How Hard is it to Start in the ER?

Runner1989 · Nov 8, 2013

It depends where you start. What state are you applying in? Different states and different hospitals want different things. One hospital may be open to new grads and another not. I would say a teaching hospital is going to hire new grads easier, and just be yourself. I started 2.5 years ago in my ED as a new grad and we have several. Just depends where you are unfortunately and if you are willing to relocate to get the job or spend some time on medsurg and then transfer. Good luck!

madisenclaire · Nov 8, 2013

I am located in Texas. The nursing programs in San Antonio are out the roof, so I will have a fair share of competition for sure. Thanks for the advice!

Guests · Nov 8, 2013

Hi! I am a BSN student, about to graduate in about 6 months.

Hello. I'm an ER nurse... I work in a large, urban ED... I started in a tiny rural (very tiny, very rural) hospital... first med-surg for a year then to the ED... 18 months later, I added a PT gig at a small-city hospital ED... then went big time to the university hospital.

I left another career and a second field of study to finally land in nursing.

Good for you getting your BSN... ED nursing is pretty interesting... and I have no aspirations to do/be anything besides an ED bedside nurse.

I am really interested in Emergency nursing

It's a pretty cool gig

, and I eventually want to become an Emergency Nurse Practitioner.

For Pete's sake, keep that to yourself... EDs want to hire and train nurses, not NP/CRNA wannabes.

Is it difficult to land an emergency job right out of school?

It's pretty difficult to land any nursing job right out of school and specialty positions (ICU/ED) even more so than that. Difficult doesn't mean impossible but you shouldn't forgo the chance to be a floor nurse in a large hospital... a number of our nurses arrived in the ED by way of the floors.

I am PALS and ACLS certified

Yawn... I don't mean that as disrespectful... good for you for popping the $500 to pull down the certs but most people I knew upon graduating had done those... I'm of the opinion that they should be considered mandatory and that nursing schools should arrange for their students to complete them before graduation...

but is there anything else I can do to set myself apart from the crowd?

NRP, STABLE, TNCC, ENPC, TCAR, and ATCN will set you apart far more than will ACLS/PALS which are held by many, many new grads. Of course, at $300 a pop, you've got to consider your own budget. On the other hand, how much are you spending on media access (cable, pandora, netflix, cell service, internet) each month? I considered it all an investment in myself.

I have had several nurses tell me that I will have trouble getting a job like that right out of school

A large percentage of new grads will... whether or not you will is hard to say.

, and that I need to start somewhere like Med-Surg

Well, it certainly does provide a strong introduction to nursing practice and there are many more floor jobs than there are ER jobs so the numbers are better in your favor. There's no reason that you can't successfully launch as a new grad in the ED but, particularly depending on the department culture and characteristics, it can be a real challenge.

TrevyRN, BSN, RN · Nov 8, 2013

I landed a job in an ER out of nursing school, but it took me a loooooong time. Over a year. I did certs and was a teacher and volunteered while I waited. And the job was 1500 miles from home. But I'm from CA where there are way more nurses and it was horrible looking for work as a new grad. I couldn't even get a med surg job LOL. I landed a job in a semi rural hosp ER in OK. Just broaden your search. Don't turn down a med surg job if you get a good one lined up. You can always keep applying for other jobs while you're employed :-)

Some of those certs are mandatory and expensive as others are saying, but they're good to have. You can also get IV certified and take ECG courses in addition to the others that were mentioned. Just be patient and keep your goals in mind.

A lot of nurses say "put in your year of med surg then move onto what you want". Not bad advice... maybe then I'd know how to make a bed decently LOL. I love the ER... a sheet, and lots of blue pads. That's what I call makin' a bed!

best of luck to you!

Altra, BSN, RN · Nov 9, 2013

I agree with the posts above that you may well not get an ED job right out of school, and that should not discourage you. Regardless of where it is ... your first job will be a gigantic learning experience.

I have a different opinion regarding ACLS & PALS ... I don't think you get enough out of it as a student. Every employer I've worked for gets new hires BLS, ACLS, PALS, and any other certifications needed to do the job within the first several months of hire ... although some report that even as employees they need to pay for these out of pocket. Whether or not a new grad without experience has ACLS or PALS already is not going to be a make or break decision point in hiring. But your mileage may vary.

If you do seek out an ER position, look for one that has oriented new grads before, and ask directly whether or not those new grads were successful and are they still working there. New grads in the ED require a department committed setting them up for success. The learning curve is steep.

Good luck to you. :)

happyinillinois · Nov 9, 2013

I started out as a new grad in ER. I was willing to work any shift, do whatever they asked of me. This is a "second career" for me, and I am more mature then your typical new grad. My nights of sowing my wild oats are long over. Being a teaching hospital, they are certainly more open then other hospitals on new grads. With the constant rotation of Resident Md's In the ER, it just seems natural to teach. With that said, I was the only non ER tech RN new grad to ever be hired. I just impressed them and worked my a** off. I had a 3 month 1:1 preceptor, and 12 months critical care classes, as well as ACLS, PALS, ENPC, TNCC, ECRN. When I got home, I studied whatever happened that I didn't understand and built up my knowledge base. I am one of the very small minority who doesn't think you need med-Surg first, because the truth is ER is nothing like Med-Surg. Your priorities aren't the same, your time management isn't the same and your workflow will never be the same. My advice is if you have your heart set on the ER, get hired as a tech, so you can see what it is really like. It is a very stressful environment. You need to be able to go toe to toe and stand your ground. Wallflowers will be trampled. The work is fast-paced and stressful. You see all walks of life and it is often heartbreaking sad. The people never stop coming. The worst part is battling other nurses to take their admitted patient, because there are 30 patients in the waiting room, and the ambulances keep coming. The best part is the comradarie amount the staff. ER RN's have a lot more autonomy then floor nurses and are treated with respect for. MD's, because the know you catch their mistakes.

1fastRN · Nov 9, 2013

It is all about networking. I got an ER job right out of school but it just happened to be networking and timing.

And hold the phone on the NP thing.... Everyone wants to be a NP right out of nursing school. Wait until you have some nursing experience and youre able to see the role of a NP before jumping the gun on that one.

Good luck!

JessiekRN · Nov 9, 2013

I started out in med surg and am now over a year and a half in the ER. I didn't know exactly what I wanted when I graduated nursing school and was open to taking anything that would be a learning experience and start paying the bills. To be honest the ER intimidated me for a long time. After almost three years in med surg I really didn't know what direction to take and applied to a few different specialities. My very wise nurse recruiter said to me- if you don't know what it is you want, why not try ER- you will see a bit of everything? I took her advice and am so glad I did. That being said, I can not imagine having jumped into it as a new grad. I am so grateful for my med surg background. It taught me how to communicate, problem solve, knowledge of medication administration and side effects, how to deal with families, diagnoses and so much more. I do not know how I would have handled the ED, which is a much more rapid pace, without that foundation. That being said tho, my best friend went straight into the ED from school, is still there and is just an awesome ER nurse. I think it is much too complex to say one way is best for everyone. Everyone learns differently, handles situations differently, etc. There are people who will sink or swim in any situation. There were new grads who could not handle my med surg floor, which had its own set of challenges. I think you will never know until you give it a try, and do your best in whatever decision you have made. The great part about nursing is if you find yourself not loving what you are doing- you put your time in, and you move on. But every experience will teach you something, and none of it will be a waste. Just remember you have a lot of time ahead of you, and you can always move on if what you've decided doesn't work out.

Ikikaeru · Nov 10, 2013

Networking! I started in the ER straight out of school. I took an ER certification through my school which had us do our externship in the ER which gave us over 90 hours hands on expericne and a full semester of simulations in our school. I knew a nurse that worked at a rural hospital and she was getting hired into the ER out of school (she worked med surge at the hospital) and told me to apply for the other positiong. I also had my EMT-B license though I didnt do much on a rig (who has time with nursing school and a job) and I also had a few other certifications.

Moral of the story , network , find out who is hiring , Look at Rural hospitals , they tend to be more willing to look at new grads compared to Urban hospitals.

EDNurse13 · Nov 16, 2013

If you can't find one right away there are a lot of benefits to that med-surg year. I took a rehab job out of school - not what I wanted but it paid the bills. As soon as I could I took a med-surg job and stayed for two years before moving to the ED. I had wanted to go to the ED as a new grad but am actually really glad I got that med-surg time. I learned a lot about prioritizing, doing a head-to-toe assessment fast, talking to doctors, starting IVs, giving an SBAR report, dealing with demanding patients etc. It is all stuff I could have learned in the ED but am glad that I do not have to learn that stuff now and can concentrate on learning the more ED specific stuff. I am orienting with a large group of new grads and it seems very very overwhelming for most of them as they try to learn how to prioritize at the same time as learning how to handle a critical patient and do an ABG and insert an IV etc. By all means chase your dream and good luck to you but if it comes down to a med-surg job or no job there are some positives to it!

Guests · Nov 16, 2013

If you can't find one right away there are a lot of benefits to that med-surg year.

Not the least of which is that, even in a large Level One, you'll end up doing time as a med-surg nurse when you have boarders. The m/s experience - and even SNF experience - will help you be a good ED nurse (and may make you look at the m/s nurses with the respect for what they do... it's a very tough thing to be good at).