Getting a job in the ER/ED?

danceluver · Apr 2, 2011

I would be interested as well to hear thoughts!

PNP4KIDZ, BSN, RN · Apr 2, 2011

I am a CPNP-PC and currently work in the ER/Urgent Care of a Children's Hospital in the Midwest. There are some states/hospitals that are now requiring that you have your CPNP-AC to work in acute care environments. I did part of my clinicals in the ER during school (we could only do so many hours there). I had worked in the Urgent Care prior as a staff nurse. I knew I loved that environment, but knew I didn't want an NP job in the PICU. So, I pursued primary care track. I love my job and feel that I am very well prepared. I collaborate with physicians, do suturing/I&D's/inhalation therapy, etc. You should contact a NP or physician during school to do some of your clinicals in that area so that you have an "in" when they are looking for another position to fill. But, make sure you are familiar with your state's or hospitals policies regarding requirements. Really, your will learn a lot during your clinicals, orientation, and once you are on-the-job. Please feel free to ask any detailed questions. Best of luck! By the way, I was in the University of South Alabama's online program and loved it! It not only prepared me for my job but the certification exam as well.

Trauma Columnist · Apr 3, 2011

I would advise as others have said I would concentrate your efforts on establishing contacts.

My intentions were to go to the ER as an APN too. I had 10 yrs as a staff nurse in a level one trauma center. I did a post MSN adult CNS and did a lot of my clinicals in the ER. Then there were no jobs. So I worked in an unrelated specialty. However I took a prn job in a community ER. Very difficult environment due the attitude of several MDs. I then went back and did a second post MSN peds CNS. Again I concentrated on acute care.

At this point I don't want to change jobs but I have more options now.

sandnnw, BSN, MSN, EMT-B, APRN · Apr 3, 2011

Initially, I'd say Urgent Care is your best bet for experience. That's where I started right out of school. Depends upon what kind of experience you get there as well. I was lucky to get into my "mom and pop" Urgent Care clinic. Lots of occupational health, lacerations, fractures. Even tackle dyspnea/CP on occasion. You'd be surprised what folks think are Urgent vs Emergent and show up on the door step, not differentiating between the two.

As well, I chose to stay in the ED as a staff RN while working part-time in the outside Urgent Care. The ED director knew of my quality of work, outside activity and my motivation to get into the ED. Some weeks I worked 70+ hours. I beefed up my CV, joined all the organizations, had CEN etc. Honestly, I don't know what else I could have done to get the job.

I see all the 4-5's and occasional 3. Admit 1-2 weekly. Small caveat, its a VA ED, so minimal trauma, women and no children. A lot of chronic conditions, HTN, DM, pain, etc.

As well, I'm an ANP! Some days, however, I wish I had sat for ACNP and am still considering going back for the cert, esp if I am going to precept ACNP students.

Its a challenging job and I work with wonderfully supportive ED Faculty. Kind of "jack of all trades, master of none" approach. Fire any questions back to me, I'll do my best.

fnpjenn · Apr 3, 2011

Thank you all for your kind responses!

I'm attending school on the east coast (almost finished) and have received zero time in the ER (and it doesn't look like I'll get anything in the 11th hour, despite my pleading). I'll be moving back to California soon, so I wonder - maybe getting an RN position in the ER would be a good first step in my case?

PNP4KIDZ, BSN, RN · Apr 4, 2011

I would probably not go in as an RN. Many hospitals sort of frown on mixing the two roles. You may have to just see what is available once you get back to California and start networking. You may even have to work a short time in another position to get some general experience. Once you are an employee, they are much more willing to take one of their "own" to train. You could even do some shadowing in the ER once you get to California. Once you nurture some relationships, I am sure they will think of you first! Those are just some suggestions. I hope something works out! I am sure there are some FNP's out there with some good ideas too! As a PNP, our facility now has approx 20 NP's in the ER/Urgent Care. We are a great team. Again, getting some exposure through maybe the shadowing, etc. will get you the furthest I think. These are just my thoughts :)

fnpjenn · Apr 4, 2011

Thank you, PNP!

I like the idea of shadowing to gain further experience and make some connections. I realized rather early into my program what a huge downside it was to go to school on the east coast when I intended to work in California! Ah well, live and learn.

I appreciate everyone's advice!

CRF250Xpert · Apr 6, 2011

+1 on never mix roles. Some hardcore old RNs have heartburn when I discuss this, but you have to learn to let go of the RN role and really take on the PA+ role. Mixing the two makes us all look like part time butt wipers. I left that job long ago - I have a great relationship with MDs and they know my skills and limitations. Why on earth would you ever work as an RN when trying to establish yourself as an independent provider - apples-n-oranges.

PNP4KIDZ, BSN, RN · Apr 6, 2011

I agree about not mixing the roles 100% for many reasons:

1. It is harder to learn the role you are in....totally different way of thinking

2. The provider/nurse/CA role is a great team with you as the director of patient care. It will be harder for others to see you in that role if you go back and forth.

3. By focusing all of your energy into you advanced practice role, you will learn more just by collaborating and being around other mid-level provicers/MD's/DO's and discussing various healthcare situations, etc.

I am a true believer that all of the healthcare roles are essential to optimize patient outcomes. What we choose to do in life is based on so many things...our passions/skills/goals/family situation, etc.

I think sticking to the NP role and maybe doing some shadowing even while in a different area of the hospital or community would get you where you want to be, and you would be gaining skills as an NP in the meantime.

Best of luck with the rest of your schooling and certification exam. You will do great! Let me know how things go!!!

fnpjenn · Apr 10, 2011

Thank you! I appreciate the insights, and you guys have convinced me -- no mixing roles. It totally makes sense now that you've explained why. I'm going to do my best to find an MD/PA/NP in San Diego who will let me shadow in the ER. If you know of anyone, please let me know! :)

sandnnw, BSN, MSN, EMT-B, APRN · Apr 11, 2011

A word about mixing roles...

There are different situations, for different folks in varied locations across the country. While some here *may* have been lucky enough to get a job right out of grad school, I live in a metro area with 2 PA and 5+ NP schools, all within a 100m radius. As a new grad, you have to "set yourself apart" from the rest of the resumes. Everyone in the stack already has an MSN and certification, but fewer will have EMT, RNC, CEN, CCRN, AC/PALS, military courses. Remember, the hospital is not hiring you, the ED Director probably will. You *must* stand out to a MD/FACEP. Having that "extra" will give you an edge over the rest of the crowded stack.

As well, some of us have bills/loans. I would not sit idle while waiting for that dream ED job. Again, an Urgent Care (not minute clinic) is an excellent place to start, if you can get hired there. I was so lucky in my long search, sending out tons of resumes and finally taking a chance, offering to volunteer a few weeks, literally a "trial period" if you will, in my private Walk-In clinic. I absolutely fell in love with the place, suturing my first week. They hired me day two, and I also believe this little gem helped me get into the ED as an NP.

In my situation, I also was bound by the hospital via contract, as they helped pay for grad school, so I had to work, period. Trying to get a part-time job as a new graduate was difficult in my case, unless I settled for a pain clinic, no thanks. It does not sound like you have that burden, so you may not have to mix roles. Also, as many wise folks have pointed out before, your first job will not likely be that dream/sweet position you were hoping for. Hopefully, it will be a stepping stone toward that goal.

I wish you luck, keep us informed of your progress.