Views on New Grads Entering the ER.

I have been a nurse for a year now. The entire time has been in an ER. I have had mixed reception. Many are open to new grads and many are against it. The ones against it seem to be older nurses who had to come up through med/surg, CCU etc. Recently I overheard one of our doctors telling one nurse (against it) that no matter how much experience you have you still need to learn/relearn in the ER. You are not with a patient over an extended period of time so your assessments are different. The nurses who are accepting have been a great help especially when I have been able to draw on their experiences.

hello-
i will have been a nurse for two years in february of 2007, and i began my career in the er.
i think the er is the perfect place for a new grad because you literally see everything and get to develop strong assessment skills and advanced critical care nursing skills...i think it's only the perfect place when the new grad is exceptionally mature and the orientation program is tailored to the individual's needs(mine was 6 months, including a critical care course).
i have definitely had the experience of having older nurses turn against we new grads, but most have been accomodating and helpful. the docs in my er really love us because they say we have fresh, positive attitudes and are willing to learn..this has sort of set the new grads against the old nurses.
my experience has been great because the staff is so supportive, but the acuity level in my ed is really high and so that part is stressful.
if you need to know anything else, just ask!

I know that a lot of the top trauma centers prefer new grads so they can teach them from square one....and don't have to "unlearn" them. I personally think that it's great to have certain experience---like peds or esp. newborns or L and D--areas that are very specialized and not a lot of ER nurses know too much about. But being a new grad is good too. I think the most important thing is that you have a passion for the job. I loved my ER days more than any other job I've had (except the one as a waitress in an Italian Restaurant where the pizza guys were just so darn cute).

Dear Erika,
I am a new RN ( as of March 06) and am working in the ER which I totally love. I had the fortune of being an LPN beforehand and have had med-surg, cardiac, ortho, some peds/ob, research, Dr.office and neuro so I don't know if I can give an un-biased answer so to speak. But I do think that having some type of patient care or floor experience is very beneficial to working in the ER. Just the basics of having hands on experience and learning good communication skills is so helpful, because as you know in the ER we see people at horrible moments in their lives and knowing how to talk to them at this crucial time is a good skill. After graduating, I completed an intense three month critical care internship, I felt was more intense than school was and not everyone made it through. If I had not gone through this internship I would not have felt prepared for the ER at the least. Being an LPN before was also priceless experience as well. There are several RN's in my ER that went straight from school into the internship and then into the ER, and I have seen them struggle with a few things, like time organization. And also like a few skills, like changing an ostomy appliance (we had a pt come in a domestic where his girlfriend ripped it off ouch!) and irrigating a post-op turp that had come back in with urinary retention 2 to clots. Anyways, hope this info helps and good luck!

I think that as long as a solid preceptorship program is in place, having a new grad join the ER is fine. But if no such program is in place, I feel that it is certainly better to have some experience in practice before "coming down." The hospital in which I work has an RN Residency program for the ED, in which they bring aboard 2 graduate nurses per 6 months. It has done quite well, and I speak from experience, having been one of those graduate nurses at one time. IMO, had such a program not been there, I would never not have been able to hack it. But I had a fantastic preceptor with tremendous experience who was VERY patient with me. Hospitals that have such programs benefit in training new RNs to their particular way of doing things.

I have 10 years experience in a level one trauma center. I had one year of ICU and one year of med-surg experience prior to this. New grads can make it in the ER but have to have a solid (12-16 weeks) orientation with both classroom and clinical time. They must also receive ongoing mentoring for at least one year. Otherwise, you are setting new grads up to fail. In the ER, because the patient population is so diverse, a new RN (either new grad or new to the ER) needs plenty of experiences: taking care of both routine patients, critical patients (both peds and adult) and many different types of care.

We do a dis-service to both our new nurses and our patients when we throw them on the floor after little to no orientation and no mentoring. I always told the nurses that I precepted that it takes a year before you even know what questions to ask and at least two years to feel comfortable.

While I started as a new grad in the ER over a year ago, I have mixed feelings about it. It is a good place to learn, and the only place I can really see myself working. BUT I feel like most new grads need some time elsewhere first - I really feel like going to the ICU or something similar first would be beneficial. New grads don't have the knowledge or "gut feelings" to know when a currently okay pt is getting ready to go bad. Sure, you develop those things, but I do wish sometimes that I would have started out in the ICU. But I think if I had started my career somewhere else, I would have probably burned out by now (I could never do floor nursing; ICU just seems too involved for me ) ER is unique in the "treat and street" or "stabilize and admit" mentality, and it takes a special kind of nurse to be able to do that, new grad or experienced.

Personally, I think that a new grad could be fine in the ER with the proper training, but in my experience most of the hospitals in my area are terrible with orientation. The nurses end up trying to fend for themselves and it can be a disaster. I was thankful for my experience prior to entering the ER but again, I had little or no orientation, kind of on the job training. In the hospital that I presently work, they require 1 yr of floor nursing prior to ER. Someone stated in a prior post that it takes a couple of years to feel truly comfortable and I truly feel that is true. After 9 yrs in the ER, there are days when I learn something new or see something that I have never seen before. I think though that is why the ER is definitely for me as I keep learning everytime I step through the door.