ER first assignment for new RN?

huggietoes · Jul 26, 2004

I am an ER nurse and I definitely do not recommend going into the ER right out of school. You really need that year of Med/Surg to get your feet wet, acquire instincts, learn to provide care to multiple patients as well as assessment, hospital policy, etc. before being 'thrown to the wolves'. In my experience those that come to the unit right out of school do not always fare well, lack confidence and usually leave the unit before their orientation is over. All that being said there are those that jump in with both feet and do just fine, especially those that have training in emergency medical care (such as paramedic, EMT-III). Good luck to you. We are always looking for fresh recruits!

MrsWampthang, BSN, RN · Jul 26, 2004

Do a search and look at the responses. I would agree though that new grads fresh out of school shouldn't be in any type of specialty area if they have never worked as any type of medical person. School clinicals don't do justice to the situations you will encounter in specialty areas, so would never be enough to prepare you for those areas. New grads that have worked as student nurses, or techs in specialty areas such as ER, or CVU etc, do have an idea of what the work load is like and will likely thrive as a new grad in these areas. Likewise, seasoned EMTs, and paramedics will probably do well in the ER as they would already be used to the fast pace of the ER. But for the fresh out of school grad, get your basic patient care and treatment skills down to a science before you tackle the specialty areas. :)

JMHO,

Pam :)

Jen2 · Jul 26, 2004

I will graduate in May, 2005 with an ADN and plan on going directly into the ED. However I did work as a phlebotomist for 4 years and was on the code team. This summer I did a 10 week extership in the ED and loved it. My nursing instructors are stictly against me going straight into the ED, but this was the reason I went to nursing school in the first place. I asked the nursing director of the ED if I should do a year on the floor first before applying to the ED and after she talked with my preceptor and did my evaluation she said that I would have a GN position there next June if I wanted it. Maybe you could go this route. Try getting an extership in the ED or a part-time position as an aid to see if you really would like it or not. Really learn from it and seek out constructive critisism from other nurses and managers in the department to see what you should do. Good luck to you!

missmercy · Jul 26, 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

Jen2 · Jul 26, 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

That's a wonderful attitude to have. I'll bet you are going to be a wonderful preceptor. You sound like someone that I would love to orient me. ((hugs))

MichaelSSSS · Jul 27, 2004

Thanks for all of the imput - you guys are great! Good advice - you all sound like you know what's what!

Michael

RN4NICU, LPN, LVN · Jul 27, 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

I heard that. NICU used to be the same way. Now, if you have a license (or are license eligible) and a pulse (doesn't even have to be all that regular - we don't ask questions!) - You're hired! Just about any unit you want. New grads seem to have an easier time getting jobs than experienced nurses, actually. I think that has a lot to do with the fact that experienced nurses demand a higher wage and with experience, comes knowledge - there is more grass elsewhere (it may or may not be any greener) and being loyal to a facility is of little benefit if that facility is not loyal to you. Many of my friends are amazed at the rate at which nurses change jobs. Then again, their employers provide comprehensive health coverage, dont bicker with them over vacations and days off, etc.

NurseJacqui · Jul 27, 2004

I went to the ER right out of nursing school as did many of my coworkers. Some of our best ER nurses have never worked a day of med-surg. If you have a supportive staff and the drive and ambition to succeed in the emergency room, you will be fine. It's a little overwhelming at first but then again, you will be overwhelmed anywhere. And if you are trained in the ER, you will always think like an ER nurse. We have had nurses form other units come to the ER to work and it takes a while for them to get out of that med-surg mindframe. It's a totally different ballgame. Good luck to you! :)

shinerchia · Jul 27, 2004

Dear new grad:

Going into an ED straight from school only places you and your pts at risk. It might not be fun to hear, but you are only taxing an already stressed system if you go directly to an ED from college. You will draw from the seasoned nurses, an invaluable and low-density-high-demand resource, which is in already understaffed. Some rare exceptions exist, but they most likely involve a very seasoned LPN from a sick-tele unit that is getting an RN lic. They shouldn't involve a tech that watched experienced nurses think and perform care. Watching me think and make life saving decisions for my pts does not qualify you to start out in the ED upon graduation; sorry.

Go get day to day experience seeing every class of drug, with every disease process, in a stable controlled environment (you'll find this on a MedSurg floor). After you get comfortable with all of that, reevaluate if the ED is really what you want to do and use all of that knowledge to help people instinctively and without wondering...what is this disease and how will I be treating it. You may find that the well controlled MedSurg floor is a lot safer for you and more comfortable than the controlled chaos in a ED with multi pts not doing well. I understand the want to go into an ED and help, but as a new grad you aren't going to be much help. You'll simply have no clue about hemodynamics, swans, ful pulm edema, SIADH, HHNC, DKA, AMI, CVA, sub A. Hemorrhage, AAA, pylo, PID, Ectopics, etc.

Granted, there is nothing magical about the ED. People think we work magic, but it's just simple ABCD (deffghhi) and CIAMPEDS. Those simple steps either turn folks around or don't, but you really should get comfortable and have a head packed full of experience before you start taking shifts in the ED.

I know every unit in every hospital is understaffed and will only get worse in the coming years, but we cannot let the standard of care lapse simply because we don't have the nurses.

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.

Trauma Columnist · Jul 27, 2004

I came to a busy level one trauma center from two years of ICU. Absolutely love it here! Really enjoy the fast pace and patient variety. That said...it is an individual thing whether a new grad will do well right out of school in a busy ER. IMHO a new grad has to be willing to do a lot of additional studying and put a lot of effort into the orientation process and ask lots of questions in order to be comfortable. We've had lots of new grads though and most make fine ER nurses. Good luck...

MichaelSSSS · Jul 27, 2004

I will graduate in May, 2005 with an ADN and plan on going directly into the ED. However I did work as a phlebotomist for 4 years and was on the code team. This summer I did a 10 week extership in the ED and loved it. My nursing instructors are stictly against me going straight into the ED, but this was the reason I went to nursing school in the first place. I asked the nursing director of the ED if I should do a year on the floor first before applying to the ED and after she talked with my preceptor and did my evaluation she said that I would have a GN position there next June if I wanted it. Maybe you could go this route. Try getting an extership in the ED or a part-time position as an aid to see if you really would like it or not. Really learn from it and seek out constructive critisism from other nurses and managers in the department to see what you should do. Good luck to you!

That's a great idea... thanks