New grads in the ER

  1. Do you feel new grads are able to function in the ER? If not what length/type of experience do you think they need? Also what type of prep courses would be good?
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  2. 25 Comments

  3. by   debi87021
    Yes, i believe that new grads can function in a ER with the help of experienced nurses. Everyone has to learn somewhere. If ER is what a grad wants to do then by george teach them. Then you won't have to make them unlearn other departments. For instance, assessments. Assessments on the medical floor take up to 10 minutes sometimes, assessments in the ER, on the other hand, should take no less than 1 minute in my book. Worry about the full assessment later. Prep courses: TNCC, ACLS and PALS, ENCP just to name a few.
  4. by   TazziRN
    I started as a new grad in a busy ER 15 years ago, and I still work ER. I remember some of my instructors telling us that we should not go to specialty units until we've done at least 6 months in MedSurg. I don't really agree with that, although I will admit that I once saw a COPDer with an ankle injury, and I wanted to focus on his resp because I didn't realize what a COPDer's norm is like. If the new grad has a good preceptor and is in an ER that is willing to take the time to teach, go for it!
  5. by   Morganskylar
    I am a new grad in a very busy ER. I am precepting with wonderful nurses. I love it, I don't think I would have liked to have done anything else. I think as long as you have good support and expirenced nurses working with and around you, you will do great. At least this is my biased opinion.
  6. by   Karina212
    I started in the ER as a new grad, also. For me, it was not a good experience. The nurses were great, but it was so extremely busy and unorganized that I could not handle it as a brand new nurse, and not even my preceptors could help me at times. When you're not used to, for example, IV pump malfunctioning or not fully comfortable with drip calculations when you're starting a Dopamine drip on a crashing patient with no one to help you, it really is not safe! I personally didn't feel good about it, but maybe I just am not a true ER nurse anyway.
  7. by   New CCU RN
    I started out in CICU which as another area that is up for debate as to whether new grads should be allowed there. The hospital I work for (large teaching institution) will not allow new grads in ER until they have a year under their belt. Some ICU's will accept new grads.

    I don't think I'd want to start ER right out of school. There is just sooo many different things, it seems hard to become proficient in everything being so new. While CICU can be just as intense, it is a more controlled environment with more specialized types of patients.

    Personally, if you really want ER, fine go for it. I would think it may be a better idea to do a year or two in an ICU to get familiar with the drips, with codes, with vents, and then head to the ER where you may not be managing these as much but will need to be very quick and know exactly what you are doing with the drips, etc.

    Just my opinion.
  8. by   jeannet83
    Kerri, I wouldn't be so down on yourself. I think it is extremely hard for a new grad to start in the ER. The only way I'd recommend it is if the new grad had done an internship in the ED during school, was extremely active in EMS, had worked as a tech in the ED or the hospital offered a six month extern program. And even then, I still think there is a huge learning curve. Really in the ED, you are a "jack of all trades". One needs to know about alot of different medical conditions from OB/GYN to peds to crappy hearts and lungs and DKA among others. Also one has to have alot of technical skills such as working with venitators, vasoactive infusions, code situations. So it is alot to learn. I don't think it's a matter of whether or not you are "really an ED nurse".

    I would never tell someone to not go for their dreams but on the other hand, I think the transition is so much smoother with at least a year or two of ICU or telemetry.

    That's my two cents worth-Jeanne
  9. by   inodou
    I am glad to see this subject. I am in college now and will be a RN in 2 years. I have been a EMT-B for 7 years. I am wanting to go directly to ED when I get out, but like someone said earlier, I was told to work on the floor a little while first. I think with my EMS background that it would not be that hard for me to make the transition.
  10. by   dsczephyr
    I think when all is said and done, it is a very individual decision and depends greatly on the person's confidence, knowledge, abilities, and personality. Opportunity also is a major factor. I am a Nationally Registered EMT with ten years volunteer experience in three states. I also have an Associate's Degree in Criminal Justice and am working to finish my BS in Criminal Justice. I will be graduating with my Associate's Degree in Nursing on June 1, 2003. For me, to do the kind of nursing I want to do (Forensic Nursing in the ED setting) I know I need the med-surg time first. It's hard to wait. But I also know that a year or two of dealing with infectious disease, general medical patients, and having dual diagnosis patients with substance abuse and mental illness (that's what I will be doing where I have been hired) will prepare me far better for the kind of nursing I want to do than just jumping right into the deep end of the pond. We all want instant gratification, but it's not always the right thing to do. And yet, there are a few who can really pull it off. And so, like I said - it's very individual. Denise
  11. by   Scavenger'sWife
    Read the posting by dsczephyr. It is very well said and IMHO, very true.

    Very generally speaking, I feel few new grads are ready for ED. They lack too many basic skills. I do not care where you went to school, it truly does not prepare you for the "real world". You may, for example, be very able to take a BP...but how able are you to take one on a patient who is bleeding out from a GI bleed? You may have great luck starting your IVs in school, but how many 85 year old patients with spider veins and paper skin did you have? or babies? (I have worked with new grads who NEVER had started an IV independently! )

    The list can go on & on. So I really think it is a good idea to get experience, polish your skills, learn telemetry, get ACLS and PALS, get your organizational skills honed, and obtain some experience with the scarey stuff like bleeders, the dying, the psychotic, the drunk & disorderlies, etc.....Med-Surg will get you most of this. And learn about patho-phys and disease process.

    Also, I would ask one or more of your instructors in nursing school where they thought you belonged. These nurses have seen you in action and may have helpful advice.
  12. by   flaerman
    Jim, Yes new grads can be precepted into great ER nurses', not all but I am a preceptor and have precepted a few myself. You need good assessment skills and a good knowledge base. I find that paramedics who have gone to nursing school do well. If you were good in school it helps or even if you had worked as a tech in an ER. The last 3 we precepted in our dept wound up with one leaving to go to med/surg for more experience, the other 2 did okay but one moved away and one went agency after gaining a year of experience to make better money. I am also in charge of our dept's orientation of new staff and we just some supposedly experienced nurse who are far from what we expected. One is gone and another will probably go as he is just lacks good critcal thinking skills and lacks a good knowledge base. Excellent critcal thinking skiils are what make the difference between a good ER nurse and an average one. Good luck--Paul
  13. by   Sarah, RNBScN
    Get your floor experience first. Learning to look after a pt. load of 8 - 10 pts. Prioritize and organize your skills that you've worked on for the last 3 yrs. or 2 yrs. depending on the length of your program. Your the RN - meds, IV, tx. and procedures that the RPN may not be allowed to do.

    The learning has just begun...when you spread your own wings.
  14. by   jetsetter
    I was a new grad last may and went straight to ER, it was horribly hard, and I loved every minute!!!!!!!!!!

    dont let anyone talk you out of doing what you want to do. If its not right for you , it will take you one shift to know.

    follow your heart, not your checkbook or someone else's opinion, and you'll do just fine.

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