My brain says no but my heart says yes

[Megsd, BSN, RN]

I am rapidly approaching graduation in November and need to start thinking of what I want to do with my shiny new RN license. Of the clinical experiences I have had, my favorites had been cardiac, CICU and ER. I was fortunate enough to spend 3 days in ER (two at the level 1 trauma center, and one in the pediatric ER)

We are doing preceptorships this quarter and I chose not to list ER as my top choice because I felt I would benefit from floor nursing and get a better grasp of time management for multiple pts, etc. I have been placed on an advanced care Neuro unit, which I think will be a good opportunity for me to accomplish these things. I didn't really expect any of my classmates to get ER (I don't know why) and when two of them did, I found myself very disappointed and annoyed that I didn't leap at that opportunity because deep down, that's my favorite place to be.

While the sheer amount of on-my-toes knowledge required in the ER still boggles my mind, and I know it will take time and practice to improve on that, I LOVE being in the ER. I love the pace, the variety, the close relationship with the other nurses and doctors, the autonomy (once trust has been gained). I am particularly captivated by the trauma aspect and hope someday to be on the trauma team. If I could be an ER nurse, and be good at it, I think I would be very happy.

...but that's the kicker... will I be good at it? I thought at first I'd spend a year or so in ICU first, but I have an opportunity to spend this week there and quite frankly, I don't like it as much as I thought I would. It was just a lot of suctioning, foley-bag emptying, and oral care. It didn't really feel like I accomplished anything. So now I'm rethinking my plan and thinking about trying to get an ER position. I am applying for a new RN internship that would potentially get me a job in the ER with 4-5 months of training, and then a regular orientation after that. But I just don't know if it's the wisest choice to make, even though that's where I am drawn to. I have read in other threads that people sink or swim and it takes certain characteristics to make it... how do I know if I have what it takes?

Sorry this is so long, but this dilemma is driving me crazy!

[raynefall]

Meg,

You will never know if you can make it if you don't try it. The emergency department is not for everyone but it is meant for alot of us, and the only way you will know what your niche is is if you step forward and just do it! Don't let it scare you, remember we all had to start from the beginning. :)

IMO, one does not need a year of med surg or ICU to be an ED nurse, it helps, but as long as you a have thorough, and supportive orientation then you should be fine.

Good luck on the internship.

[donsterRN, ASN, BSN]

I'm just beginning my studies in nursing, so I cannot comment on the educational aspect of clinical rotations, etc. But I did work for a while as an ER tech while I was studying something else, and I can tell you that I learned so much in that job! I saw many things that I wouldn't have seen on an inpt floor or outpt setting. The docs and nurses were wonderful to me in making sure I had the opportunity to see and do so much. It terrified me at first, but I learned to just love it. I think if you have the opportunity to study something you love, then you should take it!

Much good luck to you! I'm eager to get where you are!

[HM2VikingRN, RN]

go for the ER

[JuLyAnGeL]

[color=pink]i don't know wat to say , but i will say goodluck and trust urself cuz urself only now wat you want

[CritterLover, BSN, RN]

i really don't think it matters what type of unit (er, icu, med/surg etc) you go to as a new grad.

what is important is that you find a "quality" unit: a unit that is supportive, nurturing, and has a good orientation program.

look for a unit with a decent mix of newer and more experienced nurses; and at least some of the experienced nurses like to teach/mentor.

look for a unit with a strong manager that has a management style that works for you.

look for an orientation program that is consistent -- you don't want to be swtiching preceptors every time you come to work. (don't expect to always have the same preceptor -- yours may be sick from time to time, and a little variety is good. it is helpful to see how others do things. but having many different preceptors is a bad thing)

avoid any unit that seems to have a "toxic" enviornment: lots of turnover, lots of back-biting, nurses that stay over for hours each shift to chart; "punitive" environments, environments where nurses are disciplined/punished, rather than educated, for every little mistake.

if you can get a good foundation in a nurturing unit, then you will be able to work anywhere.

so even if the er of your dreams doesn't have the good qualities, it doesn't mean you should never work there; however, i wouldn't work there as a new grad.

(by the way, a "formal" orientation program does not equal a "good" orientation program. it certainly helps to have a structured orientation, but sometimes these great oreintation programs that some units promote are great in name only. other things -- esp an experienced, consistent, patient and willing preceptor -- are much more important. you can learn a whole bunch from a great preceptor).

[GilaRRT]

I tend to agree. Go for ER if you want to work that area. I never understood the mantra, "One year of MedSurg before moving to a specialty."

MedSurg is it's own animal and should be considered it's own specialty IMHO. I have seen outstanding floor nurses get killed in the ER and top notch ER nurses die when working on the floor. Each area will focus on specific aspects of nursing care, and one should not be viewed as superior to the other.

[avatar78]

i really don't think it matters what type of unit (er, icu, med/surg etc) you go to as a new grad.

what is important is that you find a "quality" unit: a unit that is supportive, nurturing, and has a good orientation program.

look for a unit with a decent mix of newer and more experienced nurses; and at least some of the experienced nurses like to teach/mentor.

look for a unit with a strong manager that has a management style that works for you.

look for an orientation program that is consistent -- you don't want to be swtiching preceptors every time you come to work. (don't expect to always have the same preceptor -- yours may be sick from time to time, and a little variety is good. it is helpful to see how others do things. but having many different preceptors is a bad thing)

avoid any unit that seems to have a "toxic" enviornment: lots of turnover, lots of back-biting, nurses that stay over for hours each shift to chart; "punitive" environments, environments where nurses are disciplined/punished, rather than educated, for every little mistake.

if you can get a good foundation in a nurturing unit, then you will be able to work anywhere.

this sounds like really good advice. what's the best way to figure out if it's a great er or not?

[nuangel1, BSN, RN]

go for it

[CritterLover, BSN, RN]

this sounds like really good advice. what's the best way to figure out if it's a great er or not?

you do research.

you ask very pointed questions during your interview about length of orientation, format of orientation, average number of preceptors for each orientee (two to three would be a good answer, since a little variety is a good thing), average staff turnover rates, how long have most employees been there, how many nurses with less than 2 yrs experience there are.

another good question is about how much experience the charge nurse has. one of the units where i work frequently has new grads with 5 or so mos of experience in charge. this isn't because they rotate charge to all rns, it is because these nurses actually have senority after 5 months.

once you ask the manager (or whoever is doing the interview), you ask to speak with the staff nurses.

talk to the new grads....what did they think about their orientation? and don't just ask "was it good?" ask specific questions -- how many preceptors did you have? did you feel welcome? how long was the orientation? how were your misktakes handled? did you feel prepared? if no, why not (it is very common to not feel prepared, so expect that).

talk to the more experienced nurses. how long have they been there? why did they stay so long? what do they like about their unit? do they take their lunch breaks? do they get out on time?

more importantly, pay attention to how the staff treats you when you are talking to them. are you welcomed? do you feel intimidated?

also try to talk with employees that no longer work there to find out why, maybe some nurses you went to school with that graduated before you.

[AnnieOaklyRN, BSN, RN, EMT-P]

hi,

I am a new grad in the ER and LOVE it, its where I belong!! Is there anyway you could change your selection for your preceptorship?? I had 9 years of EMS experience so that helped me get the ER job. If you cannot change your selection I would recomend applying for an ER tech position there so that you at least have one foot in the door.

Good luck

Sweetooth

[GrnHonu99, RN]

I thought at first I'd spend a year or so in ICU first, but I have an opportunity to spend this week there and quite frankly, I don't like it as much as I thought I would. It was just a lot of suctioning, foley-bag emptying, and oral care. It didn't really feel like I accomplished anything!

Ok, there def. is quite a bit of foley emptying, suctioning and def. oral care...however, don't discount the ICU so quickly. I work in neuro ICU and I love it! We get traumas as direct admits occasionally..we get quite a few direct admits that before the doc can even get there we are hanging drips...coding..etc..it rocks! I love that I can come back next shift and follow my pt...It's neuro so things are always exciting:) I think i'd like ER too, I just don't like that my time with my pts is so short...