New nurses and the ER

libran1984, ASN, RN · Jun 23, 2014

I was an LPN in the ER for 3 years and transferred to a different hospital as a new grad RN. However, perhaps it is because I was an ER LPN for 3 years, I'm surpassing most people's expectations of a new grad in the ED. From doing ABGs to accessing Ports, I did it all as an LPN, but I never did "initial assesments". So my preceptor was extremely excited to FINALLY, after 2 weeks of on the floor clinical, show me how to document a NIH stroke scale; the actual task i was already familiar with and certified for.

In my case, my preceptors love that I was an LPN prior to coming to work in this new, very busy ER (250 pts/day).

The one criticism, I've had thus far was this.....

I had 3 monitored beds, 2 of which were empty, one was in a holding pattern, awaiting a room for admission. I left for ten minutes to go start an IV for another nurse who was falling behind over in fast track. I come back and receive a slight reprimand for leaving my section without notifying my preceptor... and I mean, it was a very slight reprimand or more like a reminder. "These are your patients now and you need to stay within this section." Understood.

To be totally truthful, I find being an ER RN is immensely easier and much less stressful than being an ER LPN was. Being responsible for 3-4 people is great when compared to sharing responsibility for 6-8 patients with 2 supervising RNs and then there were all the RNs not assigned to work with you (the LPN) who persistently requested your presence at every bathroom break, lunch break, difficult stick, suture removal, catheter assistance, CBI, septic work up, transportation, or splint application. It was a burden to be an LPN because everyone dumped the stuff on me that they didn't want to do themselves. In the end, it made me a MUCH better RN.

So that is my experience with ER nurses and their feeling towards myself as a 'new grad'. I would think, with your past LPN experience, you'll do just fine and it will work to your advantage.

SVT511 · Jun 23, 2014

Thank you so much for sharing! I definitely don't have all the experience you gained while working as LPN in the ER but I am quick at learning and a willing participant!

danggirl16 · Jun 23, 2014

I started ER nursing about 6 years ago after 13 years of various assorted med/surg jobs. At some point we are all the new ER nurse. I had a great welcome to my first ER assignment but I wasn't a "new" nurse. Since then I've had the pleasure of orienting new nurses both new grads and experienced but new to the ER. Personally, getting another staff member regardless of experience is always better than being a nurse short! (well not always but that is a different topic!). The biggest issue I've run into is attitude. Some of the new grad nurses have a sort of superiority complex like "I'm younger and I know more than you"...and, that may be true but ER nursing is a heck of a lot more than book knowledge. With the experienced but new to the ER nurses, many don't seem to take constructive criticism well from anyone. But I think even worse is that the ones precepting make assumptions about what their orientee does or doesn't know.

My little bit of 2 cent advice is - If you don't know, ASK...always. Don't act like you know just to save your pride because it could mean someone's life. Also, when starting out I think it is important to have some time with your preceptor to discuss what you know and what you need help with especially since you already have quite a bit of nursing experience. I've always hated someone talking down to me, explaining things like I didn't have any experience BUT I've learned that unless you communicate it to them, your preceptor can't just crystal ball your background, experience etc.

Then, just check your attitude. Every ER I've worked in has been an extremely tight knit team. If you go in like you know everything and don't want to hear what others say, I guarantee you will not be accepted into the group and without the support of your team, work will be hellish.

SVT511 · Jun 25, 2014

Thank you, danggirl16!!! I appreciate it! I am definitely not holier-than-thou haha I am actually really easy going so I don't think that will be a problem. Your comment definitely puts me at ease :) I would have a lot of work to do, but I'm willing to take the time to get there!

NurseOnAMotorcycle, ASN, RN · Jun 26, 2014

It's the same as starting on any new floor. There will be people who hold judgement to see what kind of person you are, there will be extra friendly ones who are thrilled to have some more helping hands.

Because it's an emergency setting, be quick to ask for help if you are unsure about a patient. :)

Also, anyone who is pale and sweaty is automatically someone to be seen immediately.

Good luck!

Jasel, BSN, RN · Jun 26, 2014

I'm kind of like you. I was an LPN for 3 years and have been an ER-RN for 9 months. I don't think the experienced nurses have a problem with newer nurses. Where I work at least there is a lot of team work. I'd have to say the thing I like the most are my co-workers.

So when you feel more comfortable with your skills offer to help out when you can or just jump in. Don't be afraid to take advice. Even if it's something you don't agree with you can always just ignore it. Learn what your techs do and learn from them. Many of the ones I work with are EMTs and have been doing things for years I've been doing for months or don't know how to do. Don't be afraid to ask doctors questions (although try to figure out which ones are more approachable)

You'll learn something new everyday. I work with a nurse now who worked in the ER with my mom 30 years ago when she was pregnant with me. She says she's still learning.

Oh I should probably add I definitely enjoy the ER.

SVT511 · Jul 1, 2014

You guys are awesome! Thank you :)

LJ85, ADN, BSN, CNA, LPN · Aug 2, 2014

I'm in the same boat except in NJ LPNs do not have the ability to work in hospitals, so I never had a hospital experience except for clinical rotation. I was so lucky to be hired as a new grad in an ED, I hope I handle it well. I'm a little intimidated but I know once I learn something I will be diligent to master it.