Green employees (nurses) in ER - page 2

Just a question in general--how do people feel about new, right-out-of-school RNs running right into ER? Are we ready--for those of you have some experience? Is it someplace you feel comfortable... Read More

  1. by   mattsmom81
    Ya know, on second thought I decided to add something here...

    I remembered back to the first times I saw some of the horrendous things that come into the ER. Aborting fetus, legs twisted backwards, GSW to head, open eviscerated belly wounds, SIDS babies....I honestly don't think I could have handled that stuff as a new grad. Like Hank, I did ER for a few years then moved to the more 'controlled chaos' of ICU. Some folks thrive on the adrenaline rush of ER, some find it too much. I can handle it in small doses only now...LOL!

    Are you a totally unflappable student nurse that loves the sickest patients and fastest moving situations...are you drawn to watch/participate in codes?If you're the type who is a bit queasy or gets shook fairly easily (this isn't meant negatively, it describes many new grads when nursing reality hits) it might be better for you to get a slower start....consider 6 mo or so on medsurg to see how you like the emergency situations on the floors...then ask to cross train to ER fasttrack if'll find out soon enough whether it's for you or not....ER is a 'reality shock' kinda place. Good luck to you!

    'The world is your oyster'.
    Last edit by mattsmom81 on May 3, '02
  2. by   traumajunkee
    I have been in ER a long time and have also seen great ER nurses come right out of school but most of them had a clinical rotation in ER while in school, worked ER in some capacity while in school, or had some other sort of EMS back ground. If you feel prepared to make decisions concerning life and death and had a strong clinical experience in school then go for it. In the ER many times it is the nurse's "intuition" based on clinical experience that saves lives. If you still feel like you need training then make sure they have a prolonged internship program. The ER is the one place where you cannot be supported by other nurses until you get your footing. Everyone needs to be self sufficient. I always advise new nurses that want speciality areas to get a minimum of 1 year icu experience. It is the key to diversity in your career. There is no area in the U.S. that does not need critical care nurses. It is also the stepping stone to other areas such as ER, anesthesia, surgery,travel nursing, etc... It is where you hone fine clinical skills.
    Good luck whatever you decide.
  3. by   JBudd
    I worked med-surg, scout camp, overseas orphanages, specialty wards, etc., for 15 years before moving to the ER. I really think learning to organize and assess before entering the chaotic world of ER is important. I literally had 4 people talking to me at once the other night while in charge, not one would give way to another, some important stuff & some not so, being directed at me. I don't think as a new grad I'd have had the guts to ignore the doctor first! Which I did, because what he was wanting wasn't nearly as urgent.
    So, if you already have great (or even just pretty good) organisational and prioritizing skills, go for it, otherwise, give yourself a chance to develop some before entering this sometimes crazy but beloved place.

    PS: I sometimes tell people you know your life is a bit odd when you consider night shift in the ER the oasis of peace in your life!:roll
  4. by   MollyJ
    I've seen new grads (and others) chewed up and spit out by the ED and that's pretty sad when it happens to a new GN. They think it's a general statement on their fitness as a nurse.

    I think an ED with a good orientation and mentoring program could be okay for a new grad but prepare to be pretty darn ground down for about a year. (that's what I saw happen to a friend who is, to this day, an ED nurse).
  5. by   mattsmom81
    So many ER nurses I work with were EMT-P's first I've noticed...of course they do very well as new nurse grads in ER with their background.
  6. by   tigger86334

    i have been working er's for most of my career, but i started out as a floor nurse, worked my way to the icu and then into the er. just getting out of school and jumping into the er alot of people can get hurt patients as well as nurses. as you know the er can be a scary place.
  7. by   MPHkatie
    in critical care areas is now a reality. I was an ER tech and wanted only to do ER, but my manager said- go to ICU for a year and then we'll hire you back. And she did. Now, I work in a different ER that hires new grads, and even with their paramedic experience we have not yet had one finish orientation on time, they also have all had to rotate through the MICu and SICU to get some critical care experience, all the while we are paying them. I'm not against them, but I see that they were an enormous financial drain to the department . Some of them are doing ok now, some are not. I still think it's probably ok to hire them, but maybe not to hire 7 of them, as we did last year. It was rather difficult to provide staffing when you knew that over half your night shift staff was new grads 10 days off orientation.

    My other thing is that my year in critical care was perfect. I don't really see critical care patients with swans and lines all the time now, but I am one of the few people that knows how to trouble shoot an a line and get it working again. I didn't learn all my trouble shooting tricks in 6 shifts in a unit, it took a year, and I still don't know all the tricks. The surgeons know me and are glad to see me, and in general I am just mroe comfortable in traumas because of that.

    People will go where they want to go, no matter what they hear. So, basically, get a good orientation, and try to have something else thats important in your life at the time, so you don't obsess about it.
  8. by   teeituptom
    Howdy yall
    from deep in the heart of texas

    Back to new grads in the ER. If they are the type to survive in ER, then they will. If they are not the type to survive then they wont no matter how much training you give them. Ive seen new grads do very well, Ive seen new grads do only so-so, and Ive seen new grads leave nursing all together and to never return. Its seems to be up to the individuals own drive, perseverance and desires for life in nursing.

    keep it in the short grass yall
  9. by   mattsmom81
    I hear what you're saying Tom...but isn't it sad when they crash and burn in hi stress areas like ER or ICU and give up nursing completely? All that time in school wasted because a new grad bit off more than they could chew and were eaten alive in the high stress, fast world of critical care...

    It's one of the reasons I still advise some 'grounding' in medsurg before deciding on a specialty area...can't beat the confidence building from a short stint on a busy med surg unit, IMO. New grads can 'find themselves' a bit there...see what they it peds, moms and babies, geriatrics, surgery, critical care, etc. JMHO.
  10. by   zudy
    If you want to be in ER, go for it . I spent my first year in ICU to gain experience, I hated it. Getting into the ER felt like coming home. And I still love!
  11. by   James Huffman
    Normally speaking, I recommend that nurses spend a year or 2 on a general med/surg unit prior to going to any specialty area. (Since most nurses don't undergo a formal internship, perhaps it would be a good idea to instill in new graduates the idea that a med/surg stint is their internship). There are exceptions, of course, but I've found that specialty areas are often less forgiving of the learning curve that most new grads go through than more generalized units.

    I'm also concerned about nurses who specialize too quickly, and are pegged into too narrow a track too early. Start off broad, and you can focus later on.

    Jim Huffman, RN
  12. by   teeituptom
    howdy yall
    from deep in the heart of texas

    Well Matts Mom, I agree with the experience in m/s,or telemtry also, but administration doesnt. And some do well, and I feel bad about the ones who dont.10 years ago, we never would have taken a new grad. However we are taking 4 or 5 new grads a year at least here.

    keep it in the short grass yall

  13. by   brassdragon
    I am also a new grad wanting ER, I did have some experience as an EMT on a fire department but not too much. I had a chance to get into a small ER (yesterday, as I am out loking for the right job) But the more I thought about it and as it was explained to me by the nurse showing me around ER is a busy place and may be hard to learn those basic assessment skills. Also it may depend on where a new grad may want to end up, I was unaware that ER is not considered critical care and unless I knew I would want to stay in the ER I would need more experience to go onto other critical areas, I am thinking about starting in a small telemetry unit after doing a 8 week new grad program at the hospital. There I would learn all my critical skills along with improving my assessment skills. The ER is not going anywhere and the only difference would be that I would be a better nurse.