After I graduate can I start right off in the ER?

TazziRN, RN · May 20, 2006

This has been an old argument. I went straight into the ER 18 years ago, even though our instructors told us to go into medsurg for at least 6 months first. The logic was that you should get a good solid assessment base before specializing. Most of my class went straight into critical care.

Sometimes I regret it because I don't know what maintenance of chronic problems look like. I once had a COPD-er come in wheezing and I had almost slapped O2 and a monitor on him before he told me he was there for a jammed toe.

Whether or not you can do it depends on the facility you apply at, if they're willing to train you. I'm at a rural hospital now and new grads are not allowed to specialize until after they've been on medsurg for 6 months. At our place it makes sense, because we have little backup and the specialty nurses need the experience under their belts to be able to think on the run.

loquacity · May 20, 2006

mny instructor who works in the Er says that gernally you can't but sicne the healthcare system is so desperate right now you can.

ChocoholicRN · May 20, 2006

I don't know from first hand experience, but a close friend of mine does. She graduated last May with a BSN and by September she was orienting as an ER nurse at a busy hospital in Manhattan. At this hospital, she needs to complete a year of orienting before she can work on her own in the ER. She loves it though and had little experience prior to this job but is still doing well.

allnurses Guide · May 20, 2006

After I graduated, I was one of only three people in my whole class to go into Med/Surge. The rest went into Critical Care, ER, and OB.

The thing I always tell people is to get a job as a aide/tech on the type of unit that you would like to work on when you graduate.

HoosiER RN, RN · May 21, 2006

Before I went to nursing school I worked in the ER as an orderly so of course planned to go there upon graduation. There was no position open then so went to medsurg/peds, ended up there for 9 yrs then HHC for 5, now ER for 6. Looking back I was dumb as a box of rocks right out of school prob would of killed someone in ER. Am so thankful for my varied experience now. I now believe every nurse should try differrent areas before settling down. Specialization is for insects

burn out · May 21, 2006

I know you are probably all eager to jump right into the blood and guts and codes and stuff but I would really recommend at least one year of floor nursing before going into any speacilty unit. The skills in patient care and organization learned that first year are ones that you will and can use use for the rest of you nursing days and will be needed to build on when you get into the more critical areas. By floor nursing you are getting to master and rely on all those assessment skills you just learned without the aid of any monitors most of the time...this will be invaluable to your patients because some times the machines do not show a true picture of your patients and should never surpass personal assessments.

Also some facilities will not even let you into their critical care or ER without

at least one year floor nursing.

JMBM · May 22, 2006

Traumas are challenging and exciting, but ER nursing is so, so, so much more. In most ERs, for every hour you spend in the trauma room, there will be 100 hours caring for patients whose problems are cardiac, stroke, diabetes, asthma, septic, etc. The truly fantastic ER nurses I've worked with are the ones with broad assessment skills and the ability to make judgments and order priorities based on those assessments. Even with your trauma patients, once you clear the trauma room, a good ER nurse will have to care for that patient for the hours (usually) it takes before he/she moves upstairs. I went straight into the ER after school (after 20+ years as a medic) and, like an earlier writer, I sometimes regretted not getting some experience elsewhere to solidify those general nursing care skills. Still, if you can find a hospital with a good, long and thorough internship program, by all means go for it. Just prepare yourself for a very steep learning curve and not a few sleepless nights. One hint - if you do go for some experience, get some peds experience. Most ER nurses don't get enough work with kids to be really good at it, and so a nurse with peds experience is gold in the ER.

lvs2nrs3535 · May 23, 2006

Great advice people, thanks so much. I just graduated from my ADN program and have a job already on a very busy med/surg floor. I was wondering if perhaps I wasnt making a mistake, because what I truly want is ER nursing. This is my dream, and my clinical rotation at a local hospital in the ER confirmed it for me. I love this forum!!! Thanks for the confirmation that I made the right choice.

vampireslayer · May 23, 2006

I think it can be done...going straight to ER, but you will stress yourself out WAY more that way. It's awful, stressful, scary, wondering if you're going to really really screw up and kill someone next time you come to work. The new nurses who aren't scared are (in my opinion obviously) just too stupid to realize what's at stake.

Having said that, I went into ER right out of school, but I was sick to my stomach and stressed out every single day while I was driving to work, for months and months! If you do go straight into the ER, make sure they have a really really good internship program that habitually takes new grads. I think one of the reasons that I went straight to the ER was that I was afraid of getting "stuck" on a med-surg floor because there's such a shortage of nurses everywhere, and not being able to move to ER when I thought I was ready. At graduation time, all the departments are actively looking to hire, so it was easier to get into the ER at the time of graduation. For me to wait 6 months, I'd have been competing with all of the other new grads that wanted ER, I just didn't want to pass up the opportunity, knowing they were actively recruiting at the time I was graduating.

What I would say is definitely try to get a job in the ER as a tech, even one day a week, if you can swing that along with your other med-surg job. It's really hard to even land a job as a tech in our ER, they prefer nursing students or EMTs, but maybe as a graduate nurse, you'd have a leg-up on landing a tech job. That will prepare you for the ER too. I wish I'd been a tech in an ER while I was in nursing school, but with a family & kids & all the running around that that entails, along with school, I just didn't think I had the time to spare.

Good luck!

VS

SeaChelleRN06 · May 24, 2006

I just graduated a few weeks ago and applied to an ER Nurse Intern Program at one of our local hospitals. It is a 20 week program designed for GN's/RN's with no previous ED experience. This program has a great reputation for taking brand new nurses and molding them into compitent ER nurses. It's 2 1/2 weeks of classroom time and 18 weeks with a preceptor. There are several different phases and classes that take about one year to finish. I have alot of friends that have done this and are doing great. I start in a few weeks so I'll let you know how it goes! ANd I definately agree about getting a tech job first. It helps so much even if you only do work on or two shift a week.

rjflyn, ASN, RN · May 24, 2006

Why wait until you graduate. Alot of places will hire you as a tech, nurse tech or aid. Coming from someone who has spent 18 years in the ER its total bull that one "needs to get floor exp". I have seen so many good floor nurses have to be untaught bad habits that just dont work in the ER. Most involve time, ie they want to do something that we just dont have the time to do. Of course it goes the other way too, good ER nurses going to the floor/ICU have to be untaught things as well.

RJ