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

Larry77, RN · May 25, 2006

Coming from someone who has spent 18 years in the ER its total bull that one "needs to get floor exp". RJ

I don't think anyone is saying you NEED to get experience, but rather that there is advantages to "getting your feet wet" in med/surg. I don't think there is any "advantage" to starting right out of nursing school, but yes it can be done.

I liked what the poster said about peds because while I did start in LTC then Med/Surg, I had no experience with peds. In the ED peds has been my biggest challenge-they just don't give you much exposure to peds in nursing school.

You will find what your weak area is and just let it be known to your preceptor and you will get tons of exposure. When my preceptor found out I didn't have any peds experience I did nothing but peds for a week and still start a lot of the peds IV's we have.

With floor experience you also get to know what it is like for the floor nurses-seeing things through their eyes. You will be able to understand the information they would want to know when you call report etc. Also if you are in a smaller hospital like mine (240 bed) then you will get to know some of them which goes a long way.

Always has been two sides to this issue and there always will be.

Larry

Happy-ER-RN, RN · May 25, 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

I completely agree with this thread. I also started out as a new grad in the ER and was sick with stress for several months. It was horrible, I would come home and just cry on a regular basis. I love my job now, but even after a year I still sometimes feel like I'm in way over my head. It's amazing how much the Drs rely on the nurses and your assessment and knowledge is very often what will save a patient's life--which is really scary when you are new. You just have to know when to ask for help and don't let them throw you out to the wolves. That's part of the stress, you want to appear competent, but at the same time you want to scream "OH, my god someone get in here I have no idea what I am doing!"

If I could go back, I would still go right to the ER. All the pain was worth it.

anonymurse · May 26, 2006

I had some really good advice, all different. One ER nurse who's monstrously good and fast went straight into the ER and doesn't see why anyone else shouldn't. She thinks to be the best nurse you can be, it's important to go where you'll flourish right off the bat.

Another fantastic ER nurse spent a year in ICU first and said she has a thing against people going straight in. She says a nurse needs time to develop critical thinking, and a less fast-paced environment gives you more time to think everything through.

However, another nurse pointed out that if the ER wants you to get ICU experience first, the ICU will probably want you to get something else first, too.

Another spent a year in telemetry first and recommended it as the perfect pace, somewhere between med-surg and acute care, plus he got to learn all kinds of cardiac stuff there which is useful daily.

I've asked more, but so far, the only nurses I've met who recommend med-surg as the best prereq to the ER don't have ER experience (though of course that may change as I ask more nurses).

HRM672 · May 26, 2006

If a person graduated and started off in the OR, would they have difficulty in getting an ER job (with good orientation) years down the road if they decided to make a change? What do you think?

DonnielleRN2B · May 27, 2006

Thats where I am going. I will be in a 4 month internship with possibility of extending it if i am not ready. Make sure you are comfortable with your education dept and your coworkers for support and guidance.

Larry77, RN · May 27, 2006

If a person graduated and started off in the OR, would they have difficulty in getting an ER job (with good orientation) years down the road if they decided to make a change? What do you think?

If you are talking about working in the OR as a circulating nurse I think it would be difficult because it is such a specialized job and so far from any other kind of nursing job out there. You will know all the crazy names for all the funky tools that surgeons ask for and how to set up every surgery your hospital does but you won't be putting in many IV's or doing very many procedures at all. In my opinion the person with the fun job in the OR is the scrubtech...they are the ones holding the retractors working directly with the surgeon. The RN basically is the gopher-running around getting equipment. Even the scrub nurse just stands there handing tools off. Something goes wrong in the OR you would have to do some ACLS but this would be rare because the anesthesiologist keeps such a close eye on the pt.

Don't get me wrong of course it can be done but I just don't think you would be any closer to learning what you would have to learn for the ED. OR is very very specialized. I would have to start from scratch to learn an OR job even after my experience on a surgical floor and ED.

In my opinion the two best areas for knowledge that helps in the ED is clinic nursing and Telemetry nursing.

anonymurse · May 27, 2006

In my opinion the two best areas for knowledge that helps in the ED is clinic nursing and Telemetry nursing.

Well cool, that's 2 votes for tele.

HRM672 · May 27, 2006

Thanks :)

bill4745, RN · May 29, 2006

I would suggest a year of critical care first, something that my ER now requires. It is tough to pick up crtical care skills in the ER-you can easily kill a patient in the process.

jcarew · May 31, 2006

Hello,

I am a SNE in the ER. I will graduate May of 07. I really am hooked on ER. Now that I have read these posts though I am beginning to wonder if I should stay until graduation. What is your advice? Should I stay and get a year as a SNE in ER and then apply for a position there or should I try to go to Med/surg, etc. before applying to the ED? If I go to another floor, how long before I should apply back to the ED? Thanks!

paphgrl · May 31, 2006

I started in the ER. 9 months later I decided to transfer to a med/surg floor. Once I get a year of med/surg, I plan to get experience in critical care...THEN return to the ER.

Imagine how difficult it was for me to transfer after only 9 months. My confidence is as low as ever. My only consolation is that I made a good, but very difficult decision.

When I return to the ER I will have critical care experience. I will be confident with arterial lines and multiple IV drips. I will be able to take charge in a trauma with the confidence that comes from an experienced nurse.

nyema11 RN · Mar 20, 2008

I graduate in May and I got an internship in the ER. So yes you can go into the er s8 out of school. I thought all new grads had to go to med surg. BUt that is not true most of my friends have taken jobs in NICU and CCU