How to get a job as a new grad in the E.R.?

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    I am in a BSN nursing program now and I am really interested in working in the E.R. On Thursday I shadowed an instructor of mine who works at the E.R. at NYU. I LOVE the energy and I know I have the attributes and qualities it takes to work there.

    So my question is... A lot of nurses say you need to get experience on a med-surg floor. Do you think this would help for in the future to work in the E.R.? I want to be confident in being an E.R. nurse, so I know it might not be the best decision to try work there straight out of nursing school. A nurse in the E.R. had told me she had the opportunity to get a job right out of nursing school in the ICU so she worked there for 5 years. Do you need experience in the ICU to be an E.R. nurse or vice versa? What steps should I take to get there sooner and prepare myself? (a nurse recommended taking the ACLS and PALS before i try to get a job to better my chances). I'm def interested in being in a setting where it is fast-paced and I will always be learning. Also, is it that hard to get a job in an E.R. everywhere else as it is here in NYC?

    Thank you!!
    Last edit by Laurenslovely on Apr 14, '12
  2. 8 Comments so far...

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    I can't answer the NYC question, however I have been an ER nurse for the last 7 years and started right out of nursing school. Back then, you couldn't take ACLS/PALS until you actually passed your boards (they wanted you to focus on that over anything else) but I will tell you what DID help: Working as a tech in the ER during nursing schoo. I think as a new grad you are never going to be 100% confident. Heck, after 7 years I am not confident in everything and still ask questions. But I think that is a quality that is appreciated because it is always better to ask if you don't know or are unsure of something.

    The experience in the ICU before ER and vise versa is going to vary. Some require it, some don't. At my facility (I am at a Level 1 pediatric trauma center in Missouri) we have a really good new grad program. It is 6mo long and you are with three different nurses (one day, one mid and one night so you get a feel for each shift), however those are the only nurses you will be with through your program. As far as going in right out of school, that is going to be a personal choice. You can always apply and see what happens. When I got my position, I had been a tech for 2 years in the ER, so I had a little bit of an abridged preceptorship. It was 2 weeks long and then I was on my own (I don't recommend that route). However, I know other facilities have 12 week orientation programs, no matter the experience. You can always ask for more time on orientation as well. So don't let the whole "fresh out of nursing school" label keep you from applying. My recommendation is apply anywhere they will take the application and see how it goes.

    Good luck! ER is a very interesting area and you will constantly be learning something new.
    Laurenslovely likes this.
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    First, I suggest using the search function to find the other threads on this exact topic. They're fairly common, and the advice gets repeated.

    Secondly, I have to agree that EDs vary by the type of experience they require for new hires. I'm of the personal opinion that if a common/semi-common specialty unit (Telemetry, ICU, Emergency, GI, Burn) doesn't hire new nurses because "it never works out," that reflects negatively on the department, not the nurses they hire. /soapbox

    Third, I suggest you get more experience, especially if it can help get you acquainted with emergency and/or prehospital care. Sitting through an EMT class and the state exam for that license is a great way to go - much more than a CNA if you're aiming for the ED. The former are trained to assess and think, the latter are expressly barred from it. Many EDs hire EMTs in addition to/instead of CNAs. If you can't find a spot in an ED, you can try for one on a rig or doing some other sort of transport or prehospital care.

    As for NYC - some of the docs in my ED did their residencies there. From what they've said, the hospitals themselves can be rather nice, but the all the EDs in the city are like stepping into the third world. You're a braver person than I if you want to practice in that kind of environment.
    Laurenslovely and hiddencatRN like this.
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    Classes or cert: ACLS and Pals minimum (have these before you apply)..TNCC great way to assess your trauma pt (not require but shows you are interested).
    Jobs: ER tech (in my area, hard to get) or Unit secretary in ED (easier to get a job but a much more complicated job). EMT on a rig, not the best job for getting into the ED, the ED manager will never see you.

    Goal: get to know the people who will hire you and make a good impression. (head on shoulder, reliable)

    Confidence.... the only way to be confident in the ED is to see things a million times and then you are probably going to make a mistake. Not being confident is better. When you are not confident you will ask a lot of question of other nurses and the doctors, triple check that drug you are about to give to that infant (scary) and make sure that pt is on the monitor. Competent is a better goal.
    Last edit by Robublind on Apr 18, '12 : Reason: add on to blood already drawn
    Laurenslovely likes this.
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    Love that last reason to edit, robublind
    Laurenslovely likes this.
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    Quote from TheSquire
    First, I suggest using the search function to find the other threads on this exact topic. They're fairly common, and the advice gets repeated.
    Seconded. There are a ton of threads here with some great advice as well as discussion on new grads in the ED. Several board regulars started in the ED as new grads and have posted in depth in other threads about how we did it and what to look for.
    Laurenslovely likes this.
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    Quote from rndiver82
    I can't answer the NYC question, however I have been an ER nurse for the last 7 years and started right out of nursing school. Back then, you couldn't take ACLS/PALS until you actually passed your boards (they wanted you to focus on that over anything else)

    However, I know other facilities have 12 week orientation programs, no matter the experience. You can always ask for more time on orientation as well. So don't let the whole "fresh out of nursing school" label keep you from applying. My recommendation is apply anywhere they will take the application and see how it goes.

    Good luck! ER is a very interesting area and you will constantly be learning something new.
    Thank you for the encouragment!! It's true "new grad" is just a label-- I can't let it to stop me from achieving what I want. I wasn't aware of the hospital orientaion programs, it seems like a real opportunity. As for the ACLS/PALS, you still do have to have your license to take the class, at least here in NY.
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    Quote from TheSquire
    As for NYC - some of the docs in my ED did their residencies there. From what they've said, the hospitals themselves can be rather nice, but the all the EDs in the city are like stepping into the third world. You're a braver person than I if you want to practice in that kind of environment.
    Thank you for the advice, I really love the energy. I think it may be a personality attribute rather than being brave!
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    Quote from Robublind
    Classes or cert: ACLS and Pals minimum (have these before you apply)..TNCC great way to assess your trauma pt (not require but shows you are interested).

    Confidence.... the only way to be confident in the ED is to see things a million times and then you are probably going to make a mistake. Not being confident is better. When you are not confident you will ask a lot of question of other nurses and the doctors, triple check that drug you are about to give to that infant (scary) and make sure that pt is on the monitor. Competent is a better goal.
    Very wise advice! I'm known for constantly asking questions as it is. I don't lack confidence, but I am interested in becoming a good nurse. I will look into the TNCC class as well. Thank you


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