New grad in rural ER?

Specialties Emergency

Published

I've been debating on whether to go out of state for an opportunity in a rural hospital. Part of my reluctance to go is based on concerns that I will not have enough support during orientation and that I will have too much responsibility too soon. Plus, I have been wanting to get a little floor experience before going into a specialty. However, floor experience is hard to come by. To cut it short, my question is how have new grads/inexperienced nurse done in a rural ED? This ED is a level V. What are your thoughts on the matter. Thank you.

Specializes in FNP- psych, internal med, pediatric.

I just started at a rural ER with one year of experience, and it's so completely wonderful, IMO! 2 trauma beds and 5 non-urgent rooms. One RN, one mid level provider, and one CNA. The hardest part is just getting the rhythm of anything in nursing. It's all about timing whether it's ER or med/surg. Only time will allow you to get into your flow. It's just about when to go in the rooms, calling to give report to do admits, entering meds, past med hx, allergies, starting IV's, getting meds from the pharmacy. Vitals every 30 min. Then the other part of the ER stuff is kinda like OR nursing in that, you're charting when radiology gets the pt and brings them back, when the provider gets into the room, when you gave meds, follow-up on your meds, etc. The hardest part of any nursing job is learning their computer system and where to find what you want when you need it. It's gets chaotic when 4 people walk in together, but it's all about prioirtizing, and just going through the motions. Get'em in 'n'out is very nice. I love it, and my orientation is all dependent on how long it takes me to be independent. Then they say, you're off orientation, your first day on your shift is ........:up:

Absolutely, 400 pt per year is quite low. Just make sure your ready to take on being a charge nurse. I was not ready for type of position straight out of nursing school, with my current facility, but I have worked in critical access hospitals and I understand the flow and organization, so I think you would be fine, sounds like they have a lot of support for their staff when needed. I would however suggest a longer orientation period. No one understands the full aspects of a position in 4 weeks. Best of luck to you!

Specializes in ED, Cardiac-step down, tele, med surg.

Thank you. I talked to the DON and she said that they would be willing to extend my orientation until I was ready. They really need someone and are invested in teaching me. The DON also assured me that I would never be alone to deal with something beyond my ability. How would I know I was ready to be a charge nurse? As far as I know the charge nurse must know the acuity level of all the patients in the hospital and must be able to prioritize, delegate, and direct care. Do you have any tips for me on how to be an effective charge nurse?

Its a learning process, from what you stated you have an understanding of what the charge nurse does. You also need to be aware of current policies and procedures for that facility. Its a learning process that develops over time you will mess up from time to time, but no one is perfect. All you can do is put each day as a new start and assure the safety of patients while providing quality care.

Do not underestimate yourself. Be diligent, follow dr orders, and ask for help when you need it. It is a great learning experience. You were nervous and got the iv. Next time you won't be so nervous. A lot of procedures come with practice, but sometimes if you just relax and know you have ack up ( if you really actually have backup). You cando it!

This sounds like a great opportunity for you - go for it! They are willing to mentor you and are setting you up to win. Don't worry, they will know when you are ready to be charge....trust them. Alot is learning as you go and it sounds like they really want a good team and all will fill in the gaps...just remain eager to learn and in no time flat you'll be on top!

Specializes in ER.
I asked the DON the questions. She said the get about 400 ER patients per year, most of the traumas being minor, lacerations, injections, falls, fractured hips, there have been acute MIs, a few sepsis cases who are transported out. A few major traumas who are transported out (infrequent). She said there are about 3 nurses per shift, the total number of patients in the hospital is 25 (it's a critical access hospital). The DON said she is notified directly of any major traumas and she is 2 minutes away from the hospital. She said the orientation is usually 4 weeks at that she has trained new nurses in the past and that has been enough time. She said she would extend this if needed. She said I would be rotating as med nurse, treatment nurse, charge nurse (everyone rotates). As charge I would be responsible for the 25 beds and ER. She assured me that I would not be left alone to deal with things I would not be capable of. So given that info, do you think it's too much for a new grad?

Are you doing nights or days, or rotating? Daytime you'll have managers, a secretary and respiratory to fall back on if it's busy. Nights, you may be in that ER all by yourself, especially if the floor is full. It's not just a skill issue, but a security issue.

Are you ready to stabilize a sick chest pain with multiple drips, and juggle the paperwork and other patients as they come in? If you are in the middle of that chest pain and a second one walks in, can you handle it? No matter what they tell you, that is the level of juggling you are looking at. If a third one walked in... who are your resources that can come immediately? (not call around and find someone at home) I am concerned about this job, though it sounds like a good opportunity, it will require mad prioritizing and efficiency on your part.

Four weeks orientation isn't enugh for a new grad in med surg, and you will be orienting to med surg and ER. (AND charge??!) I worked in a critical access hospital the same size, and some shifts were dead, some shifts were like the gates were opened and poured criticals. It was just me and the maintenance man. How far away from the ER area are your med/surg nurses? If you hollered would they hear? Realistically, with 25 other patients you cannot pull from them. If your boss is your backup ask her how often she's put on scrubs and worked as staff. If she says once a year, that's no good, but once a month is really good.

Specializes in ED, Cardiac-step down, tele, med surg.
Are you doing nights or days, or rotating? Daytime you'll have managers, a secretary and respiratory to fall back on if it's busy. Nights, you may be in that ER all by yourself, especially if the floor is full. It's not just a skill issue, but a security issue.

Are you ready to stabilize a sick chest pain with multiple drips, and juggle the paperwork and other patients as they come in? If you are in the middle of that chest pain and a second one walks in, can you handle it? No matter what they tell you, that is the level of juggling you are looking at. If a third one walked in... who are your resources that can come immediately? (not call around and find someone at home) I am concerned about this job, though it sounds like a good opportunity, it will require mad prioritizing and efficiency on your part.

Four weeks orientation isn't enugh for a new grad in med surg, and you will be orienting to med surg and ER. (AND charge??!) I worked in a critical access hospital the same size, and some shifts were dead, some shifts were like the gates were opened and poured criticals. It was just me and the maintenance man. How far away from the ER area are your med/surg nurses? If you hollered would they hear? Realistically, with 25 other patients you cannot pull from them. If your boss is your backup ask her how often she's put on scrubs and worked as staff. If she says once a year, that's no good, but once a month is really good.

The DON said that she is called for all major traumas directly and is 2 minutes away. She's had 40 years of experience. My hours are 2pm-10pm (no nights) and there are others on duty. I will not be left alone. This hospital doesn't have critical care capacity, the most it could do was give clot busters and transfer the patient to another hospital (1 hour away). All this hospital does is stabilize and move the patient right away. To answer your question, no, I could not stabilize a patient on multiple drips and juggle paperwork and a second or third one coming in. I would have someone call the DON, and tell the others to come and help. There will be two RNs with me. The other patients in the med/surg part are mostly swing bed patients. All acute patients are transferred out to the major hospital. I know I will need more orientation and have asked about this. The DON said they will give me extra time. Realistically, I think I will need 4 months of orientation. In light of what I've just said, do you think it's too much? I don't want to move away and not be able to do it and have to move back. I have another job locally. Please let me know. Thanks

I think you are panicking before it is time. I really do. The DON wouldn't hire a new grad and ditch them like that, liability is on her too. I think that other people are mixing up posts (it wasn't the OP that said she was left alone or would be left alone, she stated there are 3 on shift) and getting you worried. I think you will do great. You know your limits, the time it would take to feel comfortable (and with the descriptions you are giving, I think you are freaking out and way under crediting yourself). I think you will be fine! If you wanna be there, say yes. You can do this. Do not discredit yourself or let others freak you out. It isn't as if you will be cracking chests, massaging hearts and dealing with blocked airways alone. This isn't major trauma, you will be FINE!

Specializes in ER.

What I understand is that there are three on shift, but those three cover the ER, and 25 other patients in the hospital. If that's true the RN going down to the ER can easily be alone, and someone being able to come from the floor is a great plan on paper, but the ratio doesn't make it very dependable.

Specializes in Acute Care Psych, DNP Student.
Are you doing nights or days, or rotating? Daytime you'll have managers, a secretary and respiratory to fall back on if it's busy. Nights, you may be in that ER all by yourself, especially if the floor is full. It's not just a skill issue, but a security issue.

Are you ready to stabilize a sick chest pain with multiple drips, and juggle the paperwork and other patients as they come in? If you are in the middle of that chest pain and a second one walks in, can you handle it? No matter what they tell you, that is the level of juggling you are looking at. If a third one walked in... who are your resources that can come immediately? (not call around and find someone at home) I am concerned about this job, though it sounds like a good opportunity, it will require mad prioritizing and efficiency on your part.

Four weeks orientation isn't enugh for a new grad in med surg, and you will be orienting to med surg and ER. (AND charge??!) I worked in a critical access hospital the same size, and some shifts were dead, some shifts were like the gates were opened and poured criticals. It was just me and the maintenance man. How far away from the ER area are your med/surg nurses? If you hollered would they hear? Realistically, with 25 other patients you cannot pull from them. If your boss is your backup ask her how often she's put on scrubs and worked as staff. If she says once a year, that's no good, but once a month is really good.

This is the voice of wisdom. I've been in a similar spot, and let me tell you...waiting for the helicopter to show up while one is circling the drain and you've got other high acuity patients...it is terrifying.

Specializes in ED, Cardiac-step down, tele, med surg.
This is the voice of wisdom. I've been in a similar spot, and let me tell you...waiting for the helicopter to show up while one is circling the drain and you've got other high acuity patients...it is terrifying.

It sounds terrifying, but I don't think the DON would leave me stranded. She is 2 minutes away. All I can do is the best that I can and not make a mistake in prioritizing. I can do this on paper, but honestly, my skill set is not that good yet. My last preceptor said that I have the knowledge base down, but that I needed to be able to translate that knowledge physical reality and I did have difficulty with that. My time management is not efficient yet either. In a larger hospital, I know that unless I had a residency program that consisted of 6 month of orientation, I would not be able to do it, in the ED that is. My plan was to get into a med/surg unit and build from there. That opportunity does not exist for me at the present time. I have a job at a SNF now and another part time job. My thought was that this being a smaller hospital and lower acuity it would be easier for me to start in the ED, plus I would get a broader set of skills, and have more options in the future. The DON knows I'm a new grad and said that the hospital has oriented other new grads and that they love to teach there. She said that nursing students come and do clinicals there. Honestly, she is the nicest and most welcoming nurse I've ever spoken to. She is so appreciative of me coming on as a new employee. I've really never experienced that kind of gratitude before. It's hard for me to imagine that she would put me in a position that would risk the lives of others.

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