Survey: Should new grads work in the emergency room? - page 2

Here are the results of last months survey question Should new grads work in the emergency room? : Please feel free to read and post any comments that you have right here in this discussion... Read More

  1. by   TEEJAY 56
    I have been a critical care nurse for 27 years.New grads need to get a good foundation for patient care prior to coming to the E.R.
    One year as a med-surg nurse,then 1 year as a I.C.U. nurse prior to coming to the E.R. is a formula that I have seen that works well. I also work as a preceptor for new nurse's coming to the E.R. and I think we should not confuse eagerness with experience. With all the talk about eating our young, I offer this as food for thought.!
  2. by   MollyJ
    I do not think it so much "Depends on the person" as it depends on the ED. Granted the new grad's personality enters into it but the ED must be staffed for and prepared to nurture the new grad. That means an adequate orientation and support program.

    Behind all this "depends on the person" doo-doo is the assumption that, if you don't make it, it's because YOU didn't have the right stuff. I've seen good new grads ground up and spit out by the ED and they leave believing they didn't have "the right stuff". For every nurse who posts, "Yeah!" "sure!" "great!", there are a dozen nurses who left feeling stupid and inadequate because they got thrown into the deep end without proper support. I think this is also true for ICU, L & D and other sub-speciality units. Nurses, taking their cue from admin, treat each other like disposable Kleenex.

    There is a sharp edge to the "right stuff" thinking.
  3. by   Y2KRN
    Molly,

    I could not agree with you more. I am currently an ER nurse, relative new nurse (just made two years!) I have always wanted to be an ER nurse did the med-surg thing first, for a year and then off to the ER. I worked at a level 2 trauma for the first six months when new to the ER. That ER was able to support and nurture me. Due to a job advancement for my husband, we transfered to another state Va. I currently work in the 2nd busiest ER in the state of Va, this place has a wonderful, but short staff and nurses are droping like flies. I have considered going else where but, I have a 10 min. drive currently with two small children I do not want to have to fight DC traffic to go to another place.

    The hospital I work at would be a great place for a new grad to come if we had the staff to support them!!!! It does have some to do with personality but, as you so solidly said it takes the right enviroment as well. Again, if one trys ER and does not feel it is a fit, it DOES NOT mean that they have failed. Many talents are needed in the nursing profession and that is what makes it so unique and rewarding. I wish that stress would not get soo down, and I wish hospital administrators would wise up! Just my humble opinion. Thanks for your comments Molly!

    Y2KRN
  4. by   SmilingBluEyes
    Welp I dunno bout you, but MED SURG sure is NOT a nurturing environment to "grow"new nurses. * I would rather sew my HEAD TO A CARPET than have started out there!* Who has time to learn when they throw you 12 patients on all ends of the hallway? I would have quit very soon if I had started at the med-surg unit where I was first hired..... Glad I did not have to gut my way thru that when I graduated. I still say motivated grads can make it about anywhere, given the right support.
    Last edit by SmilingBluEyes on Jun 5, '02
  5. by   Tiiki
    I dunno guys, I cannot imagine a new grad in our ER. It's a huge hospital/trauma center. So much is expected of you, yes, we support one another, but no one has the time to hover over a "newbie." Your patients have one foot in the grave, the last thing they can handle is a med error. The pace is quick, there may not be the opportunity to explain procedures. I think previous critical care experience is a must. Everyone is citing shortages for allowing grads, but doing such at what cost???

    Just my 2 cents!!
    Jo-Anne
  6. by   Love-A-Nurse
    originally posted by 2ndcareerrn
    i feel that this should be done on a case by case baisis. not everyone is capable of dealing with the stress and pace of the er.
    i have seen more than one experienced critical care nurse from the unit come down to play with us in the er end up leaving to go back to the unit. i have seen a l&d rn do exceptionally well on her transition into the er. so, it varies from person to person whether or not they can make it.

    i feel that if a hospital is going to put new grads into the critical care, er or other fast-paced or high stress positions then they (the hosp) needs to have an internship set up so that while they are getting work experience in the er, they are also going to classes to learn the basics of why they do what they do.

    i have had new grads working with me and the most important thing the successful ones brought was a desire to learn. we try to give the new grads 12 weeks orientation. during this time they spend 2 days a week in class...simple things like abg's, drugs, 12 lead interpetation, and anything else we want to throw at them. it has really made a difference in our new grad success rate.

    oh, i was a new grad rn when i started in the er. but i did have 2 yrs as an lpn and 6 yrs as a emt-i behind me.

    but, i don't think a blanket policy of putting all new grads on med-surg is necessary. you may just miss out on a really great nurse for your er.

    bob

    thank you for your post. er is just the place i want to go after i take and pass rn boards. every one of us started out as a new grad and is still learning.
  7. by   SmilingBluEyes
    you post makes sense to me, LPN, Future RN......good luck in your schooling and in becoming an RN! Some of the BEST Rn students in my class were LPN's ...your contributions are priceless!
  8. by   Teshiee
    Good luck future Rn. I agree what you are saying giving someone 12 patients is not preparation what time would you learn about their condition you just want to hang that iv piggyback on time. I wish you well don't be suprised if they call you "Trauma Momma" because you are so good!
  9. by   nightengale2222
    I have been working in an ER now for over a year. I started my position after fresh from nursing school.
    I absolutely love my job. I could not imagine doing anything else. Yes, it was a challenge as a new nurse, but not one that I could not handle. My preceptor I credit with giving me the support and independence to fill my new role. Not all the nurses in the ER were happy with having a "baby nurse" in the ER. But I have proved myself, and of course I'm still learning. I've been described as having a strong personality, motivated, professional and being a team player. However, I do feel that not every new nurse could survive the ER, then again most experienced floor nurses couldn't either..and have told me so theirself. I just knew in my gut that this was for me. As for a year of med-surg nursing before working in the ER..I don't agree. Basic nursing care, time management and skills should be aquired before is graduated from nursing school. I would have been miserable working on a med-surg floor, and don't see how it could have made a positive influence. I probably would have ended up hating nursing. The er is a world all of it's own, nothing like a med-surg floor. Acuity, patient load, drugs...are all different. To all new nurses who desire to work in the er I say go for it!
  10. by   BKPruitt
    As a current nursing student with previous EMT experience, I fully expect to be hired as a fresh grad into an ED environment.

    I may not be a typical grad, but I bring several years of emergency experience in spontanious diagnosis and reaction that's impossible for a typical Med-surg nurse to hold. In addition I've proven myself under fire -- a big plus.

    The previous post that said Med-surg is NOT a place to cultivate new grads is on target. Every such floor I've seen has among the highest patient-nurse ratios in the hospital, caring for some of the most acute patients. All of which only breeds bad attitudes and a negative environment for the newly graduated and empressionable.

    Nope, no Med-surg for me. I'd rather hang around unemployed until a smart ED manager recognizes me as a good hire. And they will!

  11. by   MollyJ
    Okay--more reasons why nurses might want to be med-surg nurses before they go to the ED. What people don't understand is that med-surg simply broadens your sense of what's "out there" and how subtly problems can evolve.

    Nurses/paramedics who come from a first responder background _may_ lack a sense of continuity in care and they lack much of a background in what being on a med, any med, can do to your life. I have experienced in some people from first responder backgrounds--NOT ALL--a lack of respect for the care of the acute medical problem in the ED. First responders idea of continuing care is the report to the ED staff. Even ED patients deserve a "discharge plan". Floor nursing, by it's nature, forces you to see how life-altering med administration can be to patients. It forces you to see what a big deal illness is in people's lives. ED nurses don't have to deal with that LIKE floor nurses do, but awareness of the issues can deepen your compassion.

    Myself, I floated for 6 months (lots of humility) and then settled in a step-down ICU.

    I just think that there are many paths to the same outcome and it is just smart to always say, "i CAN learn something from this situation."
  12. by   BKPruitt
    I do agree about the lack of "community sense" Molly. For some reason, paramedic types seem to become more hardened than the standard nurse -- the probable reasons are self evident and often serves them well in their unique situation.

    The same fact might also reinforce arguments for their transition into ED rather than a complete care floor. The same hardness that must be displayed on the street while treating a 7-year-old car accident victim can lead to sound decisions when bodies build-up in ER. Care at a rabid level is second-hand to these characters.

    Maybe an ER is the best place for the fresh grad RN, and former EMT/Paramedic, to develope that admittedly important "sense of community."
  13. by   Marty1
    I too am of the belief that is shoud be on a case by case bases.
    Some new grads may be EXACTLY what an ER needs however
    if the ER is ALL new grads then I think it creates problems for all those around .

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