Med Surg or ER for New Grad

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I just wanted to get your opinions on whether you think a new grad nurse should start out on a Med Surg floor or in the ER. Eventually, I know that I want to work in the ER but I was told that Med Surg nursing would give me the time to develop the skills to be successful in the ER. My only concern about becoming a Med Surg nurse first is that I'm worried after spending time in Med Surg no one would be willing to hire me in the ER (or at least this is what I have been told). I just accepted a nurse extern position at a well known local hospital and I have the choice of what department to apply for after graduating. Working in the ER seems intense and the last thing I want to do is get in over my head right after graduating. What are your thoughts about this? Thanks in advance for your input!

Specializes in LTC.

In this economy my honest opinion is to apply to everything and accept whatever offer you get.

There is a lot of debates on these boards whether or not new grads should jump into specialty areas right away. I would make my decision based on what the hospital offers for orientation to specialty areas, what kind of support systems they offer new grads, and your own personal feelings of confidence.

Specializes in LTC.

Kudos !! To you....

Congratulations on your extern position! I do not believe that new graduate nurses need to start out in med/surg. If you are interested in the ER, I think it would be great to start off learning how things are done in the ER vs starting in med/surg where things might be different. A lot of the Nurse Managers I have spoken with prefer new grads over experienced nurses who come into the ER without ER experience because they can "shape" new grads into the er way. But the hospital cannot hire new grads so they take the experienced nurses. My friend was hired into the ER as a new grad and has the same orientation length, preceptor, etc as the experienced nurse. The other nurse is struggling because he learned a different way of doing things. But this is only one example, I am sure there is more for both sides.

Plus, if you start in the ER you can build hours to become certified. You will also be able to obtain your ACLS, EKG leads, possibly Pals and so much more.

http://www.ena.org/BCEN/Pages/default.aspx

Good luck with your decision.

Specializes in ER.

I'm worried after spending time in Med Surg no one would be willing to hire me in the ER

That's a load of crap, and nothing to be worried about! I work in a community hospital where they pretty much won't hire any new grads into anything except Med-Surg. This summer I'm transferring to the ER and I know I've already been approved. If you get hired into Med-Surg first, you still learn alot (I sure have!) and make connections... I wouldn't have had as many opportunities as I've had if it weren't for all the various departments/employees I've met and got to know.

Specializes in Telemetry.

I worked ER as a nurses aid. I felt it was too steep a learning curve to try right after graduating. So I decided to do something 'slower' and went to a telemetry/step down unit. That learning curve nearly defeated me, but I understand a whole lot of what I saw in the ER much better after working tele. I think the hardest thing to understand about the ER apposed to working on a floor is that ER is what I call 'sloppy' nursing. Please do not misunderstand my wordage to mean that the ER nurses do a half - butt job. Far from it...but floor nurses are much more detailed oriented when it comes to a lot of things. Exampleish? Report from a floor nurse includes last pain medicine, a slew of labs, dressing change orders, activity orders, etc. A report from an ER nurse can pretty much go like their blood pressure is better, they're breathing with good oxygenation, and they'll be there in 10 minutes. :p In the ER you have to assess, stabilze, and ship them out because there's a whole crew of new ones waiting in the lobby. On the floor your planning what's going to happen to the patient on your shift and over the next couple of days. What I also noticed in the ER was that ER nurses usually get out on time....very rarely was a patient so critical that the nurse couldn't give report and leave. ER nursing reports are bare bones and you kinda figure out the rest on the way. Floor nurses will get miffed if you forgot to report the tinest thing. And for the floor nurse that is rightly so because missing tiny details can cause great delays in care on the floor. I don't know what is right for you. I'm glad I was an ER aid first, and I'm very satisfied that I decided to go to telemetry and I'd like to hit the ICU before I tried the ER as a nurse.

What Nursedolphin says about ERs liking to hire new grads is somewhat true, but they also have a great preference for ICU and critical care experienced nurses. Some of that want to hire new grads over experience has nothing to do with 'molding' the new grad as you would think. In the 4 years I worked in a large teaching hospital I saw many rounds of new grads come through. They got very excellent teaching for a new grad, but there is no education that even comes close to experience. The hospital I worked for always had tons of new grads and very few experienced nurses. New grads get paid less and are willing to get 'molded' into doing more by management...if you get my drift. The constant turn over and the fact that tons of new grads always want to start somewhere exciting like the ER made the experienced nurses more dispensable which is really, really bad for new grads. You have no idea how bad you are going to want plenty of experienced (5 yrs or more) nurses around you in ANY hospital setting until you get out of preceptorship and are on your own.

Specializes in ER/ICU/STICU.

Nonsense. If you want to work in the ER and you have a chance to do that, I say go for it! Why waste your time with med surg and then go to the ER? Med surg and ER have different skill sets you will have to learn. In my opinion one does not necessarily set you up for success in the other.

My only concern about becoming a Med Surg nurse first is that I'm worried after spending time in Med Surg no one would be willing to hire me in the ER (or at least this is what I have been told).

Listed below are some observations and anecdotes:

I'm not new to working around nurses at all, but I'm only now finishing the first year of a two year BSN program (have another B.S.).

That said, in the hospital I did rotations in what you said is true. They will not allow people to transfer from med-surg to ER (or any other area) because they can't ever find a willing replacement to work in med-surg. When the unit manager does the person apparently always wants to transfer off to ER, ICU, or OR after a few months. Here, jobs for nurses aren't too hard to find compared to many places in the country but like many other places nurses, as a whole, don't seem to enjoy working in med-surg. This means that ER positions rapidly fill when open and often by new nurses because those with some element of time in position can't transfer because the new people aren't applying for med-surg.

I know when I finish this program if all that's available to me is med-surg or LTC I'll quickly go back to doing what I've been doing prior to my "re-schooling."

I have another potentially offensive observation about this that I won't share based on a realistic perspective. PM if you want to know.

I think the hardest thing to understand about the ER apposed to working on a floor is that ER is what I call 'sloppy' nursing. Please do not misunderstand my wordage to mean that the ER nurses do a half - butt job. Far from it...but floor nurses are much more detailed oriented when it comes to a lot of things. Exampleish? Report from a floor nurse includes last pain medicine, a slew of labs, dressing change orders, activity orders, etc. A report from an ER nurse can pretty much go like their blood pressure is better, they're breathing with good oxygenation, and they'll be there in 10 minutes. :p In the ER you have to assess, stabilze, and ship them out because there's a whole crew of new ones waiting in the lobby. On the floor your planning what's going to happen to the patient on your shift and over the next couple of days. What I also noticed in the ER was that ER nurses usually get out on time....very rarely was a patient so critical that the nurse couldn't give report and leave. ER nursing reports are bare bones and you kinda figure out the rest on the way. Floor nurses will get miffed if you forgot to report the tinest thing. And for the floor nurse that is rightly so because missing tiny details can cause great delays in care on the floor.

And that's exactly why I view ER as a better work enviroment compared to "the floor."

Specializes in Telemetry.

I agree with you IMTHATGUY. Just trying to trying to go over some pros and cons. :)

Specializes in ER.

I graduated in December and started my first nursing job at a level 2 trauma center in February. I knew I wanted ER and went after it, and that was the best thing I could have done for myself because I LOVE my job. My coworkers are amazing, my preceptor is knowledgable and a great teacher, and all the more experienced nurses are very supportive of me. That said, it isn't easy, but having that strong support really has helped me learn quickly and grow much faster than I would have if I'd been somewhere that didn't have adequate support for a new grad. My coworkers make sure I am not only learning the routine parts of ER nursing, but that I get the chance to handle codes, traumas, and critically ill patients. If you have a good preceptor and supportive nurses around you, ER won't be any harder to adjust to than med-surg.

Specializes in Pediatrics.

I was an ED tech for 3 years, and did my senior preceptorship in the ED, I loved it there. I know that is where I want to be unfourtnantly all the hoslpitals in my area require either 1-2years expereince or a BSN to get into the internship programs. So I am working on getting both:lol2:

If you know that you want the ER then go for it, if you do not like it you can always go somewhere else, but if it was me I would jump at the chance to work back in the ED.

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