New grad advice???

SOCALRACERX911_RN · Feb 18, 2003

Steth,

I completed my 3month ER New Grad orientation in Nov. and l wouldn't work anywhere else. Knowing and finding the right ER New Grad program is key, so ask lots of questions. Although I had a well rounded medical background prior to becoming a nurse, I don't think it matters, its how bad you want to work there. I have fellow new grads who did not have any medical background and are just doing fine. I think you've had enough life experiences that you should be able to handle anything the ER will throw out at you. It is fast paced. One more thing, the OR is cool and laid back, because I've had prior OR experience Im doing both. You can have the best of both world.

RN STING-ER

ERNurse752, RN · Feb 19, 2003

Find a hospital with a good orientation program (at least 12 weeks) and go for it!

I think working med-surg for a year can be a good thing, but you have to do what makes you happy. It isn't right for everbody!

Good luck!

veetach · Feb 20, 2003

I always play the devils advocate on this one, I recommend at least 1-2 years in Med-Surg. Of course, hospitals now will put new grads in the ER, because they dont have to pay as much for the RN. But to be fair to yourself. You should have some time on a med surg floor. There is nothing like the experience you get taking care of stable patients before you are dropped into a busy ER and expected to know exactly what to do with a patient in an unstable critical situation.

pointhope · Feb 22, 2003

I too recommend time on another floor before going to the ER. Critical Care would be adviseable. Even Tele. Because you have to be DEAD ON ACURATE with your drugs, doses and ability to titrate in a code in the ER. Sometimes many codes at once and not much time to teach. You will also learn great time management skills in the other units before you are expected to use them in a crisis in the ER. In the ER many therapies are initiated but not followed. The knowledge of what the floor will need while they follow this patients is crucial to your appropriate care. Since the ER initiates but does not usually follow the patients, you may miss out on some important skills. For example, you will see how to insert a central line, rarely or never be the one to D/C it and watch for complications. You may be the one to start a blood transfusion, but not know what a transfusion reaction one hour later looks like. See what I mean. I could give hundreds of examples. And then some day later when you are still in ER and the ICU beds are full, you will be expected to do all these follow up skills and assessments and you will lack the experience to do the job (but you may not want to admit this since you have been in ER for a while). You will do your best and assess the patients like you did while you were on the ER floor and you will miss something critical and wish you had gone to ICU etc for some further training. Don't want to be a downer, but want you to come to work in ER fully capeable. Good Luck, whichever you choose.

ERDIVA2B · Mar 4, 2003

I myself just received my RN last June, but have been an LPN working in tele, and an ER Tech in a level one trauma center for 4 years, I completed a 3 month training program with my hospital, excellent! WE did a basic arrhythmia course, 1 week, and a Critical Care Course by AACN course material, and an ER course by ENA guidelines, and materials, plus our actual ER on the floor time with our Coaches. I suggest finding a teaching hospital that has a great training program! I love it!!

veetach · Mar 7, 2003

For all of you new grad nurses in the ER. I commend you on your enthusiasm and it sounds like the hospitals are at least trying to prepare you for your time in the ER. BUT..... unless you have had previous nursing experience in other units, you will run across things that you have never had to deal with before.

With all due respect, dont let your enthusiasm get carried away. NOTHING is as valuable as experience. Learning all facets of hospital staff nursing gives you a wonderful resource to pull from when you do go to a specialty unit.

I currently work with new grads who are really enjoying themselves in the ER. They are not bad nurses, just NEW nurses.

When it comes to things like holding patients with a triple lumen central line, TPN on one port and critical drips on the others, they are stumped. They cant do CBI or assist with PD on dialysis patients. These are all things that can be learned on a good med surg floor. There are many many procedures that are foreign to them because they came right into the ER as a new grad. (where you are expected to know all and to be proficient in your skills and identification of cardiac rhythms, drugs, compatibilities of drugs and treatment of unstable critically ill people. At least that is the case in OUR ER)

I am sorry, I still say. Get some med surg or tele experience, you wont regret it.

KC CHICK · Mar 7, 2003

Tele experience IS wonderful experience.

However, everyone is different. My best friend's husband got a grad nurse job in the ER of a teaching hospital downtown. He loves it!!

You know you're capabilities. Assess your learning and coping abilities and decide for yourself what the best choice is for YOU.

Good Luck!

Anne

jeannet83 · Mar 7, 2003

Steth, Hi! You ask a very good question to which alot of folks will have different answers based on their experiences. I have to say that I look back to my new grad experience 20 years ago on an unusual kind of surgical intermediate care unit in that we had arterial line monitoring and everyone was on bedside monitors (no telemetry) and we did drips. It was hard enough that first yr to get down organization skills, learn new tasks, deal with drips, codes, etc. I, for myself, could not imagine working as a new grad in our busy level I ER/trauma center and currently we do not hire new grads. I have to agree with most that either floor or step-down or even intensive care is a better way to "break in" that first year of nursing.

But if you really desire to go to ER, I do have a few suggestions. Ask alot of questions in your interview:

1) How long is internship or orientation?

2) Do you offer core ER classes, CEN review, critical care courses?

3) Will you definitely get to go to these classes as part of orientation? (You can of course think of a more tactful way of saying it!).

4) How is the repoire (sp?) between the docs and nurses?

5) What is the average patient load?

6) What is the most patients I will have at one time?

Check out the mood of the staff. Are people helping each other out? How are things flowing? Is there alot of yelling and screaming going on? (personally, I don't believe in screaming mimi's in code situations :eek: ) How well are the docs working with the nurses? Are their patients is stretchers in hallways all over the place? (yeah,yeah, I know, a reality at most places, but we actually don't do it-yet).

I think the most important things to look for is a supportive environment, an excellent internship including classes.

I know of hospitals that are offering six month internships for new grads who will agree to work in the ER for at least one year after the internship.

Well, anyway, just a few thoughts. Good luck with your decision! And remember, even if you do a year on the floor/ICU before ER, it will fly by!! You'll be in ER before you know it!

Take care, Jeanne

dcc43210 · Mar 7, 2003

Seth,

Regarding the fact that you are a 49 year old male entering nursing as a second career: WAY TO GO!!!!!!