ED as a new grad?

[Maverickm808, ADN]

so this is for all the pros out there. My local hospital offers a transition program for new grads to enter ER or ICU positions for a first job. What are your opinions and views about critical care for new grads? Yay or nay, and why?

[Kuriin, BSN, RN]

I am starting in the ED as a new grad in late March in a new grad program. I did my preceptorship in the ED, so I am excited. However, I am definitely nervous about not being able to do my skills nearly as fast as some of the experienced nurses.

[ERnursebyday]

Lots and lots of practice! Ask questions.

[NICU Guy, BSN, RN]

Depends on the hospital. Slow transition with a preceptor and non-critical patient once you are on your own, then new grad in critical care is acceptable. Very little orientation and then thrown into the deep end- not good for a new grad.

[CVICU-Nurse1.5]

I am doing a year internship in an ICU unit and will be able to apply for it after I graduate. There is nothing wrong with going ED or ICU, all the other male interns in my group are interning at the ED. No reason to go Med Surg if your heart is on a specific area, especially if they are willing to invest training into you.

[barcode120x, RN, NP]

Just because a critical care area is open to new grads, doesn't necessarily mean you should jump on it as a new grad. Research first. Find out how long their orientation is, maybe speak some of the nurses there and ask how it is. I personally wouldn't recommend ICU first. I would recommend DOU/telemetry floor for a year or so first before transitioning to ICU. Why? Throughout school I had always wanted ICU right after graduating. I was a lift lift tech for 3 years and was always in ICU and CCU assisting with turns baths, code blues, etc, but despite having that exposure, I was glad that I started on telemetry/DOU first as a new grad. Having 3 years of hospital experience before working did not even prepare me for what a working nurse does in a hospital. Being a new grad nurse/working is DIFFERENT than being a nursing student and you will learn that the hard way. My orientation was amazing, but just working as a nurse in general on the telemetry floor (where there is critical thinking involved) is tough and I was so glad I started there instead of ICU. I had a classmate that started off straight in ICU and she said it was tough. She didn't have great preceptors, was alone majority of the time, had conflicts with "nursing practice" between her and her preceptor and basically had to figure out things on her own (she was no-doubt ready for ICU though, one of the smartest people I know and closest of friends). We started around the same time, but after talking to her throughout orientation, again I am glad I started on telemetry first. Critical care is probably one of the hardest specialities so keep in mind that you are jumping in there fresh of the boat (and it'll be even more tough if you haven't had much hospital experience aside from nursing school). It's a scary thing because these are the sickest patients any literally 1 mess up could kill your patient.

ED? Go for it. I honestly think any other specialty in the hospital is great for a new grad, just be aware and prepared if you are going to ICU.

[promeza]

That is a loaded question. 23 years ago I went straight into ICU as a new grad. There was a nursing shortage so they fought to grab me. Was it the right decision. For me it definitely was. I love ICU, and within a year I was taken care of open heart patients. That hospital also did trauma so I got a well rounded education. I did have preceptor for about three months and then I was sort of on my own.

I loved it and at the same time was terrified everyday I went to work. Since then I have trained many new ICU nurses and almost all of them had done at least two years on a tele floor. Yet they reminded me of "me". They were terrified also and were afraid of even turning the patients.

The truth is that everything was new so I figured I would learn "new" whether it was on the floor or on the unit. It was still going to be new. The problem with that is that you don't know what you don't know. Here is and example: I saw that my patient was really diuresing and was filling up his foley bag. I didn't know what that meant or if I should even be concerned (I was that green). I saw the unit manager walking by and just sort of made a comment, "boy my patient is peeing, he has almost already filled his bag". The manager quickly told me to keep an eye on his potassium as it may need to be replaced. At that moment I took a mental note to say" aha, lots of pee could mean a depletion of potassium". That is how I learned.

Another caution about going straight in was that I noticed myself focusing on tasks. I would right down my vitals, and hemodynamics. I would push the saline to get the C.O. and would wedge the swan. The staff was impressed that I felt so comfortable so quick. The problem was that i was good at the tasks but I did't always really know why my patient had those number or how to properly interpret them given my patient status as a whole.

It took three years before I drove to work and realized that i had not been worried about what kind of patient I was getting. It took three years before I no longer had that pain in my gut as I showed up to work.

Everyone is different and most people should not go straight into ICU. But if your passionate about it and the hospital has a good program, and you are willing to put in the extra time outside of work to learn then why not. You should have at least a good three months with a preceptor by your side and that should be plenty of time to decide if you are cut out for it or not.

[bgxyrnf, MSN, RN]

I say take the best job that you can get and then work your butt off for the next year to get yourself up to speed. There are a ton of resources out there (you should see the size of my library of hard copies and ebooks) between publications, the docs, the RTs, the pharmacists, and your fellow nurses.

If you are a self-starter, independent learner, self-confident, thick-skinned, and open-minded person, there is no reason that you cannot successfully start your career in critical care.

The more formal support you have in the way of a structured new grad program, the more successful that you will be.

[Señor V, ADN]

Dude! I have not graduated yet but I personally would jump all over that. My opinions are biased because I have only worked in the ICU as a CNA but that is most definitely what I want to do - ICU. So if it was me I'd be signed up for it already. As you know many hospitals/managers wont take new grads into the Critical Care setting so this seems like a golden opportunity to get your foot in the door. Just saying.

[Brink48]

I know a lot of hospitals that take new grads in the ED. Most have new grad programs where you work under a nurse for a few months.

[Fireman767]

As someone said, just because theyou take new grads doesn't mean jump on it. It is very rough to work in an er as a new rn. I was a floor rn for 1.5 years and I moved to the er, and I still feel unprepared at times. I also came from an emt background as well. If this is your first position and you lack experience there, tread carefully.

Gain experience, learn the field and how to treat people because er is a different beast than floor nursing.

Just remember, just as easy as it was to get the license it's equally easy to lose it. In the er we don't use as much fancy equipment as on the floors. We mix our own mess and antibiotics, we push mess running on a verbal order from a doctor without having it checked by a pharmacist. Very easy to make mistakes if your not careful, especially if you lack the experience of working as a nurse and learning the basics first. Just don't lose your license in the process of jumping right to the er

[akulahawkRN, ADN, RN, EMT-P]

I got my first (and so far only) nursing job in the ER as a new grad. I was lucky in that I was given a relatively long orientation, about 6 months before I was set off on my own. I still have a couple nurses that I use in a mentorship capacity as I learn things. I was a Paramedic for quite a while and that did help as I'm more used to the chaos of the field and can handle better the ER because of that.

Now then, I've been an ER Nurse for about a year now and while I'm comfortable with many things, there are still things I'm not yet all that good at. I'm still learning how to do certain roles when working codes. Part of this is that I'm used to running codes and leading the team instead of filling a specific role and (fortunately) we don't do many codes. I've been at the top of the game before and I know what that performance level is. I know I'm not there yet and I won't be there for a while.

There are a lot of easy ways to put your license in jeopardy in the ER so be careful. Unlike most other environments in the hospital, sometimes physician workload/volume requires us to take verbal orders and implement those. It's very easy to get an order wrong when you do this. You have to pay attention to what is being said, especially for some labs. An order for BNP can sound very close to BMP. Sometimes the physicians will order quite a bit of tests/labs so your memory needs to be ready to handle that. I'm getting better at it but there still are tests that I'm not quite sure how to order it to cover what is needed.

Sometimes there are physicians that want to see the patient before any orders will be put in and there are some that want us to follow protocol and put in quite a bit before the patient is even seen.

While I do some bedside triage when the department census is low enough, I'm not quite yet able to do triage on my own where I see patients, triage them, put in certain orders, and return them to the waiting room.

The point is, like other posters above me, there's quite the learning curve and it's steep at first. I'm at the point where the curve flattens out a bit but I've got a ways to go. Would I have done as well right away without having Paramedic experience? Probably not. What did help is that I already know how to interpret an ECG. I already know how to run a code if I had to. I'd get into trouble for going too far in certain area (like airway management in a code) but I at least know that I can tread water until help arrives. I already have a feel for "sick/not sick" but that still being refined. I'm also getting more into the larger picture of things but I can still get bogged down in certain tasks.

In my opinion, new grads can do well in the ED, but they need a good, supportive environment that will allow them to grow into the department. I would expect that the ICU would be very similar in that regard.