Road to the ER

  1. I graduate soon and I was wodering about where everyone stood on where to start ER nursing at. I have concluded I would be old school and start with a year of med-surg and then go to the ER. I have also been hearing that a year of ICU before ER is quite beneficial as well. Any thoughts? Also when is a good time to start with the TNCC and CEN cert's?
  2. Visit cinja profile page

    About cinja

    Joined: Apr '05; Posts: 141; Likes: 23
    Flight Nurse; from US
    Specialty: 5 year(s) of experience in CCRN, CEN

    7 Comments

  3. by   cardiac.cure03
    I know quite a few people in my graduating class that started right off in ER and are doing great with it. With the right orientation and preceptor, you should be ready to go!
  4. by   cinja
    I guess for everyone that does well there must 3 or 4 that are struggling. My friend just today who graduated the past December said it is sink or swim for him, a new grad in the ER. Said everyone is nice but wat too busy to help him when he gets stuck not knowing what to do. told me if I could survive a year of med-surg I would be able to come down and learn quite quick.
  5. by   bill4745
    I'm old school-get a year of M/S or tele/ICU.
    We hired 6 new grads (some type of grant) and after 6 months of orientation, 3 of the 6 are near termination (either their own desire or from the hospital). It is difficult to learn critical care skills in the ER since you are not doing critical care most of the time.
    The 3 grads who are leaving have had their confidence smashed, and have a blemish on their resumes.
  6. by   Medic/Nurse
    I guess it is an "individual" thing. Like bill, I've seen very mixed results with new grads in the ED. The sink or swim thing is TRUE --- off orientation, you best be able to keep up, sure I always will answer questions/help - but, I will usually have my own nightmare assignment going on!

    Not sure what your story is - some do make it though?

    Do you have prior experience in healthcare?


    As far as TNCC - I would do this in 6 months or a year, It is a 4 YEAR completion - so, I'm not too sure how much you would meaningfully retain unless you were able to incorporate the course into actual practice.

    CEN - is Board Certification in Emergency Nursing. The BCEN reccs 2 years ED practice. Also, an individual thing here too. Did mine 5 months post NCLEX, passed easily - but I had been a medic for a long time.


    Bottom line -

    How well do you critically think?
    What kind of prior experience do you have?
    How prepared do you feel?
    What kind of emotional maturity do you have?

    Good Luck.
  7. by   mom2michael
    Quote from NREMT-P/RN
    Bottom line -

    How well do you critically think?
    What kind of prior experience do you have?
    How prepared do you feel?
    What kind of emotional maturity do you have?

    Good Luck.
    :yeahthat:

    I also want to add, we have an RN that has 2 years of experience in M/S/ICU/Tele and she can't make it in our ER because she lacks at least 3 of the 4 items listed above.......
  8. by   WDWpixieRN
    Quote from mom2michael
    I also want to add, we have an RN that has 2 years of experience in M/S/ICU/Tele and she can't make it in our ER because she lacks at least 3 of the 4 items listed above.......
    So, can I ask (as a student strongly considering ED work), do you think these are skills that sometimes a person either has or doesn't have. In other words, in school, there is so much emphasis placed on the critical thinking component that both the NCLEX and NS consist of, yet many of us in my class don't consider that type of question a problem at all? But it seems there are several who are struggling like crazy?

    I'm sure like so much in NS and life, that these can be developed with time so I am not saying that a person can just eliminate themselves from consideration if they don't currently have the skillset.

    My concern is that I've applied for a summer internship in an ER and have really been hoping to go directly in to an ER somewhere on graduation if I like the setting as much as I am thinking I will. I am older; probably not as fast on my feet (brain) as I used to be; and in a situation where I am uncertain, will wait rather than jump in a make a mistake.

    So this thread and the replies just got me to thinking.....
  9. by   Medicine Eagle
    I would just like to say as an ER nurse of 8 years( I did med-surg first), that if I had tried to go straight to the ER w/o learning time management skills, how to deal with pt and family stress, and getting my basic skills fine tuned, I would have lost my mind. If/ when you go into the ER it never hurts to learn as much as you can. At 6 mo I took ACLS, TNCC, and ENPC. I would not however, attempt CEN without a couple of years under your belt. The letters are not as important as what you learn each shift from your pts and other nurses and docs. I always say and believe, that the fist time you go to work a shift and you don't learn anything then you were not paying attention. If you ever think you know it all, no matter how long you have been doing it , then it is time to hang up your stethascope. Because you are now a danger to your pts. I firmly believe that all nursing is a profession of life long learning.
    TiredBraveHeart

close