ER Experience

getoverit, BSN, RN, EMT-P · Mar 20, 2008

As a new grad, I don't think getting ICU experience would be a good transition for you to get into the ER. How much longer in school do you have?

Starting off on a telemetry/stepdown unit would be better. Or just go to the ER, hopefully the orientation will be good enough and long enough to sharpen your assessment skills to where you need them to be.

ICU experience will be with lots of drugs, monitoring hardware, and sitting for 12 hours at the bedside of some critically ill patient which doesn't translate well in the ER most of the time.

Good luck as you finish school and pursue ER nursing!!

BrnEyedGirl, BSN, MSN, RN, APRN · Mar 20, 2008

I know I will get boooed for this,.but I'm gonna say it anyway. I'm a recent transfer to the ER (a little over a year ago) after almost 8yrs as an RN on a cardiac/step down unit. I love the ER and plan to stay there,.but I must say,..many of the great folks I work with have never worked anywhere else and it shows.

It is very hard to aquire competent assesment skills in the ER. It is very hard to "see the whole picture" in the ER. I also find that many of the arguments between ER staff and floor staff (it's everywhere) is because the ER doesn't have a clue what's going on on the floors,.and the floor hasn't a clue what's going on in the ER.

The ER is very fast paced (it has to be) and very c/o focused. You spend very little time with your pt and you may be one of 4 or 5 nurses that actually care for that pt in a 3-4 hr time period. That doesn't give you much time to learn much about your pt or to put all the pieces together about what's going on.

Working on a step down unit or at least a tele unit will be the greatest learning experience you can have, especially if you work in the unit of the same hospital, then transfer to ER. It is the best way to learn how the hospital runs,.specifics for lab, radiology, etc. You get to follow through with your pts,.see what happens to the person with CHF who gets 2 units of PRC's in two hours. What happens to the LOL who recieves morphine for chest pain. What to expect from the pt who recieves 40 mg Lasix.

You also learn so much about so many different drugs, how they're given, why give them, what to expect etc. You learn what is needed from the ER for the unit to continue to care for the pt. You learn alot about how the admitting docs will treat things way different than the ER.

There are so many advantages to working a full shift with the same pt. I could go on and on,..I honestly believe you will be a better, safer, more confident nurse by spending a year or two on the floor first.

I wish you the best of luck,.nursing is a great career for those of us who love it and we need more excited new grads! Hang in there and learn as much as you can,..find someone you admire and watch, ask questions!

Good Luck!

Trauma Columnist · Mar 20, 2008

Think it depends on the nurse. I had one year of ICU experience before I went to the level one truama center - loved it and found my niche! I think that nursing is a big career field and there is something for each personality.

rlgiv · Mar 20, 2008

I worked as an extern for a year in an ER before graduating. They put me with another RN and I worked there schedule for that year. IT was like a year long orientation. When I graduated I stepped right into a staff job and felt comfortably in that ER which was a small rural hospital. I worked there in a staff position for about four months before I moved into the second busiest ER in my state where I did another four month orientation. I'm fine. I work at just as high a level as other RN's with more experience.

We have floor nurses who float down to the ER and are overwhelmed. We have ICU nurses that feel the same. IMO just come and jump in the fire. There is no better experience than just doing it. The learning curve is extremely sharp but if thats what you wanna do life is to short to be wasting time.

Good luck in school!

Blee O'Myacin, BSN, RN · Mar 20, 2008

I am still in school. I'm still not sure what I want to go into, but right now, the ER is what I'm leaning toward. Anyway, a good friend of mine who is a nurse told me I should get experience in another department before going to the ER. Her reasoning is it would be better for a new grad to get experience in assessment skills before going to the ER. She recommends ICU or a step down. As ER nurses, would you recommend starting off in an ER, or would you recommend getting experience on another floor? If you think experience is needed before the ER, where would be the best place to start?

I think that if you find a hospital with a good ER residency program, you will be fine. If you go somewhere else "for experience", with your heart in the ER, you will regret it.

I spent 3 years in the ICU, I would not change that for the world. I felt very comfortable transitioning to the ER. Although I still feel like a fish out of water when I work the fast track assignment, even if it is gratifying to get the patient stitched up and out the door in under an hour and a half!

So I say go for it - why go do a demanding, often thankless job in an area where you don't want to be? You are setting yourself up for becoming miserable and burnt out!

Good luck!

Blee

RUBICON, RN, EMT-P · Mar 20, 2008

It depends on your background. If you have a Paramedic or other Advanced-EMT experience, than I would say starting in the ER is fine, because (as a medic) you already have been exposed to critical care issues, assessment, skill, fore-thinking and reaction. It also depends on the support/preceptorship that the hospital will give you. Generally speaking, an ER/ICU is less practical for new grads (who have no prior critical care experience) because of the time needed to invest and learn, etc. There are always exceptions to the rule, like people who are clinically smart and can anticipate situations versus waiting for more serious signs/symptoms to appear before red lights go up.

I worked on, and still work on, many ambulances for 18 years before becoming an RN. For me, the transition was not difficult because I used my experiences to guide me. While at the same time, 2 new grads with zero prior health experience were also hired. They both do well, but one seems more aware than the other, in regards to assessment and anticipation of things worse to come.

So I think it boils down to knowing yourself: We all have Potential. But what are your Abilities and what are your Limits? Take care and Best Wishes!

nickola · Mar 21, 2008

Definately get some good solid experience first. The assessment skills you'll acquire will be well worth it. I did telemetry/pre-post-open heart floor for 5 yrs b/f transferring to ER-- it proved to be invaluable since the ER I went to wouldn't take inexperienced nurses. Good luck!

DebanamRN, MSN, RN · Mar 22, 2008

I really think getting a year of good, solid experience first is very helpful. I'm on the other side of the desk, observing the RN's. Brand new grads seem to have difficulty adjusting to the ER unless they were ER techs/EMT's first. I had 9 months of cardiac/trauma stepdown before coming to the ER and it was excellent experience, and lead me to the ER. The ER can be very overwhelming, depending on your area. Smaller ER's will give you experience without the craziness. I work in the second busiest ER in the US and its extremely crazy. That being said, I'm halfway thru my RN and don't want to go anywhere else.

One thing I have learned since graduating, whatever I thought I would do, I have gone completely the other way. Go where your path takes you, and good luck! Your niche will find you.

helloworld · Mar 22, 2008

As a new grad working in the ER my answer is it really depends on you and your strengths. My best recommendation would be talk to your instructors, and see what they say to you. They know you and have seen you on the floor, they can assess your clinical skills and pretty much tell you what they think of your abilities. At least I found this to be true with my instructors. Also, see if there are any nurses who started out recently as new grads in your hospital and ask them about the preceptorship program.

I was very torn between the ER, ICU, and renal med-surg and all were actively trying to recruit me. I had always been interested in the ER but had the same concerns as you as to whether it was a good place to start, and after spending a lot of time picking my instructors brains and asking them what they thought of my abilities they all told me they thought I would have no trouble adjusting to it if that's what I wanted to do. I decided to go with my heart, and I am now in the ED orienting. It's fast paced, it's crazy, but I LOVE IT. The advantage with starting in the ED is that I am getting used to the pace from the get go, and building my time management skills to match that pace, as opposed to having to relearn and reset myself.

Regarding what someone said about not learning assessment skills, I find that's not true, but that's probably because my ED has a good preceptorship program. My preceptor allows me to take my time assessing at least two of our assigned pts when I come in, if not all, and the other nurses cover our backs if something major comes in. And because I just came out of school, head to toe assessments are still fresh in my mind. I'm now one week in and I can actually feel the difference, my assessment skills are getting sharper, I am getting more focused, I am starting to really absorb the concepts of triage, and getting a lot more accustomed to some of the more common conditions we see such as MIs, strokes, etc and how to do assessments and stabilize the patients. I am nowhere near good, let alone competent, but I can feel the changes happening in my thinking. I spend a lot of time listening, and I jump in and do whatever I can, especially when a code or a critical pt comes in. There's a great support system in place to make that possible, and any of the nurses will grab me when there's an interesting case and talk me through it, letting me do the work whenever practical.

So it really does depend a lot on you hospital and on you.

Good luck to you! The ED is a great place to work.

TaraER-RN · Mar 22, 2008

I have been an ER nurse now for almost 7 years...all of it being in the ER (I started as a new grad there). I have trained multiple new grads into our department, and truthfully in my experience it has been easier to train a new grad than a person who transfered from another area of nursing. New grads you seem to be able to mold, whereas those that come from other areas sometimes are stuck with old habits that are detrimental in the ER. That being said, that is just my experience. I know that it depends on the person...if you are energetic, feel you can multi-task/prioritize and have a good memory than the ED is for you and you should hopefully not have any problem...but if you need to build your skills and can't multi-task easily then you may want to build your skills/medication knowledge etc in another area. It really does all depend on the person...good luck!

Dave11, BSN, RN · Mar 25, 2008

Having just recently finishing precepting a new grad to the ER, I know it can be done. lol

The facility must be willing to take the time to get you up to speed. I was with my new grad for the better part of a year and I am happy/proud/relieved to say they are doing great.

Talk with some of the nurses in your ER and see if they think there is a good, or any, new grad program in place. They will be more than happy to let you know if they think it is lousy. If there is one thing nurses are not short of, its opinions.