I was a new grad in a level one trauma center. Before and during nursing school, I worked on a peds/womens unit for three years as a CNA.
I love my job. We have a great new grad program. There were nine that went through the program, and all but about three of us are thriving. One is still having serious issues with prioritization, one doesn't like the disorganization, and one... well.... I just don't know about her.
Many say they don't feel like the ED is good for a new grad. I say if you are positive it's what you want to do, and you love it, and you couldn't imagine doing anything else, then don't. Be a new grad in the ER. Yes, it's tough. You see everything. Just yesterday I had a 7week old in one room with bronchiolitis, a 28 year old ICU admit with DKA in the next, and a very old gentleman with delirium/urosepsis in the next room.
You don't have to know everything to work in the ED, you just have to be willing to learn. My first month with my preceptor was horrible. I was lost and I was scared. However, I was also willing, excited, thankful, and curious. I had a preceptor for three months. This is how we did it:
Every Monday, 12 hour class over critical care/ED issues.
Two days a week with preceptor
Before passing boards: I watched her for a day. I took one patient for a week and prioritized things to do with that pt.
Week 2: Two patients, same thing.
Week 3: Three patients, same thing.
Week 4: Stuck with three patients (this is where I started getting scared).
Week 5: Full pt. load. Preceptor was doing meds and IV starts, I did everything else on all of the pts, including all prioritization (with her guidance)
Then I took boards, passed, and started over with one pt. but gave meds and did everything, working my way up. There were days I went home feeling in over my head... but they occurred less and less.
Once I was off of orientation, I felt as comfortable as I could hope for. It gets better every day. I am now confident in my own abilities, and don't worry about killing someone. I still ask for help, and I have many very experienced coworkers that have been a Godsend in certain times. This is a teaching hospital, and the ED staff are supportive of all 9 of us.
For those that say it can't, or shouldn't be done.... I respectfully disagree.
I would advise you to join the Emergency Nurses Association as a student. The membership is MUCH cheaper than it will be after you graduate. You'll get access to the Journal of Emergency Nursing. Read it. Go online and read about different conditions, especially the critical ones (Hearts, strokes, DKA, sepsis, seizures)
See if you can find a book on rhythm interpretation. Study not only the rhythms, but what the treatments are. What do you give for new onset A-fib? Why? What is the first thing you do if the monitor reads v-tach? Why? What if the pt. is stable, but has a heart rate of 30? What do you anticipate being done?
Maybe find a CEN review book, and study up on that. It'll have differential diagnoses in it, and it'll tell you about lots of stuff you may have never seen, but are bound to see in the ER.
Don't stop learning, and don't think you can't do it. You'll be awesome.