New Grad hired in the ER, question.

[Alexx_xox]

Hey guys,

So I want to bring up a hot topic here that I hear often. As I have stated before, I am a new grad, about to take my NCLEX and I was hired in the ER prior to graduation. I was only one of 2 new grads offered a position in the ER at my local hospital.

I often here MANY seasoned nurses say that new grads should NOT be hired in critical care positions. I feel I have an advantage over other new grads since I have worked as a nurse apprentice in the ER prior to graduating.

I know a lot of students do not feel they belong in med/surg or any "stepping stone" unit, so I am here to ask you guys your opinion. Whether you're a nurse for 2 years or 25, what is YOUR opinion on a new grad starting in the ER?

In case anyone is wondering my opinion, I am a firm believer that some people are meant to go into critical care- BOTTOM LINE. I don't really believe new grads NEED to start on a med/surg floor to gain their experience and time management. I truly believe some just do better than others in critical care right off the bat.

I am a mother to 2 sons, as well as a hairstylist and managed to work full time throughout the entire RN program, so I do not feel like I am lacking in time management.

I know I still have soooo much to learn and I absolutely LOVE being given the opportunity to learn in a critical and fast paced environment.

Let me know what YOU guys think. Im also going to add a poll in case some of you guys do not have the time to write out your answer, but if you do, please take the time to respond because I truly am curious.

Thanks so much,

XO, Alex

[SpankedInPittsburgh, DNP, RN]

I'm a long term ER Nurse who worked about a year in a step down unit before I applied to the ER. Did that experience help me? Not much to be honest. Every job has its own discrete qualities and duties. I've worked with bad ER crews and good ones and there is something to be learned for both of them. The ER lives on teamwork. When I was on the floor I watched nurses let new nurses "drown" with the excuse that this would teach them something. Any decent ER nurse will not allow this to happen. Always help your colleagues and in turn they will help you. Experienced ER Nurses who have not become jaded will know that it is their job to help develop a new member of the team who will be called on the future to help with patients and develop yet new members. Be humble and helpful and pay attention. Hold on it should be a fun ride. Good luck!!!

[gemmi999]

I'm a ED nurse that started in the ED as a new grad. I couldn't imagine doing anything else. It's tough but possible, especially if you have a good team!

[Crush]

I agree with you. Not everyone is cut out for critical care. And some should not start in critical care.

Everyone is different. If you worked as an apprentice prior to graduation then you have an idea of how the ER can

be and whoever hired you felt you could do it.

Congratulations on your new job.

I agree. Most new grads should start with a med-surg unit but that is not for everyone.

[thoughtful21, BSN, RN]

I know two nurses who started in ER as new grads, and it was a perfect fit for them. :) They both had EMT experience. Best wishes to you!

[thecareerchanger, BSN]

This is an interesting post. I am still a nursing student but I have interest to work in critical care but was told I would have to work in med-surg first. I have nothing against med-surg and am willing to work in almost any unit for that first job but if the opportunity comes to work in critical care right after graduation I am pretty sure I am doing it!

[That Guy, BSN, RN, EMT-B]

Some do well, some do not. Some would benefit having some clinical experience under their belt, others jump right in. Blanket statements like this are pointless, chest beating nonsense.

[NurseYoshi]

I precepted in a Pediatric ER and did well when it came to communicating with the child(ren) and parents, but as far as skills and assessments, I felt so rushed and like I couldn't learn the skills I needed in that fast paced environment. I took a job (that I'll start in 2 more weeks because all the orientation for the hospital has been PACKED thanks to all the other students getting jobs along with me LOL) on a med-surg unit in a small hospital that's currently connected to the massive facility I work at now. Since the smaller one is expanding, they've agreed to train me for ICU or PCU (Stepdown) once those currently being upgraded units are done and all the nurses and myself are settled. If not, I'll probably transfer to one of the ERs between those 2 facilites after I feel prepared. Now I have several friends going straight into the ER and I feel that they're in the right if they are comfortable with what they'll be required to do after the seemingly short orientation period our huge ER gives new grads.

[turtlesRcool]

I precepted in a Pediatric ER and did well when it came to communicating with the child(ren) and parents, but as far as skills and assessments, I felt so rushed and like I couldn't learn the skills I needed in that fast paced environment. I took a job (that I'll start in 2 more weeks because all the orientation for the hospital has been PACKED thanks to all the other students getting jobs along with me LOL) on a med-surg unit in a small hospital that's currently connected to the massive facility I work at now. Since the smaller one is expanding, they've agreed to train me for ICU or PCU (Stepdown) once those currently being upgraded units are done and all the nurses and myself are settled. If not, I'll probably transfer to one of the ERs between those 2 facilites after I feel prepared. Now I have several friends going straight into the ER and I feel that they're in the right if they are comfortable with what they'll be required to do after the seemingly short orientation period our huge ER gives new grads.

Back to listening (or not) to what 'experienced' nurses say...

When I was in my last semester of nursing school, the manager of the floor I did my clinicals on warned us not to go right into the ED. She said that we'd pick up too many sloppy habits and never get solid assessment skills if we started there. Interesting to hear you say the fast pace made the learning aspect difficult.

On the flip side, I was hired with some other new grads, and when we were getting our preceptor assignments, one or two were starting in ICU or Stepdown, but would be going to med-surg with another preceptor half way through. The rationale was that new grads didn't get enough practice with time management if they started in critical care, and the education department wanted to make sure they got experience managing more than two patients.

Every department has its own challenges, including med-surg. I think that with proper orientation and the right personality, a new grad could be successful in pretty much any area of the hospital.

[Alexx_xox]

I agree. Most new grads should start with a med-surg unit but that is not for everyone.

Yup, we are all so different. Thanks for your input.

[Alexx_xox]

I'm a long term ER Nurse who worked about a year in a step down unit before I applied to the ER. Did that experience help me? Not much to be honest. Every job has its own discrete qualities and duties. I've worked with bad ER crews and good ones and there is something to be learned for both of them. The ER lives on teamwork. When I was on the floor I watched nurses let new nurses "drown" with the excuse that this would teach them something. Any decent ER nurse will not allow this to happen. Always help your colleagues and in turn they will help you. Experienced ER Nurses who have not become jaded will know that it is their job to help develop a new member of the team who will be called on the future to help with patients and develop yet new members. Be humble and helpful and pay attention. Hold on it should be a fun ride. Good luck!!!

Throughout school I worked in an ER and we had an amazing team and you're 100% correct. Team work truly makes the dream work!!

[Alexx_xox]

I precepted in a Pediatric ER and did well when it came to communicating with the child(ren) and parents, but as far as skills and assessments, I felt so rushed and like I couldn't learn the skills I needed in that fast paced environment. I took a job (that I'll start in 2 more weeks because all the orientation for the hospital has been PACKED thanks to all the other students getting jobs along with me LOL) on a med-surg unit in a small hospital that's currently connected to the massive facility I work at now. Since the smaller one is expanding, they've agreed to train me for ICU or PCU (Stepdown) once those currently being upgraded units are done and all the nurses and myself are settled. If not, I'll probably transfer to one of the ERs between those 2 facilites after I feel prepared. Now I have several friends going straight into the ER and I feel that they're in the right if they are comfortable with what they'll be required to do after the seemingly short orientation period our huge ER gives new grads.

Where I was hired we get a total of 16 weeks, which I feel is a very fair amount of time. I feel prepared for the work load only because I was working the entire time I was in school as as nurse apprentice full time. I would take over nurses assignments as they went to lunch. I was not allowed to do initial assessments, but I was allowed to do assessments throughout the care as long as I notified someone of anything abnormal. We were also allowed to give all meds unless they were IV push. I considered myself a mini nurse.

[Alexx_xox]

Back to listening (or not) to what 'experienced' nurses say...

When I was in my last semester of nursing school, the manager of the floor I did my clinicals on warned us not to go right into the ED. She said that we'd pick up too many sloppy habits and never get solid assessment skills if we started there. Interesting to hear you say the fast pace made the learning aspect difficult.

On the flip side, I was hired with some other new grads, and when we were getting our preceptor assignments, one or two were starting in ICU or Stepdown, but would be going to med-surg with another preceptor half way through. The rationale was that new grads didn't get enough practice with time management if they started in critical care, and the education department wanted to make sure they got experience managing more than two patients.

Every department has its own challenges, including med-surg. I think that with proper orientation and the right personality, a new grad could be successful in pretty much any area of the hospital.

I completely love your thinking, I agree that they can be successful wherever they are placed with the proper training and enough patience and time from a good preceptor.