Views on New Grads Entering the ER. - page 2

hi all... i am in my final semester on nursing school!! my graduation is august 10th! woohoo ... sorry i am so excited! i am doing a school project on new grads entering the er. i would like your view points good and bad. do... Read More

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    Since I've been in the ER for >20 years I have seen attitudes change including mine. When I started all graduate nurses were supposed to have a year of Med/Surg. experience. I was lucky in that I had worked as a monitor certified tech in a Step Down Unit {PCU} so I started on the step down floor. When I started working in ER's all applicants were expected to have a year of experience.

    Over the years and after precepting more nurses than I can remember I can honestly say it has nothing to do with experience. You are either an ER nurse or you are not. ( The same probably can be said for Peds, OB/GYN, Psych. etc.)

    At my current hospital we will usually take 2 new grads per semester regardless of how many openings we have. We feel that they need extensive orientation and a prolonged preceptorship to be successful. Taking too many new grads would be unfair to both the new grads and the staff. In our area we have combined with other hospitals to run a learning program for Critical Care/ER new grads. For about a month they have two days of lecture/clinical lab per week and complete the rest of their hours on their assigned unit at their home hospital. We also include ACLS, Pals, ENPC, and TNCC. Althought our hospital is not a level 1 trauma center we are seeing more and more walk-in/drop off GSW's and stabbings. This gives our new grads a solid Educational Base at a time when they still have good learning/study habits.{As opposed to us older folk who cring at the words class or test:uhoh21: )

    As well as new grads we are also importing Nurses from the Phillipines (again 2 at a time). I have to admit at first I was concerned about this. But we treat them the same as new grads and I wouldn't trade any of my new international nurses for the world.

    In both cases the preceptors (as well as the preceptee's) know within a few weeks if the ER is the right fit for them. When it is not, that staff member is placed in another unit within the facility. Not only do we want to train our young nurses but we want to keep them. Usually loyality repays loyality. Just this month I have a Phillipino Nurse returning to the ER. He came over about 2 years ago and found he wasn't ready for the ER . It was apparent that he was struggling and therefore not enjoying the experience. During discussions between his preceptor and himself it was decided that he needed some Med/Surg and PCU experience. He had come from a very small hospital and was unfamiliar with much of our equipment and standards of care. He decided to move to an opening on the Oncology floor but has continues his learning with ACLS, PALS etc. The staff is thrilled he is returning as a much more confident, happy RN. He has been assigned a new preceptor and will not be rushed. Both He and his preceptor will know when he is ready.

    As to what I takes to be an ER nurse, I would say Self Confidence, Assertiveness, The ability to take constructive suggestions, And more importantly a new grad needs to understand that they don't know everything and must be willing to ask questions. The new grads that scare us and ultimately do not success in the ER are those who think they know it all, don't ask questions, and don't take the advice of more seasoned nurses.

    For any of you who are still in school and are intrested in ER Nursing - GO FOR IT - Just make sure you choose a position that gives you the support that you need to succeed. Check to see what kind of orientation and preceptorship they are offering, what continuing education they provide, and what their expected time line is. If they expect you to be functional on your own in less that 6 months you may want to check around. Remember, this is a sellers market, you are in demand. Demand a program that will give you the best chance of succeeding. We need nurses. and in my case...Especially ER nurses because I would like to retire with the knowledge that when I need emergency care I will have not only a knowledgeable nurse but a satisfied/content nurse at my bedside.
    jjnmrsmom and ak127 like this.

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    ER is a whole other animal, because it is so diverse. I worked in an ER and trained new grads, we only took 2 a year, they went through CC classes for 2-4 weeks, then 6mo training in the ER, they worked their preceptor schedule. We had great success, but we had a great orientation system in place. I still think critical care experience is good to have, but it is not required, not all good CCU nurses make good ER nurses. It requires a certian personality type, as does all the different areas do. Good luck!!!
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    I started in the ER when I graduated 3 years ago, and I can't begin to tell you how amazing it is. Don't let anyone tell you you can't do it!
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    I started working in the ER after working a year on a cardiac telemetry floor. I initially wanted to work in the ER right after school, but I am glad that I chose not to. I think that it is okay to work in the ER as a new grad if you have a background dealing with the emergency department (EMT, ED tech, Paramedic, etc), but it would be harder for the person who hasn't. It also takes a strong personality and like someone said before, you are either a ER nurse or not. It is very easy to weed out the ones who aren't strong enough for the job in a month or two.
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    I started in the ER as a new grad a year and a half ago, and I absolutely love it. There are a difference of opinions...some nurses say...u must have experience before entering a critical care setting...and other say...u learn as you go. From my experience, as a new grad, you are willing to learn anything and everything. You are motivated. I didn't have a very long orientation at all because we were sooo short on nurses. However, I am a fast learner so I learned as I went. I still ask questions when I don't know something. You don't experience every scenario in your first few months of orientation. That's what's great about the scenarios all the time. However, you must have a strong orientation to get a base!!! I hope this helps.

    I am now working as an Agency Nurse at different ER's, and I don't think I like it very much. I was given 3 patients after 2 hrs. of mini-orientation(going over basic charting) and was cancelled 2 out of the 3 days I signed up. I hope it gets better. If anyone has an input on this, pls let me now.
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    From past experience using many agency nurses over many years both as charge nurse and Clinical Leader, I have found that the nurses that have had at least 3-4 years experience in a stable ER environment that they are comfortable with and can grow in, adjust to being agency nurses much better. It is very seldom that we get an agency or traveler with less than 2 years experience that works out for us. I'm not saying that no-one can do it, it's just that from an employers point of view the expectation is that an agency or traveling nurse should be able to "hit the floor running". We ask them to come in 1 hour before their first shift to do a computer learning packet (We are phasing in CPOE) and then we buddy them with one of our nurses for 4 hours. After that they are on their own.

    From a personal view point, I give agency/travelers all the credit in the world. I've been an ER Nurse for over 20 years and could not imagine going into a strange ER with a patient population I don't know and ED Doc's I don't know. I personally could never do it. I need to be comfortable in my surroundings and know which Doc's to completely truat and which to question.
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    As a new grad- i have a follow up question: i precepted in the ER my last quarter of school, and i fell in LOVE with the dynamics and teamwork that i saw (the best i've ever seen in any dept). here's my prob, applying for jobs now, i've been told in almost every place that at least a year of floor experience is required for ER positions around here, what dept should i try to get into to provide the most used and valuable knowledge needed in the ER? are they all similar, or should i take cardiac/tele, or should reg. med surg work>? i have been working as an LPN in chemical dependency for a year, and i know that is gonna help! but i want to be planning ahead and preparing myself in the best way to excel in the ER later on. Thanks!
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    Congratulations on your upcoming graduation!!
    If ER nursing is what you want do do, then go for it!!
    The ER I'm at now (Level I) just hired 20 new grads! I started in the ER as a new grad 3 years ago, and I love it. I did my first year as a staff nurse, then worked some agency and traveled as soon as I got the 1 year under my belt.

    congrats once again!
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    In the ER, you will learn about all different adult injuries and illnesses, especially if your employer wants you to take advantage of workshops and seminars out there. Your veteran nurses will be able to mentor you as well. In my experience the area of nursing expertise which is the least common and therefore the most valuable is labor and delivery as well as pediatrics---mainly infants and newborns. The nurses who work in L and D, and peds must stay there forever because I rarely met one in the ER. You'll always find an ex-CCU, SICU or med-surg nurse in the ER and it's great to have that expertise available, but nurses that know how to care for a precipitously born baby in distress or a woman about to give birth are about as common as hen's teeth.
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    How do you like working as an Agency Nurse in the ER?

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