New grad in rural ER?

missnurse01, MSN, RN · Jul 7, 2012

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.

hi!

I did rural ER after about 5 years of tele, prob a level 3 though, and it was invaluable to me for developing my critical thinking skills. We had to deal with whatever came through the door without the ability to get extra staff from other areas of the hospital, and no ICU. We had to manage all critical pt's till they could transport out, vents, etc. When I went to a level 1 trauma center it was so busy it was mostly task oriented. Even the trauma. I had 6 weeks of orientation, but in the ER your orientation depends just on what you get exposed to everyday. I wouldn't miss the opportunity. Floor nursing is COMPLETELY different than ER nursing, altho spending time on the floor will get you familiar with meds and health conditions, but you will get exposed to them in the ER as well.

I say go for it! esp if ER is your focus anyway.

Me

itsnowornever, BSN, RN · Jul 7, 2012

I've been debating this (except the rural part) and have decided that I will not snub an offer for floor nursing, but I will go after an ER position like a bulldog. Do what your heart tells you. If the ER feels like home, go after it like a mad man/woman.

amzyRN · Jul 7, 2012

My heart is torn. I really like the ED, but I have trepidations. In my past tiny bit of experience in the ED, I found it a little bit unsettling because it was so unpredictable and I was still learning. I was at a level II trauma center, so there were some very sick patients coming in. Luckily I had support, because I did not have the capacity to care for those patients on my own. With the rural ED, it's supposedly a level V trauma center, meaning they ship out all of the sick patients, but it's sill lots of responsibilty seeings as there won't be lot's of RNs around. Also, you never know what your going to get in the ED. Someone on this forum said that in a rural hospital "you are it." That's a little unsettling. I just have these trepidations, the "what iffs". I really do not want to miss this opportunity, but there's underlying doubt and hesitation and I want to get to the bottom of it.

ecerrn · Jul 8, 2012

I think you should find out what kind of support you can expect before going. Shipping out a patient is not always easy and they have to be stabilized first, and sometimes you get to go with them...can you handle that? It took me two years before I could walk in to work and handle whatever hit the fan, but this is in a city hospital...I'd want that kind of experience to e comfortable in a rural setting where you will probably see some of the very worst cases spaced farther apart...have a strong foundation first then go for it.

WRNCEN · Jul 8, 2012

If you think ER is your passion go for it! I started as a new grad in a rural ER level 5 and did just fine. I think ER is a department that you sink or swim in a a new grad, but starting in a small ER is better you will get a more quality experience with a variety of patient acuity. Make sure staffing has a good ratio of experienced staff to aid in your learning and mentoring.

amzyRN · Jul 8, 2012

This is a state without ratios. I think their ratios are 7 pts/RN. That's a lot to me.

WRNCEN · Jul 8, 2012

ER staff to patient ratio isn't like the standard inpatient units. Turnover of pt is very high at times, it would be unlikely to have 7 high acuity pt at one time, this is an unsafe practice not saying that it doesn't happen. How many patients per year does this ER see? For mine it's about 25,000 and we have on average a 4:1 staff pt ratio.any er's are not opted to take on a new grad, so if the opportunity arises and you really love the environment of the ER give it a shot!

amzyRN · Jul 8, 2012

I really like the ER. The variety is awesome, that's what I like about it. When I was in the ER (had an experience through school), I was a little bit overwhelmed. I felt like I needed more support. I also felt rushed, like I had to start an IV quickly, but I didn't have the technique down yet. I was able to start the IV, but it was stressing. I think the pace was what I was having trouble with and my time management needed work. I think I could probably handle a level V ER but want to be sure I can do it before moving.

WRNCEN · Jul 8, 2012

Some things to consider...

Average pt per year

How the unit is staffed: RN per shift, support staff experience of staff, pr RN ratio average

type and length of orientation

A level 5 ER sees it all, the variety of experience is very beneficial and with a small ER you will be able to improve your critical thinking skills. At times yes you will be rushed but teamwork and excellent co workers should assist you. As a charge RN I would never put a new grad or new ER RN in hands of a critical pt without assistance even seasoned nurses need help at times. An example is an acute MI pt it really takes 2 nurses to get the care done effectively especially in a level 5 ED.

amzyRN · Jul 8, 2012

thank you i will ask those questions before going

amzyRN · Jul 9, 2012

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?