ER first assignment for new RN?

CSLee3, ASN, BSN, LVN, EMT-P · Jul 27, 2004

It is hard to beat a "year on the floor". Get your med surg experience first, you will be a better rounded nurse. Case in point....ER techs....awesome job and are much needed, but unless they have been to med surg before as a cna or tech...they are lost in med surg area. Two different areas of care and responsibilities.

Your skill level and confidence will improve with the year or two on general medicine or surgical floor.

happiness in your hood.............C

shinerchia · Jul 27, 2004

i came to a busy level one trauma center from two years of icu. absolutely love it here! ...

so you came from a critical care background where people had been (for the most part) diagnosed and where there for critical care. this is exactly the experience i suggest before someone walk into a job at her/his local ed.

we've had lots of new grads though and most make fine er nurses. good luck...

as for the "lots" of new grads with zippiddy doo experience that managed to not kill nor delay the correct treatment (honestly ask yourself is pts could have gotten better or faster tx with an experienced nurse that thinks 12 steps ahead)......i'm happy. as for the ones that didn't quite make it to the "most" category....shame, shame, shame on us for exposing our pts to them.

disclaimer:

if i made you feel uncomfortable in you abilities; i apologize. my posts are never intended to question you ability, your expertise, your thought process, nor you dedication. my posts never reflect the views of the usaf or any of its subsidiaries; they are my own thoughts and should be accounted for as such!

zenman · Jul 28, 2004

If you find my remarks offense, I apologize in advance to any potential new grad, any person that precepts in the ED, anyone that reads this, or anyone else.

Are you sure you covered everyone?

I started off in the ED and now I think every nurse should spend at least one year in a trauma center, but not necessarily start there. You certainly learn to get organized and when everything is falling apart, you are going, "what's all the excitement?"

I'm still amazed to hear ED, CCU, ICU nurses, (in my small hospital) say, "we're so busy!" My response is usually, "Isn't that why you work in this area?" :)

Jen2 · Jul 28, 2004

During my rotation on the med surge floor I didn't feel as if I learned a whole lot. Many of my patients had the same things going on and were all pretty much on the same meds. However while I was in the ED I got to see and learn so much more. I got to use all of my skills such as counting fetal heart tones and assessing children and babies. These were things that I could not do on the adult med/surg floor. I loved being on the floor, but just feel that I got a better learning experience in the ED and also had better precepting.

I think having a good preceptor is the key for a new nurse in any area not just a specialty. I don't want to go to the ED because I'm an adreneline junkie and I want to be where the action is at, and not because of the TV show ER. I love it there because I can use all of the skills I have been taught under excellent preceptorship (much better than I had on the floor) and I fit into the unit. From my first day there I felt at home and very comfortable with the chaos. My preceptor couldn't believe that when a trauma came in I was yelling out a BP and starting a line in the midst of the cluster around the patient.

Specialty areas may not be for everyone at first, but some of us thrive. For some of us we have only wanted to work in a certain area for years and we realize that we will have to work harder and we are willing to do so. Welcome us. Share your years of expertise with us. Quiz us about what we are doing and why. Give us freedom but be there when we have a question. We don't need a babysitter, we need mentors. The type of attitude like "you didn't work med/surg for a year like I did, so therefore you have no clue what's going on " is not fair. I could go to med/surg for a year under terrible preceptorship and be worse off. Someone needs to fill the shoes of the ones that came before us. Just because we are doing if differently than some did does not make us incapable.

missmercy · Jul 28, 2004

Certainly did not intend to imply that new RNs are not acceptable in the ER!! We have gotten some exceptional newbies who DO thrive and fit perfectly down in our ER. :chuckle However, there have been more of them who have been overwhelmed and frankly, as you said - :crying2: - failed because of poor precepting as opposed to their own skills or work ethics. Our ER is pretty hectic, who's isn't? and some of the "been there done that crew" have been there forever. There are about three of them that I would like to send elsewhere -- they are not supportive and very demanding and harsh -:stone- need an attitude adjustment and a half!! I hope this batch of newbies has some exceptionally strong folks who will bark back -- or even bite back if needed!!! I tell you what -- they have been forewarned and I have already made it clear that the "gnawing of the newbies" is unacceptable and will NOT be tolerated!!:angryfire

I am thrilled for you being such a great fit into the ED!! Good for you!! Be the best ED nurse you can and set an example for the other nurses -- how to work like crazy, teach by example and play nicely!!! Congrats on the great fit!!! Go forth and conquer!!! :)

MrsWampthang, BSN, RN · Jul 28, 2004

Our facility has recently hired a number of new grads ( at least 5 this month) and they are being placed in the ER -- where we are woefully understaffed. I have difficulty with this situation in that there will be few decent preceptors for these green folks and I can only hope that they will not be over-worked, overwhelmed right from the get-go! Used to have a year + of experience as an RN prior to working ED -- my how things have changed. I will do my best to educate, support and encourage my newbies --- God knows we need them

There is no way a specialty area should hire new grads with no experience just to fill the openings. For one thing, they will be overwhelmed right from the get go. It would be interesting to know how many of your new hires are still there after a year or even 6 months. Some people do thrive in a specialty area like the ER, but some never get it. Critical think on your feet skills are a must for the ER and unless you have worked in an enviroment that has given you that type of experience, ER is not the place to start as a new grad. Working as a tech or as an extern is an excellent way to learn the ropes and see if that is what you want to do. We have two gals that came to us from the police department and they are great ER nurses and also took on the added SANE nurse certification. (thank goodness, I hate doing rapes). I agree that some nurses that come from the floor never get it either. They are still in the floor mode and not in the multi-task mode, do it now and do it quick mode.

Just my opinion, good luck if you go to the ER right out of school. It's a tough area and we are bad about "eating our young."

Pam :)

missmercy · Jul 28, 2004

There is no way a specialty area should hire new grads with no experience just to fill the openings. For one thing, they will be overwhelmed right from the get go. It would be interesting to know how many of your new hires are still there after a year or even 6 months. Some people do thrive in a specialty area like the ER, but some never get it. Critical think on your feet skills are a must for the ER and unless you have worked in an enviroment that has given you that type of experience, ER is not the place to start as a new grad. Working as a tech or as an extern is an excellent way to learn the ropes and see if that is what you want to do. We have two gals that came to us from the police department and they are great ER nurses and also took on the added SANE nurse certification. (thank goodness, I hate doing rapes). I agree that some nurses that come from the floor never get it either. They are still in the floor mode and not in the multi-task mode, do it now and do it quick mode.
Just my opinion, good luck if you go to the ER right out of school. It's a tough area and we are bad about "eating our young."
Pam :)

Keep in mind -- I don't do the hiring! I am merely the person who gets to takw care of them whereever the "HR gods" will them to go. I would love to create an ideal setting for each and every nurse -- newbie or not -- to train and develop their skills -- unfortunately, in the real worls... I can't do that. So I must make the best of whatever situation I find them in. I have suggested to HR that they may want to re-evaluate their hiring requirements for certain areas.... but, frankly I think they are far more interested in getting staffing numbers up rather than finding the best possible person to fill the spots.

nursenary57 · Jul 28, 2004

I have been out of school for 2 years and I started out in a level 1 ER. It was the best experience that I have had. I learned more in my first three months there than I did in nursing school. I think being successful counts on 2 things:

1) You. Your attitude, willingness to learn and open to seeing how things are done by other RNs. After every shift I went home and studied the new things that I saw (I still do). I was one of five new grads that was in a new grad internship program and I am further along in my development than the other four because I did extra while they did not. For example, when we took ACLS I studied constantly while they spent their time hanging out laughing or *****ing about how hard it was. They were just happy to be out of school and when they went home they kicked back, had a drink and went shopping with their new paychecks. I went home, opened the ACLS book and studied for 2-3 hours. That doesn't make me smarter but it does make me better prepared.

2) Your preceptor. You have to have a good preceptor who is willing to train you, whether it be med-surg, ER, ICU, L&D, etc. A preceptor who remembers what it is like to come out of nursing school and being scared to death that you will do something wrong and unintentionally hurt someone.

One of the new grads I started with had a preceptor who would chew her out in front of patients! "You don't know that? I can't believe they let you graduate without knowing that!" or "You never do that!" That is a horrible way to treat someone.

The preceptor should know their pathophysiology, assessment, meds and procedures but none of that matters if they don't genuinely take an interest in your learning. I had awesome preceptors (3 different ones due to day/night shift and scheduling, all with 20+ years experience in ER ICU, L&D, OB, Cath lab, etc.) I can still go to them and ask about anything. And I didn't just stop at them. If I had a question I asked several nurses because they all have different experiences and learned different things. For instance, we have a large burn center so burn patients go straight there. I have seen 2 burns come in to the ED in 2 years. So how do I learn about burns? One of the RNs I work with worked burn ICU and she taught me a few things about burns. I took the Advanced Burn Life Support class by the American Burn Association. Now I'm going to work in the burn ICU to put the book knowledge together with the actual hands-on experience.

Now I agree that experience is good and more experience is better. But that reminds me of a saying "Practice doesn't make perfect. Perfect practice makes perfect." You may choose the med-surg route and get stuck with ten patients with 15 meds apiece due at 0900 and an RN precepting because it is something she is required to do once a year. Or you may get incredible preceptors such as I did.

I worked as a pharmacy tech for 2.5 years and I came out of school with a good understanding of pharmacology (though now I know what I really should have been asking the pharmacists). So I was ahead of most new grads in that area. But I wish instead that I had worked as a tech in the ER or ICU because I would have gotten more experience in the most important thing there is in nursing to know- seeing what a truly sick person looks like. Just like achieving any skill it requires repetition. Recognizing when someone is going down ("circiling the drain" is a term you will become familiar with) will put you a step ahead in knowing what needs to be done so hopefully you can initiate the right treatment to head off any problems.

So I have no problems with a new grad being in the ER. Many factors will lead to your success or failure, with the main factor being you! ER may be right down your alley or you may realize that it isn't for you. Everyone has a niche. I wish you luck in your chosen path. If their is anything I can help you with just e-mail me - [email protected] and I will do what I can.

Remember that preperation is key, because hope is not a strategy. Pyke

Katnip, RN · Jul 28, 2004

A student rotation and actually being the nurse are vastly different things. Yes, you see a much wider variety of things in an ED. You are also responsible for being organized and being able to recognize when a good situation is going bad--preferable well before it does. Med-surge helps you get organized, be able to insert a Foley with your eyes closed, and interpret lab values without having to think about them.

I did a year on an IMC unit and have just started in the ED last week. There is a HUGE difference in my abilities and that of a new grad. I'm not saying they aren't good, but they are much slower, and really don't have enough hands on to know what's what.

I'd recommend if you want to go straight into the ED after graduating, to at least get as much experience as an ED tech as you can. It will give you a lot more than a few weeks of very valuable hands-on experience, and you should learn a lot.