunities to build their clinical judgment, interprofessional collaboration, and technical nursing skills. Students took care of patients involved in traumas, cardiac or respiratory arrest, shortness of breath, abdominal pain, and injuries, among many other issues. Students debriefed at the end of the clinical day to reflect on what they learned and connect disease processes to nurses’ actions to care for their patients.

Clinical Judgment

The students developed their clinical judgment by applying the knowledge they had learned in their classes and putting it into practice. The students analyzed laboratory data, reviewed diagnostic studies, looked at prescribers’ orders, and performed assessments. This experience increased their clinical judgment by linking different concepts and assessing how different disease processes affect one another.

Interprofessional Collaboration

The students learned to anticipate the client’s needs by engaging with the health care team members. Students learned from physicians and interacted with them during their time in the emergency department. During these encounters, the students learned communication and professional skills that they did not have before this experience. Many students interacted with respiratory therapists while patients were on the ventilator and learned about the ventilator while helping perform nursing care on these patients. Students interacted with radiology technicians and learned the importance of monitoring the patient in radiologic procedures. Students collaborated with the pharmacists while they made their rounds consulting about medication. Pharmacists also were present during trauma codes and cardiac arrests, so the students observed the role of the pharmacists in the hospital in an emergent situation. This interaction with interprofessional teams allowed the students to understand how important it is for health care teams to work together.

Technical Nursing Skills

Many students are eager to perform skills during their usual clinical rotations. Students performed assessments, initiated intravenous placement, performed catheterizations, administered medications, and assisted health care providers with procedures, postmortem care, and many other nursing skills. Some students got to assist with level I or level II traumas. This experience allowed the students to practice chest compressions, watch chest tube placements, observe endotracheal intubations, and help with running a code on a patient. By the end of this ED elective, most students were proficient in starting intravenous placements, using infusion pumps, and performing assessments. Students assisted providers with procedures; they understood teamwork by helping with these patients during an emergent situation.

Career Development

This ED elective allowed the students to develop their future career and professional skills. The students learned how to manage patients, organize their time and care, prioritize patients for assessment, and communicate with other health care professionals. Through this elective, students gained more confidence in themselves and their skills before participating in their preceptorship. Most students who participated in this elective stated that the emergency department was where they wanted to work after graduation, giving them an inside look at the work of an ED nurse.

Reflections from Students and Faculty

Students were eager to learn and take care of the patients. When the students met in the morning, they were eager for their assignments and to start the day. Students repeatedly said that they enjoyed this elective, and they were grateful for the opportunity to learn. Students commented, “I felt I had more opportunities to learn hands-on skills and what it is like to be a nurse during this summer’s clinical than I have in all other clinical experiences. This elective was easily the most beneficial clinical I have had.” Another student commented, “I learned so much and will be able to use the information I learned in next semester and my nursing career. I give this course a 10/10 recommendation.” At the end of each 10-hour day, the students continued to smile and were excited to share their experiences.

This experience was very humbling as a faculty member because it is easy to get discouraged in times of crisis. It was re-energizing because of the students’ dedication to learning and passion for caring. The students dealt with death, suicide, trauma, and very sick patients, but they provided care with poise and grace. They gave all they had to help patients and learn how to give their best to future patients. As the faculty member involved in this course, it is of recommendation that nursing schools provide more elective courses in specialty areas such as the emergency department, intensive care units, and the operating room.

Author Disclosures

Conflicts of interest: none to report