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This is a discussion on New grad in rural ER? in Emergency Nursing, part of Nursing Specialties ... I've been debating on whether to go out of state for an opportunity in a rural hospital. Part of my...by amzyRN Jul 6, '12I'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.
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- Jul 7, '12 by missnurse01Quote from amzyRNhi!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.
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.
- Jul 7, '12 by itsnoworneverI'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.
- Jul 7, '12 by amzyRNMy 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.
- Jul 7, '12 by ecerrnI 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.
- 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.
- Jul 8, '12 by amzyRNThis is a state without ratios. I think their ratios are 7 pts/RN. That's a lot to me.
- 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!
- Jul 8, '12 by amzyRNI 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.
- 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.