Need advice: should I start out in ER or tele/med-surg?

  1. Here's my situation: I'm an ADN student graduating in May. I'm 29 years old and currently work as an extern (pretty much a CNA) on the tele floor of a community hospital. I plan to stay at this hospital when I graduate. I have always been interested in ER nursing, but we only get 1 day in the ER to observe as students so it's been hard to make a judgement call based on this limited time. This is a "second career" for me, so I am still learning basic patient care from scratch, but I do consider my critical thinking skills to be strong. I'm trying to decide whether to do my preceptorship in the ER and try to get hired there upon graduation, or do my preceptorship in ICU or general tele and get hired on the floor where I currently work.

    The monkey wrench in this situation is that my husband and I want to have a baby (our first) this year. I know, sounds crazy trying to do this as a first-year nurse, but many factors have weighed into our decision and we feel that now is the right time. I am wondering which choice might be easier on me considering our plans. I have more familiarity with the tele floor, but it is certainly not an easy place to work either. Regarding the ER, it is a community hospital as I said, so serious traumas get flown out. Although I ultimately see myself in the ER, I wonder if given my situation it might be best to get the general med-surg experience while I deal with a pregnancy and then head to ER when I have more experience.

    I am trying to find a balance for what is best for my family, nursing career, and mental health :chuckle, which makes for a tough decision. But any advice and input would be much appreciated. Thanks in advance.
    Last edit by secondfiddle on Nov 4, '06
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    About secondfiddle

    Joined: Jan '05; Posts: 45


  3. by   bill4745
    A year of tele would make you a much better ER nurse, and would also make you more marketable in the future should you decide to leave the ER. Going straight into ER is a poor idea for a new grad - bad for the grad; bad for the patients.
  4. by   augigi
    And if you're planning on leaving in the near future, it's a BAD idea to start in a specialty! It takes an awful lot of time and resources (on the unit AND you) to train you up, for you to leave to have babies. You'd be better working tele for experience, then coming back and getting stuck into whatever specialty you're interested in, than starting a specialty and then losing your skills.
  5. by   UKRNinUSA
    I would stay put - being a new grad is tough, being pregnant can be tough -why double your trouble? You've got plenty of time to specialize after you get back in your groove. And in case you run into some troublesome somatic complaints while pregnant, you will probably get more support from colleagues that already know you than ICU/ER nurses that are wondering why the hell you decided to get pregnant and take time off after they've put all this effort into training you. Plus there is the pregnant/new mommy brain factor - I personally found it comparable to early dementia.
  6. by   secondfiddle
    Thank you so much for the replies. They confirmed my gut feeling that I should just start out in med-surg given my situation (also not a bad idea regardless to get that broad experience, I think). I want to clarify, though, that I don't plan to start nursing and then "stay home and have babies" as one poster seemed to think. Being a stay-at-home mom is really my worst nightmare - I definitely want to return to work as soon as it is healthy and comfortable to do so. Depending on how I feel, I may want to come back part time for a while, but I'm going to play that by ear. Thanks again
  7. by   Jennifer, RN
    I worked tele for 5 years (started out on tele as new grad) before transferring to ER. The first 5 years of nursing, I learned so much and became so confident in basic nursing care, assessment and procedures that transferring to the ER was way less stressful. The ER is a very fast pace environment, sometimes you don't have the help or teamwork you need, and you have to know how to perform tasks accurately and at the speed of light. You also need to be able to assess and recognize critically ill patients, which takes practice. While working on tele, you will learn cardiac rhythms and arrhythmias and the drugs used to treat them. You will also most likely take care of pts that turn critical, and you will learn to prioritize and expediate tasks. You will also be involved in code situations and probably become ACLS certified. Once you feel comfortable as a nurse and confident in the care you give, you won't question whether you are ready to transfer to the ER. Give yourself some time to become a nurse before you throw yourself into the fire. Congrats on having a baby. My first child was 3 months old when I started nursing school, was one of the hardest things I have ever done in my life, but completely worth it. Plus, if you wait until the time is right to have kids, you will never have them. Children are the work of God.
  8. by   mom2michael
    I've been an ER tech all through school and I quit a few months ago to work on a Tele/Step down unit for more exposure my last semester of school. I do not regret this one bit. I've learned a lot but it has also made me realize I have so much more to learn before I can be a really good ER nurse. So, despite the fact I said I would "never be a floor nurse" I've accepted a GN/RN position on the Tele/Step down unit I work on for the experience. So yes, for at least 1-2 years I'm going to be a good floor nurse so I can get some experience and learn some stuff before I even think about ER. I feel really good about my decision too because the staff I work with is awesome and they can't wait for me to start as a GN next month. I still miss the ER but this is only going to make me an even better ER nurse when the time is right.
  9. by   nursebearfeet
    I would advise any new grad to get into med/surg or the like before transitioning into the ER. A good base of knowledge and critical thinking are a must in the ER. Dont give up the dream, I wouldn't want to work any where else, but it's hard enough getting into the swing of being a new nurse on your own without the stress of the ER. Give it some time.
  10. by   Jabramac
    I had to choose as well when I graduated, but with a totally different back ground. I applied to one hospital to the ER and another hospital in a different city to the ICU. I was offered a job at both places. It was a tough choice for me but what won out was that my goal was to be in the ER in that one hospital, and live in that one community. I knew from the start it would be a very tough position for me as a new grad, and it was. I had to prove myself everyday to my coworkers who were not used to training in new grads. In retrospect I wish I had the floor experience, especially ICU experience. I think with ICU and ER experience you can go just about anywhere from there. But, it was a decision I made, and I am glad I did it.
  11. by   ibnathan
    I was going to say go for it, but if you are going to get pregnant then I would go to tele instead of med-surg. I myself am graduating in Dec. and I will be going straight into ICU. In tele you will learn alot more than a straight up med-surg unit. You'll know cardiac drugs and cardiac dysrhythmias, code management and a whole lot more. Good Luck! your almost done and may the force be with you.
  12. by   LoriLeahRN
    Will have to agree with the majority here, folks. Start out on M/S tele, learn your skills and pay your dues, your future ER coworkers as well as your patients will appreciate it and respect you for it, and you'll be glad you did!

    Good luck!
  13. by   HokieNurse
    First of all, good luck with everything you do, which ever career path you choose and your family to be. I also want you to serious think about what your dreams are, I am also a new grad looking for a job and I have talked to more than a few nurse managers for ICU/Critical Care/ER and many of them would rather hire a new grad than hire a med/surg nurse with 1 or 2 years experience. They consider the new grads "trainable", fresh meat they can mold the way they want. Most places also have extensive orientation programs for new grads, including lots or orientating time and lots of class room time. I was considering going into med/surg for the experience first, but after talking to the nurse managers of the ICU/Critical care and ED I don't want to risk missing an oppertunity.
    I am sure you will make the right decision for you!
  14. by   JRapha'sRN
    I would find out what kind of orientation is offered by the ED. When we hire a new grad they are put in ICU for several weeks (up to three months) as well as on a tele floor for the same amount of time and then come down to the ED and work with a preceptor for 3-6 months. If your ER can do this for you, it is ideal. If not, and they will throw you right in, then I would agree with most of the other posters and say start on your med/surg/tele floor.