ER or ICU for the New Grad

allnurses Guide · Dec 25, 2006

I'm a nursing student and I've been cautioned to get some med-surg experience before going to any specialty area; however, I was wondering if a new grad had to be placed in either the er or the icu which area should he/she be placed.
I would prefer responses from professionals who have been on both sides of the spectrum.

Many hospitals offer new nurse residency programs in various specialities i.e. ER, ICU, OR, PACU, Med-Surg etc. I went thru an ICU residency program as new RN. I think you should go into the area you want to go into and not be directed to do something you don't like. It has worked out well for me, but now looking back I think the most important thing to look at is the hospital and the envirnoment you will be working in. My first hospital wasn't nurse friendly and generally had a large nurse turnover making it a difficult envirnoment to work in.

Good Luck!

RN34TX · Dec 25, 2006

Telling new grads that they need med/surg experience first is nothing but old, outdated advice from nurses who need to update and get with the times.

You need to go where your interests and passions are in order to be the best and most successful nurse you can be.

New grad programs for specialty areas are very common today.

It's a waste of time, money, resources, etc. to have nurses who chose med/surg as their specialty to be constantly training new grads on their units only to lose them in a year or 5 to ICU, ER, NICU, etc.

I started as a med/surg nurse before going to ICU but felt that it was time to move on after 6-7 years.

Was the med/surg experience helpful and valuable in transitioning to an adult ICU?

Absolutely.

But was it necessary?

No, I just would have had a much longer orientation/preceptorship as a new grad with no experience at all.

TazziRN, RN · Dec 25, 2006

RN34, the OP specifically asked for opinions about which specialty area.

I am in the ER, I have been since graduating in '88. I love it. The idea of going into the ICU, with all those machines, scares me to death. However, some of my classmates went into ICU and they were scared to death of getting people with parts hanging off and holes where there weren't meant to be holes. I remember one classmate saying, "You put them together and give them to me, I'll maintain them until they get well or die." It just depends on what you have an interest in. If you're not sure, or if you think you'd like both, then accept a preceptorship in one and then cross train in the other later on.

RN34TX · Dec 25, 2006

RN34, the OP specifically asked for opinions about which specialty area.
I am in the ER, I have been since graduating in '88. I love it. The idea of going into the ICU, with all those machines, scares me to death. However, some of my classmates went into ICU and they were scared to death of getting people with parts hanging off and holes where there weren't meant to be holes. I remember one classmate saying, "You put them together and give them to me, I'll maintain them until they get well or die." It just depends on what you have an interest in. If you're not sure, or if you think you'd like both, then accept a preceptorship in one and then cross train in the other later on.

OK.

I guess I was commenting on the OP getting cautioned to go to med/surg before entering another specialty.

In that case, I second your thoughts on going where one has a genuine interest.

But if the OP is torn between the two.....wouldn't it be easier to start in ICU and then cross train to ER later?

I'm asking because I really don't know. I've never been a real ER nurse, only floated occasionally to help out in staffing crunches.

You made the comment about all of the "machines" scaring you so I was thinking that maybe getting trained to ICU first might be the better way to go.

I don't know.

The OP needs some input from someone who has worked full time for a while in both ER and ICU settings to get a more knowledgeable comparison between the two.

Lacie, BSN, RN · Dec 25, 2006

Dont let being a new grad stop you from entering either area. Telling new grads to get med/surg first is way way too outdated in todays time of technology and most hospitals have good orientation/preceptorships for these areas of specialty. It's all dependant on which seems to interest you the most. I went straight into CCU/CVICU out of school and that was 24 years ago. I havent regretted one day of doing so.

TazziRN, RN · Dec 25, 2006

It wouldn't really make any difference because the machines that you learn about in ICU are not used in the ER. Knowing one helps you with the other but they are not completely interchangeable.

Trauma Columnist · Dec 25, 2006

When I graduated with my RN, I went into med-surg, lasted 6 months because of the rotating shifts (had to rotate all three in one week). My sleep was nonexistent!. Then I went to a busy ICU for a year and loved it. Then...we moved and I went to the ER. This the place for me - loved it very much and did it for 10 years.

Personally, I think a new grad can do any unit with a good solid orientation which includes didactic as well as clinical experience. You must also cultivate an environemnt where the new grad is welcomed and questions embraced.

npryde · Dec 25, 2006

Wow! All the responses were very wise, extremely insightful, and professional. I admire all the responsders for their wisdom. I was a former paramedic and now in the nursing field as a student. I have personally struggled b/t where I wanted to go when I graduate: ED or ICU. Both have aspects that are very attractive to me. I know there are pluses and minuses to both fields (as with all fields). Your responses to follow your heart and try first thing in your desired area is inspirational. I had seen the "you must start in med/surg" replies many, many times before. Very dogmatic and absolute.

Your enlightend replies seem very innovative compared to the other replies I've heard in the past that have said, "there only my way" and "nothing else works -ever."

And the posts alluding to the new training programs...thanks for pointing the benefits of those. :welcome:

tiezto · Dec 26, 2006

I know that the OP requested seasoned nurses to respond - but this is the same exact issue that has my mind all tangled. I have worked as a clin tech in a small ICU since July, and just finished a 250hr preceptorship in the ED. I definitely respect the opinions of all experienced nurses when they say 1-2 yrs of med-surg helps the new grad get their organizational skills/time management down and allows them to learn to detect more "subtle changes."

Personally, I think I would grow faster if I was just immersed in the worst of it. I am leaning toward critical care because I feel something special in the ICU. Experienced nurses: wouldn't it be better to go from ICU to ED rather than the other way around? I can't rationalize this without bias from my ICU experience (ie. "ED nurses always send our pt's up with IV's in the AC" and "Emergency nurses know a little about a lot of things"- a frustrated, burnt-out ICU nurse)

I admire emergency nurses and hope to work in that field at some point, as I love the speed/adrenalin & generally positive turnaround. I want to do both ICU & Emergency at some point - but I'm leaning toward skipping the whole med-surg thing. Sorry if this isn't making any sense - just switched to nights.

bidimom · Dec 26, 2006

First of all Merry Christmas to you! Second, I went right from school to a small inner city ED. If you know for sure that is what you want to do, then go for it. Be ready to hear alot of comments from staff about how new grads should not be in the ED. Also, be ready to prove yourself and your nursing skills. Once you prove you are a good, caring nurse that isn't afraid to learn or to ask for help, everything should go smoothly! I knew right from the beginning that med-surg wasn't for me! Don't do it if you know you don't want to you'll end up hating nursing. Hope this helps some.

AfloydRN, BSN, RN · Dec 31, 2006

I was a new grad and went into the ER after graduation. My only other experience was as a CNA. As the above nurse said- be ready. It is SUPER fast paced. You will either " Get it" or not. Ask alot of questions and attend as many educational offerings as are offered. Make yourself part of the team. Be optimistic and not negative. Pe prepared to hear alot of negativity down there. ER's are known for this. Don't get caught up in it. Just do your job.