I do not think that a new grad shuld go directly to the ER from nursing school because there is just too much to know. I am a firm believer in the one year of med-surg. While med-surg is a specialty in and of itself, I believe that a new nurse needs to learn the basics such as assessments, time management techniques, stress management. I know how stressful working the floors can be and I am sure that working in the ER can be double that. A nurse really needs to know her stuff and be a confident nurse and a new grad just doesn't have that. Just my two cents.
Jun 3, '02
Joined: Mar '01; Posts: 1,050; Likes: 43
I feel that this should be done on a case by case baisis. Not everyone is capable of dealing with the stress and pace of the ER.
I have seen more than one experienced critical care nurse from the unit come down to play with us in the ER end up leaving to go back to the unit. I have seen a L&D RN do exceptionally well on her transition into the ER. So, it varies from person to person whether or not they can make it.
I feel that if a hospital is going to put new grads into the critical care, ER or other fast-paced or high stress positions then they (the hosp) needs to have an internship set up so that while they are getting work experience in the ER, they are also going to classes to learn the basics of why they do what they do.
I have had new grads working with me and the most important thing the successful ones brought was a desire to learn. We try to give the new grads 12 weeks orientation. During this time they spend 2 days a week in class...simple things like ABG's, drugs, 12 lead interpetation, and anything else we want to throw at them. It has really made a difference in our new grad success rate.
Oh, I was a new grad RN when I started in the ER. But I did have 2 yrs as an LPN and 6 yrs as a EMT-I behind me.
But, I don't think a blanket policy of putting all new grads on Med-Surg is necessary. You may just miss out on a really great nurse for your ER.
Starting out as a "new" nurse is stressful enough without the added pressure that the ER would bring. I'm an ER nurse. First off, they'd never hire a new grad. Zero experience, and experience is what you need in a crisis. You also aren't babied in the ER, the Dr's expect you to know your stuff. They bark out orders..such as.."do a conscious sedation," and the last thing they need is someone saying.."gee....what's that?" The vast majority of ER's also require a critical care course as well as your ACLS. New grads aren't usually equipped with that.
In short, NO new grads shouldn't be in the ER. They don't have the knowledge or experience to work effectively.
Jun 4, '02
Occupation: clinical leader
Joined: Mar '02; Posts: 2
I am a ED nurse with 15 yrs experience and I believe New grads can succeed in the ED with the right support. We hired 4 new grads in my ED and they have all done well. They have all moved at a different pace but are all becoming good ED nurses. In this age of shortages we need to look at new and different ways to pull RNs into our speciality. I think nursing does itself a great disservice by holding onto rules from 20 years ago. We need to look to the future and stop eating our young and start nurturing them.
Jun 4, '02
Occupation: Nursing Student (RN)
Joined: Feb '02; Posts: 1
I am a new grad with ER experience from the military. The hospital I will be working for has hired 10 new grads in the ER. We will have a 12 week internship and orientation with a preceptor for 6-8 weeks. I know this hospital is going to prepare us for the eye-opening experiences we will witness and I look forward to that.
I take my boards on the 12th of June, and by the 30th of June I will be a new grad RN working in the ER. I feel ER in my gut, and I know I will be prepared.
My 'ER' was a Burn Unit, first job, which as you know has its ICU/ER ups ALL THE TIME. I received the job offer while still in nursing school, ran it by my Sr. med-surg instructor (I think, this was 20 years ago!), who felt it might not be the right move. Well, I was young, knew better than she, so dove riight in to critical care from my accelerated BSN. As much as a LOVED the work, the theory was strong, but clinical was weak; so I left after about 7-8 months, always with the plan to return. Wel, here I am 20 years later, but my 'path' has never taken me back. Lots of specialty areas, and cardiac ICUs, then hospice, but never back to my first love of burn unit
Jun 4, '02
Joined: Apr '02; Posts: 38,750; Likes: 16,271
I think a new grad, under the right direction and supervision could EXCEL in ER..they notice the littlest things and sometimes are the first ones to do so. I say, go for it. Just keep eyes and ears open and be a SPONGE!
Jun 4, '02
Joined: Mar '01; Posts: 1,898; Likes: 37
Years ago I would of said no to new grads in the ER. Now I have to agree with Bob, it depends on the grad. Some do very well with good orientation and support system. With the nursing shortage looming larger every day we don't have the choices for help that we used to. We are very short help now in our ER and I would take a new grad that is eager to learn and excited about the ER in a heart beat. I went right into critical care when I graduated 27yrs ago and I did fine!!
I fully support our department who hires new grads to our ER, HOWEVER, not one of them has been able to get off orientation on time, and we have sent every one for a month on our payroll to an ICU. The do very well with the less acute patients, but have a great deal of trouble when working with any unstable patient on Drips. They don't know how to work with and adjust drips- most of the time they don't titrate and the patient has a sort of strange response. Now, we have also had RN's come off the med surg areas have a great deal of trouble with drips and adjustments as well. I am a big proponent of critical care (ICU) experience for at least six months to get used to working with those patients. But as we have a shortage, I welcome all of our new grads, and just sort of hover when they get the drip patients. (they usually ask- do you think I can go up or down?) If there were no shortage, I would so encourage them to go to an ICU for a year.
Jun 4, '02
Occupation: ED staff nurse
Joined: Nov '01; Posts: 1,150; Likes: 232
Depends on the person. I've worked with some who did just fine, they are the ones who ask for guidance and then there are those who don't ask for help until they are already in trouble. Most of the new grads who do well in our ED did their preceptorship with us. They can be a lot of fun to have around too
Jun 4, '02
Occupation: Registered Nurse
Joined: Oct '01; Posts: 2
I believe that the new grad should get experience in med surg for at least 1-2 years before attempting to work in the ER. There is alot of med surg knowledge that is needed in order to build your knowledge as an ER nurse. Without this background you would not understand the reasoning and the importance of why things are done the way they are done in the ER. The ER is a difficult place to work in to begin with and this baseline knowledge is definitely needed.
Jun 5, '02
Joined: Nov '01; Posts: 765; Likes: 14
I agree with the proper support a new grad can pretty much survive anywhere he or she desires. It is an individual basis some people can handle stress better than others, some are more organized as well. Knowing that fact where ever they may go they will be a great asset to their unit. Like the things we learn as we go along. Med surg would definately be a great edge but required no! There are other ways tying in the knowledge.