Grow your own’ nurses for staffing the ED

Having trouble finding experienced ED nurses due to the nursing shortage? Why not "grow your own" by starting an internship program for recent graduates?

Recent nursing school graduates often are capable of working in the ED, says George D. Velianoff, RN, DNS, CHE, executive vice president of nursing for the Des Plaines, IL-based Emergency Nurses Association. "They need to be able to prioritize multiple tasks and think critically," he says. "However, for this to be effective, a good mentoring and orientation program is needed — not two weeks of training and You’re on your own.’"

HCA/North Texas Division, which has 10 EDs, has developed an innovative internship program. "This broadens the pool of applicants to include recent nursing school graduates and experienced nurses without an ED background," explains Cindy Asche, RN, BSN, nurse manager of the ED at Medical City Dallas Hospital. "A lot of nurses would like to work in the ED but don’t have critical care experience, so they have never been able to get a foot in the door," says Asche. "Other nurses are burned out and need a change."

Here are some key components of the ED nurse internship program:

  • All EDs in the system share the workload. No one hospital has to bear the entire cost of putting on an ED internship, Asche notes. For example, each ED took a different day to be responsible for providing lectures. "Several of us wrote the objectives and course curriculum so we could have quality control over what people are teaching."

  • Each ED makes autonomous decisions. "Every ED in our system sets its own criteria, hires its own interns, sets a salary, and decides whether there will be a contract or bonus," Asche says.

  • Interns attend lectures in a central location, then work clinical shifts in their assigned EDs. The six-week internship program is intensive and combines lectures with clinical shifts, she says. "The nurses are getting a phenomenal amount of education in that time. We feel that it will give them the knowledge basis for being a good ED nurse."

    The coursework reviews the emergency nursing core curriculum, every major system in the body, and frequently seen emergency medical conditions, says Asche.

    She estimates that $7,500 of educational nonproductive time is invested in each intern, including classroom time and clinical experience.

  • Each ED arranges lectures with experts. Each ED tries to secure the most knowledgeable experts in its institution to teach segments of the course, says Asche. "For example, we got the nurse educator who teaches cardiac assessment for our hospital to do that segment, and we had our ED medical director do a lecture on overdose and substance abuse."

  • Every intern is assigned a staff nurse as a mentor for the 12-week program.
    The mentor’s job is to make sure the intern is competent, she says. "They go over the things they have learned in class and put them into practical application."

    Staff nurses are supportive of the mentoring program because they don’t want to work short-staffed, she explains. "They like the prospect of being able to grow’ their own nurses to fit into their unit. They are willing to do an awful lot so they are not working short."