Critical care experience before ER?

[supernova004]

I'm graduating from nursing school in a few months. I've loved my ER experiences IMMENSELY. The hospitals in my area say they want a few years of ICU experience in candidates. I've been applying to critical care and step-down units for my first job.

The other day I talked to a unit manager in a hospital out of my area who runs both an ICU and an ED. He said he couldn't disagree more, that that sort of thinking was old school. He said if I want to do ER, I should just aim for the ER.

Your thoughts?

[LT Dave]

I happen to be an ICU RN who is now in the ER. My experience has given me a great advantage over the rest of the staff. There are now 3 of us who worked in the SICU and MICU before going ER and we stand out from all the others.

ICU experience make CODES and all other Medical Emergencies 2nd nature for you to treat. You are on auto pilot and know what to do with out having anxiety. After you can handle ICU the rest is easy. The ER is more frustrating, but I find all the different situations interesting. Good luck.

[JSRN81]

At our facility, at least 6 months of critical care or other acute care experience is recommended before working in the ER. We have two "internships" available for new grads every year, and they undergo over a year of training under a preceptor in the ER. Otherwise, they do not take new grads. The poster above was right about codes being second nature when you have worked in an intensive care before the ER. I have worked ICU for over 3 years now, and when I float to the ER, I'm always pulled into a code, whether or not its my patient because the ER staff know that I have that experience. You have a better understanding of how to titrate drips and different medications when you work ICU before ER. Often times we have ER staff call up to the unit asking about meds because they aren't terribly familiar with them. If you want to feel comfortable and transition in easy, I would recommend some ICU experience first.

JS

[Larry77, RN]

At our hospital is is harder to get in to the ICU then into ER and neither take new grads, must have 1yr Acute care experience for both. I still think Med/Surg is a smart way to go...sure there are good ED/ICU nurses that never worked Med/Surg but I think it's an easier transition if it's done this way.

[mom23RN]

I went right into ER as a new grad. I'm sure it would have been nice to have some sort of expeirence period... but I didn't want to work anywhere else.

I have to disagree that having some sort of other experience would make you a "better" nurse or give you some kind of advantage. I think that an "experienced" nurse gives you an advantage. Whether you get that experience in the ED or critical care. *shrug*

I say if you like ER than GO FOR IT!!!! I loved it!!!!

[supernova004]

Lots of perspectives. It's very helpful, thanks!

I start my 150 hour monitored care unit/telemetry preceptorship tommorrow and I think that if I do well in that setting, I'll start in a step-down or a med/surg unit first then move up to ICU. If I'm not digging my preceptorship, I'll think about a direct move to ER.

That's my thinking process at this point, but I welcome more perspectives and feedback.