New grads in the ER

Specialties Emergency

Published

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?

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.:D

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!

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.

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.

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.

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.

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.

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

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

Specializes in Med Surg, Post partum, peds, newborn nur.

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.

Specializes in ED, Forensic, Long-term care.

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

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