New Grad hired in the ER, question.

Nurses General Nursing

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  1. Should new grads be able to start in a critical care position?

    • 80
      YES
    • 27
      NO

107 members have participated

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

Specializes in Pediatrics Retired.

I graduated from nursing school on a Friday and started the following Monday as a GN in a Pedi ER. You learn what you need to learn about what you need to do in the department you work for. You definitely need to have the right ER nurse mentality/personality. Just a hint...I learned more about starting IVs from the ER tech than from any of my preceptors. Good luck!

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Alexx XOX, great point/argument.

As you mentioned, "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."

Absolutely correct. If theres one thing Ive noticed is that certain departments have certain personalities that flourish and thrive in that environment. At the end of the day, everything you learn, you'll learn on the job, and being an effective floor nurse does not by ANY means guarantee that youll be a good ED nurse. I started out on telemetry after which I transferred to the emergency department. The critical thinking that you develop and utilize working as an ed nurse is miles ahead of the critical thinking you use working on a med/surg or even telemetry unit.

The truth is that nurses in general eat their young. However, this goes double for emergency nurses. ED nurses are very fast and down to the point. Some are better as teachers than others, but for the most part, they get impatient when a new coworker doesn't "get it" as fast as they would like them to.

Bottom line: soak in as much knowledge as possible... Pick a nurse that you see knows what theyre doing and everyone respects, and model and learn from that nurse... check on your patients often and always assess how a treatment worked... always show confidence... and one of the biggest things: BE PROACTIVE... thats the key to keeping up with the crazy pace of the ed. Dont wait for problems to arise... know what is needed for your patient and get started on it before youre told to do so..

Keep it up and hope this helps :)

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Specializes in Mental Health, Gerontology, Palliative.
I use the term "stepping stone" because that is what it is often referred to by instructors in my program. In fact, many of them advocated for students not to stay in a med-surg unit as it hindered their abilities to think on a more critical level. I am not speaking for myself, but what instructors have told us. I have no history on a med-surg unit I have just worked in the ER for a year and a half.

I think your instructors dont know what they are talking about. A person's ability to think critically is not limited by the area that they are working in.

No sour grapes here either, I ended up working in district nursing as a new grad, something I was told would be impossible without experience

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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.

I was a PCT for a year and some months during nursing school on a Stepdown unit and interviewed in two ERs, but neither really felt right for me right now. I promise you that these next few years (and years and years) I'll be playing around trying to figure out where I'd like to be as a long-term job. I have no long-term goals of staying in med-surg. I love critical care, but I also love Peds, oncology, and I'm thinking about going into management after more experience. I feel like not getting my dream job in the ER as a new grad was sort of a blessing for me since I feel clueless about what I want to do. I'll probably end up with a prn ER gig at a small ER for a while. Who knows.

Hakuna matata. Do what makes you happiest and follow your dreams.

PS how do y'all know when you've found your dream unit/specialty? I feel like I loved everywhere I went during nursing school and I'm honestly considering getting the experience to become a float nurse until I can find a place I love.

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Personally, before I went into nursing school I worked at the coroners office doing autopsies. I knew from before starting school that I wanted to do ER/trauma resus. My end goal is ultimately trauma resus. I just knew thats where I wanted to be. As far as you losing every unit, that is super awesome and the idea of doing float until you find a permanent home does not sound like a bad idea to be honest. I think its worth a try for sure! Good luck.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
I use the term "stepping stone" because that is what it is often referred to by instructors in my program. In fact, many of them advocated for students not to stay in a med-surg unit as it hindered their abilities to think on a more critical level. I am not speaking for myself, but what instructors have told us. I have no history on a med-surg unit I have just worked in the ER for a year and a half.

It makes me sad to hear these kinds of statements from nursing instructors. This is where the "nursing hierarchy" mentality starts - critical care is somehow the top of the heap and long term care is beneath the notice of any true nurse. I hope this isn't going on in too many schools; if you're providing the care that someone needs when they need it, you're a nurse. And "thinking critically" is required in all nursing positions, or it wouldn't be a position that requires a nurse.

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It makes me sad to hear these kinds of statements from nursing instructors. This is where the "nursing hierarchy" mentality starts - critical care is somehow the top of the heap and long term care is beneath the notice of any true nurse. I hope this isn't going on in too many schools; if you're providing the care that someone needs when they need it, you're a nurse. And "thinking critically" is required in all nursing positions, or it wouldn't be a position that requires a nurse.

In my experience, this does still happen and its really sad because they put these images and ideas straight into the heads of students so sometimes they don't know any better. I'm glad I did this post and got some insight from other nurses. At the end of the day, if you have RN after your name, YOU'RE A NURSE!! It doesn't matter where you work as long as you love the job you are doing.

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I know many nurses, who have only worked in psych straight from school, go right into ED after 2 or 3 years with no prior med/surg experience. No IV, no catheter experience. IM injections only.

They will train you on the skills you need. One said she was in classroom/simulation orientation for 3 weeks before hitting the floor. Total orientation period was 12 weeks.

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Specializes in orthopedic/trauma, Informatics, diabetes.

I asked a nurse from the ICU, we were in some sort of meeting, why they hire new grads for ICU. She told me they have so much trouble staffing as it is 1:1 (maybe 1:2). The travelers are a crap shoot as the what you are going to get and they are gone after they are done. She said that it is easier for them to spend more time in orientation with a new grad than dealing with float pool or travelers.

I have had to take my son to the ED 3 times in the last year-he is a Type 1 and we weren't sure about dka. One of the nurses tried to give him his insulin IM. They left him tethered to the stretcher (IV) and told him they needed a urine sample. No urinal or call bell. They told us the bathroom was down the hall. Gave him no specimen cup. It was comical if it wasn't so sad.

I know that EDs are overrun with non-urgent issues, but I swear, if there was some sort of critical thinking, they could get people out of there faster. I had to spend the night one night (no beds available). They wouldn't feed him (diabetic??????), I had to sleep on the stretcher with him as there was one straight chair in the room.

They were fabulous when he was REALLY sick, but once you are stable, they forget you are there.

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I think it depends on the confidence you have in your skills. And if you have completed an internship, are still excited, go for it! Good luck!

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I know that EDs are overrun with non-urgent issues, but I swear, if there was some sort of critical thinking, they could get people out of there faster. I had to spend the night one night (no beds available). They wouldn't feed him (diabetic??????), I had to sleep on the stretcher with him as there was one straight chair in the room.

They were fabulous when he was REALLY sick, but once you are stable, they forget you are there.

.

There. I feel better.

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Specializes in Geriatrics, Emergency Nursing.

I work in a very busy ER with very high acuity patients. I started off as a new grad and we hire and train new grads to work in the ER. It's a steep learning curve and about 95% of us did fine

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