[bluekitty]

Hi, I was wondering how some of you got started in your careers as an RN? How did you work your way into the ER?

I'm a new grad and I loved my preceptorship in the ER. I am addicted! Hospitals where I am moving to do not hire new grads in their ERs, understandably, it is an intense environment for a new nurse. What areas should I focus on working in to gain experience for the ER?
Thanks for your help!!

[suzy253]

Hi & welcome to Allnurses! A couple of fellow studentns from my graduating class (May) are starting out in the ER. Some hospitals will hire new grads directly in the ER, ICU, etc....some not. I think it's good to start out in Med Surg to get up to speed. Good luck.

[debbyed]

You could keep looking or take another job at the hospital you want to work at in PCU (step down unit would be great. Make it known to the supervisors that you would be willing to float down to the ER just to help out moving patient as necessary. Start to network with ER staff so they know who you are and so you'll know when positions are opening up. Once you've been there for a year bid on an open ER position.

Best of luck to you.

[JBudd]

Some of our new grads have just taken to ER like a duck to water, others simply cannot cope with the wide range of everything you need to do, especially patients that we can't get moved out to a floor bed. They learn how to do all the immediate acute care, but have no firm grounding in the routine stuff that keeps going. I did years of medsurg, camp nursing, volunteering, and step down before coming to the ER, and still felt like a novice. It is much harder to move out of an ER to the floor, than from the floor to the ER. Since your ER doesn't allow new grads, they won't have a preceptor program in place to really teach you all the ins and outs. My ER had a 6 month program for new grads, and as I said, some fly and some wallow.

Take advantage of the floors for a while, get the time management down without the whirlwind of ED around you (not to say med-surg doesn't run at a high speed, but not quite the same broadness of diagnosis or acuity). The time spent learning to do assessments and reassessments without quite so much pressure is in my opinion very valuable.

Take the certifications available to get ready for ER ahead of time, TNCC, ACLS, ENPC.

Good luck in whatever you choose!

[JMBM]

ED nurses come from all over. Quite a few in our department have military backgrounds and have worked pre-hospital EMS. The thing that I think sets ED work apart is the chaos. Your patients and priorities change by the minute. Its really hard as a new grad to be perfecting basic skills at the same time you are being constantly called on to make on-the-fly judgments of what and how to do next. Absolutely the only way a new grad should go into an ER is with an established and solid training/preceptorship program. If one isn't available, look for any position where you'll get lots of hands-on experience with lots of patients with chances to learn. That could be a busy Med-surg floor (is there any other kind?). A PCU would be ideal, since there'd be some complex cases. Personally, I think getting Peds experience would be great. Most of us don't get enough work with kids to be really good at it, so the former peds nurses among us get lots of requests for help. Best of luck. Don't hurry. There's a whole lifetime of learning out there.

[PedsER-RN]

Originally Posted by bluekitty

Hi, I was wondering how some of you got started in your careers as an RN? How did you work your way into the ER?

I'm a new grad and I loved my preceptorship in the ER. I am addicted! Hospitals where I am moving to do not hire new grads in their ERs, understandably, it is an intense environment for a new nurse. What areas should I focus on working in to gain experience for the ER?
Thanks for your help!!

I started in the peds ER during the beginning of my senior year as a nurse tech. When I graduated I was hired as a GN and have been an RN there ever since.


I'd say either ICU or step-down/tele would be a good place to work since your hosp. doesn't hire new grads in the ER. Work somewhere that will allow you to gain organizational skills and a good foundation with a wide variety of patients/diseases. Preferably a busy unit, so you can also develop good time management.

[PhillyKidRN]

I actually had a really unique thing happen to me when I was interviewing for staff nurse positions. I like med/surg, but I need something with more stress and more action because I function my best when I am under stress and pressure. So I requested an interview in the ER of a hospital that was actually like 5 hours away from home. I figured I wanted a shot at landing a position there and if they refused because I had no experience then I would take something closer to home. This hospital uses the clinical ladder system where level 4s run the show on the units. For most applicants, one interview with one level four is sufficient to either offer or not offer the candidate a position. For me, I had 2 different interviews in the same day and they were both really positive about my starting in the ER despite not having any ER experience. I maintained my position with the nurse recruiter as well as the level 4s and told them I was thrilled to have the opportunity to interview for a position, but I did not want to interview for any other unit. I told them I need to be in the ER and that's all I wanted to interview for. I ended up being offered a position after they talked with several of my nursing instructors and other people. Before I accepted the position I talked to both of the level 4s and I explained to them that I wanted then to be 100% sure I was an acceptable candidate for the position. They both told me they weren't looking for proof that I could cut it in the ER, they were looking for something from anyone they talked to saying I couldn't hack it. They said I was a strong candidate and they were confident that I could be successful.

So what does this all mean.... well, I have started in the ER and I am getting along just great. I had a rough first day trying to get used to the environment and how things worked, but I am adjusted to the enviornment and I am doing well. I am able to manage my section of patients with minimal help from my preceptor. I would encourage you, if you feel like you understood the ER when you rotated through and you enjoyed it, pursue your hospital further if you haven't already taken another position. Otherwise, maybe interview with another hospital and only be willing to do an intervew in the ER. You could explain to them that you had expereicne there in school and did well, and all you are asing for is an opportuinity to meet with the manager and be given a chance at obtaining a position there. Good luck in your job search! This is such an exciting time!

[ERnursing4me]

I think either you are made for it or you are not. I graduated in May and started my new job in an ED July 10th, finally out of the classroom type orientation I hit the floor Monday with my preceptor. I was told and discouraged my many experienced ER nurses (most of whom have known me for >10yrs and knew my experience/exposure to emergency services type environment) new grads do not belong in an ED. I should do med/surg or ICU/CCU for a year to get experience building my assessment skills and time management skills....EXCUSE me what 2 traits do successful ER nurses have....ASSESSMENT and Time Management skills...
Assessment skills can be critical so you have to work hard to develop those and your instinct...it is either something you have or you dont.....keep looking and if you feel strong enough about an ER - GO FOR IT!!!!!!
by the way the nurses that were very vocal about me needing med/surg (which I hate) were the very ones that started out in an ED.......
Good luck
Lynne, ERRN

[ERRN629]

Hey there!
I'm in my third year as an emergency dept. nurse, and I came down here right out of school with my only work history being a waitress!!!!! If it's truly what you want, and you're willing to work your butt into the ground, you can do it and you'll love it. Don't let anyone try to tell you otherwise! It's scary and can still be overwhelming at times, but keep your chin up and you can do it! Best of luck!!!!!!!!!!!!!!